Low Sex Desire (Decreased Libido)

Low Sex Desire (Decreased Libido)

Low Sex Desire (Libido) The low sex desire is called when the desire for sex is lower than average. This decreased libido leads to un-satisfaction in opposite partner. Even the person who suffers with less i.e. diminished sexual desire & low frequency of sex suffers with various psychological depression disorders. Even the relation between the couples deteriorates. Causes of Low libido i.e. diminished sex desire are: - (1) Hormones Disorder: (a) Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies) Hypogonadisms, Hypothyroidisms, Testosterone deficiency, hyperprolactinemias, Hypogonadotropics states: Hypothalamic - pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, drug-induced hyperprolactinemia, untreated endocrinopathies, Diabetics Glucorticoid excess, Hypopituitarisms, Cushings disease, Addisons disease. Isolated gonadotropin deficiency (non acquired): Pituitary, Hypothalamic Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Following inflammation, Infiltrative or destructive processes (autoimmune, hemosiderosis), Fertile eunuch syndrome, Idiopathic hypopituitarism, (b) hypogonadism: testicular failure, development defect, drugs, trauma, congenital defect, congenital adrenal hyperplasia, Chromosomal defect, testosterone hormone biosynthetic defect, Mumps orchitis leading to testicular atrophy, Primary testicular defect-disorders of testicular differentiation or inborn errors of testosterone synthesis, Klinefelter syndrome, Other X polysomies (i.e. XXXXY, XXXY) Rainbow syndrome (d) Hypothyroidisms (e) Untreated endocrinopathies & Diabetics (f) Glucorticoids excess, Cushings disease, Addisons disease 2) Excess asthenia i.e. chronic asthenia is a also a significant cause of low sex desire. 3) Sickle cell disease, chronic cardiac disease, chronic renal disorder, chronic pulmonary dysfunction, chronic hepatic disease, Infections mono-nucleosis, hepatitis, chronic balanitis, chronic prostatitis, and chronic urethritis. 4) Addiction as chronic alcoholism, chronic smoker, heroin or cannabis use. 5) Drugs: Sedative: Narcotics, tranquillizers, amphetamine, cocaine, many antidepressant, and anti-psychotics, anti -hypertensives, many other drugs. 6) Psychiatric disorder as depression, neurosis, & many other psychiatric disorders. 6) Disorders of sex centre: In the brain there is a particular center in the hippocampus part of fore brain, which regulates the desire of sex. Sex center has some well-defined portion, which control different component of normal sexuality. These are as follows as one part of sex center controls sexual desire other parts controls erection, time taken in orgasm enjoy of sexual act including enjoyment of orgasm. So any disorder of sex center due to various causes can lead to less desire. This occurs due to desire controlling portions of sex center does not work properly so that inspite of \not having any physical or mental disorders the patient desire for sex is low. Beside low sex desire patient may be sexually otherwise for or patient may be suffering with impotence, premature ejaculation. The causes of sex centre dysfunction can be divided into two groups: (1) immediate cause, and (2) remote causes. Such a classification is helpful in the treatment of decreased libido. If the loss of desire is due to immediate causes, a removal of these factors results in adequate sexual desire. If it is due to remote causes, then detailed sex therapy may be necessary for a more lasting cure. It can cause less sexual desire alone or patient may have associated erectile disorder, premature ejaculation, or lack of enjoyment of sex. Diagnostic Tests: For diagnosis of cause of low libido (sex desire) detailed history is taken. After which thorough physical examination is done for relevant causes. For diagnosis of cause of low libido following tests are required. These tests include Complete male hormone profile (do not bold). Thyroids test Serum prolactin SHBG DHT Level Investigation for systemic diseases Other tests which may be required depending on likelihood of the any of above causes. Detailed Sex Counseling: detailed sex counseling session, in which our male & female sex counselors meet with respective patient, trying to found out if there is any likelihood of sex centre disorder or other disorder as the cause of low sex desire. In biochemistry Tests as liver function or kidney function tests are done. These tests confirm the diagnosis of low sex desire confirmed. Treatment: Once the diagnosis of cause of low sex desire is made, treatment includes medicines & sex therapy sessions to cure the basic cause. The various treatments offered are: (a) Hormone therapy: Like in case of hormone deficiency or disorder of other glands the correction of hormone dysfunction is done. Hormone therapy is given in the form of oral tablets. Skin cream, gels or scrotal patches. These medicines are given in well tested prescribed doses as described in authentic textbooks. Some hormone precursors have also been used for increasing sex drive in many patients in whom no hormone disorder is found, 1) Male hormone testosterone replacement: The replacement of male hormone testosterone is one of the common treatments for decreased sex desire. The various preparation of testosterone is : a) Oral preparation, which is available in capsule form. It needs to be given one to three capsules daily. These have no side effects. b)Transdermal gel preparation are available which are applied on the any part of body once daily. This is absolutely safe with no side effects, economical & easy to use. c)Tran dermal Testosterone given as scrotal patch. It is very effective & has no side effects. i) Sublingual Testosterone cyclodextrin is now available which is very fast acting & very effective in curing low libido. j) Local application of D.H.T. gel is new preparation for male hormone replacement. It is very effective for increasing penile size, & in cases of cure of breast development in boys. k) Injection Testosterone esters: These include Testosterone enanthate & testosterone cypionate given intramuscular injections every 10 to 14 days. l) Long acting testosterone as testosterone bucilate given once in 4 months. m) Testosterones implants are now available which once injected remain effective for up to six months. n) New human androgen receptor modulators they increase the effect of male hormone over androgens. 2) Growths Hormones Therapy; is given when somatotropin deficiency is found. 3) IGF-1 therapy; is given when somatomedin c is subnormal. 4) DHT Therapy is given in many patients. It is very effective in most patients. This treatment is also effective in many patients when all above treatment has failed. The other good thing about this is that it is available as skin gel so taking this is simple & has no side effects. This treatment is very effective in those in whom male hormone is unable to work due to inability to generate the final end product for testosterone efficacy due to 5 alpha reductase defects. In such patient replacement of final target hormone is replaced leading to good sexual feelings & desire. In such situation even male hormone can be used in higher than usual doses leading to achievement normal sex desire. 5) Gonadotropin therapy is also very effective in normalizing low desire.Gonadotropin releasing hormone therapy is effective in many cases of low libido. (b) Treat other systemic disease when they are detected. (c) Treatment of chronic asthenia is done by replacement of antiasthenic drug with good results. (d) Treatment of Urogenital infection balanitis, prostatitis, and epididymitis gives immediate relief & very dramatic increase in sex desire. (e) Stop Offending drugs which patients is consuming is identified after detailed history & drug challenge is discontinued with permanent cure of the low libido disorder (f)Treatment of psychiatric disorder are diagnosed & treated. (g)Treatment of sex center disorder: In cases of low libido due to sex center disorder there are many drugs, which improve the libido like hormone precursors, sex center stimulator drugs. These drugs act on sex center & correct the biochemical defect in sex center, leading return of the libido. (h)Sex therapy is offered in which we teach the patient about the various techniques in such a way that it increase the enjoyment of body touch sex centre starts functioning normally & patient develops normal sex desire in addition males get better hardness of penis & sustained penile erection & takes longer time in discharge. All this improves the desire of sex as well as enjoyment of sex. Response of treatment: Person gets completely cured in two months time when treatment is started after the diagnosis of cause. After appropriate medicine therapy, sex education & sex therapy patient recover in two months time. The sexual desire of patient recovers. After return of libido to normal his family relationship also normalizes. Side Effects: The above mentioned drug treatment It has no side effects if given in proper disease and in-patients when it is really indicated. This it is absolutely safe when it is given by qualified doctor in proper doses.