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WTF Happened To My Sex Drive?

I don’t mean to catch you mid-croissant on this topic, but I want to report the latest research on a woman’s libido and its relationship to her masturbation activities. If you’re a woman in your mid-40s or older, partnered or not, straight or gay, you may have noticed something about your sex drive you’re not thrilled about. In fact, you may be getting downright worried. “After all,” you think, “I’m barely at the midpoint of my life, in my prime, really. I’ve got decades ahead. But that craving I used to have for a good old fashioned roll in the hay is gone, wow, gone.”

Thinking back just a few years, you remember when you could literally fantasize yourself to orgasm. Those glorious days when your partner (or partners) of the moment could walk in front of you or be mixing a martini and the only thing you could think about was ripping his or her clothes off. “Ah! Those days,” you smile.

So what happened?

Well, female libido is pretty complicated, and now the largest study ever conducted on midlife female sexuality confirms it. Entitled SWAN (Study of Women Across the Nation), researchers from seven medical centers around the country tracked the sexual behavior of 3,302 women age 42 to 52 from a range of ethnic groups, partnered or not, over a period of ten years. They did so by asking participants to periodically have their hormone levels monitored and fill out questionnaires asking about frequency of sexual desire, masturbation, sexual arousal, orgasm, and any pain during intercourse.

Quick hormone review
You may know what happens to your hormones in your 40s and beyond, but let’s review the basics. As ovarian function declines, measurable levels of the three ovarian hormones fall. These are estrogen (makes you female–hips, breasts, flirty behavior), progesterone (prepares the uterus to receive a fertilized egg), and testosterone (libido, desire, and when you’re out drinking with friends making eye contact with that person across the room, unadulterated horniness).

Testosterone also comes from your adrenals, two walnut-sized glands perched atop your kidneys. In your 40s, levels of adrenal testosterone and its precursor molecule DHEA also start to drop.

In response to the falling ovarian hormone levels, your pituitary (the master gland tucked beneath your brain and the controlling force behind your ovaries, adrenal glands, and thyroid gland) starts pumping out two ovary stimulators: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). When you’re in actual menopause, your ovarian hormone levels are low and your FSH/LH levels are very high.

Got all this?

SWAN study conclusions
Based on ten years of questionnaires and hormone measurements, the SWAN study concluded (to no one’s surprise) that women’s sexuality is complex. And while hormones play a significant role, a woman’s emotional wellbeing and the quality of her intimate relationships are the most important factors when it comes to sexual desire.

I wrote about this topic in a previous Health Tip based on a New York Times article discussing how partner boredom was a major sex drive determinant. Women interviewed for that article commented that their libido had blossomed when a new partner arrived on the scene.

Because the relationship issue was such an important determinant in partnered sexual activity, the SWAN study asked about masturbation and found that non-partnered sex was actually a better measure of a woman’s libido than her desire for and enjoyment of partnered sex. Hormones are involved…again.

As testosterone and DHEA levels dropped and FSH levels rose, desire for and frequency of masturbation fell. Interestingly, masturbation was not related to estrogen levels. When women took testosterone or DHEA, there were predictable increases in the blood levels of each, but also measurable increases in masturbation activity. However–and this is a big however–there was not necessarily a comparable increase in partnered activity, because it relies so heavily on the status of the relationship with a partner. Adding estrogen was useful in relieving menopause symptoms (like hot flashes, night sweats, and vaginal dryness) and suppressing libido-killing FSH.

As you might imagine, pain during sex was another real sex-drive downer. Potential therapies included both vaginal estrogen and pelvic floor treatments from a physical therapist. A further villain for many women can be the SSRI antidepressants. It’s estimated that as many as 25% of women over 45 are using them. One of the first recommendations for improving libido was to switch to a non-SSRI antidepressant like Wellbutrin, which has no effect on sexual function, or try to get off antidepressants altogether.

