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Loss of Libido  

2008-07-17 20:41:37|  分类: 之初本善 |  标签: |举报 |字号 订阅

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"I was so deep-down exhausted, I was beyond desire. I thought, 'This is gonna be permanent.' It wasn't. My husband never gave up, thank heaven."

—Lila

Perhaps the most frustrating change in your sexual life is the loss of libido, of "those urges." You've lost your hair, your breast is altered or gone, you've put on weight, you have no energy, you're tired, you're nauseated, and you hurt in new places. No wonder you're not feeling sexy.

Your sex life may be altered by vaginal pain resulting from breast cancer treatment, especially after bone marrow transplantation. Certain chemotherapies can cause short-term ulcers in the body's mucous membranes (mouth, throat, vagina, rectum). Physical changes may result from treatment-induced menopause, tamoxifen therapy, or the end of hormone replacement therapy. Add the psychological stress, and pleasure from sex may seem like ancient history.

Advice from your doctors, or from friends who've been down the same road, may help, but some impairment of sexual function is generally unavoidable. Over time, however, things do get better.

Depression and libido

Depression is a common result of both the diagnosis and the treatment of breast cancer, and it directly affects your interest in sex. If you're depressed, sex may be the last thing you want to deal with. (You may even develop a real aversion to sex.) A sensitive partner picks up on this and holds back. But then, when you've recovered, your partner may continue to show no interest in sex, and you may assume it's because you're no longer desirable.

If you are depressed and unable to turn the corner, you need help. Try to consider therapists or group support. You've undoubtedly heard of the success of new medications, but you'll have to be careful. Some therapies for depression may cause loss of libido, including Prozac (chemical name: fluoxetine) and Zoloft (chemical name: sertraline). Medications must be carefully administered and monitored by a qualified medical professional (usually a psychiatrist). Effective dose levels are important and not always appropriately prescribed, and for many medications it takes three weeks or more for you to feel the benefit.

Depression, however, is too debilitating a condition to ignore, so be sure to seek help. There are some things that time alone doesn't heal.

Hormones and libido

You may find that it has become harder to get aroused, and even harder to experience orgasm. "It takes so long to make it happen," said one woman. This dullness of response—if you can call it a response—is a consistent complaint. You must be open with your doctor, so that he or she can suggest appropriate medical solutions. Loss of desire and drive may be directly related to your lower estrogen, progesterone, or testosterone levels, brought on by your breast cancer treatment.

If you're having problems with sex, you might want to try downplaying the importance of orgasm, at least for a while. While you're recovering, try concentrating on pleasure from touching, kissing, and imagery, rather than penis-in-vagina orgasm. De-emphasizing vaginal orgasm may actually allow it to happen again sooner than you expected.

For some women who've had minimal interest in or opportunity for sex before all this happened, loss of libido may not be much of a problem. But if it is for you, talk to your doctor about the possibility of a hormone evaluation. A woman's sex drive is somewhat dependent on the hormone testosterone (the primary hormone in men), produced in the ovaries and the adrenal glands. A little goes a long way, and an adjustment may help restore sexual interest.

But if your testosterone level is within normal range (20 to 60 nanograms per deciliter in a blood test), more testosterone probably won't help. In fact, too much testosterone can produce acne, irritability, and male characteristics such as facial hair or a deepened voice. In addition, it's not known if "testosterone replacement therapy" is safe for women with a personal history of breast cancer.

Pain, nausea, and libido

Painful intercourse can destroy your interest in sex faster than anything else. Vaginal ulcers that arise during certain chemotherapies (such as 5-fluorouracil) are a major source of such pain. The ulcers may be particularly severe in women who have had bone marrow transplantation, but they do go away when treatment ends. Women with genital herpes may have an outbreak of the disease brought on by stress and a weakened immune system. Steroids and antibiotics can cause yeast infections in the mouth and vagina. Pain medications, narcotics in particular, can also reduce libido.

Menopause, whether natural or treatment-induced, can cause thinning and shortening of the vaginal walls. Vaginal dryness (lack of natural lubrication) is another menopausal side effect. These conditions can contribute to pain during sex.

Nausea, a side effect of chemotherapy, can kill your interest in anything, particularly sex. And some anti-nausea medications depress libido.

 

 

3 Kinds of Drugs That Can Kill Your Sex Drive

If you're having sex drive issues, check your medicine cabinet. Several varieties of prescription medication can dampen desire.

Birth control
Some hormonal birth control methods such as pills and patches can increase women's levels of sex-hormone-binding globulin (SHBG), which drops the amount of testosterone that's floating around freely in the bloodstream.

A small but alarming 2006 Boston University study, authored by Irwin Goldstein, MD, director of San Diego Sexual Medicine and editor in chief of The Journal of Sexual Medicine, found the Pill to have a long-term effect on libido in some women. The level of SHBG was twice as high in women who had taken the Pill—four months after they'd stopped taking the medication—as those who never had.

