Ep 15: How To Fix My Low Sex Drive? l Solution For Low Libido

Sexpert + Topic Intro Allo #AskTheSexpert was started with the intention of normalizing conversations around sexual wellness and sexual health. In the episodes so far, we've talked about a lot of topics, but there's one thing we are yet to talk about- not wanting to have sex, or having a different desire towards sex. Welcome. You're watching Allo #AskTheSexpert, I�m Artika and today I'm going to be hosting another sexpert to talk about an equally important topic related to sex. So let me welcome a psychiatrist with Allo Health and a sexual medicine expert, Dr. Karthik. Hello Dr. Karthik. Thank you Artika, nice to be back here again. Yeah, it's always so great seeing you. With another interesting topic, maybe. Yeah, very interesting. I think we've been on repeat talking about sex and sexuality and sexual health concerns. One of the things which came to my notice and I thought we should talk about is having a different almost definition of desire that some people experience. And in that sense, seeing that it's not maybe as high as that of other people's. So, I mean, what what can we talk about with respect to low desire The science behind Sexual Desire when it comes to sex? So when we talk about low desire it is actually one of the most important problems in sexual health, because when we talk about sexual health, it goes down in four phases. Okay. First is your desire, next is your erection, next is your ejaculation, next is your resolution. Now, it is designed in such a way that only if desire is normal the subsequent three stages are normal, only if arousal-erection is normal only then the ejaculation will look normal. So if the desire at the initial phase only is gone wrong, then subsequently the person would not have a proper erection, or an ejaculation or resolution. In simple terms, now you will be able to have proper sexual activity with a person only if you intend to do so. If the intent only is not there then you know, there is no point in going ahead with it. Okay, so this is mostly misdiagnosed. Like let's say the person actually has reduced desire to perform with a partner, but then he comes down to us, presents to us with erectile dysfunction- he comes and tells me that I am unable to have a good enough erection or unable to sustain for a longer time. Only upon inquiring you would get to know that you know his desire also is kind of less. So then if you treat the desire as such subsequently all the other phases would get rectified themselves. Right. So basically saying that any kind of sexual activity will typically have four interlinked phases, that follow each other in some sort of a chronological order. And I think one of the terms that you mentioned here was �intent� that one of the leading factors for desire is intent. But, you know, as we have unfortunately seen in many cases of assault and sexual abuse, that the intent is not there but other phases do follow. And it's a big conversation and a debate that starts off right. Like if somebody has been a victim of sexual assault or rape and if they have come to an orgasm, Relationship between Intent & Desire then it's like, oh, �were they enjoying the rape?� That's it's a very controversial topic. But this has been heard in media, etc.. So what I'm getting at is that okay apart from intent- are there other factors that lead up to desire. I didn't get your question per se, but let's to put it in a scientific way, desire is a very complicated term, to be really frank. One for you to have a normal desire you should have a very good relationship with the partner as such if there is no proper relationship apart from sex I�m talking about, then you would not probably be having the desire. At the same time your sex hormones also should be at normal levels. Let�s say in simple terms, testosterone. Now, testosterone is a hormone which is majorly res- or a derivative of testosterone. What we understand down yeah is the one which is responsible majorly for dseire both in men and woman, it's the same hormone. So if the hormone itself is less than it might lead to low desire. Okay. But again when I said desire it's not as a whole sometimes desire can be just partner specific it could be less like in a person might not be getting the same desire with one particular partner but he might be able to fantasize himself with others or he might be able to have sexual activity with somebody interested there but not specifically with one partner. Even that is an entity right now. Yeah, no, I think that's exactly what I was, you know, wanting to know more about- the different factors and for example, you mentioned hormonal factors as being one which are not at all related to intent. And that makes me also wonder that then in itself is low desire a medical concern Is Low Libido / Sexual Desire an issue? for which we can kind of map out the causes? Yes, definitely. Okay. So first and foremost, what generally we think is sex hormones are so important that if sex hormone is less than the desire is less, not really. Majority of the Hypoactive Sexual Desire Disorder (HSDD), what we call it as are majorly psychogenic in you know in etiogenicity what I mean to say is most of the factors are why the person is not getting any done with that particular partners because of maybe their interpersonal relationships are you know bad or any of the other things. It could be you know as well as a primary psychiatric disorder. Like you know a simple depression. One of the core features of depression is that the person would not be willing and you would not have that intent to perform sexual