May 28, 2014
What do you make of this? How would you advise? About a week ago,on my Online Medical Advice website, a young woman from South Africa wrote to me as follows:
“I have been thinking of asking for professional help for a while, because there seems to be a serious problem that I just can’t ignore. I am 32 years old, married for 7 years to a man two years my junior. Together we have four lovely children.
The problem started to appear after I started my third pregnancy and lately I just can’t handle it anymore. I do not want to have sex. I do not feel the need to. If I do it does not happen more than 2 or 3 times a month. Yesterday I realized that the mere thought of having sex disgusts me! I feel ashamed and insufficient to satisfy my husband who has been complaining about it recently. What’s the matter with me? I am a young vibrant woman. I take care of my appearance and I know that men like me, but something has stopped working properly. Please, please help me!”
First of all what sticks you about this questioner as odd, or as possibly the root cause of her problem? And secondly, what further information would you like to have before reaching a conclusion and offering some sound advice? Let’s deal with the second question first. When I hear of loss of libido in a woman the first thing I think of is clarity – what exactly does the questioner mean by loss of libido. The second thing that I think of is could some medications be causing this. I wrote to her therefore as follows seeking some clarity:
“Hi there Ruth, thanks for your question. When you say loss of libido do you mean loss of interest in all things sexual – no desire, no urge, on sex drive? Or is it a case that you do have these things but that you are not responding – you have so-called Female Sexual Arousal Defect?
I also need to know if you are on any form of birth control including the IUCD and if you were ever on any antidepressants?”
Her answers to these questions were revealing in their own way. No she was not on any form of BC, not now or ever and she was never on any antidepressants. As to the first part of my question; her problem was indeed a pure loss of libido and had nothing to do with response. While answering this Ruth also let it slip that she had a full time job!
This of course underlined and re-enforced my first impressions as to what exactly was going on here. Now we have a young woman aged 32 with four young children, obviously talented and well educated and holding down a full time job and not on any form of birth control! And she wonders where her libido has gone to! When I was first reading through her question I was thinking of all sorts of fancy footwork like hormone assay and possibly testosterone replacement therapy for women. But on more sober reflection the answer was far more pedestrian.
Four small children, under the age of seven, no matter how lovely they may be, is draining enough God knows. Now add onto that a full time, and I would guess a fairly onerous job and you are approaching human limitations. On top of that we have a young woman not on any form of family planning such that any sexual activity with her husband exposes her to the risk of further pregnancy and she is wondering where her libido has gone to!
Moral considerations aside, I think Ruth is going to have to give some serious consideration to possible a permanent form of family planning – vasectomy or tubal ligation or, less satisfactory, Marina Coil or implant. Once she has her fertility under some kind of control she should consider taking a break from her work and/or from her parenting duties. What Ruth may desperately need is a quiet week in the countryside somewhere. Then perhaps she will discover where her libido had vanished to. What do you think? Please leave a comment.