There are several behavioral and psychosexual terms that have been used synonymously to describe libido – sexual appetite, desire and drive, sexual impulse and interest have each been used to illustrate the Latin word that defines and epitomizes “desire”. Libido certainly remains a very complex interplay among biological (endocrine and neurochemical), motivational and relational factors, where each that may have both an inhibiting or enhancing role. The term libido was first used by Sigmund Freud to indicate the energy correspondent to the psychic side of the sex drive. Carl S. Jung defined it as the “psychic energy” present in all that is ‘appetitus’, a kind of ‘desire towards’, not necessarily sexual.
The Global Study of Sexual Attitudes and Behaviors is an international survey of various aspects of sex and relationships among adults aged 40–80 years, an estimate of the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries is reported by Laumann and colleagues. Although the figures for low sexual desire are derived exclusively from the participant’s response to a single question, the report has the value of including a rather large variation in countries and cultures. Depending on the geographical area, prevalence of “lack of sexual interest,” a category where respondents answering “occasionally,” “periodically,” or “frequently” were included, varied from 12.5% to 28.0%.
Additionally, A low sexual desire; that is, decreased libido, can also manifest as Hypoactive Sexual Desire Disorder (HSDD) according to the(Diagnostic and Statistical Manual of Mental Disorders V). HSDD is one of the most common presenting problems in the practice of sex therapy. It is estimated that approximately 20% of men and 33% of women are affected by low or absent sexual desire.
One important note – primary and secondary reduced libido have different risk factors, clinical characteristics, and potential treatment approaches requiring direct consultation with your healthcare professional.
Now that we have identified some potential sources of the challenge at hand (pun intended), the question remains – What can be done to help boost libido?
As we seek the answer to this together let’s be really clear that libido – or sexual desire – is considered very different from sexual arousal. Our goal is to find uncover how to increase true libido or “sexual hunger.” Remember that desire and arousal are vastly different (and not interchangeable) and we’re just talking about pure desire here (and how to increase it).
“In Freud’s late phase he offers us a view of the economy of libido based upon an individual’s characterological or drive-based constitution. He writes: happiness, in the reduced sense in which we recognize it as possible, is a problem of the economics of the individual’s libido.
There is no golden rule which applies to everyone: every man must find out for himself in what particular fashion he can be saved. All kinds of different factors will operate to direct his choice. It is a question of how much real satisfaction he can expect to get from the external world, how far he is led to make himself independent of it, and, finally, how much strength he feels he has for altering the world to suit his wishes.
In this, his psychical constitution will play a decisive part, irrespectively of the external circumstances. The man who is predominantly erotic will give first preference to his emotional relationships to other people; the narcissistic man, who inclines to be self-sufficient, will seek his main satisfactions in his internal mental processes; the man of action will never give up the external world.”
– TREVOR C. PEDERSON
“THE ECONOMICS OF LIBIDO: PSYCHIC BISEXUALITY, THE SUPEREGO, AND THE CENTRALITY OF THE OEDIPUS COMPLEX”
Physical Activity versus Endurance Exercise Training
Being more physically active has been shown to be beneficial reproductively for men who are sedentary (or have a very low physical activity levels) as it results in improved testosterone levels and libido.1,2
Conversely, there are many reports in the popular literature and on the Internet suggesting that men who participate in large amounts of endurance exercise training (e.g., marathon running) can have suppressed testosterone and libido.3,4
Psychosexual Counseling and Education
Psychosexual counseling and education remain essential for an effective treatment of all types of sexual disorders. Psychosexual therapists are trained to help patients and their partners explore underlying issues that may be manifesting in low libido, along with other sexual problems, and teach strategies and exercises to manage specific issues.
According to the American Psychological Association, treatment is a multi-step process. Therapists begin by helping clients identify negative attitudes about sex, explore the origins of those ideas and find new ways of thinking about sex. The focus then shifts to behavior: therapists may ask clients to keep diaries of their sexual thoughts, watch erotic films or develop fantasies. Therapists also address any relationship problems.
In men with HSDD, combining the classical interventions designed by Masters and Johnson with more integrated psychodynamic and systemic interventions outlined in New Sex Therapy: Active Treatment Of Sexual Dysfunctions (Vol 1) by pioneering therapist Helen Singer Kaplan provide the foundation for addressing libido. Kaplan’s approach involves the use of prescribed sequences of progressively more integrated and complex sexual behaviors for the patient to engage with his partner (or during self-stimulation with structured fantasies) and a variety of psychotherapeutic interventions including interpretation, confrontation, and restructuring of the couple interaction to address the more unconscious processes that are considered to block the experience of sexual desire.