act because it's not enjoying getting the pleasure anyway. We have to come out of that misconception where reduced testosterone is the only reason maybe like a lot of other like how we think like we see a lot of people just taking testosterone injections for desire & all these things. But we need to know that God has given us more testosterone than what is actually necessary. So as per Science, if we go only 5% of this, HSDD what we call hypoactive sexual desire disorder. Only 5% of them are because of reduced testosterone. Rest, most of them are basically because of psychogenic factors. Right. I'm just wondering because, you know, like you said, it can be a partner to partner difference. It could depend on a person's mood. It could depend on so many other psychogenic factors like you put it. Then how do you identify that something that you're experiencing How to identify Low Sexual Desire in oneself? is low desire or, you know, something that you actually need to seek help for or or you know, it's just a passing phase? Frankly speaking, for any of these things, it is always better to consult your therapist or a doctor as such. Whatever it is. I mean you will not be in a position to whether you know judge whether it's a problem or not. You�re having low desire, that means you need to work it out. So once you go to a doctor and speak, he will be able to differentiate. In simple terms let�s say if the person comes and tells me that, you know, I am not being able to get that desire to perform with my wife, now reasons can be many. It could be as simple as anxiety. Like, you know, it's like an exam where the person knows that if he goes, he's he'll fail. Okay. Like this fellow is probably like the most common scenario, what we come across is they tell, they come and tell that I'm unable to have sexual activity with my wife. So I don't feel like going only. It's like, you know, who will be interested in giving a exam where you know, you're already going to flunk, so it�s that way. So we have to work it out through that and probably take it forward from there and see. The most important identifier is if the person is masturbating, let's say if he's masturbating, if he's able to fantasize other people and do it, that means it is not hypoactive sexual desire disorder because his desire is normal. It's only that he's unable to do it with that particular partner. So if masturbation everything's fine, then biologically everything is fine. His desire is good, he�s getting erection, everything. So it is high time you consult your therapist. Work it out. Just see what is the problem there and then solve it. Take it from there. And I'm just curious to know that if somebody does consult a therapist, like you said, you know, if they realize they�re in that space, they�ve identified and acknowledged it, all of which can be a little bit of a journey for people, especially when it comes to sexual health disorders, right? I feel like going to the doctor actually is the easier part of the journey, because there is somebody who is scientifically there to support you. The tougher part is actually reaching there. But let's say if somebody reaches that space- I'm just curious to understand what this therapy session Treatment For Low Sex Drive or this consultation looks like? Now that you will have to actually talk to a proper psychologist for that. But then there are various techniques, like you know there is something called as Masters and Johnson technique. All this. They work from the basics for basically, you know, where the problem arised (from), was it earlier okay? Is it a primary concern? Was it-the problem there from the beginning or was everything okay- and now it is you know, they've developed this issue. Why did they develop? How to sort it out? All these things. But what I can say as a doctor is there are medications to improve your sexual desire. Okay. Starting maybe from your testosterone replacement, which might be necessary in some cases. Yeah. -To, you know there are certain drugs, let's say *medicine name* (Disclaimer: Please consult a doctor before taking any medicines.) so there are so many other drugs and there are some natural sexual enhancers. Desire enhancers which you can try. Okay. They do help- but by the end of it therapy forms the mainstay of treatment, and that is something more scientific, which you know needs a whole lot of time to discuss. And a therapist would be a better person for that, actually. So Dr. Karthik you know low sex desire is not a very commonly talked about topic because I think there's still a lot of stigma around it and shame around even coming out and saying that you could be experiencing it. But we've still got some questions about it and I would love to take the opportunity to have you answer these questions. This segment is, of course, called Ask Your Question. We take your questions Ask Your Question- Sexpert Answers YOUR Questions! and have an expert answer them in case you have some question- after watching this episode or any of our other episodes, you can drop them in the link in this description. So I think I�ll just start from the first question itself. Okay. �My wife feels like having sex much more than I do. How do we make this work?