- Question from Website Question: What are my options regarding loss of libido? Are there any natural alternatives?
Mindy Goldman, M.D.
One of the problems with treating loss of libido is our general understanding of what someone's libido should be. We don't have good normative data on the natural history of someone's libido. Most women will notice a decrease in their libido around the time of menopause. Many times that is temporary. For some women, they do notice that their libido is permanently decreased.
A lot of the research that has looked at libido has been done in men, and there haven't been very good studies done in women. There are a few potential herbal options, although there is limited data on their safety and efficacy. These include DHEA, which is a precursor to the male hormone testosterone. There is also an herbal product called Arginmax, which contains the amino acid L-Arginine and ginkgo biloba, and, in combination, these are thought to produce smooth muscle relaxation of the muscles around the vagina and potentially increased blood flow to the genital area. I personally have not found this to be that successful, but I do think it is a safe herbal product to use.
There are a number of other herbal products starting to come on the market, but little is really known as to how safe or effective they are. In terms of prescription alternative, one option is the antidepressant Wellbutrin (chemical name: bupropion). One of the problems with treating depression with the SSRI antidepressants (including Prozac, Paxil, and Zoloft) that are commonly used is sexual dysfunction. Most commonly they cause delayed orgasm or inability to have an orgasm, but frequently decrease libido as well.
For years, psychiatrists have counter-balanced this sexual dysfunction from SSRI antidepressants by using Wellbutrin together with their other antidepressants, and we have tried primary Wellbutrin alone in some of our breast cancer patients to see if we can boost libido. It's hard to know whether you are improving someone's mood and whether that may be improving libido as well, but I have found this to be safe and effective for many women.
Another option is the male hormone, testosterone. We know that testosterones are involved in women's sexual functioning. For women who have decreases in libido and don't have breast cancer, gynecologists frequently will give very low doses of either oral or vaginal testosterone. With breast cancer patients, particularly if their tumor is hormone-receptor-positive, we don't know about the safety of testosterone. So it's important, if you are considering this as an option, to discuss this fully with your oncologist as well as your gynecologist.
Editor's Note: Wellbutrin, Prozac (chemical name: fluoxetine), Paxil (chemical name: paroxetine), and Zoloft (chemical name: sertraline) are known to reduce the effectiveness of tamoxifen. If you are taking tamoxifen, talk to your doctor about alternative antidepressants. For more information, please visit the Breastcancer.org Tamoxifen page.
The Ask-the-Expert Online Conference called Managing Menopausal Symptoms Part 2 featured Mindy Goldman, M.D. and Marisa Weiss, M.D. answering your questions about how to manage menopausal symptoms, including hot flashes, vaginal dryness, loss of libido, and more.
Editor's Note: This conference took place in July 2004.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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