His and Her Health

I checked out recent posts and tried to find an appropriate one to jump in on, however it seemed easier and more appropriate just to pose a new question. I am going to try and follow the user dona's advice for a new post.<P>I am a 30 yr old female who has had low libido issues for about 7 or 8 years. The best I can trace back the problem is that after I was divorced at 23 I went on Prozac for 2 years. I know it is normal for antidepressants to cause sexual side affects, but even after I went off the drug my sex drive never returned. Doctors have told me (medical and mental) that the drug cannot affect me for that long. However, my sister-in-law, who is a clinical psychologists has heard horror stories about Prozac and seems to think it is a possibility. What do you all think?<P>I’ll attempt a brief history. I have had no sexual abuse, trauma, or injury. I have had multiple partners starting at age 18 to 26 – I am now in a happy marriage of 3 years. I have no problem having orgasms, in fact I would venture to say I have them too quickly (I know some of you would kill for that problem – sorry). I have vaginal dryness as well. Once we are in progress so to speak I don’t have arousal issues. But I am rarely “in the moodâ€

Welcome to the board, and thank you for all the information in your post. Never worry about being too "long winded"--too much is better than not enough ) <P>It sounds as though you have a desire problem, as opposed to an arousal problem. It is a shame your Gyn isn't more interested in your sexual desire issues, but unfortunately it's not suprising. Gyn's, for the most part, aren't trained in dealing with FSDs, and many aren't comfortable with the topic or up-to-date on what is going on in the field. Sad, isn't it, that a person who spends all day dealing with women's genitals can't see the forest for the trees (so to speak).<P>Prozac can, as you said, affect libido. I've never heard of it having a permanent effect, but that definitely doesn't mean it can't. Wellbutrin can also have an effect on libido, btw, so that may be contributing to your current situation. Wellbutrin has a lower rate of sexual side effects than most other antidepressants, and in some very limited case studies has proven to increase libido in some depressed people, but that's it. It *is* a less risky antidepressant as far as libido and pregnancy, so it could be your best bet in that department, though. I just wanted to point out that it could also be playing a role in dampening your libido. I have no idea how severe your depression is, or what you have tried; but, if it's an option you may want to look into either 5-htp or SAM-e. You can search this board for more info, or just type them into your browser and get information about them. They should be taken under a doctor's supervision, and I am not sure if either is appropriate for pregnant women, but one of them may provide an alternative with fewer side effects (especially sexual) to other anti-depressants. Your doctor is unlikely to know much about either, and may not take them seriously because the US considers these "dietary supplements." It is important to note that this is one of the few countries in the world where these drugs (and they are drugs) aren't perscriptions--the FDA classifications leave something to be desired. Studies on both have been done, and they are leading anti-dperessant perscriptions in other industrial nations. Your search should provide you with more info.<P>Depression itself can also affect libido. Am I correct in interpreting your post to mean that your libido died when you became depressed after your divorce, or were you depressed before your divorce and still in posession of a healthy libido?<P>Unfortunately, Viagra won't likely help your situation because it isn't for primary desire disorders. Viagra helps increase blood flow to the genital regions, which helps with feeling and potentially orgasm, but not primary desire order. If you already orgasm easily, it's probably not your best bet in that area. It does, however, increase lubrication, and that may help you. Or, you could try using a different lubricant. My favorite is Eros, which is a silicon-based lubricant that doesn't get sticky or dry out. It's very smoothe, and very "thin," not goopy. Another favorite of mine is Astorglide (the unflavored version, if you can find it). This might be an easier route than viagra, and won't encourage you to possibly orgasm faster.<P>Many women, btw, feel the same as you do after orgasm. Not all women who can orgasm are multi-orgasmic, and once they do orgam they are "done." There are a few books on how to have multiple orgasms, and you may want to check them out. If you can learn to become multi-orgasmic, or delay your own orgasm a bit, it may help with the "are you don't yet?" feeling many women get after orgasm.<P>Your general state of health may, unfortunately, also be playing a large part in your lack of drive. Chronic facial/sinus pain, asthma and allergies could all easily keep your body in a state of general malaise. Pain isn't an aphrodesiac, and both asthma and allergies can keep you feeling tired. Tiredness is a HUGE libido killer, and some of the medicines (even over-the-counter brands) for allergies can have sexual side effects. Check your asthma and allergy medicine literature to see if this is listed, or ask your doctor or pharmacist.<P>Hopefully, some of the other posters here will have more suggestions for you, perhaps including a Gyn that will be more interested in your libido concerns.

