Sexual desire and your hormones

Written by Christine Webber, psychotherapist, and Dr David Delvin, GP and family planning specialist



If you're a woman, have you noticed that whenever you feel angry, tearful, headachy, a bit below par, or lacking in sex drive, someone – helpful or otherwise – will tell you that: 'it must be your hormones'?

Most of us are fed up with this kind of generalisation. We're fed up, too, with the fact that no one explains exactly why our moods or ailments seem to be dismissed in this way. We want precise answers to all sorts of questions, especially to do with how our hormones affect our sex lives. That's what we want, but the harsh truth is that there are very few precise answers to be had.

I once tried to ask my own gynaecologist about hormones. His answer was: 'Don't ask me. I'm not very good on that sort of thing.'

So, although he was a highly trained specialist, he would not or could not talk about the one subject I really wanted to discuss – and this despite the fact that I'm a psychotherapist, and married to a doctor!

Our wish to understand our hormones and our bodies is a pretty modern phenomenon. Little more than 100 years ago, women had no reliable contraception and, as a result, had babies most years. These women only had a 50 per cent chance of reaching the menopause, and I don't think that too many of them had the time or inclination to worry about their libidos, or whether a better understanding of their hormones would help.

Nowadays, women can expect to live to an average age of 85. They remain fitter longer, they limit their families, and the majority of them will have several significant sexual relationships in their lives

So today's woman has better health and more options – and with this improved state of things she wants a superior quality of life, especially in the bedroom.

There are many women who feel that their hormones must be responsible for the things that are going wrong in their sexual relationships.

Today, one of the commonest female sexual problems is loss of desire.

Indeed, in North America drug companies have been claiming in 2006 that no less than 43 per cent of women have what they term 'female sexual arousal disorder' or 'FSAD'. I must say that in the UK, many doctors and psychosexual experts take that claim with a large pinch of salt!

Nonetheless, my colleagues and I do see a lot of women who complain of lack of interest in sex. But why does it happen?

It's become very fashionable to blame our hormones for loss of libido. But is there any evidence that hormones are the real culprits?

The truth is that although lots of research has been done no one has managed to come up with anything very definite on the relationship between female hormones and desire. Why? Because:

until recently researchers would have considered it too embarrassing or controversial.

this isn't a life-threatening area of medicine.

until recently, no drug company realised that there was money to be made from such research. (This is now changing, and the rush is on to market a drug that will 'turn women on'.)

it's very difficult to measure desire scientifically (there aren't any units of desire).

It's interesting that, while most women believe that loss of libido is something to do with their hormones, vast numbers of adult females haven't a clue about which hormones they have, and what they actually do. Perhaps this is unsurprising since it's very complicated. Frankly, I don't think that most doctors truly understand it, so what chance have the rest of us got! But it seems to boil down to this:

our ovaries produce large amounts of the female sex hormones - oestrogen and progesterone

they also produce small amounts of the male hormones - testosterone and androstenedione.

Both men and women also have two important hormones, both secreted by the pituitary gland, called FSH and LH.

FSH (which stands for follicle stimulating hormone) controls the formation of eggs by the ovary.

LH (which stands for luteinising hormone) controls the production of sex hormones by the ovaries. A Swiss gynaecologist (see below) has recently told us that he believes LH is strongly linked to desire.

Day one of our cycle is the first day of a period. In a monthly cycle, two main things happen:

the level of oestrogen rises slowly during the first half of the month, often dips sharply at ovulation - which occurs around about day 14 - and gradually falls off just before the period.

the level of progesterone rises sharply after ovulation, and then falls off just before the period.

But what does all this have to do with our level of desire?

If you ask a number of women whether they feel sexier at any particular time of the month, they will usually agree that they do, but they will not agree on when. About half of the women who notice fluctuations say that they feel most 'turned on' half way through their cycle. However, just as many women say they feel randiest just before - or even during - their periods.

But since we all go though the same hormonal changes, why don't we all feel sexy - or not sexy - at the same point in the cycle? The truth is that nobody knows.

My own personal – and totally unscientific – theory about those of us who claim to feel increased desire just before the period is that what we're really thrilling to is the sensation of having sex when our womb lining is thickest.

We seem to feel extra sensitivity in our vaginas – possibly because of some kind of pressure or sense of engorgement resulting from the thicker womb lining – and this enables us to enjoy the feeling of a penis inside us more than usual.

This enjoyment, however, may have little to do with increased libido. Instead it may simply be a response to different physical feelings in our genitals.

