Libido Disorders

(Sexual Desire Disorders)

Desire for sexual activity or expression is natural and healthy.  However, it is estimated that five to ten percent of men[i] suffer from low libido or low desire for sex.  This rate increases as men age and can be due to a number of different reasons.

The main reasons for low libido in men include:

  • Psychological Causes

    • Depression and Anxiety Disorders

    • Pornography Addiction

    • Relationship Difficulties

  • Physical Causes

    • Erectile Dysfunction

    • Penile Curvatures

    • Premature Ejaculation

  • Hormonal Disorders

    • Low Testosterone

    • High Prolactin

  • Medication Induced

    • Testosterone Blockers

    • Narcotics

    • Alcohol Consumption

    • 5-Alpha Reductase Inhibitors

    • Serotonin Agents

 

 

PSYCHOLOGICAL CAUSES

Relationship difficulties are perhaps the leading cause of low libido.  Strains in the emotional aspects of a relationship oftentimes spill over into the bedroom.  Rather than sexual activity bringing a couple together, it can be a wedge that divides a couple apart.  This is especially true if one or both partners use sexual activity or lack of sexual activity as a playing card in their emotional/relationship struggles.  Psychotherapy or marriage counseling is an important option in overcoming not only the relationship problems, but the sexual dysfunction that stems from that strained relationship.

Individuals who suffer from depression often have a lack of interest in things they once enjoyed – this can include lack of interest in sexual activity.  Treatment of depression can significantly improve interest in activities that once brought fulfillment and pleasure.  One down side is that oftentimes, medications used to treat depression and anxiety can decrease libido .  However, alternative antidepressant therapies may actually improve libido.

 

Pornography addiction can also reduce libido. In these cases, men have a reduced desire for sexual activity with their partner and an often increased desire for pornography and/or masturbation.  In other cases, sexual activity with a partner is not as sexually stimulating as pornography and can lead to sexual dysfunction during intercourse.  Pornography viewing can also create a strain in the sexual relationship a couple has as pornography often feels like infidelity or adultery to the other partner.  Treatment of pornography addiction can be essential in restoring libido for both partners.

 

 

PHYSICAL CAUSES

Any difficulties with engaging in sex can be associated with sexual “failure” or “embarrassment”.  This can lead to a decreased desire to engage in sexual activity.  Failure of men to attain or maintain an erection or ejaculating before intercourse can create fear and apprehension.  Feelings of fear and apprehension can replace the natural feeling of anticipation for sexual activity.  Treating erectile dysfunction and premature ejaculation can restore libido in many of these men.

Body image issues can also be a concern that may affect some men.  If they are concerned or embarrassed about their bodies during sexual activity, this can lead to a desire to not act out sexually.  These types of body images vary.  Concerns which may decrease desire for being sexual include:

  • Weight issues (too thin, increased fat, decreased muscle mass, etc.)

  • Body hair (too much or too little)

  • Penis size (too small or too large)

  • Penis curvatures

  • Birth marks

 

Most of these issues can be resolved by men embracing their bodies and their partners reassuring them of their bodies.  In the short term, making love with the lights out can resolve many body image concerns.  Men who are concerned about weight issues can take steps over time to improve their physique through exercise and diet.  Men who feel too hairy can trim or shave body hair.  Men with body dysmorphic disorder who are overly concerned about the size of their penis can put their minds at ease or see a competent therapist or healthcare provider.  Accepting slight penile curvatures or seeking treatment for severe curvatures can be helpful.  Embracing birthmarks, or if necessary seeking treatment for the removal of a birthmark can help with those concerns.  Most often, men who share themselves sexually with a loving spouse often find that reassurance by their spouse leads to resolution of fears and anxieties that can interfere with libido, so simply being up front with your concerns can open communication lines for men to receive reassurances from their wife.

Sexual pain can also lead to low libido.  Painful ejaculation, painful erections, prostatitis, acute angle erections, penis injuries, etc. can decrease the desire for sexually activity since it ultimately leads to pain.  Treatment of these issues can resolve pain and thus increase libido.

 

 

HORMONAL CAUSES

Low testosterone can cause low libido.  Testosterone is one of the main drivers for libido.  In fact, this is one reason why teenagers and young adults often have very high libidos and older men tend to have a less robust libido.  Treatment of low testosterone can help increase libido.  This may include the use of vitamins (zinc 25mg at bedtime and 1,000 of vitamin D) to naturally increase testosterone.  Or it may involve testosterone replacement under the care of a clinician. 

Another cause of low libido is a condition called hyperprolactinemia.  In this disorder, the hormone prolactin is secreted by the pituitary gland in levels that are too high.  As a reminder, prolactin is released during ejaculation and places a man in the refractory stage.  During the refractory stage a man’s erection goes away and he loses the desire to engage in sexual activity again right away.  Thus having an increased prolactin level can cause a sense of not wanting to engage sexually.  Medications like cabergoline are available by prescription and can help decrease prolactin levels to normal ranges and thus restore libido.

 

 

MEDICATION/SUBSTANCE CAUSES

Medications that affect serotonin (SSRI’s and SNRI’s) can also decrease libido.  These are often used in the treatment of depression and anxiety disorders.  As a reminder, serotonin gives men a sense of well-being and it is released during ejaculation along with prolactin.  Thus serotonin can also place a man in a state of sexual neutrality and he may not want to engage in sexual activity.  Clinicians may opt to add or switch to bupropion, another antidepressant that can actually increase libido.  Or they may opt to add a medication like cyproheptadine that can temporarily decrease serotonin levels for a few hours in order to increase libido for a sexual encounter.

A large number of medications can cause issues with libido.   Obviously, medications that block testosterone and even 5-alpha reductase inhibitors can cause issues with libido.  Testosterone blockers are typically only given for certain cancers and often cannot be removed, but alternatives to 5-alpha reductase inhibitors for prostate disorders or male pattern baldness may be an option.  Simply reducing the dosage may help libido and still give some of the desired effects on the prostate and or baldness.  Other causes of low testosterone can be the use of narcotics and alcohol.

 

[i] Laumann EO et al.  Sexual Dysfunction in the United States: Prevalence and Predictors, JAMA 1999; 281(6): 537-44.