As Dona said, welcome! Your first post, though long, is helpful in our knowing what to recommend. (You’ll note, that my responses are also somewhat long.)<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>2-Can you tell me specific tests that I should request from my doctor?<BR>3-Is this a problem I should just expect because of my depressive disorder?<BR>4-Can you recommend any physicians in the Raleigh, NC area?<BR>5-And any other advice that might be helpful.<BR></font><HR></BLOCKQUOTE><P>I see that Dona has answered your first question, and I agree with her assessment, so I’ll leave that one out.<P>Specific tests… (I will assume you mean hormonal tests. There are others, but not many specifically associated with libido.)<P>Here’s some reference material that is on my website. See my profile for more information. (Sorry for the length…)<P> <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>Call every doc who has run *any* blood work on you for the last couple of years. Request that they either mail, fax, carrier pidgeon, etc *FULL* copies of all results to you. This is really important, and something that you should ask for in the future. <P>(Don't accept *only* a "reading" over the phone, though I'd take careful notes if they offer. Then ask for them to mail or fax. If they refuse, politely inform them that you are legally entitled to full copies of your medical records, and that they need to get with the program.)<P>Probably the most important test(s) in relation to desire disorder/ low libido, arousal disorder and sensation issues are:<P><UL TYPE=SQUARE><LI>Total and Free T by equilibrium dialysis if possible (see an explanation of this in the blood-work section of the website listed in my profile.)<LI>Thyroid Function Tests (TSH, Thyroxine/T4)<LI>Prolactin / PRL (A blood test that measures the amount of the hormone prolactin.)<LI>LH / ICSH (Luteinizing hormone) <LI>FSH (Follicle Stimulating Hormone)<LI>Estradiol<LI>SHBG (Sex Hormone Binding Globulin)<LI>DHEA and DHEAS</UL><P>There are some additional issues, if you've not had your tests done yet.<P>Get your Total and Free T levels measured with a test called "equilibrium dialysis." The only other reliable method we recommend is the Free Androgen Index, sometimes also called the Free Testosterone Index, which is the index of Total T/SHBG. This issue is incredibly important. (The cheapest and most widely used test is RIA. RIA is *completely* unreliable to measure T levels in women, especially those levels found in women with very low testosterone. In fact, the FDA is currently working to either force the makers of the RIA tests to show its accuracy in women, or forbid their use in women.)<P>Have your blood drawn in the morning hours, and during the middle third of your cycle, about days 8-15. (This piece is probably not of immense importance, though it currently is thought to give the most accurate picture of your T levels. The monthly cycle doesn't apply to those on hormonal birth control since you're not ovulating. Post-menopausal women don't generally have to worry about either, it appears, and thus blood can be drawn anytime.)<P>The assay methods for all the other tests are generally just fine. <P>The problem with Free T, is the extremely low levels in women. Accurately determining Free T levels, especially at the lower end of the normal range, much less those below the range are very difficult. Equilibrium dialysis is to our knowledge the only assay that can properly determine Free T values over the whole range. <P><B>Notes on the FAI.</B><BR>The Free Androgen Index is calculated by taking Total Testosterone in noml/L and dividing by SHBG in nmol/L<BR>(Total T nmol/L / SHBG in nmol/L)<P>Total T is not often given in nmol/L, but ng/dl. To convert to nmol/L, multiply the value in ng/dL by 3.467.<P><B>Example:</B> Total T of 10ng/dL = 353.634 nmol/L.<BR>If SHBG was 80 nmol, the FAI would be 0.4333.<P></font><HR></BLOCKQUOTE><P><B> 3-Is this a problem I should just expect because of my depressive disorder?</B><P>Perhaps. Depression can have deleterious effect on your levels of desire, and there may not be any way to resolve that, other than resolving the depression itself. But there are causes for depression, which can also have a direct effect on libido.<P>I’m not at all sure any of your issues are hormonal, but you might consider that testosterone levels have a very significant impact on mood and depression in both men and women. (Low T levels also can cause low or diminished genital and nipple/breast sensation, low lubrication etc. Estrogen can also cause low lubrication and genital tissue atrophy.)<P>Given your complaints, I’d probably request/require a full FSD Panel as we call it. (The test shown above.) <P>On that vein… How did your current provider decide you had PCOS (poly-cystic ovarian syndrome?) It generally would require a testosterone test, and probably some others relating to insulin resistance. Did your provider do these things? What were the results? If you do have PCOS, then testosterone is not likely a problem with your FSD, but certainly could be an issue in your fertility problems. (It’s a common reason for women who have troubles becoming pregnant.)<P><B> 4-Can you recommend any physicians in the Raleigh, NC area?</B><BR>There is a list of providers on the website I’m involved with. I see there is none listed for NC, but I can do a bit of research and see if we can find one. If you want to pursue this, see my profile and email me. (It’s not allowed to give references to providers here, unfortunately.)<P><B> 5-And any other advice that might be helpful.</B><P>Three books.<P>I'm Not in the Mood: What Every Woman Should Know about Improving Her Libido, by Judith Reichman - Score, 9/10 <P>Resurrecting Sex: Resolving Sexual Problems and Rejuvenating Your Relationship by David Schnarch (One really doesn't need both of David Schnarch's books, but both are good and somewhat different. Resurrecting Sex discusses medical causes for sexual dysfunction, where Passionate Marriage only reviews the psychological, though it's an excellent book.)<P>Natural Hormone Balance for Women: Look Younger, Feel Stronger, and Live Life with Exuberance by Uzzi Reiss - Score N/A<P>---<BR>A couple other questions…<BR>Are you on any other medications? Many can cause problems.<BR>You seem to indicate your relationship is in excellent health, but I want to make sure. Is that so?<BR>Do you have potential social causes for your low libido - such as religious or other inhibitions to being sexual?<BR>Is sex painful, during, or after?<P>In summary, I’d seriously consider seeing an expert in FSD and getting a full physical work-up. It’s my belief that if you have serious physical/hormonal issues, then finding a solution to your problems via some other route will likely be unsuccessful. <P>Best wishes,<BR>Greg<P><BR>------------------<BR><A HREF="www.newshe.com/cgi-bin/ubb_newshe/ubbmis...stressed_12345" TARGET=_blank>Click here for my profile and more information.</A> Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.<P>[This message has been edited by distressed_12345 (edited 28 July 2003).]<P>**Thank you<p>[Note: This message has been edited by NEWSHE Moderator]

