The real reasons reasons so many women have lost their SEX DRIVE

Drug giants have spent millions trying, but no one’s yet found a female Viagra. Why? They’ve all been looking in the wrong place . . .

WOMEN, it seems, are increasingly losing interest in sex. Around a third of premenopausal women and half of older women report sexual problems, with lack of desire a main cause.

A study recently published in the journal BMJ Open found that more than a third of 5,000 women aged between 16 and 74 surveyed said they’d lost interest in sex for three months or more in the previous year.

And nearly two-thirds of these women said they found their lack of libido distressing.

This is not a problem unique to women — around one in five men experience low libido at some point, but they definitely have the advantage when it comes to treatments.

It’s now 20 years since Viagra provided an instant fix for men who struggled to achieve an erection however, scientists have not been able to produce as successful a pill to help women feel more in the mood.

Some experts think the reason this has proved so elusive is that many women are dealing with

underlying health conditions, from incontinence to menopausal symptoms and pelvic pain, which affect their interest in sex, and no ‘pink Viagra’ is going to sort this out.

‘PINK VIAGRA’

YET for years a female Viagra has been the Holy Grail. So there has been some excitement about a drug called bremelanotide, which has just undergone successful phase 3 clinical trials in the US, the last stage before a drug can be licensed.

It was originally tested as a tanning pill in the Eighties but was also found to boost muscle recovery. Body builders of both sexes discovered unexpected benefits — the men reported spontaneous erections, the women said it put them ‘in the mood’.

The drug company, Palatin Technologies, switched their efforts to developing it as a treatment for female sexual dysfunction. It works by binding to chemicals in the brain involved in sexual desire, increasing production of the ‘feel-good’ chemical dopamine which plays a key function in arousal. For best effects, the woman must inject herself around 45 minutes before sex.

Trials found it worked better than a placebo but the development of the treatment suffered a setback in 2007 when the original nasal spray version was found to cause high blood pressure in some, leading the Food and Drug Administration in the US to halt trials.

The manner of administering the drug was changed to an injection.

The latest trials have shown that as well as improving a woman’s libido, bremalanotide also makes sex more satisfying for premenopausal women. Palatin Technologies now hopes to make billions from worldwide sales.

But before the champagne is opened, experts urge caution. Not least because bremelanotide would not be the first ‘female Viagra’ to be licensed and promise much —only to then fall short. Addyi was also labelled the female Viagra when it was launched in 2015.

Originally developed as an antidepressant, it reduces the effect of the brain chemical serotonin, which in turn leads to an increase in dopamine levels.

In Ireland, Addyi is yet to receive approval due to the cost (up to €800 for a month’s supply) as well as concerns about its effectiveness.

Even in the US, where it is licensed, take–up has been slow, probably because Addyi doesn’t help all women — only around 10% found any increase in ‘sexually satisyfing events’ compared to those taking a placebo, and around 75% of those who take it suffer sideeffects such as low blood pressure, nausea, headache and dizziness. It also has to be taken daily, and drinking alcohol can make the sideeffects worse.

But if a pill isn’t the answer, researchers at the University of Michigan in the US have been trying out a new device which sends electrical signals from a needle inserted in a woman’s ankle to stimulate nerves and blood supply in the genital area.

Although it reportedly creates a pleasant tingling, there are concerns about how practical it is during energetic love-making sessions (as the needle needs to remain in situ).

THE BIGGER PICTURE

THE focus on pills — and zappers — misses the bigger problem, say experts. This is not just that there are so many complex factors in female desire, such as stress and breakdown of relationships — though clearly these play a role.

‘A woman seeks intimacy which leads her to be receptive to sexual stimuli and only then feels desire,’ says Dr Catherine Hood, a consultant in psychosexual medicine.

However, experts are increasingly admitting that often low libido in women is nothing to do with what’s going on in their head — there are a whole range of physical issues that can kill desire.

It might be that the muscles in their pelvis are so tense it makes it difficult to have sex, or the impact of the menopause makes it painful.

Fix the physical problem, they say, and a woman’s normal desire for sex will return.

‘There are many physical reasons why women lose their desire for sex, including illness and pelvic pain,’ says Dr Hood. ‘It may be that drugs could help solve issues that are caused by genuine chemical or hormonal imbalances, but these are just one small part of a bigger picture when it comes to low libido.’

Yet these physical factors are often overlooked, says women’s health therapist Myra Robson.

‘We see women who are trying to maintain good sex lives while dealing with issues such as endometriosis, [where womb lining-like tissue develops elsewhere, causing scarring and irritation] which can cause deep pelvic pain; fibroids, which affect the lining of the womb, and stress incontinence, which affects one in three women after childbirth,’ she adds.

