Libido
Libido: Understanding our sexual drive and function
Written by: Dr. Madeleine Clark, ND
Experiencing lowered libido can be an upsetting and frustrating experience for individuals. It can make them feel down, unlike themselves, and put pressure on relationships they are in. Lowered libido is important to address because it impacts our quality of life and life satisfaction Why does our libido change? What factors do we need to consider when we experience a change in sexual interest or drive?
Sexuality and libido is best understood from a biopsychosocial model: which takes into account sexual function that changes over time (i.e. with age and stage of our life), and reflects an individuals fluctuations in health status, neurochemical balances, psychological concerns, interpersonal concerns (relationships), socio-cultural beliefs, and personal values.
We can also further divide up sexuality in to understanding that healthy sexual function involves desire, our ability to be aroused (our genitalia and our own perceptions of arousal), stay aroused, our ability to orgasm and sexual activity being pain free.
When we take this lens to our sexual function we start to understand there may be many things we need to tease out to understand why someone is feeling as if their libido has changed or is lower.
What do we know about sexual response?
Models have been developed to try and understand and explain human sexual responses. The first model, proposed by Masters and Johnson, gave us the “sexual response cycle”. This encompasses different stages that were observed in laboratory setting (yes they studied sex in a lab). These linear stages happened in order, starting with “desire”, “arousal” “excitement”, “plateau”, “orgasm” and “resolution”. This model sees sexual response as an innate, natural and biological phenomenon, that depends on proper functioning of hormones, nerves, blood flow and muscles.
However, what this model lacked was the ability to describe responsive desire, and the decision to engage in sexual activity being more complex than just an innate biological drive. Models that take into account intimacy and the complexities of why we choose to engage with sexual activity suit more individuals and situations.
They can explain situations in which we may feel sexually neutral at the time we consider engaging in sexual activity, and that the choice to proceed (or not proceed) can involve more than just biological drive. These additional factors may include; motivation, interpersonal issues, cultural and religious beliefs, partners health, relationship quality, past sexual abuse, and cognitive distractions.
How do our Brains & Hormones contribute to Sexual Function?
Our sexual response is controlled by a mix of neurobiology & hormones. Excitatory neurotransmitters such as oxytocin and norepinephrine stimulate arousal, whereas melanocortins and dopamine stimulate desire and attention. Inhibitory pathways use serotonin, opioids, and endocannabinoids are also involved in reward pathways and sedation. We think that in hypoactive sexual desire disorder that the inhibitory responses out weigh the excitatory ones.
Sometimes we like to talk to patients about the gas pedal and break metaphor when it comes to sexual drive. We often think that lower libido is due to an absence of gas pedal (excitatory response, stimulus, innate drive for sex), which we term “sponteanous desire”. This type of sexual drive is what we see in the media and in movies, where at a drop of a hat we feel interested and sexual. However, sometimes it is the inhibitor signals or “brake” being on. Which can be a number of different reasons (you feel tired, in pain, you have been touched all day by your children, your partner is annoying today, you have a lot to do at work). It is also completely normal to experience responsive desire (interest that comes from a response - a partner doing something nice for you, seeing something sexual on TV). It all depends on the individual and their current context.
Hormones such as testosterone also play a role in sexual function and desire in women. This is not actually due to a change in hormones related to menopause, but due to a gradual decline happening due to age. In a women's late 40s and early 50s circulating testosterone is approximately half of what it was in their early 20s.
We don't know what level of testosterone indicates that it might be impacting sexual function and desire, therefore we don't typically test it in the blood in the case of libido.
How do we divide up biological, psychological and sociocultural factors?
Biological factors
Current health status
Hypoactive Sexual Desire Disorder
Orgasm disorders
Sexual Pain Disorders
Genitourinary Syndrome of Menopause
Pelvic Floor Dysfunction
Vulvodynia
Medical history (hormonal, muscular, cardiovascular health)
Surgical history
Reproductive history
Medications
Psychological Factors
Anxiety
Depression
Personality variables
History of sexual abuse or trauma
Alcohol abuse
Substance abuse
Poor self-image
Stress
Distraction
What is social cultural facotrs
Limited sexual health education
Religious or cultural morals or values
Age descrimination
Partner & relationship factors
The presence or absence of a partner
The quality of a relationship
Communication in a relationship
Considering all these factors enables us to better understand patients' concerns and provide optimal support for their sexual well-being. Often, the overlap of biological, psychological, and social elements requires the expertise of multiple healthcare providers. At Crafted Balance, we take an integrative approach to care. Book a consultation with one of our naturopathic doctors to explore how we can support your health in a comprehensive, well-rounded way.