Decline in sexual desire - Causes and Symptoms

Definition

The decline in sexual desire (or libido) is a problem caused by numerous physical and psychological conditions, which can affect both men and women. It manifests itself with a reduction in the frequency and intensity of sexual desire, both spontaneous and in response to erotic stimuli.

Libido is one of the phases of the sexual cycle: it triggers excitement and is closely connected to erotic pleasure. Desire is influenced by the state of health, nutrition, hormonal levels, the intake of certain drugs and a psychic component (presence of fantasies, desire to engage in sexual activity, satisfaction of one's body, etc.).

In some cases, the reduction of libido is a temporary condition, related to lifestyle and transitory situations, such as stress, fatigue and weakness (eg feverish states). Other times, on the other hand, it is a symptom of real pathologies (including hormonal alterations and major depression).

In women, the decline in desire can also be seen with reactions, such as dyspareunias (painful relationships) and vaginisms (non-voluntary spasms of the vaginal wall that make penetration impossible). By contrast, humans may not be able to achieve or maintain a complete erection (erectile dysfunction).

If prolonged, the decrease in libido can have repercussions on the psychological sphere and on the couple relationship.

The decline in sexual desire may be secondary to endocrine diseases that cause adrenal insufficiency (Addison's disease) or, on the contrary, hypersurralism (Cushing's syndrome).

Other factors that cause a decrease in libido include hormonal imbalances with decreased testosterone production (eg male hypogonadism and hypopituitarism), increased prolactin production (hyperprolactinemia) and decreased thyroid hormones (as in hypothyroidism).

Different genital diseases can cause or contribute to dysfunction. In women, these include vaginitis (atrophic or secondary to vaginal infections, such as in the case of genital herpes, candidiasis and trichomoniasis), vulvar dystrophies, lichen sclerosus and narrowing of the post-surgical vaginal intake. Furthermore, it may depend on specific circumstances, such as phases of the menstrual cycle, pregnancy and menopause.

In humans, however, the decrease in libido can be associated with erectile dysfunction and derive from structural pathologies of the genital organs (eg La Peyronie's disease) and from neurological and vascular disorders (atherosclerosis of the penile arteries, priapism, spinal cord trauma etc.).

The decrease or absence of sexual desire can also depend on numerous chronic diseases, such as uremia, liver failure and various cancers. Neurological causes include some secondary damage, for example, to diabetes, multiple sclerosis, spinal cord dysfunction or surgical lesions.

The decline in sexual desire may also depend on the abuse of alcohol and drugs (eg cocaine, opioids and heroin).

The drugs that affect libido include: weak androgen receptor antagonists (eg spironolactone), antihypertensives, neuroleptics, hypnotics, antiepileptics and some antidepressants. In some cases, even oral estrogen therapy and hormonal contraceptives can cause a reduction in sexual response.

Mood disorders are closely related to decreased desire and excitement. Also concerns about a negative outcome (eg performance anxiety, fear of unwanted pregnancies or contracting sexually transmitted diseases and inability to have an orgasm) can contribute to an altered sexual response.