Sex: Libido Support

When low libido interferes with quality of life in women it is termed hypoactive sexual desire disorder. (HSDD). The neurochemical basis of HSDD in women  has not been fully elucidated, however, it is currently realized that low sexual desire results from hypofunctional excitation and hyperfunctional inhibition of response pathways, or a combination of the two. Sexual desire is believed to be regulated by neuromodulators, including neurotransmitters and hormones of excitatory pathways such as dopamine, norepinephrine, melanacortins, and oxytocin; and inhibitory pathways, including serotonin, opioids, and endocannabinoids. Decreased neural activation of brain regions associated with sexual arousal and lack of disinhibition of brain wave regions involved in cognitive processing in women with hypoactive sexual desire disorder can impair vaginal vasocongestion and lubrication and decreased female orgasm.

Melanocortin stimulates dopamine, stimulates desire. Estrogen and progesterone stimulate desire. Serotonin acts as a negative regulator on dopamine and testosterone. Testosterone increases dopamine to increase desire. Serotonin decreases desire. Opioids decrease testosterone and desire.

Medications associated with low desire include antiepileptic drugs, cardiovascular and antihypertensive agents, hormonal medications including antiandrogens, GnRH agonists, oral contraceptive pills, pain relievers including NSAIDs and opioids, other psychotropic medications, and drugs of abuse, such as alcohol and amphetamines.

Natural Therapies for Libido

Self Esteem

Relax, take care of yourself, do activities that make you feel better and good about who you are.

Relationships

Take and make time for your relationships with people, and make time for sex.

Nutrition

Healthy nutrition in the form of the Mediterranean diet may be helpful.

Exercise 

Important for relief of stress, production of endorphins, self esteem and overall health.

Yoga

May be beneficial for increased satisfaction, desires, arousal and orgasm.

Yoga poses for better sex can be found at: http://www.prevention.com/fitness/yoga/yoga-poses-for-better-sex/slide/2

Acupuncture

May help libido, especially for women who are on antidepressants.

Meditation

Meditation focusing on total body sensations of the present moment may help with desire, arousal and lubrication and decreased sex related distress and depression.

Weight Control

Supplements

Iron

Iron deficiency may contribute to libido problems, including loss of desire, problems with arousal, lubrication and ability to have an orgasm.

 

Zinc

 

Macca

May help if your libido is low, especially of you are on an antidepressants. 

It is a phytoestrogen, so its use should be reviewed with your oncologist if you have an estrogen dependent cancer history.

High iodine content may help to support hormones.

 

Panax Ginseng (Asian Ginseng)

May help to increase libido.

 

Torbulus Terrestris

May help with libido, arousal, lubrication.

Should be used at doses of 7.5 mg.

 

DHEA

DHEA is required for the production of testosterone. 

Supplementation may help with libido in women.

 

Ashwagandha Root

Amy help to stimulate libido and enhance satisfaction.

 

Muira Puama

May help with libido and orgasm

 

Dark Chocolate

May help to increase dopamine levels in the brain

Dopamine can help to elevate mood, relaxation and improve the bodies response to stimulation

 

Avena Sativa (oat straw)

Can increase sexual desire through improved circulation, 

May help with menstrual cramps and bloating

Excellent source of B vitamins

May help with blood sugar, by decreases spikes

May be sued as a remedy for stress, anxiety, depression and tensions.

May help to support excellent bone health

 

Catuba

Active component is yohimbine that may help to stimulate libido and desire

Increases dopamine levels in the brain

 

Damiana

May help to enhance libido through relief of stress and enhanced circulation

 

Suma Root (Brazilian ginseng)

May help with hormone balance and libido.

May help to elevate estrogen levels

 

Tongat Ali

May help with libido, stress and brain function

 

Pumpkin Seeds

Contain zinc, may help to black the enzyme that converts testosterone to estrogen

 

Watermelon

May help to relax vasculature and increase blood flow

 

L-arginine

May help to improve clitoral blood flow and improve sexual response

 

Rhodiola

Helps to prevent breakdown of dopamine and serotonin. 