That kind of long-term effect is pretty rare, however, according to Hilda Hutcherson, MD, an ob-gyn professor at Columbia University. She finds that birth-control-related sex drive problems usually go away when her patients switch pill formulations. "It's the progestin that seems to affect libido," Dr. Hutcherson says. "Some progestins have an androgen [male hormone] effect, and those tend to have less effect on libido."
Or try another form of birth control completely. With most women Dr. Hutcherson has seen in practice, she says she's found that "if you take them off the Pill, their sex drive comes back."

Antidepressants
Selective serotonin-reuptake inhibitors (SSRIs) such as Prozac are supposed to cheer you up, but they can interfere with one potential source of happiness: sexual pleasure. Some doctors will keep the SSRI but add Wellbutrin, which increases dopamine and acts as an "antidote to the SSRIs," according to Dr. Goldstein. For others, a doctor might switch the patient to Wellbutrin and cut the SSRI.

Everyone's body reacts differently to drugs, however, and for some, depression itself is more of a sex drive dampener than the SSRIs are. For still another set of patients, notes Marjorie Green, MD, director of the Mount Auburn Female Sexual Medicine Center in Cambridge, Mass., and a clinical instructor at Harvard Medical School, "When you give them SSRIs, they get a libido and can be sexually functional when they weren't able to be before."

Diabetes drugs
Both diabetes and the medicine used to treat it can diminish desire, arousal, and orgasm. And those changes, in turn, can affect sexual interest. As Dr. Hutcherson puts it, "Who wants it if it's not fun?"

What if you need the medicine?
Sometimes simply switching to another type of medicine, or even a different formulation of the same medicine, can solve the sex drive side effect. But if it does not, and you need the medication, and your regular provider isn't coming up with any new ideas, don't despair. "Go see a sexual medicine expert who can work with the physician prescribing the medicine to figure out other strategies," advises Alan M. Altman, MD, an assistant clinical professor at Harvard Medical School and a specialist in menopausal issues and midlife sexuality.

Sexual Arousal Dependent On Flow Of Potassium Ions In Brain Cells

When it comes to sex, a female rat knows how to avoid a communication breakdown. To announce her sexual readiness, she will automatically arch her back, deflect her tail and stand rigid to allow an aroused male to mount. Now, Rockefeller University researchers have figured out the precise chemical and physical mechanism in a group of brain cells that controls this swayback posture, a reflex called lordosis that signals one of life’s most complex yet primitive instincts — the need for sex.

The group of cells that generates lordosis behavior resides deep in the brain in a structure called the hypothalamus. When an aroused male touches the flanks of a female, these cells determine whether the female will present her rump. “By way of these cells, the female controls sexual reproduction,” says lead researcher Donald Pfaff, head of the Laboratory of Neurobiology and Behavior. “That’s why these cells are so important.”
In past years, Pfaff and his colleagues have teased apart the neural circuitry and hormonal regulation of lordosis. “The struggle now,” he says, “is to understand it intimately at the cellular level, to bring it down to as fine a degree of chemical and physical knowledge as we possibly can.”
All neurons, whether they reside in the hypothalamus or elsewhere, maintain a constant flux of charged ions across their cell membranes via donut-shaped proteins called ion channels. The rise and fall of different brain chemicals can affect the flow of these ions into and out of the cell by opening or closing the channels. Although the Pfaff lab had long known that norepinephrine, a brain chemical that heightens alertness and mediates stress, excites these cells in the hypothalamus, the question was which ions it affects and how.
Using a technique called whole cell patch clamp, Anna W.J. Lee, a postdoc in the Pfaff lab, found that norepineprine prevents the exit of potassium ions from these cells, called ventromedial hypothalamic neurons, a block that activates them. (Specifically, norepinephrine reduces the fast-acting A-type potassium current.) With potassium ions locked inside the cells, the cells fire pulses of electrical activity, which then trigger the rest of the lordosis circuit to operate.
But that’s not all. The team found that when female rats are treated with the sex hormone estradiol before the experiment, the number of cells that respond to norepinephrine soar, making the impulse to mate stronger. It turns out that the sex hormone turns on a set of genes, those for the receptor onto which norepinephrine binds — a self-fulfilling biological prophecy in the name of female reproduction.
Besides activating these cells in the hypothalamus, Pfaff and his colleagues believe that norepinephrine plays a much broader role in stimulating sexual behavior. “Female rats not only become generally aroused and alert but also sexually aroused,” says Pfaff. “The action of norepinephrine on these hypothalamic cells is a way in which generalized arousal force facilitates sexual arousal, which, in turn, fosters sex behavior, without which reproduction cannot occur.”

 

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