How can I get my doctor to take me seriously about my libido problems?

April 4, 2007 9:26 AM

How can I get my doctor to take me seriously about my libido problems?

I'm 21, a woman, and engaged to my boyfriend of three years. I have always been overweight (yet confident, healthy and body positive!) and I have been using oral contraceptives for three years. I have not made any drastic changes to warrant my problem.

About a year ago, my sex drive just... disappeared. I went from thinking and breathing sex most of the day, masturbating often and initiating most sexual encounters to barely wanting to undress, play or do anything sexual whatsoever. The change wasn't really noticeable until I realized that my partner and I weren't having sex very often and that I consistently had to turn him down for one reason or another. We are definitely attracted to each other and have no relationship problems that would cause sexual dysfunction. This, to me, feels more than just the "honeymoon phase" ending. He and I have wonderful communication and openness--it is not a relationship problem. I have always thought that if both parties are comfortable with the rate of sexual activity, even if it's low, then there's no problem---but I'm not comfortable with it! I want more sex and I want my sex drive back!

It feels like a physical thing, so I want to see my doctor about it. I've talked to my NP, who shot me down completely: I'm not horny because I'm fat ("by the way, consider Weight Watchers"), and besides, I shouldn't worry about it because I'm so young; since I depend on the state to fulfill my meager health needs, I can usually only see pissy nurses who aren't getting paid enough and have some kind of vendetta against sexually-active young women. Back when I was on my parent's insurance, I mentioned it to my family doctor, who laughed and said that I don't need to worry about it because I am not married (!).

Perhaps it's just been a string of bad experiences that makes me so unconfident with talking to doctors about my sexual problems, but I want to know how to get a doctor to take me seriously. I wish I could say, "Humor me, doc. Give me a barrage of hormonal tests, thyroid tests, what have you until everything comes out fine--maybe then I'll be satisfied with 'lose weight, hurf durf butter eater'." This is a pretty ...conservative region, so it's not easy to find a sex-positive doctor. It seems my age, my size and my gender have just been a joke and frankly, I'm sick of it. What do I do? What are the magic words?

anonymous because the last thing i need is my employer googling my screenname and reading about my sex life

posted by anonymous to health & fitness (34 comments total)

Try coming off your oral contraceptives. They are a well-known libido-inhibitor in some people. Maybe they didn't affect you that way before but, for whatever reason, do so now.
posted by londongeezer at 9:39 AM on April 4, 2007

When I was first on birth control, I still had a vigorous sex drive. Then it died. When I went off birth control (because of the way it affected my mood), my libido began to come back. That was about three years ago. It's still not as strong as it was before the pill, but it's much better.

It sounds like for the particular doctors you went to, nothing you could have said would have made a difference - their prejudices drove their practice. A good doctor should take you seriously. I don't know how to find a good doctor, it's hard.
posted by mai at 9:44 AM on April 4, 2007

Totally agree about the oral contraceptives*. It's worth a try - if it doesn't work (give you body a good six months or so to get them out of your system) you can always go back on them.

Worked for me. Twice. Tried another brand/dose later on, but same result. They just don't do nice things to my libido.
posted by twiki at 9:45 AM on April 4, 2007

My wife had a similar change after awhile on oral contraceptives. Based on everything I've heard, things should improve drastically if you go off of them (wife's stopping next month, so no first-hand experience there yet).
posted by chundo at 9:45 AM on April 4, 2007

, I mentioned it to my family doctor, who laughed and said that I don't need to worry about it because I am not married (!).

Holy crap, I hate your doctor. I had an ob/gyn who said almost the exact same thing to me (when I was 23 and living with my now-husband).

That's such an unhealthy and awful attitude and I think as for primary care, you need to keep trying new NP's and doctors until you find one who doesn't treat you like a second-rate citizen because you're an unmarried woman who wants to (heaven forbid!) enjoy sex.

In the meantime, go to Planned Parenthood. You'll be able to see a NP or doctor who is not going to be shocked or appalled that you have premarital sex and who is probably going to be a lot more sex-positive than your run-of-the-mill GP.