Testosterone Replacement Therapy
Medically speaking, symptoms of hypogonadism (HG) should be established (including low energy, afternoon fatigue, loss of muscle, increased body fat, loss of body hair, decreased strength and endurance) with a healthcare professional. HG, or abnormally low testosterone levels, is a particularly well-known and common cause of low libido. Besides low libido, hypogonadism is also associated with decreased nocturnal erections, decreased ease of arousal, orgasm delay and, in men with profoundly low levels, poor erectile function.
Testosterone is associated with many androgenic–anabolic processes in the male, and although not universally accepted, it is thought to play a key role in male sexual libido.5 Treatment with testosterone replacement therapies results in restoration of normal serum testosterone (T) levels and increased libido. The beneficial effect of testosterone on sexual motivation and the presence of sexual thoughts have been reported by several studies.
Testosterone can be administered with a variety of formulations that include: intramuscular injections of testosterone cypionate that requires to be applied every 2 to 3 weeks, testosterone undecanoate that is administered intramuscularly in 10–14 weeks intervals; it can also be administered daily in gel or dermal patches, testosterone pellets, or in a buccal system that is administered in the oral mucosa. The latest approval in the U.S. is now the first and only weekly auto-injector testosterone therapy – XYOSTED (testosterone enanthate) injection. Availability of these formulations varies around the world.
Treatments for Endocrinologic Disorders
Treatment of endocrinopathies, such as hypothyroidism or hyperthyroidism, improves sexual desire impairment that can accompany these conditions. Uncontrolled diabetes mellitus may respond to improved plasma glucose control, especially in patients with recently diagnosed diabetes. Hypogonadism is common in patients with diabetes, many of whom may respond to testosterone treatment.
Treatment of Depression, Anxiety, PTSD, and Acute Stress
Treatment of depression should include the use of pharmacotherapy; although many of these medications each may have an impact in sexual function and libido. Antidepressants that have less impact on patients’ sexual function include mirtazapine, bupropion, and the serotonin-norepinephrine reuptake inhibitors like venlafaxine and duloxetine. The combination of pharmacotherapy and psychotherapy has been shown to improve the efficacy of the treatment of depression; therefore, such combinations should be provided whenever possible.
Identification and proper treatment of several anxiety disorders such as posttraumatic stress disorder, acute stress disorder, and generalized anxiety disorder is critical for the management for the restoration of libido.
Sexual Desire on Fire: Increasing Your Libido Now
We have learned that libido – or sexual desire – is an attitude toward an object, while sexual arousal is a state with specific feelings, usually attached to the genitals. Remember, that there can be sexual arousal without sexual desire, and sexual desire without arousal. Libido has several roots, with a complex interplay among biological, motivational and relational factors, that may all have both an inhibiting or enhancing role. We’ve explored some of the psychosexual and medical treatment strategies to increase libido.
We have deliberately not addressed the various dietary/nutrition recommendations and/or vitamin and other supplemental aids in this article as many lack the proper validation with research yet to be done or data that are inconclusive. Studies have demonstrated the effectiveness of a hypocaloric, hyperproteic, and hypolipidemic diet on the libido, improving sexual and erectile functions, as well as increasing testosterone levels. Herbal medicine, also for example, has been identified for having an effect upon the hypothalamic-pituitary-testicular axis, thus increasing the libido. For entertainment purposes, we may explore these myths and misperceptions in a future article.
For now, we can all just agree that treatment to address our individual libido the starting point should be etiologically oriented. The treatment should be based on the individual needs of the patient, and always under the supervision of a trained healthcare professional.
- Cormie P, Newton RU, Taaffe DR, et al. Exercise maintains sexual activity in men undergoing androgen suppression for prostate cancer: A randomized controlled trial. Prostate Cancer Prostatic Dis. 2013;16(2):170–5.
- White JR, Case DA, McWhirter D, Mattison AM. Enhanced sexual behavior in exercising men. Arch Sex Behav. 1990;19(3):193–209.
- Arce JC, De Souza MJ. Exercise and male factor infertility. Sports Med. 1993;15(3):146–69.
- Bennington V. Get your sexy back: How your workouts are crushing your libido. Available from: http://breakingmuscle.com
- Boloña ER, Uraga MV, Haddad RM, et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82(1):20–8.