Sexual health consists of the promotion of healthy sexuality as well as the diagnosis, treatment and rehabilitation of sexual disorders and conditions that affect sexual function.
Libido is known as the sex drive and is an individual’s desire for sexual activity. A loss of libido, or a reduced sex drive, means a lack of desire for, or interest in, sexual activity. This can affect both men and women for such reasons as certain medical conditions, stress and depression. It can also be a side effect of common prescription medications. Normal causes of loss of libido can be due to aging, since testosterone levels tend to decrease in older men.1

All men’s libido must always be in overdrive, right? Not necessarily. A survey of men aged 18-59 found that 15 percent of men lacked sexual interest for several months within the past year.2

Causes of a Low Sex Drive

  • Mental State – Psychological wellbeing can drastically impact several bodily functions — erections included. Increased stress at work, relationship problems, depression and performance anxiety are all things that can negatively impact erections.3
  • Aging – Tactile stimulation of the genitalia is essential to achieve and maintain an erection. It has been shown that a decrease in penile tactile sensitivity occurs with increasing age.4 Along with this, there is also a decrease in testosterone levels as men age.1
  • Medications – Many medications have been implicated as causes of erectile dysfunction and decreased libido. These medications include: blood pressure medications, anti-depressants for depression and anxiety, anti-retroviral agents, anti-seizure medications and commonly used prostate medications (5-alpha reductase inhibitors).3
  • Alcohol – Small amounts improve erection and sexual drive because of its vasodilatory (increased blood flow) effect and the suppression of anxiety. Large amounts can cause sedation, decreased libido and transient erectile dysfunction.5
  • Medical conditions – Chronic medical conditions can also lead to a decrease in libido. These include diabetes mellitus, chronic kidney disease, heart disease, obstructive sleep apnea and obesity.6-9
  • Hormonal Imbalances – Testosterone is known to enhance sexual interest, increase the frequency of sexual acts and increase the frequency of nocturnal erections. Low levels of testosterone may be linked to low libido and is also associated with Type 2 diabetes, increased fat stores and cardiovascular disease. However, many men with low testosterone may not have any symptoms.8 Other hormonal imbalances that can lead to low testosterone are high levels of prolactin and abnormal thyroid levels.9-10

Management

Now that we know what can lead to a decrease in libido, what can we do it about it? First, it is very important to recognize that you are not alone and this is not an uncommon problem. As mentioned above, 15 percent of men have complained of a reduced sex drive in the past year, so it’s important not to feel ashamed. There may be treatment options.

  • See Your Doctor – You and your physician can find the type of treatment that works best for you. It also provides your physician an opportunity to assess whether you may have any medical conditions that could be contributing to your reduced libido. Furthermore, as certain medications can also impact your sex drive, your physician may be able to provide alternative therapies.
  • Stress Management – Your mental state can dramatically impact your libido. The most important thing to do is to realize what these stressors are and how to address them. This can be done through a variety of methods such as counselling, seeing your physician and involving your partner in the conversation.
  • Diet, Exercise and Weight Loss – Your penis health is closely linked to your heart health. Recent evidence suggests that erectile dysfunction may predict future cardiovascular problems. How does this relate to your libido? People who are overweight are more likely to have lower levels of testosterone. Exercise is great way to lose excess weight and can also serve as a means to reduce stress, which can impact your sex drive.

References

  1. Rajfer J. Decreased Testosterone in the Aging Male. Rev Urol. 5(Suppl 1):S1-S2.
  2. Montgomery, KA. Sexual Desire Disorders. Psychiatry (Edgmont). 2008;5:50-55.
  3. Lue TF. Erectile dysfunction. N Engl J Med. 2000;342:1802-1813.
  4. Rowand DL, et al. Aging and sexual function in men. Arch Sex Behav. 1993;22:545-557.
  5. Chew KK, et al. Alcohol consumption and male erectile dysfunction: an unfounded reputation for risk? J Sex Med. 2009;6:1386-1394.
  6. Wang, et al. Low Testosterone Associated with Obesity and the Metabolic Syndrome Contributes to Sexual Dysfunction and Cardiovascular Disease Risk in Men with Type 2 Diabetes. Diabetes Care. 2011;34:1669-1697.
  7. Saenz de Tejada I, et al. Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. N Engl J Med. 1989;320:1025-1030.
  8. Traish AM, et al. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl. 2009;30:23-32.
  9. Andersen ML, et al. The association of testosterone, sleep, and sexual function in men and women. Brain Res. 2011;1416:80-104.
  10. Leonard MP, et al. Hyperprolactinemia and impotence: why, when and how to investigate. J Urol. 1989;142:992-994.
  11. Corona G, et al. Thyroid hormones and male sexual function. Int J Androl. 2012;35:668-679.
  12. Compostella L, et al. History of erectile dysfunction as a predictor of poor physical performance after an acute myocardiac infarction. Eur J Prev Cardiol. 2017. [Epub ahead of print]