Sexual Health

In my gynecology and natural medicine practice, I treat literally thousands of women of all ages who are suffering from hormone imbalances. Typically, patients coming to see me enter my office citing such common complaints as hot flashes, irregular bleeding, night sweats, weight gain, fibrocystic breasts, headaches and fatigue. Unfortunately, they are often less comfortable discussing their sex drive or sexual function. When asked, I am often told that they "don't feel as sexy as they used to" and "sex isn't as enjoyable as it was decades ago" but "I guess that's what happens when you aren't twenty any more!"

Clinically, these women are suffering from hypoactive sexual desire disorder, more commonly referred to in lay language as "low libido". As a physician, I am vehement that women should not assume that problems with arousal and desire are a natural consequence of aging. A woman's libido and sexual response are complex and can be dependent on multiple factors including emotional intimacy, non- biological stimuli such as smells, sounds and touch, and biological factors including hormone production and balance. For our purposes here, I will focus on the latter variable impacting sexual desire and response: hormone production and balance.

In my practice, I found a high correlation between estrogen dominance and less frequent sexual activity as well as reported reduced sexual pleasure. As I have discussed in both my book From Hormone Hell To Hormone Well and in previous newsletters, the human body produces three sex hormones: estrogen, progesterone and testosterone. Typically, women in their twenties evidence a physiologic balance of these three hormones, which later becomes their baseline for normal, healthy hormone production. As women age, however, their hormone levels begin to shift and this can occur as early as then end of the second or the beginning of the third decade of life. Progesterone is the first hormone to drop off in levels of production, actually dropping 120 times faster than estrogen levels. When progesterone levels begin to fall an imbalance occurs and the female body is said to be estrogen dominant.

Estrogen dominance can cause many physical, mental and emotional symptoms. Among these are: water retention, fibrocystic breasts, depression, dry and wrinkly skin, irregular and sometimes heavy bleeding, a higher predisposition for breast and/or uterine cancers and- yes-a much lower libido. Without the progesterone required to balance estrogen production, the female body's sexual anatomy is handicapped. This is evidenced by vaginal atrophy (loss of muscle tension), decreased vaginal mucus production (vaginal dryness) and decreased clitoral blood flow leading to reduced responsiveness. It should be obvious to even the lay person that the traditional medical community's response of giving a woman with low sex drive more estrogen (usually in the form of synthetic estrogen replacement therapy) will not have the desired effect of increasing sex drive. Of even greater concern, is that adding more estrogen will most likely amplify the body's negative symptoms and harmful side effects known to be associated with estrogen dominance.

The fact that progesterone deficiency and estrogen dominance is most often the underlying physiologic cause of low libido frequently surprises my patients. They have somehow come to think of testosterone as the sex drive hormone. Testosterone does influence libido but it acts differently in men and women. Let me explain.

Remember when I said that progesterone was the first hormone in women to slough off in production, well testosterone is the last. Most women will not experience a drop in their testosterone levels until they are post-menopausal, usually late forties to mid- fifties. At that time, an individualized prescription of human-identical hormones will almost always include testosterone replacement. It should be noted that women who have undergone a complete or partial hysterectomy resulting in their entering surgical menopause will more immediately require a comprehensive complement of all three sex hormones, e.g. estrogen, progesterone and testosterone.

In men, progesterone is the biochemical precursor of testosterone. When progesterone levels begin to drop in men, testosterone levels also fall. This occurs when a man enters male menopause- or andropause- usually sometimes in the mid to late forties. While this article is dedicated to the discussion of women and sex drive, it should be noted that hormone imbalance can also result in decreased libido and sexual performance for men. Again, human-identical hormone replacement can be an effective treatment of choice.

In many cases, human-identical progesterone therapy can sufficiently treat hypo-active sexual desire and response. In addition to the literal physical benefits related to sexual function including increased vaginal lubrication and improved clitoral response, human- identical progesterone replacement therapy may also positively some of the more subjective variables impacting sexual desire. For instance, frequently women report to me that their sex drive is also positively impacted when the human-identical progesterone I prescribe helps them to stop retaining water, more easily lose the extra weight hugging their thighs and abdomen, and stabilize their mood and energy swings.

In treating thousands of women with low libido, I have found that human-identical hormone replacement therapy almost always is a precursor for positive changes in a woman's feelings of sexuality as well as self-perception and self-confidence. With life expectancy for women extending well into the eighties, it should be good to know that, with human- identical hormone replacement, it can be possible for sexual desire and pleasure to be just as potent and enjoyable for the young-at-heart as it is for the young-in-years!

Recommended supplements:

Dr. Randolph's Natural Balance Cream for Women and Men