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Questions and Answers about
Libido

"I don't get horny any more"
Doctors think that "OK is good enough," but patients don't

Q:  I'm a 36-year-old married man with a problem.  I'm healthy and I don't smoke or use drugs, and I rarely drink.  I'm happy, except for one thing.  I don't get horny any more.  I still have sex, but that's primarily because I want to please my wife.  I never have that burning desire for sex that I once had.  When I do have sex, it feels OK, but it's not as intensely pleasurable as it once was.  I saw my doctor about this, and since I can still get an erection, have sex and an orgasm, he didn't see what the problem is.  He just doesn't get it.  Is there hope for me, or should I just give up?  Steve

A:  Yes, there is hope for you.  First, let me tell you a little secret about doctors and their modus operandi when confronted with a problem for which they're clueless.  Doctors don't like to concede a lack of knowledge, so rather than admit that they cannot solve a problem, they'll trivialize it.  If the problem is sufficiently minimized, there's no problem to be solved (at least in their minds), so this mitigates their anxiety about not knowing the answer to the problem.  This psychological defense mechanism doesn't just afflict quacks who work in seedy offices; I know physicians who are members of the faculty at the most prestigious medical schools in the world, and they do it, too.  When they don't have an answer, they pull this dismissive stunt.  Furthermore, in subsequent private conversations with their colleagues, they'll often denigrate both the problem and the patient.

That's enough psychological dissection of doctors and how they respond to a potential threat to their egos.  Now, on to your problem.  I'm amazed that so many doctors simplistically assume that erection and orgasm are evidence that everything is A-OK in that department.  There are erections, and there are rock-hard, fully inflated erections.  In terms of preorgasmic and orgasmic sexual pleasure, there is pleasure, and there is pleasurable that is indescribably intense.  The realization that pleasure varies so much was one of the primary factors that spurred my interest in researching sex, because this topic has been given short shrift by the medical profession.  Ask a typical gynecologist or urologist why some women can give men more sexual pleasure during intercourse.  The traditional medical view is that this is explained by one variable, vaginal tightness.  If you want to be entertained, you might try this some time:  press the doc for more reasons why this variation exists.  Most likely, he will hem and haw, say "um," scratch his head, and look befuddled.  Ask him to enumerate a half-dozen reasons, and he'd be utterly stumped.  This is one of the central flaws of medicine.  Doctors assume that the absence of disease is health, and pleasure is pleasure.  Obviously, things aren't so black and white.  People don't just want to be free from disease, they want to have radiant health and feel great.  They don't want just so-so sexual pleasure, they want intense sexual pleasure.  However, physicians possess a different mindset, and they think that "OK is good enough."  This conviction pervades most specialties within medicine (with the notable exception of plastic surgery, where there is a relentless pursuit of "even better").

Hence, I am not surprised by the apathy evinced by your physician when you discussed your problem with him.  The good news for you is that there are many causes of diminished libido and sexual pleasure that are easily treatable.  I can't discuss every possible cause in this space, but here are a few that I will briefly mention.  Your testosterone level may be low, or your estrogen level may be too high, thus depressing your testosterone-to-estrogen ratio.  You may have too much SHBG (sex hormone binding globulin), a blood protein that gloms onto testosterone to transport it, but in the process makes the testosterone inactive.  You may have another hormonal imbalance, even endocrine problems that seemingly have nothing to do with sex.  You may be deficient in some nutrient, or you may be suffering from an exposure to some chemical in the environment.  Surprisingly, common chemicals that people are exposed to every day have the potential to rob them of sexual gratification.  As strange as this may sound, the problem may not be you, but your wife.  Apart from the obvious (e.g., is your wife still attractive and loving?), there are several physiological reasons why your libido hinges not just on you, but also what goes on in your wife's body.  I explain all these things, and many more, in my book.

Some causes of diminished libido

Q:  I am a 26-year-old woman and my partner is 32.  We have been together for five months and last month decided to get married.  Yet I have problems with him in terms of sex.  At the beginning of our relationship, he was horny.  A month later he began to lose interest in sex.  We started to do it less often (like once in ten days). When I talked to him about my worries, he told me that he had this problem in his past relationships.  He also revealed that his fiancée left him because they were having sex only once per month.  He has been seeing a therapist for the past three months.  This doctor gave him an antidepressant as a part of therapy.  Since then he cannot come at all.  He does it only for my pleasure, I guess.  We have sex once every seven to ten days.  This depresses me a lot.  What do you recommend?  Is there any hope?  Should I be patient?  How should I behave?  Thank you.

A:  This matter is obviously troubling to you, and for good reason.  At your age, you should be having the time of your life in the bedroom.  If things are bad now, and they are, they will only get worse in the future unless he is treated.  Being patient and waiting will do no good.  Based on what you said, there is no indication that this problem will spontaneously resolve.

