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Descreased Sexual Responsiveness
| There are a number of causes for
a woman to feel decreased sexual responsiveness with intercourse. Women report that it is
"not as good as it used to be," or that "it never was as good as my friends
tell me it should be." Several of the more commonly recognized causes of decreased
sexual responsiveness, and the reasons these causes are responsible for decreased sexual
responsiveness, are discussed below. |
| Vaginal Delivery |
| The normal vaginal entrance remains closed at rest even after excessive childbirth trauma to the vagina and vulva. The vaginal entrance dilates about three centimeters (a little larger than an inch) for intercourse in order to allow introduction of the penis into the vagina. During vaginal delivery, the vaginal entrance is stretched to over ten centimeters (over four inches) to allow the delivery of the baby's head. The delivery of the baby's head causes the vast majority of stretching, and, at times, tearing of the tissue between the vagina and the labia minora because the baby's head must pass under the pubic bone for delivery. This excessive posterior stretching not only damages the floor support of the vaginal entrance, but also the labia minora. The labia minora are stretched out of shape at their attachment at the posterior vaginal entrance and throughout their entire length up to the clitoris. Of all of the vaginal and vulvar tissues, the labia minora remian stretched and elongated, even after adequate healing, for the rest of the woman's life. This elongation of the labia minora decreases the clitoral stimulation during intercourse and therefore causes a reduced sexual responsiveness after vaginal childbirth. |
|
| Even a single delivery of an
infant with an excessively large head can cause extreme tissue damage between the vagina
and anus. Clitoral stimulation caused by the normal downward pull of the labia minora and
clitoral hood on the clitoris might be altogether absent. This situation can be improved
only with functionally reconstructive surgery.
|
| Maturity-Related Decreased Sexual Responsiveness |
| Libido is the desire to engage in a physical sexual experience. Libido can normally decrease as a woman matures. As a woman matures through the third and fourth decades of life, estrogen and the small amounts of testosterone produced by the ovaries decrease. When women report a bothersome decrease in libido, physicians will attempt to restore adequate libido with estrogen, testosterone, or both. Diagnosis of libido problems is quite subjective, for libido is very individual and personal, and there are no blood tests that relate estrogen, testosterone, and satisfactory libido. |
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| Decreased Vaginal/Clitoral Responsiveness |
| Estrogen is the key here. An adequate blood level of estrogen stimulates the tissues of the vagina and the vulvae to be "youthful." (The vulvae includes the labia minora, the clitoris, and the clitoral hood.) With adequate estrogen, there is increased thickness, lushness, elasticity, nad responsiveness of the labia minora, clitoris, and vaginal tissues. This "youthfulness" is due to increased vulvar tissue growth and increased vulvar tissue blood supply. The increased blood supply augments the oxygenation of the tissues and stimulates the sensory nerves to be more sensitive and responsive in the vulvar/vaginal region. A decreasing, but not altogether absent, level of estrogen will cause a decreased sexual responsiveness. Women often report this condition as they mature. When menopause (see definitions) occurs, the ovaries produce no estrogen, but estrogen replacement therapy can restore some level of libido and sexual responsiveness. If the estrogen therapy is increased in dosage, or if the route of delivery is improved (transdermal estrogen--the patch--replaces circulating estrogen with the exact estrogen previously produced by the ovary), there is usually a like increase in libido and sexual responsiveness. |
|
| Estrogen is at the lowest level just before and during the menses; therefore, libido and sexual responsiveness are also at their lowest during the menstrual cycle. The estrogen peak on days 12 and 13 of the menstrual cycle is reported by young women as also the height of their libidos and sexual responsiveness during their menstrual cycles. The estrogen peak stimulates (via the pituitary and ovary) the release of an ovum (egg) from the ovary. This matching of ovulation and increase in libido, due to the estrogen, favors pregnancy. |
| Decreased Sexual Responsiveness Due to Medications |
| 1.) Birth control
pills can cause a profound reduction, or even absence, of libido and sexual
responsiveness. The estrogen/progesterone combination birth control pill delivers a small
daily dose of estrogen that prevents the ovary from developing and releasing an ovum. The
small dose of estrogen is very effective in preventing pregnancy, but might cause a
greatly reduced libido and sexual responsiveness. The small dose of estrogen prevents the
ovary from producing the normal and much larger amount of estrogen that normally creates
libido and stimulates sexual responsiveness. The trend in gynecology is to use a very low
dose, or an ultra low dose of estrogen in the current birth control pills. The treatment
to restore normal libido and sexual responsiveness is to discontinue the birth control
pill, but substitute an alternative contraceptive to avoid pregnancy. 2.) Birth control shots or birth control implants such as DepoProvera or Progestesert are high-dose progesterone medication (a potent anti-estrogen). Like the birth control pill, high-dose progesterone prevents both ova development/ovulation and estrogen production in the ovary. The greatly reduced or absent circulating estrogen causes reduced or absent libido and sexual responsiveness. |
| Antidepressants (Prozac, Zoloft, Paxil) |
| The newest and most effective treatment for depression is the use of Selective Seritonin Reuptake Inhibitors (SSRIs). Depression is a biochemical imbalance in the brain. The SSRTs work at the brain level to alleviate depression. A decrease or absence of libido has been associated with the use of SSRI anti-depressants, and is reported by more than 70% of women using them (some one million women in the US). The use of Viagra by women with a decreased libido due to SSRI has been reported extensively in the gynecologic literature. The literature reports--almost complete return of libido and sexual responsiveness to SSRI patients given Viagra. Prescribing Viagra for women taking SSRIs is well accepted by the gynecologic community. This, however, is off-label use of the drug, for Viagra is FDA-- approved only for the treatment of men with erectile dysfunction. |
| Other Drugs
that Can Affect Libido and Sexual Responsivenes Selective Serotonin Reuptake Inhibitors (SSRI's) used to treat depression, obsessive-compulsive disorder and/or panic disorder such as:
Other non-SSRI antidepressants, such as:
Blood pressure medications H2 blockers used to treat ulcers, such as:
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