What to try when one of you ALWAYS has a headache . . .
You’re in the mood — he’s not interested. It causes couples untold distress, but there ARE ways to reignite that spark
Aloss of interest in sex in men is often put down to the ‘male menopause’ and a drop in testosterone. But some experts aren’t convinced.
It is true that waning testosterone plays a big role in sexual dysfunction, says urologist Professor Mike Kirby, but men usually keep making the hormone throughout their lives.
And if someone who believes they suffer from low libido has their testosterone levels checked (see previous page) and it is decided this is not the cause and there’s no other underlying condition, such as depression, it’s time to talk.
Many sex problems, including low libido, remain unresolved as couples don’t communicate, says sex and relationship counsellor Victoria Lehmann.
‘After 30 years, I’m still surprised people find it so difficult to talk about their worries,’ she says. ‘There would be far fewer problems if we were able to say what we liked and didn’t like without offending anyone – “If you blow in my ear one more time . . .” Instead, we say nothing and find we’re not turned on any more.’
Sometimes, even problems such as erectile dysfunction can be all in the mind, says Prof. Kirby.
‘Men who have had one or two failures for whatever reason – depression can be a cause, for example – develop performance anxiety. They begin to really worry about being embarrassed the next time.’
That’s when evolution kicks in – unhelpfully. Anxiety or fear produces adrenaline, a mechanism that goes back to caveman days, says Prof. Kirby. ‘If you’re having wild sex in a cave and a tiger walks in you’ve either got to run or fight. And you can’t do either very well with an erection.’
So adrenaline lends a hand by switching off the erection and sending the blood to the muscles where it’s needed most.
That cycle of anxiety can be overcome – erectile dysfunction drugs such as Viagra can be prescribed until
confidence returns. In her line of work, Victoria Lehmann sees many non-physical reasons for erectile dysfunction. Sometimes it is a sign something else is wrong in a relationship. ‘I always say to men, if you don’t listen to your mind or your heart, listen to your penis – it may be trying to tell you something. Do they find their partner attractive? Do they even like them?’
Treating low libido in women is also complicated. Ever since a male anti-impotence drug became available with the licensing of Viagra in 1998, the search has been on for an equally effective solution for a drop in women’s libido. Up to 40% of women report that their sex drive wanes as the menopause begins, but younger women are clearly not immune. ‘Loss of desire is one of the most common sexual problems for women,’ adds Peter Saddington, a sex therapist. ‘In my experience, professional women in their 30s are more likely to attend sex therapy sessions for psychological reasons such as stress,
whereas older women generally come for the physiological effects of the menopause.’ (See below.)
There is still no drug to boost women’s libido. Several have been promoted as the ‘female Viagra’, only to turn out to be little better than a placebo. Studies show that taking these drugs – including Viagra itself, or pills that target sexual areas in the brain – was often not enough for a woman. Unlike in men, women could have all the signs of physical arousal yet still prefer to sleep alone. Ironically, the drug research also showed just how effective psychological support can be for couples trying to improve their sex lives. In trials, those given a drug and sex therapy did report an improvement. And those handed a placebo, also with therapy, improved nearly as much. The changes that can arrive with the menopause seem designed to dampen even the most active libido. Treatment with HRT (hormone replacement therapy) can help with physical symptoms such as vaginal dryness. But one of the oldest therapies is also the most controversial – replacing the sex hormone testosterone, which starts declining before the menopause. Recent reviews in medical journals confirm it is ‘positively associated with sexual function’ in women, and a briefing paper from the UK’s National Institute for Health and Care Excellence last year advised doctors to ‘consider’ testosterone for menopausal women with low libido if HRT isn’t helping. However, there is little precise guidance on the use of testosterone, so an increasing number of women with low libidos have been turning to bioidentical HRT, as it uses plant hormones with the same chemical structure as those made by the body.
Dr Marion Gluck, who runs a clinic in london, says: ‘We measure levels of all the hormones including testosterone and prescribe replacements in cream form for those that are low.
‘The majority of our patients are menopausal, but some are younger women who come complaining of low libido and stress and frequently test low for testosterone.’
Victoria Lehmann says some sexual problems ‘just need to be accepted and lived with’. ‘Sometimes I think we’re trying to make everything perfect. The reality is sometimes one of you is satisfied, sometimes the other is, and sometimes both are and other times neither is.
My message is: Don’t panic, this is just one day.’
Your GP may be able to refer you to a psychosexual therapist.