Here’s a link to the original article reporting the SWAN study. In a brief interview, lead researcher John F. Randolph, Jr, MD, says that where a woman’s sexual satisfaction is concerned the effect of her testosterone level is dwarfed by the status of her relationship. I completely agree with this. I’ve prescribed testosterone for women who are worried about low sex drive, have seen blood levels of testosterone rise, and then heard back that my patient felt absolutely nothing.

Dr. Randolph recommends that physicians not bother measuring testosterone or DHEA because the levels are low in this age group anyway. I agree with this as well. He also recommends that doctors treating women with low sex-drive issues encourage them to get off SSRIs if they’re taking them. Totally agree.

Although I think the SWAN study is fascinating, I disagree with some of Dr. Randolph’s recommendations. When he says he doesn’t recommend treating low libido with testosterone, it seems to go against the SWAN study outcomes. From my perspective, he’s positioning partnered sex as the norm, the goal of treatment, and suggesting that enjoyable non-partnered masturbation, attainable by raising testosterone and DHEA levels and lowering FSH levels, is not a physician’s therapeutic goal.

Anybody disagree?

To me Dr. Randolph is being more than a wee bit sexist. He may not know that non-partnered men occasionally request and are prescribed Viagra to enhance their masturbation enjoyment. It’s pricey at $40 a pop (figuratively speaking), but apparently worth it.

Okay, now back to your croissant.

Be well,
David Edelberg, MD


Posted in Blog, Knowledge Base, S, W Tagged with: , , , , , , ,
11 comments on “WTF Happened To My Sex Drive?
  1. Lori Miller says:

    Enjoyed the article!!! Note worthy info and funny. Humor is sexy. Ha!

  2. Diane says:

    I wish there was something over the counter that would really work to increase my sex drive, I have none and its driving my hubby nuts im post menopausal and am 59 years old any suggestions?

  3. It’s a good and wide ranging article, and I have several comments.

    You cite the NYT article about how interest in sex sparked in women who had a new partner. In the polyamory community, this is called New Person Energy (NPE). In the non-poly world, it’s the joy and excitement of having a new partner and the energy and lust and exploration and getting out of the rut that often builds up over time when you have been having sex with the same partner for years and years. And years.

    A large percentage of couples have sexless marriages (or sexless long term relationships). Or, at any rate, they are not having sex with their primary partner. They may have an open relationship, be poly, or in a poly/mono relationship. Or they may be cheating or have a “don’t ask don’t tell” relationship about sex with others on the side.

    Those all open up the relationship to the new hormones (and sexual experiences) from the sex with the non-primary partner.

    Masturbation is fast, easy, you know just what feels right, and, when your partner has lost interest, you hate each other, there’s resentment, etc. etc…of course masturbation is easier than revving up the partner who you wish was no longer your partner.

    But people stay for the kids, or to have a roof, or to get their next meal. And divorce is a long, painful and expensive process. If divorce was easier, faster and cheaper–there would be a lot more divorces!!

    As for your comment on viagra, research I’m aware of has shown that Cialis has a higher renewal of prescription rate, more user satisfaction, etc. than viagra. This was from a conference I attended several years ago (AASECT I believe)–but Cialis also helps generate erections for up to three days, versus the much shorter typical duration of viagra.

    But even today, these meds aren’t helping a lot of people because they’re not taking them right. They should be taken with a low fat meal or perhaps on an empty stomach (read the directions and ask your MD and your pharmacist) and erotic stimulation is needed to trigger the erection—just watching TV or doing laundry won’t make the erection happen (unless you find that sexually stimulating).

    Lastly–there are lots of post-menopausal women with the sex drive of 20 year old males–and lots who have lost their sex drive and are quite happy about it.

    Discrepancies in sexual drive and desire (not to mention what the partners want as far as sexual play and stimulation) also can differ.

    Lots of couples do not share with their partner what they want or need sexually, and just give up, or find another outlet–whether that be porn, a sex worker, another partner, masturbating, or having a sexless relationship.

