Monday, May 23, 2011

Loss of Libido in Young Woman.

Loss of Libido in Young Woman.

What do you make of this? How would you advise? About a week ago, in my slot, a young woman from South Africa wrote to me as follows:

I have been thinking of asking for professional help for a while, because there seems to be a serious problem that I just can’t ignore. I am 32 years old, married for 7 years to a man two years my junior. Together we have four lovely children.
The problem started to appear after I started my third pregnancy and lately I just can’t handle it anymore. I do not want to have sex. I do not feel the need to. If I do it does not happen more than 2 or 3 times a month. Yesterday I realized that the mere thought of having sex disgusts me! I feel ashamed and insufficient to satisfy my husband who has been complaining about it recently. What’s the matter with me? I am a young vibrant woman. I take care of my appearance and I know that men like me, but something has stopped working properly. Please, please help me!”

First of all what sticks you about this questioner as odd, or as possibly the root cause of her problem? And secondly, what further information would you like to have before reaching a conclusion and offering some sound advice? Let’s deal with the second question first. When I hear of loss of libido in a woman the first thing I think of is clarity – what exactly does the questioner mean by loss of libido. The second thing that I think of is could some medications be causing this. I wrote to her therefore as follows seeking some clarity:

“Hi there Ruth, thanks for your question. When you say loss of libido do you mean loss of interest in all things sexual – no desire, no urge, on sex drive? Or is it a case that you do have these things but that you are not responding – you have so-called Female Sexual Arousal Defect?
I also need to know if you are on any form of birth control including the IUCD and if you were ever on any antidepressants?”

Her answers to these questions were revealing in their own way. No she was not on any form of BC, not now or ever and she was never on any antidepressants. As to the first part of my question; her problem was indeed a pure loss of libido and had nothing to do with response. While answering this Ruth also let it slip that she had a full time job!

This of course underlined and re-enforced my first impressions as to what exactly was going on here. Now we have a young woman aged 32 with four young children, obviously talented and well educated and holding down a full time job and not on any form of birth control! And she wonders where her libido has gone to! When I was first reading through her question I was thinking of all sorts of fancy footwork like hormone assay and possibly testosterone replacement therapy for women. But on more sober reflection the answer was far more pedestrian.

Four small children, under the age of seven, no matter how lovely they may be, is draining enough God knows. Now add onto that a full time, and I would guess a fairly onerous job and you are approaching human limitations. On top of that we have a young woman not on any form of family planning such that any sexual activity with her husband exposes her to the risk of further pregnancy and she is wondering where her libido has gone to!

Moral considerations aside, I think Ruth is going to have to give some serious consideration to possible a permanent form of family planning – vasectomy or tubal ligation or, less satisfactory, Marina Coil or implant. Once she has her fertility under some kind of control she should consider taking a break from her work and/or from her parenting duties. What Ruth may desperately need is a quiet week in the country somewhere. Then perhaps she will discover where her libido had vanished to. 

What do you think? Please leave a comment. 

Dr Andrew Rynne. 

Wrong Diagnosis

Shoehorning the Wrong Diagnosis.

Please don’t get me wrong. I have nothing against self-diagnosis and self-help when it comes to your health. Nor am I saying for one second that doctor knows best and patients should do what they are told to do by their doctor. On the contrary, I am all in favour of assertiveness in the doctor’s consulting room, all in favour of asking loads of questions and keeping the medics on their toes. As one myself I can assure you that doctors do NOT always know best or even know at all.

There are however exceptions to this rule, there are times to perhaps acknowledge that the old docs might actually know what they are talking about sometimes. A good example of this is in the management of erectile dysfunction in young men. There is something very peculiar about this common malady whereby the sufferer seems to want to hear certain explanations for his ED and reject treatment suggestions that somehow don’t seem to suite his predetermined prejudices. Nobody wants to be told that they have performance anxiety for example.

Take Jake  from Saigon as a case in point. Jake, aged 36 came to me through my online medical consulting service. His complaint was erectile dysfunction his story typical yet quite extraordinary. Three years ago Jake bought some diet pills on the Internet and proceeded to take one a day. Of course this was foolish but if he had only left it at that it may not have been too bad. Worse was to come, much worse.

After taking these diet pills for a few days Jake noted, somewhat to his dismay, that he could no longer sustain an erection for more than a few minutes. Alarmed he went straight to his doctor and told him that diet pills had given him ED. Of course we don’t if the diet pills were in fact the cause of his ED but in Jake’s head that was the case and that was that. The doctor certainly did not agree that the diet pills had anything to do with it and offered Jake some Viagra to get him going again. Jake totally rejected this suggestion and, very annoyed he decided to consult Dr B and then Dr C. When Dr C also suggested Viagra Jake decided to see a specialist, an endocrinologist. Time to wheel in the Experts says Jake to himself.

At this stage Jake was beginning to think that maybe it was not the diet pills after all that were causing his ED and maybe the problem was a low testosterone. Armed with this new inspiration he asked the endocrinologist to run some hormone assays on him and low and behold didn’t the testosterone levels come back as “low”. Jake was at last vindicated. He knew what the problem was all along. The endocrinologist immediately ordered some Testosterone Replacement Therapy and everyone sat back and waited for Jake’s erections to return to their former magnificence.

Days ran into weeks and weeks ran into months and still the old erections would not last long enough to complete intercourse or to bring Jake’s long suffering wife to orgasm. Things were becoming desperate indeed. It was at this point that Jake was visited by yet another piece of inspiration. If his ED was not being caused by diet pills or a low testosterone level then the problem had to be a venous leek. There was something intrinsically wrong with Jake’s penis such that it would not hold the blood to sustain an erection. That had to be it. Time to see a surgeon says Jake to himself.

The Urologist obligingly went along with Jake’s suggestion of a venous leek and performed what’s called a Doppler test on his penis. And guess what? Yes you have got it, Jake was right again; he did have a venous leek! Surgery was organised to fix this defect, three month later and no improvement and Jake, at this stage a bit desperate it has to be admitted, was online availing of my $19.00. online consultation services. He presented himself as a victim of a series of stupid doctors who collectively could not fix his ED. He said very little about his not accepting the first doctor’s suggestion that his problem was performance anxiety erectile dysfunction. Nor did he acknowledge that the low testosterone theory and the venous leek theory were Jake’s inspiration and not the doctor’s.

If there is a there is a salutary lesson to be learned from this sad saga it is this: Common things are common and the commonest cause of erectile dysfunction in young is not diet pills, nor is it low testosterone levels, nor is it venous leek. No, the commonest cause of erectile difficulty in young men is performance anxiety and while that may be a bit pedestrian and lacking the exotic it is non-the-less true and very easy to fix. Jake would have done well to have listened to the first doctor he went. He could have saved himself a lot of pain.

What do you think? Please leave a comment. 

Dr Andrew Rynne.