Libido is a term that is commonly used to describe sexual drive or a desire for sexual activity. The World Health Organization (WHO) states that sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality. Moreover, modern physicians recognize the importance of libido as one of the key indicators of general health and quality of life.
Image Credit: Dean Drobot / Shutterstock.com
Throughout history, the term ‘libido’ had a diverse meaning in the work of psychiatrists and psychoanalysts. These include Sigmund Freud, who placed it on one side of his instinctual dualism, as well as Carl G. Jung, who identified libido as psychic energy. Today, such wide-ranging definitions are seldom used, and when talking about libido, we are mostly concentrated on sexual drive.
Evolutionary perspective of libido
Libido was conceived as ultimately biological in its origin. Today, libido is influenced by a plethora of developmental, psychosocial, and cultural factors. It is recognized as an important force in Darwinian evolution of natural selection, with an evolutionary purpose to urge species to procreate and pass their genetic material to subsequent generations.
A generalized sex drive is a common trait of mammalian and avian reproduction; therefore, many species experience fluctuations in their sexual responsiveness during the estrous cycle. Women remain sexually receptive in a physiological sense throughout the menstrual cycle, with subtle cyclical variations. From an evolutionary perspective, any mechanism that can increase the frequency of intercourse during fertile days has a selective advantage by improving the chance of conception.
The human sex drive is very mental with deep roots to our cultural surroundings. Although the basic sexual drive is primarily biological in nature, specifics of attraction can be influenced on a cultural level, especially at an early age of life.
Hormonal and neurobiological basis of sexual drive
In men and women alike, libido is directly linked to androgen hormones, namely testosterone. As men have approximately 40 times as much testosterone as women, they are thought to have a more intense sexual drive; however, more aggressive behavior is demonstrated as well.
Such disparity in testosterone levels also exists in other mammals. As a result, most species show a bias towards a more pronounced sexual drive and aggression of males when compared to females.
The exact role of peptides in sexual drive and arousal is still not certain, partly because of their many roles and sites of action. Still, oxytocin, which is a neuropeptide that is often referred to as the “bonding hormone,” is important in both sexual and parental behavior. Besides regulating sexual drive, complex oxytocin neural pathways control penile erection and sexual motivation in general.
Dopamine plays a strong role in libido and motivation. This hormone and neurotransmitter is one of the key players in the human body. Steroid hormones set the stage for increased dopamine synthesis and its release during periods of enhanced sexual responding, resulting in an increased sexual drive.
When a person’s libido is high, they’re more likely to desire sexual intimacy and to seek it out with a partner or through masturbation. This is healthy and normal, but an overly high libido that interferes with quality of life can be a sign of a hormonal imbalance or neurological disorder. When libido dips, interest in sex does as well and may be completely absent, which can put a strain on intimate relationships. Once diagnosed and a cause is determined, both extremes can be treated.
The neural pathways involved in sexual desire are similar in males and females and include cerebral, spinal, and peripheral components. Libido directly correlates to physical responses: when sexual desire is high, blood flow to the penis resulting in an erection signifies sexual desire, as does lubrication and enlargement of the labia.1
Overly High Libido
There’s a discernible difference between a robust libido and one that’s too high. In fact, aside from contributing to a satisfying sex life, the former has health benefits, including:
- Less stress
- Better mental health
- Healthy relationships
- Boosted confidence
- Better sleep
- More exercise
It’s when sexual appetite is so strong that it feels out of control and interferes with daily life that there may be cause for concern.
Your libido is potentially overly high if:
- Your sex life begins to impact your life, relationships, health, and work.
- Sexual desire takes over your thoughts and behavior.
- You use sex to cope with mental challenges such as depression or anxiety.
- Your relationships are at risk due to your high sexual appetite.
- You feel empty or unfulfilled after having sex.
If you have persistent sexual urges that cause you to feel uncomfortable or are out of your control, you may have hypersexual disorder.