‘These things need to be sorted out first before we go for the candles and the chocolates, and long before we even think about female Viagra.’

WHEN SEX IS PAIN

DYSPAREUNIA, or painful sex, is a common cause of low sex drive in women. Around 30% of women experience this according to an article in the Journal of Sexual Medicine in 2015. Large numbers of women do not tell their partner when sex hurts. They might want to have sex, but go off it as it is so painful.

‘It’s a common and distressing complaint and it has been a neglected female health problem and can affect young women, women after having children and women who are already through the menopause,’ says Mike Bowen, a consultant gynaecologist.

‘It can be felt as deep pain within the pelvis or superficial pain in the vulva during intercourse.’

It is associated with issues such as vaginal dryness and anxiety about sex as well as a range of physical problems, from sore skin conditions to urinary tract infections and endometriosis.

Women who have perineal scars after childbirth are also more likely to find sex painful until the scar tissue has stretched and softened, which can take years.

‘Fortunately, there are many ways to treat dyspareunia, by treating the underlying causes, whether they be physical, emotional or a combination of both,’ says Mr Bowen.

Any form of incontinence can put women off sex: stress incontinence — small leaks of urine when someone coughs, sneezes or laughs — affects one in three women in Ireland.

Stress incontinence occurs because weakness around the pelvic floor (the band of muscles that stretch from the pubic bone to the front of the spine) means the neck of the bladder is not well-supported, so urine can leak out when the bladder is put under pressure.

This commonly happens after childbirth, as the ligaments that support the pelvic floor become stretched during pregnancy or labour. Pelvic floor exercises can help — although ideally these should be done under the guidance of a specialist physiotherapist, who are in short supply.

Apps such as Squeezy and gadgets like Innovo, which emits electrical impulses to contract the pelvic floor muscles, can also provide relief.

‘There is a place for these devices but women can also try simple techniques like going to the loo before sex and abstaining from coffee and tea, which are mild diuretics,’ says Dr Hood.

A lesser-known issue is pelvic tension, when muscles in the pelvic floor are knotted and tight, which can make sex virtually impossible.

Yet it is surprisingly common: up to 15% of women aged between 18 and 50 are affected. It can be caused by stress and anxiety, slouched posture, chronic constipation and even overexercise. It is a recognised medical condition which can be treated by internal massage.

MENOPAUSE BLAME

IT’S generally assumed that desire will naturally drop with age, especially following the menopause, but there is no evidence that this should happen to women. Indeed when Tim Spector, professor of epidemiology, looked at the effect of the menopause on women’s libido he found that sexual dysfunction problems didn’t increase but stayed constant, affecting around 22% of women.

Some women actually saw improvements in sexual function after the menopause.

The four-year study results, published in the Journal of Sexual Medicine in 2015, were ‘a little surprising’, Prof Spector admits.

‘They suggest that menopause has been exaggerated as an excuse for everything,’ he says. ‘By modifying your life and attitudes towards desire, you can change things sometimes surprisingly for the better, although you are older.’

Any reduced libido is usually associated with hot flushes or vaginal

dryness (which can make sex painful). ‘As oestrogen levels drop, there can be problems like vaginal dryness,’ says specialist menopause nurse Kathy Abernethy, adding that these can be treated, eg, with hormone replacement therapy, oestrogen creams and lubricants.

Dr Hood says that women who maintain active sex lives are more likely to keep thinness and dryness at bay: ‘There’s a maxim, use it or lose it, which definitely applies to women having a great sex life past the menopause.

‘Sexual intercourse helps to keep the walls of the vagina thicker and more elastic.’

Some doctors believe that a lack of sexual desire is linked to low levels of the male hormone, testosterone, which in women is produced in small amounts in the ovaries to drive sexual arousal.

Testosterone patches deliver small amounts of a synthetic form of the hormone while creams can be used by peri and postmenopausal women.

KEEP LOVE ALIVE

WHATEVER the cause, the impact a lack of desire can have on women should not be underestimated, explains sex and relationship counsellor Denise Knowles. ‘A healthy sex life is good for your relationship and how you feel,’ she says.

‘Sex stimulates the production of feel-good hormones dopamine and oxytocin, making you feel closer to your partner as well as improving blood flow, which helps keep the circulatory system in good shape and burning calories. There are all sorts of reasons why you should foster your desire.’

But Dr Hood says people do have to make an effort. She often sees couples where the woman complains she no longer feels spontaneous desire and the man says she won’t initiate sex.

‘But perhaps we put too much emphasis on “spontaneous desire”, which only really happens in new relationships,’ she adds.

‘After two years or so, spontaneity is replaced by a new cycle of desire, which requires him to initiate intimacy to which she can respond sexually.’