I've heard that women with PCOS usually have serious desire problems--they just aren't interested. I also believe it's a condition that responds well to changes in diet, if I am recalling correctly. That may be the problem right there.

I am so pleased with the quick responses. I have put in a call to my doctor to find out abour tests that have been run so that I may clear up some of those questions.<P>"How did your current provider decide you had PCOS (poly-cystic ovarian syndrome?)" From what I remember she noticed this on a vaginal ultrasound and after the laproscopic surgery she confirmed that I did have PCOS, but said it was on the milder side.<P>"A couple other questions…<BR>Are you on any other medications? Many can cause problems. You seem to indicate your relationship is in excellent health, but I want to make sure. Is that so? Do you have potential social causes for your low libido - such as religious or other inhibitions to being sexual? Is sex painful, during, or after?"<BR>I currently take 300mg of wellbutrin, 10mg of zyrtec, flonase nasal spray, multivitamin with minerals, and calcium supplements daily. On occasion I take albuterol inhaler, 800mg motrin and viox for menstrual pain, and aleive. I do have a very healthy relationship, it certainly isn't perfect but we communicate very well about our issues and work through them, we share honesty and trust and that makes me secure in the relationship. I wouldn't say I have any "social causes" for low libido. But in trying to be truthful in my answers I am definetly on the more conservative side - I do have some inhibitions but they are more so about performing oral sex, anal sex, I prefer no or little light - not things I would consider to cause me disinterest in sex. And my husband and I can discuss these inhibitions freely and he is very understanding. He tries to ease my concerns and I try to assure him that these are my hangups and nothing to do with wether I am attracted to him or not. I do have a bit of low self esteem when it comes to body image but that is feed completely by myself - my husband does not have any complaints, he seems very physically attracted to me. As far as pain during intercourse. I had some bad cramping prior to the laproscopic procedure and have had occasional minor discomfort after the procedure. But it is isolated to one side so we can "steer" around it when it is an issue. But prior to this year I never had pain or discomfort during intercourse. <P>dona, you mentioned that you were not sure how serious my depression is. I have never attempted suicide or been hospitalized. However, I have been on medication steadily and in therapy occasionally for about 8 or 9 years. I have been seeing my current therapist for about a year and have had the most success with her.<P>Hope this has answered any questions and I will get back to you all on the lab work and PCOS.