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  Quality of Life, Depression and Libido

Libido is a complex inter-related issue being a mixture of "Heart, Head and Hormones". As doctors we have little influence on the couple's relationship, intimacy or subconscious anxieties but we do have the ability to modify sexuality by the use of hormones. Although the interpretation is entirely sexual, its Latin origin also suggests "desire" and "wished for" in general terms. Similarly adequate libido can be seen as a good barometer of physical, mental and marital health with a decline in wellbeing and mood producing problems of libido and vice versa.

In the menopausal woman, loss of libido is related to oestrogen deficiency with vaginal atrophy, flushes, sweats, insomnia, loss of energy and causing vaginal pain and dyspareunia. Many of these symptoms of atrophy can be treated with oestrogens with the removal of the hot flushes and vaginal dryness having a domino effect upon energy and sexual pleasure.

Psychosexual counselling is, of course, valuable for relationship problems but residual problems not solved by the obvious treatment of vaginal atrophy can be helped by another major female hormone, testosterone. This has a place in these patients which will not only improve libido but will have a knock-on effect upon the woman's self-confidence, desirability, self-image and even communications skills.

The Female Androgen Deficiency Syndrome (FADS) is manifested by loss of energy, loss of libido, depression, loss of self-confidence and often headaches. It occurs commonly after hysterectomy and bilateral oophorectomy but it is not uncommon in post or peri-menopausal women with intact ovaries although the exact incidence is unknown. Certainly replacement with oestrogens alone increases SHBG and decreases the concentration of available testosterone.

Testosterone is most effective but although available as implants, injection, tablets, gel and patches it is only currently licensed in the UK by implantation. This is a very effective route but other more convenient routes need to be studied and licensed. Tibolone is an oestrogenic progestogen with androgenic properties which is useful in women particularly after the menopause.

Please click here to view article A comparison of 19th Century and current attitudes to female sexuality


Related Articles:

. Studd, JWW., Collins, WP., Chakravati, S., Newton, JR., Oram, D., Parsons, A. (1977) Oestradiol and testosterone implants in the treatment of psychosexual problems in the postmenopausal woman. Brit. J. Obstet. Gynae. 84, 314-316

. Sands, R., Sutdd, J. (1995) Exogenous androgens in postmenopausal women. Am. J. Med. 98, Supp 1a

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