The Keys to Libido

It's about more than taking a pill

Illustration by Victoria Marcelino

The old adage “sex sells” says it all. From advertisements to “Fifty Shades of Grey,” sexuality grabs our attention like nothing else, except maybe food. But despite its allure and pervasive presence in the media, many of us are awfully reluctant — bashful, even — to talk about sexuality. Given that sexual dysfunction affects an estimated 43 percent of women and 31 percent of men in the United States, our reticence might be causing many of us to suffer in silence.

Libido, or sex drive, is just one facet of sexual health, and aspects of our lives that can influence libido run the gamut. Particularly because sexuality is a topic that can be difficult to broach and discuss with a partner or doctor, it can be beneficial to consider libido health in terms of four categories to help pinpoint what we might need to focus on if we are troubled by a lack of passion, says Margarita R. Ochoa-Maya, MD, CDE, an endocrinologist and founder of Advanced Health and Wellbeing, PC, in Nashua.

The four parts to a healthy libido

Intrapersonal: The concerns and history that each individual brings to a relationship can significantly affect libido health. Intrapersonal factors include how we were raised, our views on sexuality, how much we are tuned in to our body and our past experiences.

Interpersonal: Over the years, our attitude about lots of things — including sexuality — can change. “As a relationship progresses,” Ochoa-Maya says, “it often becomes more about intimacy, cuddling and trust.” Keep the lines of communication open and don’t be afraid or embarrassed to discuss sexual matters with your partner.

Anatomical: Physical factors that influence libido often center on impotency for men and pain or discomfort for women, Ochoa-Maya says. Physical problems can present a barrier to sex in even the healthiest relationships, with a variety of medical conditions and previous surgeries potentially affecting sexuality.

Environmental: Hearing your children run through the house while you are trying to have quiet time with your partner can put a damper on romantic feelings, as can living with your partner in your parents’ house. “You have to be in the mood and in the place for romance,” Ochoa-Maya says. “Circumstance and environment are very important.”

Other influences that commonly affect libido include diet, sleep, alcohol, smoking and stress, Ochoa-Maya says, along with hormones and antidepressant and blood pressure medications. Pregnancy, giving birth, breastfeeding and menopause cause big shifts in hormonal levels that can affect sexual drive, and birth control pills are a two-edged sword. “When you’re on birth control you can have more freedom in terms of sexuality,” Ochoa-Maya says, “but your hormones definitely drop,” which can stifle libido.

Cardiovascular disease and nervous system damage, including nerve trouble related to diabetes, can also weaken sex drive, as can low self-esteem, says Leon Hecht III, ND, a naturopathic doctor at North Coast Family Health in Portsmouth.

In fact, self-perceptions regarding our body can damage our confidence at any age, but accumulating years put us at particular risk, because, as we age we are more likely to have scars from surgeries and be on medication that can interfere with sexual health. “It’s not age per se so much as the circumstances that surround us as we age,” Ochoa-Maya says. Older adults can still have fulfilling relationships, “but it is a matter of factoring in all these things and making sure you have open communication.” It is also important to note, she says, that a rewarding, intimate relationship needn’t involve sex.

For sure, the emotional connection within a relationship is a “huge” force when it comes to libido, Hecht says, and a libido imbalance in your relationship might signal that something is amiss between you and your partner. But it might also mean that a physical problem lurks, so if libido-related matters create emotional distress or tension for you or your partner, or you just feel that your sex drive is stuck in low gear, talk to your doctor.

There is no real “normal” when it comes to libido; contentment rests in the mind and body of each individual, but it is a mistake to overlook the complex nature of libido, where the physical, emotional and psychological all come into play. “It’s like a sum total of all your systems working,” Hecht says. “It’s not just hormonal. It’s the nervous system and a lot of brain override as well.” Many factors are involved in a healthy libido, and patients who complain of low libido, he says, often “don’t feel good on other levels. So we try to unravel the mystery.”

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