What about libido?

It's important to realise that libido (desire) is a completely different thing from physical arousal in the genitals.

This might seem incredible, but many women who say they have no libido are actually able to become physically aroused and have orgasms without much difficulty. What they do find difficult - or impossible - is to feel any passion or any desire for sex.

Often women ask if Viagra could help 'turn them on' to sex. The answer is no. In men, Viagra is used to treat erectile dysfunction - that is to say a lack of ability to get an erection. Viagra is of little use to men who are not interested in sex, because it has no effect on desire.

Currently, trials are progressing to test Viagra on women, but the research is about whether Viagra causes helpful physical changes in the sex organs. It has been reported that in a few women, the drug will increase vaginal lubrication and swelling of the tissues round the vulva. But there is no possibility that it will turn uninterested women into sex bombs. And to date (2006), Viagra is still not licensed for the treatment of women.

Professor Alan Riley of the University of Central Lancashire - one of the UK's leading experts in sex problems - says that lack of desire is the number one sex problem in women today and that it's extremely difficult to treat.

Over 25 years ago, the American professor Dr Helen Singer Kaplan wrote a ground-breaking book called Disorders Of Sexual Desire. In it she stated that: 'In human females, (o)estrogen does not enhance sexual desire.' She also said that testosterone is the 'libido hormone' for both genders. Furthermore, she speculated that the hormone LH might in time be used clinically to increase libido.

Well, what has happened in the world of female sexuality since? Testosterone has been used at different times by different experts since the 1960s to try to 'kick start' the female libido. But no one has demonstrated any wonderful results. If they had then testosterone would have become a mainstream treatment, which it very definitely has not.

However … in 2006 the drug companies have begun to promote the idea of testosterone again. Various papers have recently been published which suggest that testosterone might be the answer to what the Americans now routinely call 'FSAD' (see above).

So over the next couple of years, you can certainly expect to see lots of newspaper articles suggesting that:

vast numbers of women have FSAD

the cause of this is hormonal – namely lack of testosterone

there's a truly marvellous new treatment, involving taking testosterone via skin patches, or whatever.

Finally, as for the female hormone LH (luteinising hormone), in 2006 Dr David Delvin and I were contacted by the noted Swiss gynaecologist Dr Michel Jemec, who has come up with a theory that LH is strongly linked with libido.

David later visited him at his clinic in Lugano, where he explained that his work has suggested that high levels of LH make a woman 'horny', while low levels make her apathetic about sex.

We await with interest publication of Dr Jemec's results in a medical journal. However, at the present moment I must stress that no treatment with LH is available.

Hit and miss

So, at the time of writing, the situation is still extremely muddled and women in this country (the UK) who have loss of libido are quite unlikely to find a doctor who will test their hormones, or offer them hormonal treatment on the NHS.

However, there is one small exception in the case of loss of libido at the menopause. For this problem, an HRT-type drug called 'tibolone' does now have an official licenselicence in Britain.

But in general, since we cannot absolutely attribute lack of sex drive to hormones - and since there is very little hormone treatment available even if we could - perhaps we need to look at the problem another way.

The first thing to say is that if you feel very definitely sexier on some days of the month than others, make sure that you and your partner capitalise on them! These are the times of the month when you should come home and go straight to bed with your loved one, some smoked salmon sandwiches and a bottle of wine - or a tub of luxury ice-cream. And if you have children, you should arrange for them to go to Granny's or to a sleep-over at a friend's house.

By planning to have lots of sex when it's going to be great, neither you nor your partner should mind so much that there are days when all you want to offer is a quickie or a cuddle.

But what if your sex drive is pretty dormant all through the month?

Well, the sorry fact is that you may be a bit bored in your relationship, or tired, or feeling resentful towards your partner.

When we are newly in love, we usually have no problems with libido. In fact we often feel as if we're permanently 'on heat'! (There are a few women who have no apparent desire in the early stages of a relationship, but they tend to have psychological problems about allowing themselves pleasure through sex.)

Of course, when we first start a relationship, everything is new and exciting so our brains are very stimulated. So maybe the answer is to work on our brains - not our hormones - to spark off our sex drives. And perhaps we need to modify our lifestyles if we are to keep our desire for sex in tip-top shape.

Unfortunately, there is a tendency for relationships to become routine after a while. Sex, which before happened on occasional dates, is there on tap once people move in together. Interestingly, once we get used to the idea that we can 'have it' anytime, we tend to have it less.

