Ladies - let us talk about intimacy and libido

​By Dr. C Groenewald

Let’s talk about intimacy…

Do you have a healthy sex life? What is a ‘healthy’ sex life? How many times a week/month is ‘normal’? What affects sex drive and libido? 

Sex, a topic sure to raise many opinions, questions, fears and uncertainties: questions you may or may not not feel comfortable to raise with your primary health care physician, your spouse or even your friends.

As South Africans, we have come a long way since the reserved ways of our parents/grandparents, but I still find that sex is a difficult subject for many men and women. Join us, for the next few weeks, where I will discuss weekly topic, based on the most frequently asked questions in my consulting rooms. We will be focussing on libido and sex drive; hormones affecting the latter; common causes and contributing factors to anorgasmia; the working mom and all the stress running a house hold entails; anxiety and depression; and lastly, pregnancy and hormones postpartum. 

This week, let us focus on libido and sex drive, as well as the hormones that fuel this drive. 

1.    Hormones, and the role they play in libido. 
A controversial topic, sex drive seems to be the most common complaint in woman suffering from sexual arousal disorder, long believed to be fuelled by our sex hormones, so before we go on, let us take a closer look at the hormones that play a role in female health:

• Oestrogen: Produced by the ovaries and to a smaller degree, by the adrenal glands (endocrine glands situated on top of our kidneys) and adipose tissue (fat cells). Responsible for the pre-ovulatory thickening of the uterine wall (endometrium), in preparation for implantation of a fertilized egg, as well as growth and development of our secondary female sexual characteristics, including breasts development, armpit hair, regulation of the menstrual cycle and reproductive system. Oestrogen also plays a role in vaginal wall thickness and lubrication, prevention of bone loss and cholesterol levels. 
• Progesterone: Produced by the corpus luteum (remnants of the ovarian follicle, which produces and releases the egg), levels rise during the second part of the menstrual cycle, and is responsible for preparing the body for pregnancy, as well as maintaining the early stages of pregnancy. 
• Luteinising Hormone (LH): Produced by the anterior pituitary gland, the LH is required to stimulate the ovarian follicles, to secrete oestradiol. A surge in LH, causes the ovarian follicle to tear and release the ripe egg. 
• Follicle stimulating hormone (FSH): Also released by the anterior pituitary gland, the FSH is responsible for the growth of the ovarian follicle, as well as secretion of oestrogen. 
• Testosterone and androstenedione, the male sex hormones, are also secreted in small amounts, in women, by our ovaries. Although primarily believed to be male hormones, these hormones not only play an important role in female hormonal regulation, but also the functioning of many organs.

So what does this have to do with your sex drive? Everything and nothing. 

Female Sexual Arousal Disorder (FSAD) is defined as a lack of response to sexual stimulation, either from a subjective (mental and emotional) or physical (swelling of labia and clitoris, vaginal discharge, swelling of breasts etc) arousal point of view. 
Libido is NOT equal to physical arousal. Libido is a subjective desire, or passion for sex. Woman with little to no libido, can still be aroused physically by genital stimulation and have enjoyable sex and orgasms. 
Genital Arousal Disorder (GAD), differs in that women are unable to become aroused physically, in spite of mental and or emotional arousal. They are unable to have an orgasm, and sex is often painful. 
Woman often blame their ‘hormones’ for a lack of sex drive and libido, when in fact, there is little to no research to substantiate this. Dr. Michel Jermec, has done extensive research in this field, interestingly identifying Luteinising Hormone as a key component in libido in women. His work suggests, that high levels of LH make woman ‘horny’, while low levels make woman more apathetic to sex. This could explain, why some women are much more easily aroused during certain phases of their cycle, than others, as LH hormone surges before ovulation.   

Physical arousal disorder, is much more likely to be hormone driven, considering the role of oestrogen in maintaining vaginal wall thickness, increasing blood flow to the genitals and lubrication. While the role of testosterone is still under discussion, it seems to play a role in the arousal of the clitoris and labia, and ultimately orgasm. That being said, there are other causes for genital arousal disorder and includes, but not limited to:
•    Anxiety, Depression and Stress
•    Effects of certain medications
•    History of sexual abuse
•    Strict religious upbringing 
•    Menopause
•    Cystitis and Vaginitis
•    Relationship with partner
•    Self Esteem and Body Image
FSAD, mental, emotional and physical, commonly, has no clear cut cause, that one can pinpoint and treat. It is a multifaceted disease, and should be treated as such. There are many contributing factors, which overlap, and can contribute to the overall lack of libido and sexual drive. Treatment should be aimed at addressing these factors, and not just symptomatic treatment. 

To identify probable causes and contributing factors of FSAD, the following assessments may be useful: 

• Overall health, including a physical examination as well as blood tests to access hormonal levels, liver function, cortisol levels, full blood count etc.; 
• Menstrual cycle, menopause, post birth and breastfeeding; 
• The Holmes-Rahe Life Stress Inventory to assess levels of stress and possible depression; 
• Constitutional prescribing; 
• Diet and lifestyle assessment; 
• Medical history and current medications; to name a view. 

From a Homeopathic point of view, the most important factor, is homeopathic constitutional prescribing, which entails finding the overall mental, emotional and physical picture, that best describes the patient. 

To give an example of such constitutional prescribing, consider the following remedy and the overall mental, emotional and physical pictures, as related to FSAD:
Sepia 
    Apathetic
    Indifference to those best loved
    Very sad
    Weeps
    Aversion to company, yet dreads to be alone
    Aversion to husband
    Irritability from exertion
    Loves thunderstorms
    Anxiety
    Anger from contradiction
    Sensitive to music and noise
    Constipation during pregnancy
    Tendency to miscarriage 5th – 7th month
    Urine thick and foul smelling, urging to urinate, burning during urination
    Bearing down sensation, as if everything would escape through vulva
    Prolapse of uterus
    Aversion to sex, or complaints after
    Dryness of vagina and vulva
    Menses either late and scanty or early and profuse 

“Sex is emotion in action” Mae West. ​​

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