� Okay, so as I told you, desire is something very subjective. It depends from you know, from it has its roots, from childhood, basically from it depends from the way you're educated about sex, whether it has been stigmatized, in which community belong to, how do you talk about it, how open you are about it, all these things. Now, what we say is that at least up in a married couple, at least once a month is something which is okay, something really less than that- it requires help. Now there can be certain discrepancies. One person might be wanting more, one person might be wanting less. The basic point here is if a person is like, you know, really pathologically there is very less desire, not even once a month then it requires medical help. Otherwise it's better you consult a therapist, try to work it out somewhere in between from point A to point B, somewhere in between, you have to compromise. And that is where something goes into. Okay, but then this is not something very simple where you can, you know. Okay, I can just ended by telling you, just do it try to do it more end of story. But that that is not how it works- if you're not feeling like doing it, either if wife is feeling too much that is a problem. Or if you're not feeling I mean, if you're if you are not at all feeling like having sex, then it is too less. Then there is a problem on both sides. Somewhere you will have to consult a therapist, work it out. That is how it goes. Yeah, I think that was where we ended our last discussion as well. That therapy could be an answer to even figuring out what's happening. And then, you know, However, this is more odd because HSDD is more commonly found in women in India, actually. Now, various reasons, again, the most common being pregnancy. Whenever a lady delivers a baby, it's nature's way of, you know, telling it have sex a bit less during that time because whenever you know you're breastfeeding the baby, a hormone called prolactin increases in the body that naturally inhibits your sexual desire. So if the wife is in the lactating period, naturally her desired would be low. But sometimes there are very, very rare instances where the prolactin hormone naturally increases because of a small tumor or because of certain drugs that you're taking you know- in most of psychiatric drugs, you give antipsychotics for some psychosis patients like schizophren!a or anything of that sort or for mood disorders where you try to control the brain to an extent. Once that happens because of those drugs, also prolactin might increase. Even that can lead to such issues. However, there are better drugs right now. If you are facing any of these issues, you consult your doctor. He or she can change the drugs. Or there a lot of other methods which can be used. Hmm. Right. You know, absolutely correct. I hope anybody who was listening in has been able to make a note of all of that information because it could be really valuable in them figuring out what's happening with them. Just moving on to the next question. �I've heard weight gain is linked with not wanting to have sex. Is that true?� Yes, definitely true, because what happens is when there is obesity, when there is increased peripheral fat in the body, your sex- male sex hormone is converted into female sex hormone. Now, the way I told you, whether in men or in women, testosterone is the major hormone which actually helps you get a desire. Now if you�re obese your hormone testosterone is converted into a different hormone estradiol in your peripheral fat. Okay. When that happens, naturally, your desire kind of goes down. Okay. So yes, obesity is definitely linked. So regular physical activity, as I suggested for any of the sexual well-being, you know, physical activity and keeping your weight under control is a must. However if you still have some other issue which is linked obesity. And there are again, medicines to help you avoid all these things so you can consult your doctor. Yeah, I mean, definitely I think obesity and weight gain also just being operative words, that a weight gain could lead to obesity and a weight gain could in general be just weight gain as well, right? Yes, It's basically a cycle. Right. A weight gain if not controlled can lead to obesity. Yes. Oh, yes. So you have to break it somewhere. Right. So exercise is the most preferable way. Hmm. Yeah, absolutely. The last question for the day is, �Is low sexual desire equal to being asexual, i.e. never wanting sex?� It's a different spectrum. Maybe- the highest order of hypoactive sexual desire disorder would be asexuality, but in hypoactive sexual desires, or at least the patient realizes that he has a problem. That is, he has a reduced desire. So he comes to you for treatment. Asexual is a term where you're not attracted to anything at all. You don't have an object to which you are sexually attracted. MM Okay. So asexuality is probably the extreme form, if you ask me. It's more complicated. Right. And rather a form of sexuality, like a low sexual desire, could mean that there are still- yes low sexual desire is a problem. Is a diagnosis. Asexuality is something related to your whole sexuality as well. You don't feel like doing it at all. I think. But the confusion is quite common, I feel because of similar definitions, and I'm sure this is something that worries a lot of people. In simple terms, asexual person is very happy with not having sex also, he doesn't need. Not a concern. HSDD the patient actually, you know, is finding it bothersome, is unable to find the desire to have it. Right. Right. That was the end of our questions. I was just looking to see if there were more. That was the end of our questions. So thank you again for sharing your time with us. Again, if you all have any questions, you can drop them in the link below. I'm pretty sure we're going to have Dr. Karthik back. So you can hear all of those answers from him. Until then, it's Dr. Karthik and Artika signing off. We'll see you again with another episode and another exciting topic. Okay, take care and bye