Also, both partners in a relationship generally go out to work, with many working extremely long hours. So masses of people are tired, stressed and don't get round to eating properly - they are in a rut.

It does seem likely that loss of libido has as much to do with these factors as it has to do with hormones. So any woman whose sex drive isn't up to much should take a very careful look at her lifestyle.

Here are some tips that should improve the situation.

Try to add some fresh romance into the relationship and spend quality time together.

Visualise your partner as he used to look in your early days of dating and allow yourself to feel the excitement you used to feel.

Exercise your mind sexually by reading erotic books or thinking sexy thoughts - especially on the days you think you might make love

Assess how much sleep you're getting as fatigue is the biggest enemy of libido.

If you're tired all the time see your doctor in case you need an iron supplement.

If you're overweight and very lethargic, see your doctor in case you have an underactive thyroid.

If your diet is composed of rushed sandwiches and processed foods, buy a book on nutrition and re-think what you are fuelling your body with.

If nutrition seems likely to be at least part of your problem, consider contacting the Natural Health Advisory Service – formerly knows as the Women's Nutritional Advisory Service.

Our expectations

Another problem nowadays may be that we expect far too much of ourselves. We, and our partners, see films and read books where women are always up for sex. But do people make films or write stories in which the women can't relax enough to have an orgasm, or when they've got a messy period, or when they're exhausted with juggling marriage, children and a demanding job? Not usually.

Many sex experts trying to deal with loss of libido believe that hidden hostility towards the partner has a great deal to do with a lack of sex drive.

Often when a woman is blaming her hormones for her lack of desire, closer inspection of the relationship reveals all sorts of stresses, strains and anger. If such a woman is fed up because her man is never romantic to her, or never takes her out, or never thanks her for a beautifully cooked meal, or always expects her to take responsibility for contraception, it's hardly surprising that she doesn't feel like rewarding him in bed. Therefore, she loses interest.

Addressing this kind of problem is much harder than deciding 'it's all to do with hormones'. The unpalatable truth is that it's the relationship that needs changing - and that cannot be done hormonally.

We often see patients who come to us because they believe that hormonal problems are at the root of their unsatisfactory love lives. After some counselling, it's common for us to find that the woman has gone off sex because of some flaw in the relationship. Perhaps the man is too bossy, or overbearing, for example. Sometimes therapy can put this right especially if both the man and the woman can accept that this is in effect a relationship rather than a purely sexual problem.

Occasionally, one or both partners refuse to face up the fact that there is no magic pill to cure their problems and that they need instead to make changes in the relationship – and when that happens, they usually stop coming for therapy.

Of course, there are specific times in a woman's life when she may have most difficulty with lack of desire. For example: after the birth of a child, after a termination, after miscarriage, when suffering from pre-menstrual tension and around the menopause.

After giving birth

Women are told to abstain from penetrative sex after the birth of a child – until they have their full medical check when the baby is about six weeks old. But many women feel a complete lack of desire for sex for several months after that. This is likely to be due to a number of reasons such as fatigue, poor nutrition, anxiety and depression.

It's also because a woman frequently becomes almost obsessed with her child and doesn't seem to have much time for her partner, especially sexually. This is clearly what nature demands. It ensures that the child is well looked after. It also helps to prevent a further pregnancy so that the new baby won't have to share mum with other new siblings too soon.

But is any of this to do with hormones? Many experts think that it is. They particularly attribute postnatal depression to an upset in hormones and tend to believe that the loss of libido is part of that illness. However, no one has yet managed to find any measurable change in blood hormone levels.

Some specialists do offer hormonal help at this time, but it is certainly not freely available all over the country. The best thing to do in this situation is to ask your GP, the practice nurse, or your health visitor what's available on the NHS in your area. There are also a few private clinics that offer hormone treatments.

However, many other doctors, psychiatrists and scientists believe that depression and loss of desire in the postnatal period can best be treated by anti-depressants - whatever its cause.

When I hear from a depressed young mum, I always put her in touch with the Meet-A-Mum-Association (details below), which is an organisation for women with postnatal depression. They can help by getting you support from other mums who understand what you're going through. They also keep an eye on treatments for PND up and down the country.

Generally speaking, the loss of libido gradually goes away as the mother gets used to being a mum, and as she grows stronger and less tired. Men can help by being romantic and kind. The article on postnatal depression covers many aspects of the problem.

Go To Next Page>>



The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use



© Copyright 1998 - 2004 NetDoctor.co.uk - All rights reserved