Lack of sex drive

Lack of sex drive (lack of libido) is extremely common in women but quite rare in men. Let's look at the possible causes in the two sexes.

How common is lack of libido in men?

It's far less common than impotence - with which it should not be confused. Impotence (erectile dysfunction or ED) affects tens of thousands of British males. But most of them have perfectly normal levels of desire - and would like to have sex if they could manage it.

In contrast, at our clinic we see only one man with lack of desire for every 12 with impotence.

Most men with lack of libido can achieve erections, but have lost the desire to have sex.

What are the causes of lack of libido in men?

Causes are either physical or psychological.

Possible physical causes include:

•  alcoholism - quite common.

•  abuse of drugs - such as cocaine.

•  anaemia - unusual unless the man has been bleeding for any reason.

•  hyperprolactinaemia - an uncommon disorder in which too much of the hormone prolactin is produced by the pituitary gland.

•  obesity - quite common; simply slimming down will often help.

•  prescribed drugs - particularly antidepressants and finasteride (Proscar), a tablet used for prostate problems.

•  low male hormone level (testosterone) - contrary to what many people think, this is rare.

•  any major 'generalised' disease, such as diabetes.

Psychological causes of male level of desire include:

•  depression - very common

•  stress

•  sex hang-ups

•  latent gayness

•  serious problems with the wife/partner.

What should a man do about this symptom?

Begin by seeing your GP. (Do not start by going to a private clinic where you could be relieved of a lot of money!)

Your doctor should usually be able to sort out the cause by discussing the problem with you, by examining you, and by doing a few tests.

If they can't sort it out, your doctor can send you to a specialist.

All the above causes of lack of libido can respond well to therapy.

The most difficult to treat are those that involve marital problems and/or hang-ups. For these, a good place to go is a Relate clinic in England, Wales and Northern Ireland or in Scotland to Couple Counselling Scotland.

Drugs for ED, such as sildenafil or tadalafil have no effect on sexual desire - only on erection.

How common is lack of sex drive in women?

Extremely common. The American Medical Association recently estimated that several million US women suffer from what they prefer to call 'female sexual arousal disorder' or 'FSAD'.

In the UK, family planning clinics and Relate clinics see large numbers of women who complain of lack of desire. Our estimate is that at any one time, several hundred thousand women in Britain are troubled by lack of libido. It's important to stress that many of these women have no problems with having orgasms. However, they still have no real desire to have sex, and their minds are not turned on by the prospect of lovemaking.

Fortunately, for many women, lack of libido is only a temporary phenomenon. Some will get over it by themselves - and a lot more can be helped by expert medical or psychosexual advice.

What are the causes of lack of libido in women?

As is the case with men, lack of desire in women can be of either physical or psychological origin.

Possible physical causes in females include:

•  anaemia - which is very common in women, because of iron loss during their periods (and in childbirth).

•  alcoholism .

•  drug abuse.

•  generalised disorders, such as diabetes.

•  post-baby sex syndrome: this is the term we have coined for the extremely common loss of libido that occurs after childbirth. It is almost certainly linked to the violent changes in hormones that occur at this time, though oddly enough, no clear-cut changes in hormones have ever been identified. The general trauma of childbirth also plays a part - and after having a baby, many women are simply too exhausted to think about sex!

•  prescribed drugs, particularly tranquillisers and anitdepressants.

•  hyperprolactinaemia - a disorder in which the pituitary gland is overactive.

You may be surprised that we haven't mentioned the menopause as a physical cause of loss of desire. In fact - contrary to myth - it doesn't usually cause loss of libido, and many women feel a lot sexier (and have more orgasms) in the postmenopausal part of their life.

Psychological causes are very common. It's entirely understandable that when a woman is having a bad time emotionally, she may lose interest in sex.

Psychological causes include:

•  depression

•  stress

•  anxiety

•  hang-ups from childhood

•  past sexual abuse or rape

•  latent lesbianism

•  serious problems with the husband/partner

•  difficult living conditions - eg sharing a home with parents or parents-in-law.

What do I do if I'm suffering from lack of desire?

It's sensible to begin by going to your GP who can discuss the problem with you and do any necessary tests.

But a very good alternative is to go to a woman doctor at a family planning clinic, since these practitioners deal with this particular problem every day of the week and are used to sorting it out.

Are there any magic remedies for loss of desire?

No. You need to sort out - with the aid of an expert if necessary - what's causing your loss of libido, and then take the appropriate action.

Far more important than any 'magic' remedy is to have the support and understanding of a partner who wants to help you defeat the problem.

Hormones are often suggested as a miracle remedy for 'FSAD' - particularly the male hormone testosterone. Alas, doctors have been trying out this hormone for 30 years - rarely with much effect. Side effects include hairiness, a deep voice, and enlargement of the clitoris.

A device called the EROS was approved by the American Food and Drug Administration (FDA) in 2001. It is a gadget that applies suction to the clitoris and is then supposed to augment desire. Cost is currently around ?200.

A much hyped new 'desire cream' has was introduced in the summer of 2001. It contains an ingredient similar to wintergreen, and its effect is to produce a tingly sensation in the clitoris. The chances of either of these 'treatments' being much help to most women seem remote.

Drugs like sildenafil have not yet been shown to help women with lack of desire, though there is some evidence that they may have a beneficial 'local' effect in increasing blood flow to the vagina and clitoris for a few hours.