Increase of dopamine may lead to enhanced libido and mood

 

Red Wine

Limit to one glass a day

High level of polyphenols, an antioxidant, can increase blood flow

 

Gingko Bilboa

Can help with libido

Can be beneficial for anti depressant induced libido difficulties

Supplements that increase dopamine
Tyrosine, green tea, caffeine, pregnenolone, magnesium, St. John's Wort, ginkgo, curcumin, butyrate, folate, Sam-E, fish oil, ginseng, resveratrol, clary sage, rosemary, kava, fresh cut grass, essential oils, flowering quince

Starting Points

Healthy lifestyle and nutrition, limit alcohol

Pharmacologic Support for Libido

Flibanserin

Decreases serotonin levels and increases dopamine and norepinephrine levels, which are

neurotransmitters that affect sexual desire. Flibanserin is believed to work on the brain function by enhancing excitatory elements and lessening the inhibitory responses to sexual cues. Data in pre menopausal women has demonstrated efficacy. Use in post-menopausal women has demonstrated efficacy, however, studies have been discontinued due to adverse events, as up to approximately 10% of women may demonstrate adverse events in the post-menopausal group, including dizziness, somnolence, nauseousness.

Bupropion sustained released combined with trazodone may act to increase dopamine and norepinephrine and modulate serotonin. A combination of bupropion plus trazodone was shown to be superior to bupropion alone. Additional studies are planned.  

Currently, investigatory agents include bremelanotide, bupropion plus trazodone, testosterone plus sildenafil, testosterone plus buspirone, tribulus terrestris, tibolone. Bremelanotid is a melanocortin receptor agonist. It is formulated as a subcutaneous injection and is in late-stage development.

Flibanserin is the only United States FDA approved medication for libido in women. It is FDA approved for pre-menopausal women. It is not FDA approved for post-menopausal women. 100 milligrams dosed at bedtime is a non-hormonal centrally acting daily oral multi-function agonist and antagonist.Trials in both pre-menopausal women and post-menopausal women have demonstrated efficacy. Approximately 50% of women with libido issues defined as a hypoactive sexual desire disorder may respond to this medication, however, it may take up to eight weeks for efficacy to emerge. The most common reported side effects are dizziness, somnolence, nauseousness, fatigue. Concomitant alcohol use is contraindicated because the medication has been found to increase sedation and may lead to hypotension and passing out.

Wellbutrin may also be efficacious as it enhances dopamine and norepinephrine and at dosages of 300 to 400 milligrams which will improve sexual desire. Side effects may include tremor, agitation, dry mouth, constipation, dizziness, nauseousness and vomiting.  Sustained release is recommended at 300 milligrams per day.

Buspirone, which reduces serotonin inhibition, is another off label treatment that has been used for sexual dysfunction. When used at dosages of 30 to 60 milligrams per day, this may be helpful for women who are already using SSRI type of drugs. In one study, Buspirone was able to aid with sexual functioning. Common side effects include anxiety, dizziness, nervousness, nauseousness, headache.

Testosterone therapy was initially approved in Europe for the treatment of libido issues and women and is approved in Australia for women with testosterone deficiency and associated symptoms such as low sexual desire. Multiple studies have demonstrated that in women with hypoactive sexual desire disorder, that a 300 microgram testosterone patch improves the primary efficacy measures of sexual desire and frequency of satisfying sexual events versus placebo. Side effects included application site reactions, acne, breast pain, headache and hirsutism.

Laboratory values such as liver function and hematologic tests, lipid profiles, clotting measures and carbohydrate metabolism remain essentially unchanged from baseline and did not differ among treatment groups.  In post-menopausal women, when the serum free testosterone levels are maintained within the normal range for pre-menopausal women, short term safety data are reassuring. The long term data in the United States is lacking. It is important to note that free testosterone is a testosterone which is active. Most testosterone is bound by sex hormone binding globulin, a protein in the blood which binds hormones. The sex hormone binding globulin can be increased by oral estrogens, hormonal contraception, thyroid hormone replacement and lowered by central adiposity and oral androgen therapy. Most radioimmunoassays lack a precision to accurately measure total testosterone levels in women, such that when possible, testosterone should be measured by liquid chromatography or mass spectrometry. Generally, up to six months are recommended to evaluate for treatment and recommended to be discontinued if no changes are noted.

Tibolone is an orally active steroid that is weakly androgenic and lowers sex hormone binding globulin levels, resulting in an increase in androgynous free testosterone.