Facts about the libido

By Dr Oge Ilegbune

Case Story: A 41-year-old lady presents to her GP for an annual heath review.

She is married with two teenage children. She seemingly has no significant health complaint or medical history.

In exploring her sexual history as part of a complete holistic history, she mentions she has had low libido because for years she has had no interest or urge or desire for sex with her husband.

It was not a problem she had thought she needed to discuss with her doctor.

Her husband is 49 years, and she describes him as always stressed and distracted with no real thought in spending time with her, turning down suggestions to do fun things together.

He would then try and have sex with her which she progressively perceives as a form of destressor for him with no thought about her own pleasure.

She says she finds every way to get out of the act and she has also observed that her husband is having challenges with erections in the past 2 years but is able to ejaculate.

He has recently been informed his random blood sugars are raised at a pharmacy but has not seen a GP for a proper assessment. In psychology, the drive is described as an innate, biologically determined urge to attain a goal or satisfy a need while an urge is a powerful desire or impulse.

If the definition is correct, there must then be many goals or many needs that are attained or determined by the drive or urge just as there would be several types of drives or urges.

The sexual drive, also known as the libido, is one such type of drive or urge or desire and the goal in this situation is the need to have sex or the act of having sex.

Depending on whom you discuss with, when it is openly laid on the table, the idea of the libido can be quite contextual.

This would suggest that there are many factors at play that can impact on the libido, and these can range from physical, emotional to circumstantial.

These are a few and include: Anxiety, Stress, Depression, Disease (Diabetes, Thyroid dysfunction, Testosterone decline etc.) Fatigue, History of sexual abuse, Medication, Menopause, Quality of relationship, Religious and Cultural dictates and processes.

Libido tends to be viewed as normal, low, and rarely above normal or high.

However, in general libido levels is only a problem if a person, their partner or both consider it as such, especially in a situation where there has been a change from their norm.

There is no recognized measure of libido. There is a certain reluctance to look at libido issues holistically as part of what can be discussed with one’s primary care giver and yet with all the possible underlying factors listed, the doctor should be the first port of call when seeking help, the gateway to other forms of help that are available.

The doctor’s role would be to unravel any interconnectivity of factors, to separate clear causes from mingled causes.

A good history would be the first step, followed by a physical assessment, mental health evaluation, and most likely certain investigations.

The subsequent treatment and management would depend on the diagnosis and could sometimes be one specific or a combination.

Treatment can range from drug management to lifestyle modification to psychological therapy etc. It is important that we start seeing libido or the sexual drive as important as other drives that affect and impact on the quality of life and enjoyment we derive.

This change in mindset would lead to the proper health-seeking behaviour required to seek appropriate help when it is necessary because, the help is certainly there.

As we popularly say, do not suffer in silence when there is no need to. Referring to the Case story at the beginning of this write-up, the GP made the following plan for the couple:

1. Full detailed holistic history, examination, and investigations for the patient.

2. Full detailed holistic history, examination, and investigations for the patient’s husband.

3. Joint couple consultation for a preliminary discussion of relationship and concerns.

4. Further physical investigations and specialist referral and counselling determined by the findings of the physical and couple consultation.

5. Commencement of structured and monitored management based on final diagnosis which could vary from couple counselling, individual counselling, lifestyle changes and physical treatment of any disease noted. Hello Dr Iku, I am 55year old.

I take tablets for high blood pressure. My friend visiting from the US gave me some baby aspirin tablets to take daily.

He says it is good for me. Is this true?

Dr Iku replies, What does baby aspirin (low dose aspirin) do?

People with heart disease, blood vessel disease, and certain types of strokes may be prescribed low dose aspirin to help prevent blood clots.

Aspirin stops platelets (type of blood cell needed for clotting) from sticking together, reducing blood from clotting.

Doctors sometimes refer to this as blood thinning.

What are the benefits of taking low dose aspirin?

Low dose aspirin is recommended for people who have already had a heart attack, blocked blood vessels and some types of stroke.

Aspirin is used to reduce their risk of getting another heart attack, blocked blood vessel, or stroke.

In this group, the advantage of taking daily aspirin outweighs the problems caused by aspirin, so it is vital that they take low dose aspirin.

What are the possible adverse effects of low dose aspirin?

The main adverse effect of aspirin is an increased risk of bleeding, particularly bleeding in the gastrointestinal tract (stomach and intestines).

Generally, these bleeds are minor, but they can be substantial and life-threatening.

Why are some people prescribed low dose aspirin?

The decision to use aspirin daily must be made after carefully weighing benefits against risks.

Daily use of low dose aspirin may lower the risk of getting a heart attack and stroke.

The risk of these illnesses increases with age; however, the risk of adverse effects from daily use of aspirin also increases with age.

In healthy people, who have never had a heart attack or stroke, aspirin can confer a small benefit in reducing heart attacks and some strokes, but this comes with a significant increase in the risk of bleeding from the gastrointestinal tract.

Doctors in the US are more likely to recommend the use of daily aspirin than those in UK.

The UK guidelines do not recommend routine use of low dose aspirin in healthy people as research has consistently shown that the risk of bleeding outweighs the benefits of aspirin use for people who have not yet suffered a heart attack or stroke.

However, current guidance from the US Preventive Services task force advises against the use of aspirin; They now acknowledge that the risk of bleeding outweighs the benefits of taking aspirin.

The current recommendation for people who have never had a stroke or heart attack is not to take daily aspirin.

Can I take low dose aspirin if I have high blood pressure?

People with a history of high blood pressure must be careful about the use of daily aspirin.

Studies have shown that if blood pressure is poorly regulated, regular use of aspirin increases the risk of bleeding in the brain (haemorrhagic stroke).

General Considerations For someone who lives in Nigeria, where access to emergency endoscopy (used in diagnosing and treating bleeding from the gut) is limited, the advice is to be cautious and avoid daily aspirin.

This is imperative if you have no history of heart attack, blood vessel disease or stroke.

Additionally, one needs to be cautious when accepting medication from anyone who does not have access to your full medical history.

Summary

• Low dose aspirin is vital for some people, those who have had a heart attack, certain types of stroke, or blood vessel disease, as the benefits of daily aspirin are greater than the bleeding risks.

• Low dose aspirin is not recommended for people with no history of heart attack, stroke, and blood vessel disease because the risk of bleeding outweighs the benefits of daily aspirin use.