LOW LIBIDO
Presented by Ameera Parsan, Mikhaela Marbella, Leann La Barrie, Crystal Littlejohn, Daniel
Marcellin, Sarvesh Arjoonsingh, Sameer Hoosaney, Osayimwense Orumwense, Sameer Manwah,
Reshiva Roopnarine
OBJECTIVES
1. Define and state how common it is
2. Discuss and classify the various causes
3. Discuss how it may present and how it would be diagnosed
4. Discuss the pharmacologic and nonpharmacologic treatments
Definition and
epidemiology
Definition
Libido - Sexual desire or the mental energy or emotion related to
sex. (national cancer institute)
WHAT DOES LOW LIBIDO MEAN?
Low libido refers to the lowered interest in having sex or lack of
interest in sexual activity
It is also referred to as Hypoactive Sexual Desire Disorder
VERY COMMON PROBLEM - 1 IN EVERY 5 MEN
EVEN HIGHER IN WOMEN
LIBIDO FLUCTUATES THROUGHOUT LIFE - BIOLOGICAL,
PSYCHOLOGICAL AND SOCIAL FACTORS
Epidemiology
MEN HAVE A HIGHER DESIRE FOR SEX AND SO HIGHER INCIDENCE OF
LOW LIBIDO IN WOMEN - 43% COMPARED TO 31% IN MALES
MALES Females
❖ Males: low libido is often linked ❖ 40% of females worldwide report
with low testosterone sexual concerns
❖ 40% over age 45 have low ❖ 26% - 43% report low sexual desire
testosterone
❖ 80% over age 70 have low PRESIDE Study:
testosterone and associated ❖ 39% of females reported low desire
decrease in libido ❖ 10%-14% was associated with
distress.
❖ 15% of females ages 45-64
❖ 11% of females ages 18-44
❖ 9% of females >64years
Causes of low
libido
Physical causes
● Sexual issues
● Medical Conditions/Medications
● Lifestyle habits
● Surgery
Psychological causes
● Stress & Anxiety
● Depression
● Low Self Esteem
● Negative Body Image
● History of Physical or Sexual Abuse
Hormonal causes
● Menopause
● Breastfeeding
● Pregnancy
● Low testosterone
Relationship issues
● Lack of communication with partner
● Unresolved conflicts or fights
● Poor communication of sexual needs
● Trust issues
Presentation and
diagnosis
Diagnosis
HISTORY
TAKING
PHYSICAL
EXAM
LABORATORY
EVALUATION
History
The patient MAY qualify for the diagnosis of acquired,
generalized HSDD if
• She answers “YES” to questions 1–4, and your review
confirms “NO” to all the factors in question 5.
The patient does NOT qualify for the diagnosis of
acquired, generalized HSDD if
• She answers “NO” to any of questions 1–4.
The patient MAY qualify for the diagnosis of acquired,
generalized HSDD if
• She answers “YES” to questions 1–4 and “YES” to any of
the factors in question 5
QUestions to ask Men
● Do you look forward to sex?
● Do you enjoy sexual activity?
● Do you fantasize about sex?
● Do you have sexual dreams?
● How easily are you sexualy aroused?
● How strong is your sex drive?
Physical exam
● Perform a pelvic examination in all female patients
with sexual concerns to confirm
○ Normal pelvic anatomy
○ Assess for genital or pelvic tenderness
○ Lesions
○ Pelvic organ prolapse
○ Pelvic floor hypertonus
○ Vulvovaginal atrophy
Laboratory testing
● Laboratory testing
should be performed
only if indicated by
history and/or
examination.
Treatment-PHARMACOLOGIC
Hormonal Causes
● Hormone Replacement Therapy
● Testosterone
● Thyroid Disorder Therapy
● Lubricant
Treatment-PHARMACOLOGIC
Psychogenic Causes (Centrally Acting)
- Bupropion SR 300mg po od (off label)- NDRI
For Premenopausal Women:
- Flibanserin 100 mg po od (FDA approved 2015)
- Bremelanotide 1.75 mg sc 45 mins prior (FDA approved)
Non-pharmacological
treatments
Behavioural changes
Some changes can positively impact on a person’s libido
include:
● Exercise (consider your causes from a few slides up)
● Proper communication with your partner
● Avoid cigarette smoking (highly unattractive), and
excessive alcohol use
● Curb any addictions to pornographic imagery
CItation for that one paper
Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet
Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel).
2016 Aug 5;6(3):17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6):
PMID: 27527226; PMCID: PMC5039517.
Counseling
Depression can be a
significant cause of low
libido. To that end, therapy
or psychiatric review may be
an appropriate avenue for
increasing libido.
Additionally, where
communication continually
breaks down, couples
counseling may be necessary
to get by tension in the
relationship that may be
reducing libido.
Treatment-Non Pharmacological
1) Surgical Interventions
❖ Penile Implants
❖ Penile Venous Surgery
❖ Revascularization
2) Education
❖ Sexual health education is an informed process that forms views and beliefs about sex,sexual
identity, and include topics ranging from human sexual anatomy, reproductive health to
emotional relationships, even reproductive rights.
❖ Address concerns about sexual response cycles
❖ Educate about various arousal techniques/materials
references
1. [Link]
ales-epidemiology-risk-factors-and-evaluation?search=low%20libido&source=search_result&selectedTi
tle=2~150&usage_type=default&display_rank=2#H8
2. Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet
Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel). 2016 Aug
5;6(3):17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6): PMID: 27527226;
PMCID: PMC5039517
3. [Link]
ales-epidemiology-risk-factors-and-evaluation?search=low%20female%20sexual%20dysfunction%20di
agnosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H26
4. [Link]
5. [Link]