Good luck, and no matter how crappy your insurance may be, do not accept dismissive behavior from doctors. That is just total bullshit.
posted by tastybrains at 9:45 AM on April 4, 2007 [1 favorite]

Also, as a personal anecdote, I also got my sex drive back (that had diminished slowly after years on antidepressants & bcp) after going off bcp and replacing it with using condoms & an extra spermicidal gel.
posted by tastybrains at 9:47 AM on April 4, 2007

Frankly, I'm shocked at the reaction you've gotten from your health care providers. Their responses were completely unprofessional and inappropriate, and there really shouldn't be anything you have to do to be taken seriously besides what you've already done. I would absolutely second the option of Planned Parenthood if you have that available, or see if you can get plugged in with either a gynecologist or a primary care physician who specializes in women's health.
posted by drpynchon at 9:56 AM on April 4, 2007

I am in precisely your situation except my doctor told me that I have no sex drive because I secretly want children and contraceptives are making me hate sex. Also, I have short hair and wear pants so I must want to be a man (?). Young, female doctor, who you'd think would be even SLIGHTLY progressive, but apparently not.

We did run all the tests and she told me everything was fine. I doubt that, but what can I do?

I have been off the pill for a year and still have no improvement in the libido department.

I'm glad you asked this because it's inspired me to get off my butt and find a new doctor to talk to. This time I'll get a referral.

I think all you can do is try going off the pill and keep going to doctors. Have you talked to planned parenthood (or any other sex-positive organization? (I'm in Canada so I can't help you with specifics here))

Maybe if you lied and told your doctors that you really, really want to have children but your lack of libido is getting in the way of procreation? I've been thinking of using that line with my nasty female doctor to see if she can find me some miracle cure.
posted by some chick at 9:58 AM on April 4, 2007

A good start would be demanding those tests, ask for the blood-work/thyroid tests. Be real up front about it and maybe be a bit of a pain in the ass. As for finding a good doctor… well as we don’t know what conservative region you’re in it may be hard to say exactly; but I recently found a new (and great) dentist by calling up all the near by dentists my insurance covered and checking them out until I found an office I was comfortable with. It took leg work but it was very much worth it. Various gay rights groups have lists of alterative friendly doctors, who I would assume who are not so hurf durf about things.
Save yourself for gay marriage, young lady…
posted by French Fry at 10:00 AM on April 4, 2007

yeah, oral contraceptives can really mess with one's sex drive.

and yes, your doctors are being dicks, it's not you. your fears and worries deserve a solution, not wisecracks. don't worry and good luck.
posted by matteo at 10:01 AM on April 4, 2007

The contraceptive timeline doesn't match well. Does anything else? Diet changes recently? How about work stress or sleep patterns (for either you or your boyfriend)?
posted by DU at 10:09 AM on April 4, 2007

Adding my voice to the "it's probably the pills" crowd. An excellent gyn once told me that women should change their pills if they start to see any side effects. She was specifically addressing mood, weight and acne issues with me, but made a point of saying that after a couple years side effects can suddenly surface, and switching to a different make of pill every couple of years isn't a bad idea.

I would assume this goes for the libido too, but I don't know enough about that. (I should though!) There are so many types and levels of pills out there, an adjustment might be all you need? Does anyone know if the "low-dose" pills as guilty of libido-theft as the regular strength?

*sigh* wishes for an equally effective method without any side effects, or at least for the male pill to come out we don't have to deal with it anymore. ;)
posted by sarahmelah at 10:10 AM on April 4, 2007

You could always emphasize the fact that you're getting married soon (no reason you can't make up a date if you don't have one yet) and you really want to have made some progress on this by then.

My main piece of advice is not to give up on fixing this problem ; life is busy and a year of infrequent sex can turn into two years very easily. Deal with it now, and don't rule out paying to see a specialist until you've explored all the ways you might find the money - your relationship is almost certainly the most important thing in your life, and sex is an important part of that.

I'll say something else as well: your loss in libido may be something to do with sex losing the "forbidden fruit" quality that it used to have, when it became clear that you were going to get engaged and get married. Suddenly sex becomes something that you are supposed to do. Even if you were really interested before, that can kind of take the excitement out of it - it's like finding out that your favorite junk food is good for you, you just look at it differently afterwards. The obvious solution to this is to make things a bit (maybe a lot) kinkier so that your sex life becomes a shared secret again and you can get back some of that if-only-they-knew quality. I hope this doesn't sound like I'm not taking your problem seriously.
posted by teleskiving at 10:23 AM on April 4, 2007 [1 favorite]

In my experience in healthcare, doctors are some of the most conservative people you are likely to meet, right in line with other "professional" jobs like lawyers and CPAs. (I'm speaking in generalities, of course. But, at the detail level, I've known quite literally a few hundred doctors, and I'd be shocked if a dozen of them would identify as "liberal" or "progressive"). Practically every doctors' lounge I've ever seen, and many doctor's offices, have a TV tuned to Fox News all day.

This has always surprised me. For one, most doctors actually are rather bright people, so it surprises me when I see them being closed minded and superstitious. But secondly, I do not understand how you could survive in that line of work and keep a narrow world view and flimsy belief system.