Fortunately, loss of libido is almost always correctable.  I don't know if doctors in your country at adept at treating it, but if they aren't, either you, your fiancé, or his doctor should read my book (The Science of Sex) for information on how to proceed.  Given that his doctor prescribed an antidepressant which worsened his problem, I doubt that his physician is knowledgeable about sex — or if he is, your fiancé is not telling him about his sexual difficulty.  Some antidepressants interfere with sexuality, but one increases libido and orgasmic potential (I discuss this in my book).

However, changing his antidepressant is not the sole solution to this problem since his difficulty with libido preceded antidepressant use.  As a doctor, I am concerned that he might have some medical problem that is lowering his testosterone level (testosterone is the primary hormone governing libido in both sexes).  Testosterone production can be reduced by testicular trauma, radiation, chemotherapy, or tumors.  Orchitis (testicular inflammation) can also lower testosterone levels; this may occur in men who develop mumps after puberty.  Pituitary tumors and AIDS can decrease testosterone levels, too.  Men may have low testosterone as a result of some genetic diseases, such as Kallmann’s syndrome, Klinefelter’s syndrome, Prader-Willi syndrome, or myotonic dystrophy, the most common form of muscular dystrophy in adults.  Testosterone levels can fall because of stress, long-term exposure to cigarette smoke, excessive alcohol consumption, obesity, sleep deprivation, sleep apnea, overtraining, and a diet that is excessively deficient in protein, fat, calories, potassium, or zinc.  Phytoestrogens, xenoestrogens, and exogenous estrogens can also reduce testosterone output.  Exposure to cadmium can reduce libido, too.  Here is an excerpt from my book:

Cadmium is a toxic metal that can partially block the action of zinc in the body. Thus, even if your intake and absorption of zinc are adequate, you may be functionally deficient in zinc if you have ingested or inhaled cadmium, which functions as an anti-nutrient. Everyone has been exposed to cadmium in food (particularly shellfish[1]), water, and air, but cadmium levels vary considerably depending on your occupation, location, and other factors. Cadmium is present in rechargeable nickel-cadmium batteries, pigments, polyvinylchloride (PVC) stabilizers, and some metal coatings, paints, inks, ceramics, and glass. Cadmium can also be found in other metals as an impurity, and in some fertilizers, nematocides[2], pesticides, and fungicides. Burning coal, oil, gas, or wood can release cadmium, as can soldering, welding, smelting, and waste incineration. The latter need not be on an industrial scale; even a neighbor burning trash might send cadmium wafting into your yard. Incidentally, cadmium is most easily absorbed through the lungs.

Here are some more facts you should know about cadmium:

	Cadmium is widely distributed throughout the body, but it accumulates primarily in the kidneys and liver of humans and animals. It is inadvisable to eat liver or kidneys since there is no practical way for you to know the cadmium content of those foods.
	Cadmium is present in cigarette smoke. The cadmium level in people who smoke is substantially higher than in nonsmokers.
	Galvanized water pipes can significantly increase cadmium levels in drinking water.
	Oysters are reputed to be an aphrodisiac (perhaps because of their zinc content), but they are often contaminated with cadmium and hence may hurt your sex life.
	In experimental animals, low dietary levels of calcium, iron, or zinc increase cadmium absorption.
	Cadmium can be released from nickel-cadmium batteries if they are put in backwards, crushed or otherwise damaged, burned or subjected to a short circuit, or even just overheated. According to a representative of the Eveready Battery Company, nickel-cadmium batteries can release cadmium at temperatures as low as 113° F[3]. Since batteries heat up when they are used or recharged, the ambient temperature need not exceed 113° F for cadmium emission to occur.

And here are a few tips for doctors:

	Since cadmium has a long persistence in the body (its elimination half-life is 20 to 30 years), you cannot count on the passage of time to reduce cadmium levels. Since cadmium is so easy to acquire and so difficult to get rid of, older people generally have higher cadmium levels.
	Chemet®, also known as succimer or dimercaptosuccinic acid (DMSA), is a chelator that can remove cadmium from the body.
	Blood levels show recent exposure to cadmium, while urine levels show both recent and long-term exposure.
	An early sign of cadmium-induced nephropathy is increased proteinuria, especially beta-2-microglobulin. [1] To minimize cadmium ingestion from eating shrimp, choose farm-raised shrimp.  Some Midwest farmers, fed up with the vagaries of raising traditional crops and animals, now grow shrimp in ponds in their fields. [2] Nematocides are substances that kill nematodes (a.k.a., roundworms), such as hookworms or pinworms. [3] As a longtime electronics enthusiast, I was skeptical that cadmium emission could occur at such a comparatively low temperature.  However, the Eveready representative insisted that was true, adding, “That’s one of the reasons we stopped making nickel-cadmium batteries.”

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