Libido, Sexual and Erectile Dysfunction
Many people think that their sex drive (libido) is this internal primal reaction that they either have or they don’t. It’s either high or it’s low and if it’s low, we want a pill that can fix it. For the most part this couldn’t be farther from the truth when we actually dive into the factors that influence libido.
Before we dive into this topic, please note that there ARE underlying biological reasons why someone may struggle with their libido that need medical attention (example, hypogonadism). For the sake of this discussion, we’re going to focus on people who do not have an underlying biological condition.
Sexual dysfunction refers to any difficulty with desire or arousal. This can oftentimes be related to having limited interest or changes that influence someone’s sexual enjoyment like pain, dryness, sleep deprivation (hello shift-workers and postpartum parents) or relationship conflict. Sexual dysfunction impacts 43-50% of women and 31% of men (Laumann et al., 1999; Allahdadi et al., 2009; Rosen, 2000).
How do we treat sexual dysfunction?
Step #1 - Cognitive desire & connection
The first step is to see if there are cognitive blocks in arousal. Are you dealing with issues connecting with your partner? Have you lost interest in your partner? Do you have a history of trauma or abuse? Are you struggling with body image issues? All of these factors have nothing to do with hormones or underlying cardiovascular issues that can impact sexual function (which we’ll get into next). If any of these factors are at play, seeking guidance from a therapist or sex counsellor can help treat these mental blocks.
Step #2 - Burnout
Are you overworking? Do you burn the candle at both ends? Are you allowing yourself ample opportunities for pleasure or do you try to get intimate at bedtime after a 12 hour workday? If you are tired and wired from living a life where you don't stop to breathe, it's going to be more challenging for you to find the energy for intimacy. Treating burnout takes time! Once you recover from burnout, carving out appropriate (and realistic) time to connect and be intimate with your partner, is another step to support sexual connection.
Step #3 - Medications
Could it be that your prescription medications are impacting your sexual function? If so, there may be prescription alternatives that you can discuss with your doctor if your sexual health is being influenced by your meds. Some common meds that may impact sexual function include: hormonal contraceptives, anti-depressants, anxiolytics, anticonvulsants, cancer therapies, steroids, statins, and more. DO NOT stop taking your prescription medications without discussing a plan of action with your medical team.
Step #4 - Mental Health
Many medical conditions can be linked to issues with sexual function. Depression and anxiety often impact one’s sexual desire, so implementing strategies to manage your mental health would be the first step in addressing your libido. Please note that some commonly prescribed SSRI’s may negatively impact your libido and there might be effective drug alternatives without the sexual side effects.
Step #5 - Postpartum Hormones
While we like to blame hormones for everything, as you can see from this list your sex hormones are not the only factors at play. There may be times, however, when hormones can absolutely impact sexual desire and function. Let’s take postpartum as an example. Lactational amenorrhea (when breastfeeding inhibits ovulation) can cause vaginal dryness due to low estrogen during the postpartum time. Estrogen is needed to support vaginal tissues and without it, may cause painful intercourse resulting in a lack of sexual desire. Combined with added newborn care and insomnia, postpartum moms are faced with multiple barriers that may *temporarily* influence their desire. Also, treating postpartum anxiety, postpartum depression or postpartum thyroiditis can also help to rule out medical concerns that may influence libido postpartum.
Step #6 - Peri-menopause or Post-menopause
Similar to postpartum, with a drop in estrogen and testosterone for individuals when they reach menopause, this can change vaginal health by increasing the chances of UTI’s, vaginal dryness and atrophy. THIS CAN BE TREATED! If you are close to this transition of life, seek out support for vaginal health early. Other concerns that might impact sexual health around menopause can include cardiovascular factors, depression, anxiety, insomnia and fatigue.
Step #7 - Erectile Dysfunction & Cardiovascular Health
The elephant in the room. Let me share a grim statistic with you… erectile dysfunction (ED) is a bigger predictor of mortality than androgen hormone (testosterone) levels! That’s right. Even if a male has normal testosterone levels, having ED increases the risk of death between 45-70%. Most males will have ED symptoms 3 years before they experience any cardiovascular symptoms (Antonio 2022; Khanna 2022).
Are you having morning erections? If there has been a decrease in morning or spontaneous erections, this can be an indication of issues with overall cardiovascular health. Roughly 50% of males will have ED by age 45 and there is no treatment to reverse ED; only ongoing management. So screening for sexual function in males EARLY (in their 30’s) to PREVENT erectile dysfunction is our best option to support overall sexual function AND cardiovascular health. Some areas to explore would be exercise, lifestyle, stress, sleep and nutrition, along with checking your blood pressure, waist circumference and getting blood work to assess your blood sugar, cholesterol and inflammatory markers.
Step #8 - How is your partner doing?
There is a statistically significant increase for you to have sexual dysfunction if your partner is struggling. So, if the male partner is struggling with ED (whereby 50% of male’s by age 45 will struggle), this puts the female partner at a greater risk for sexual dysfunction as well. So we must always screen for both partners to appropriately manage sexual health.
Step #9 - Self-exporation
Sometimes people may rely on a partner to achieve a successful sexual experience. If that has always worked for you and you have no concerns, then great! But if you are struggling with sexual function or your own libido, learning about what feels right (and safe) in your own body (before bringing in a partner) is another tool to help improve your sexual experience and libido.
Perhaps you were shamed as a child for self-exploration or the topic of sex was taboo in your household. This could be one of the underlying reasons why you are struggling with your sexual health as an adult. It is NORMAL for children (boys and girls) to begin exploring their bodies at a young age. If you are a parent who has witnessed your child explore their body, this would be a great opportunity to begin discussing body parts using the correct anatomical language. This would also be a great time to discuss safety around WHEN it is appropriate to explore oneself and how to say "no" if other people ask to touch them. These principles help to prevent sexual abuse in kids - a topic that I should unpack in much more detail another day. Bottom-line: self-exploration is normal and should be welcomed at any age.
Step #10 - Normalizing the discussion
Many people struggle with bringing up sexual concerns to their healthcare team. Whether it be ED, vaginal dryness, decreased libido, pain, etc. This is not ok! Sexual health is part of overall health. Men often report shame or stigma when seeking health for ED or low libido and this discussion must be normalized.
Seek out support from a healthcare team that you feel comfortable having this discussion with. Sexual health is about much more than making babies.
International Index Erectile Function:
Female Sexual Function Index:
The Pink Canary by Dr. Jordin Wiggins