If seeing all sorts of bodily dysfunctions and injuries and ailments and having your fingers in every orifice a human has to offer doesn't make you a little open minded I don't know what possibly could.

With all that said, you've hit some pretty shitty docs, and you have to keep looking. I echo the sentiment above to seek out a Planned Parenthood if one is in your town, or even in reasonable driving distance.
posted by Ynoxas at 10:50 AM on April 4, 2007

Wow, I'll second and third the comments about the inappropriate responses from your health care providers. (Don't worry, you're not married?!)

I'll also second the recommendation to try a different pill. Your hormones can and do change with age, etc.

(As an anecdote, I want to throw in that oral contraceptives have NO side effects on me whatsoever; I was over 30 before I finally learned that the reason why *every* woman in the world isn't on the pill is because it affects many women poorly. But I heart the pill. There aren't many askMe posts with people contributing this side of it, so, there it is.)

And, oh, I really don't want to say this because you really don't want to hear this, but, my libido is oh-so-much better when I'm in better shape and actively exercising. You say you're healthy, which I am not disputing, but you don't mention exercise. As we age our bodies do change, and maybe you need some exercise-induced endorphin rush to assist? (I'm really not trying to sound like your doctors because I already hate them, but, I'm speaking from personal experience.)
posted by iguanapolitico at 11:04 AM on April 4, 2007

Wow. So sorry about all of this. The first thing, I would recommend is either going off the pill or switching to a lower estrogen, more potent second generation progestin pill like Lo-Ovral or Alesse (or generic equivalent). The pill may not be the sole cause of your problem, but it's definitely not helping.

There's a few hormonal things that are routinely checked, but honestly I have never in 10 years seen that produce a helpful diagnosis in a young person. Are there any other medical issues, for instance diabetes or anemia? Are you taking other medications which can frequently affect sex drive, particularly antidepressants? Don't forget about herbal treatments or drugs, alcohol and nicotine particularly. These are the questions a competent, sensitive practitioner who has enough time to deal with you should go through.

In my opinion, that might be all that your typical primary care physician is capable of dealing with. Once you've worked through these issues, there's not much else that could be going on that was covered well in medical school and options that are left on the table are complicated and difficult to handle in the context of the 4-patients-an-hour medical mill we are all forced to deal with. Might be something somewhat simple like depression, self-esteem, or stress. Might be something related to your past that is unresolved. More likely it has to do with relationship dynamics and once you bring your partner into the discussion, things really begin to get complex.

I don't really know what to tell you about your experience with the medical system. The best way to find a doctor you can work with is to get a personal recommendation from someone. I am not surprised to hear that there are places where you get this conservative shit thrown at you, but I will tell you that many of us are progressive and open minded, two characteristics that are essential if you want to help people. Keep looking and try not to let your past experiences with medical providers poison a relationship with a new one who might be able to help you better.

By the way, assuming truly positive self-esteem, and a supportive partner, it's very likely not your weight.
posted by Slarty Bartfast at 11:30 AM on April 4, 2007

Doctors can minimize things in people who look young and healthy. I had unbelievably painful endometriosis brushed off by many docs for about 15 yrs till I diagnosed myself.

Please check out PCOS (polycystic ovarian syndrome), since libido changes are a common sign and being overweight is very common in women with PCOS.

There are lots of great docs out there. I am sure you can find better. You just need to keep trying.
posted by selfmedicating at 11:50 AM on April 4, 2007

Nthing anyone who said that the birth control could be your problem. I was on Ortho-Tri-Cyclen for three years without incident when suddenly, about two years ago, I became a moody, weepy, bitchy mess -- I basically had PMS 24-7. I asked my doctor and she switched me to a low-dose contraceptive (first Mircette, then Alesse) and ever since then I've been fine. The side effects stopped almost immediately.

With regard to health care, have you considered trying Planned Parenthood? Since you mentioned that you get health coverage from the state, Planned Parenthood probably accepts it, and if not they'll give you fees on a sliding scale. I know it probably varies from region to region, but the one I used to go to was great -- clean, professional, and every doctor I saw was quite caring and sympathetic.
posted by AV at 11:51 AM on April 4, 2007

Just to be contrary--have you considered that your relationship may no longer be in a state of limerance?
posted by Carol Anne at 11:58 AM on April 4, 2007

The contraceptive timeline doesn't match well.

