WTF Happened To My Sex Drive?

Health Tips / 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