He’s Gotta Have It

What is that urban legend? An 18-year old teenager thinks about sex every 3 minutes. And that’s while he’s awake. Ah, those were the days. Now that you are older, more serious, possibly more responsible, maybe partnered, and may even have little ones, you may have nowhere near this frequency of sexual thoughts. Haven’t you wondered about why things may have changed (or not!) as you age? Do you need to eat more oysters?

What is Libido?

The desire to have sex is called libido. It is considered by many to be an “instinctual” and “primitive biological urge” and by others as an “existential need.” Libido levels differ widely among individuals, but are pretty characteristic for an individual, similar to handwriting style. After all, we are creatures of habit. Having said that, libido can also vary from day to day, and even by the hour, in any individual. Importantly, libido doesn’t correlate with normal or high levels of the male hormone testosterone, but can fall with low hormone levels.

Why and When to Evaluate Libido?

Low sex drive is most commonly due to stress, and stress comes in many forms: financial, physical, travel (circadian) and emotional. The reason is pretty clear, as I have noted before. Think of yourself as a caveman, which we were not so long ago. Being anxious or worried puts your nervous system into a primitive “fight-or-flight” response and buries the sex drive. Relaxation though, stimulates the “rest and restore” nervous system and allows the sexual appetite to bloom. For a robust libido, you need energy, relaxation, and time. So get some sleep, reduce your stress and you might find that you feel 18 years old again.
But what if your sex drive has been workable and stable for years, thank you very much, but recently has taken a nosedive. In this case, the low libido might in fact be a symptom of an underlying organic disorder and should not be ignored. Below is a list of medical conditions that cross my mind in a patient with new onset of decreased sexual desire:
Acute stress                                      Erectile dysfunction
Depression                                        Peyronie disease (penile curvature)
Sleep apnea/disorders                        Diabetes mellitus
Low testosterone                               Malnutrition
Hyperprolactinemia                             Medications (5-alpha reductase inhibitors, opiates)
Hypothyroidism                                 Cancer
Anemia                                             Drug abuse
The changing nature of relationships also affects libido, but this may not be an organic problem. One way I make this distinction is to decide whether the overall pattern or frequency of sexual activity (i.e. the event, either with a partner or with self-stimulation) has changed. If not, then desire may be intact. Yup, believe it or not, good, old fashioned medical intuition figures highly in the decision to evaluate a man for loss of sexual drive. And Robert Byrne may have actually gotten it right when he said: “Anybody who believes that the way to a man’s heart is through his stomach flunked geography.”