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Libido: Easy Come, Easy Go.

“Where did my libido go? I used to be horny, but now, not so much.” This is a very common concern in my office, and is sometimes associated with pregnancy, early parenting, or menopause… and sometimes with any other time of your life.

Rodent libido is directly tied to circulating levels of testosterone, both in males and females. But humans are far more complex; testosterone levels in women do not clearly correlate with sex drive. Our brains can directly get us all revved up, or all revved down.

Many of my patients are seeking an easy answer, a magic supplement that will instantly bring the spark back to a relationship long gone stale. I will offer you a list of those options shortly, but here’s the real answer: 90% of sex occurs between the ears. What goes on between the sheets is a reflection of what’s going on outside of the sheets.

Our lives are busy: we stay at work late, we bring work home, work emails follow us via our cell phones and laptops, the kids need attention, divide and conquer, make plans with friends, did anyone remember to buy toilet paper… When is there time to look into your lover’s eyes, talk, feel the love that brought you together, and physically share the intimacy that you feel permeating your shared lives?

The real answer is to make intimacy a priority – not just physical intimacy, but maintaining and growing the love that brought you together into the relationship in the first place. And that’s tough to do in the long term. So here are some suggestions:

– Date night. At least once or twice per week, it’s just the two of you. No cell phones, friends, relatives, TV, or computers allowed.

-Early to bed. Long before you’re exhausted and don’t have the strength for your next breath. Close the lights, lock out the kids, and plan on spending time together. Eat lightly beforehand – you want to be comfortable.

-Set the mood. Wear something sexy, shower together, a small dab of perfume, a glass of red wine (limit the alcohol – too much will kill the night), scented candles, nice background music. Barry White on the stereo?

– Certain scents are known to put people in the mood. For women: cinnamon, vanilla and musk. For men, the scent of pumpkin pie combined with lavender.

-Anticipate sex. Send a text that you can’t wait to be together. Say what you plan to do. Anticipation is self-fulfilling.

-Break out of the ordinary. Get out of your ruts. Change the time, location, position, and initiator. Break out the videos, toys, sexual lubricants, bubble baths, candles, feathers… whatever floats your boat. Explore your fantasies and make them happen.

-Romance. Engage, flirt, tease, give each other a massage, take a bath together.

– For the long-term: lose weight, get regular aerobic exercise, stop smoking, spend free time together, share each other’s interests, do yoga or other breathing exercises, use reliable contraception.

-Avoid the mood killers. No talk of conflicts during romance time – but do resolve your conflicts through regular solid communication. Remove visual distractions such as photos of your parents, work projects, piles of laundry, etc. Depression, exhaustion, and stress are guaranteed mood killers.

-Other libido killers: processed baked goods, dairy, various medications such a blood pressure medicines or SSRI antidepressants (including Prozac, Lexapro, Celexa, Paxil, and others), cardiovascular disease, pain, anxiety, history of abuse, low self esteem, and feeling a lack of connection.

As promised, here’s a list of magic foods/supplements that have been suggested as libido enhancers. No promises here – and I am not including the underlying mechanisms for want of space: black raspberries, broccoli, cloves, figs, coffee, dark chocolate, watermelon, eggs, saffron, lettuce, ginger, tomato, avocado, almonds, strawberries, oysters, pomegranate, halibut, asparagus, garlic, bananas, celery, walnuts, beets, pumpkin seeds, peanut butter, beef, nutmeg, mangos, peaches, liver.

Various recommended vitamins/supplements include: vitamin E, zinc, vitamin C, arginine, vitamin A, vitamin C, octacosanol, Beta-carotene, vitamin B6, vitamin B complex, gingko, ginseng, L-arginine, rhodiola, DHEA (no more than 25 mg. daily), omega-3/6 supplements.

The list of over-the-counter products grows each year. As long as people buy them, someone is around to take your money and promise you the moon. Their websites have glowing first-person accounts of success, which I have never, ever heard directly from anyone who has tried them. If throwing away money makes you horny, here’s a partial list of products available: Avlimil, Climestra, Extenze for Women, Fematril, FemElle, Femtia, FemXL, HerSolution Gel & Tablets, Intivar, K-Y Intense, Libido for Her, LibiGel, Lyriana, Provestra, Scentuelle, Vibrel, Vigorelle, Zestra.

Inventions that are supposed to increase female desire come and go. In 2001 a device called the EROS was approved by the American Food and Drug Administration (FDA) for treating low sexual desire. The gadget applies suction to the clitoris and so (in theory) increases desire. While it apparently works to some degree in clinical trials, I suspect this is an awkward choice for many.

How about other prescription products: -Viagra? Sadly, not so much. While it may increase blood flow in the labia and clitoris for a few hours, this type of medication has not been shown to reliably increase libido in women. -Estrogen replacement therapy may improve vaginal lubrication and diminish discomfort, but it does not appear to improve libido. -Testosterone supplementation may improve libido, but there can be adverse masculinizing side effects and long-term health concerns. This is one to discuss with your doctor.

To summarize, there is no substitute for spending time with the person you love, communicating well, and carving out uninterrupted time for real intimacy.

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