  4. Dr E says:

    Hi Diane
    There’s an herbal blend called ITI Woman that is supposed to enhance libido. Available in our apothecary

  5. Diane says:

    Where is the link to the apothecary I have tried just about everything.

  6. Dr. R says:

    Hi Diane. The Apothecary link is on the navigation bar (far right) of the WholeHealth Chicago banner that is on every page of the website. Sorry you’ve been struggling to find it. If you continue to have difficulty just go to this link; shop.wholehealthchicago.com

  7. Dr E says:

    Hi Dr Berend
    Thank you VERY much for all the interesting points. Really appreciate your taking the time to write this

  8. Ann says:

    I agree Dr. E. In 2007 at the age of 42 I had a hysterectomy bilateral oophorosalpingectomy due to persistent cervical high grade intra epithelial squamous lesions, status post both conization and LEEP procedures. I also had endometrial displasia, so I told my GYN to just take it all, one less organ I have to worry about getting cancer. Within days the headaches and hot flashes became intolerable and I requested estrogen. Within a few months I had zero libido; and requested testosterone replacement as well. Ahh to have libido again…joy! Even though my desire for my husband was near nill, to be as frank as you, I just really don’t like him that way anymore. I never thought I’d be one of those that stayed in a relationship like that; but I am and there are reasons. At least I have myself…aka masturbation 🙂 And as much as I would like to have sex with another actual person, I have to actually LIKE them first. Until then, I’ll be going at it solo. On a side note, I don’t care what the potential risk are for HRT, the benefits for me far exceed the risk; and I can’t foresee myself taking a drug holiday anytime in the near future. I can’t imagine my life without those delicious little hormones.

  9. Sue says:

    I’m appalled at the medical establishment’s clearly sexist stance on treating women with testosterone. Sexual benefits aside,the increase in energy, elimination of fatigue and muscle strength/capacity for exercise were dramatic for me back when EstraTest was still available orally.
    I now know that my testosterone levels were low even pre-menopausal, which is common for those with Hashimoto’s thyroiditis. Yes, the impact on my sexuality is like night & day with testosterone. Without testosterone, I have no sensation. desire, or enjoyment of sensual activities. Of course this impacts my life, my self image, and my relationships!
    It also vastly improved my overall health, by the easier incorporation of walking & exercise into my life, and the energy level that nothing else helped even after 20+ years with autoimmune thyroiditis. The connection between testosterone therapy with
    DHEA ‘s positive impact on autoimmune diseases like Lupus seems apparent to me.

    HELLO! Yes! Women frequently (probably always) benefit from testosterone therapy! The medical establishment, especially endocrinologists seem profoundly out of touch with patient’s clinical experiences!!

  10. Maureen says:

    Sorry nothing much to add, but…..maybe just maybe,,and (Hopefully ) after recently removed from the pain meds, I will regain…….that, what’s it called, oh ya libido.


    Of many of the energy building substances.
    We live in a culture in the U.S of hurry hurry hurry!

    You know the saying “good things come to those who wait?
    I don’t see a lot of waiting in the U.S.

    Stop and smell the Roses?
    It’s ok…..stop and visit that Family Member too. At the end of the day, I will breathe and smile.
    For what it’s worth…

  11. Kevin says:

    My wife will look deep into my eyes and try to convince me that it’s not me it’s her. I wish she wouldn’t. I adore her. She works hard, I work hard. I rub her feet, she floats the tips of her finger nails across my back. I can still make her laugh. When we make love it’s long and satisfying but it is getting her to that point which is becoming a little difficult and sometimes incredibly dissapointing. I feel rejection like a punch in the gut. I go to my garage, hit the bag and think at the same time. “What’s different ? Is she attracted to someone else? I love her so much I would fight for us. Would she fight? Twenty years married in 2017 and I’m still in love with her,is she bored with me?

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