An overly high libido is nothing to be ashamed of and may have an underlying medical cause, such as:
- High levels of the mood-regulating neurochemicals dopamine, serotonin, or both
- Certain medications
- A condition that affects parts of the brain that can impact sexual behavior such as epilepsy or dementia
Once the cause of overly high libido is determined, treatment can be targeted to manage the problem. For example, if a medication is to blame, the dosage may be changed or a different drug prescribed.
Likewise, once identified and treated, an underlying brain disorder may no longer affect sexual desire. Other strategies, including psychotherapy and increased physical activity, may help as well.
Waning sexual desire is more common than overly high libido and has more potential causes, most of which, once identified, can be treated to restore sexual interest.
There are no clinical criteria for diagnosing low libido. What’s more, there is a high degree of variation in how it is experienced (since what is “normal” sexual desire for one person may seem high or low to another). However, commonly cited symptoms include:
- Loss of desire for a partner
- Disinterest in masturbation
- Few or no sexual fantasies
- Stress or concern about a lack of interest in sex
A persistently low libido may be an indication of hypoactive sexual desire disorder, which is a lack of desire as well as a lack of sexual fantasies for an extended period of time.
Hormonal shifts are a common cause of low libido. People of all sexes can experience dips in libido in response to decreases in estrogen, progesterone, and testosterone, with low testosterone being a prime suspect.1
Low testosterone, also known as low T, is especially an issue for men, since, in addition to affecting libido, testosterone stimulates sperm production and contributes to muscle mass. Medications to raise testosterone can be considered if fertility is of interest.2
Very low testosterone—defined as below 300 nanograms per deciliter of blood—is called “hypogonadism.” This condition affects 3 million to 4 million men in the United States.3 For most of them, testosterone levels begin to drop after 30.4
Low libido is not the same as erectile dysfunction, although both can lead to stress, confusion, and friction between partners. Overview of Erectile Dysfunction
Women also can experience a decrease in sexual desire as a result of low testosterone levels, but, for most, waning estrogen is more likely the issue. In a 2008 study, 26% of premenopausal women and 52% of menopausal women (estrogen dips during menopause) struggled with low sexual desire.5
People of all gender identities may be sensitive to a lengthy list of emotional and medical factors associated with low libido. A common one is high levels of stress, which can impact hormones and influence the fight-or-flight response, in which heart rate, blood pressure, and breathing increase dramatically in response to a stressful situation and hormones known to decrease sex drive—cortisol and epinephrine—are released.6 This may cause sexual desire to evaporate altogether.7
Other potential causes of low libido include:
- Pain during sexual intercourse
- High blood pressure
- Prescription drugs—especially certain antidepressants, including Prozac (fluoxetine)
- Excess alcohol consumption
- Drug use
- Low self-esteem
- Body image issues
- Relationship concerns or issues
The key to effectively treating low libido is identifying the cause. In many cases, a combination of approaches may be necessary to enhance sexual drive.
When a certain habit is likely to be involved in low libido, such as being sedentary, changing your behavior may be helpful, such as:
- Getting more exercise
- Following a healthy, nutritious diet
- Managing stress
- Quitting smoking, drug use, or excessive alcohol consumption
- Communicating more directly about your needs with your sexual partner
A therapist who specializes in sexual issues can help you (and your partner, should you choose to attend sessions together) identify emotional sources of lack of sexual drive. They can also offer practical tips and techniques for enhancing desire and enjoyment in the bedroom.
For men, an erectile dysfunctional medication such as Viagra (sildenafil) may be helpful, even though lifting libido is not a primary purpose of these drugs
If you’re taking a medication you suspect may be affecting your sex drive, do not stop taking it without first talking to your healthcare provider. They may be able to adjust your dose or prescribe a different medication.
More likely to be effective than prescription medications is hormone replacement strategies, including:
- Testosterone replacement therapy, which can be delivered via injection, topical gel, nasally, or orally8
- Intrarosa (prasterone), a suppository that is inserted into the vagina to relieve pain during sex