Actually, side effects from oral contraceptives can be very gradual in onset. For example, I was on Loestrin for four or five years and perfectly happy with it, but eventually a number of side effects crept in that became so unbearable I finally went off it. Unfortunately, none of the BCPs I've tried since then have been any better, and I've basically had to give up on hormonal birth control entirely at this point.
posted by scody at 12:03 PM on April 4, 2007

Something of a sequel to selfmedicating's thoughts on PCOS...you may want to ask for a referral to an endocrinologist. In my experience, the testing and bloodwork you get in that environment is more comprehensive and interpreted more precisely than in that of a GP or OB/GYN.
posted by gnomeloaf at 12:14 PM on April 4, 2007

I read an article a few years ago about disgusting way overweight people are treated by health care workers. Not all problems can be solved (or are created by) weight change.

I agree with everyone pointing a finger at the birth control. I still haven't found a pill that won't zap my libido. I once had a boyfriend make a comment like "ohhh, so THAT'S how the pill works . . . can't get pregnant if you never want sex!!"
posted by necessitas at 12:44 PM on April 4, 2007 [1 favorite]

Anonymous, please email me.
posted by bilabial at 1:16 PM on April 4, 2007

While I do not believe limerance explains this particular situation, Carol Anne has taught me something today. Thank you.
posted by Ynoxas at 1:50 PM on April 4, 2007

Golly, Ynoxas, you're welcome! When everybody goes one way, sometimes I want to point to a different direction.
posted by Carol Anne at 3:04 PM on April 4, 2007

I agree with all the "it could be the pill" comments - it's happened to me too.

Getting a physician or nurse to take your concerns seriously can be a daunting task, especially in a culture that's disinclined to care much about women's sexual issues. The best that you can do is to be assertive, and if you're not getting the level of service that you expect then switch to someone who will listen to your concerns.

This may sound weird, but you might also consider taking your boyfriend along for these appointments. It presents a unified front (it becomes "our problem" as opposed to "my problem") which will help deal with anyone who wants to get all "you're not even married, oh noes!!11!" on you; and if part of the problem is that you're being treated this way because you're female, you may find that you dont get the same type of response with your fiance right in the room with you.
posted by supercrayon at 3:53 PM on April 4, 2007

As I mentioned in this lively thread, I am skeptical that discussing your obesity is an appropriate intervention for your libido problems.
posted by Slarty Bartfast at 4:05 PM on April 4, 2007

Also, I like teleskiving's advice and supercrayon has a hell of an idea.
posted by Slarty Bartfast at 4:08 PM on April 4, 2007

I'm not at all suprised by the response of your doctors. I've had a female doc almost start laughing at me for the same problem once, it is just not something that they are taught about at all, and I think it would be a real long shot to find a doc who would treat this as a problem to be solved.

Try taking a break from the pill, and see if that helps. You may or may not have the lack of sex drive come back if you go back on it.

Do try exercise. It is not necessary that you actually lose any weight doing this for it to have an effect on your libido. Pick something you find fun to do. Also, there is one specific exercise that may help -- do Kegels.

I suggest reading Women's Bodies, Women's Wisdom for more information on hormones and libido issues. Keep in mind that most medical research is done on men, so there might not be much that most docs even could offer you.

I do hope you find a doc who isn't such an ass, I just don't think it will be that easy.
posted by yohko at 4:26 PM on April 4, 2007

Uh, no one has mentioned Wellbutrin? A little known secret is that many people use the drug to increase their libido. It is somewhat of a panacea (ADD, depression, stop smoking) ... and someone I met has a problem with none of these. They did notice a general horniness and increased sexual pleasure.

There are some pretty nasty side effects listed for people who happen to be bipolar or suffer from a variety of conditions that most people do not. Apparently it causes seizures for some people. This is off label use but I'm surprised your doctor didn't mention it.

Oh and DO NOT drink on it. It has a big "DO NOT DRINK" warning on the label, but they put that on pretty much anything that metabolizes in your liver. After two drinks it felt like I had four drinks.

So ask your doctor today, about Wellbutrin!
posted by geoff. at 5:15 PM on April 4, 2007 [1 favorite]

So ask your doctor today, about Wellbutrin!

I have prescribed this for this problem. Sort of disappointing results, in my experience. But it reminded me of this funny/tragic story: I had a 400 pound patient with a *ton* of medical problems, wheelchair confined on oxygen, heart disease, diabetes the whole works. Absolutely sweet lady, I love her. She was taking Wellbutrin for depression but was absolutely tormented by the increase in her libido, mostly because she felt that her days of "gettin' some" were over. She eventually had to come off of it. One day, after a lengthy hospitalization, she met a man with a similar degree of medical problems over at the rehabilitation hospital. Apparently, they found some way to overcome their um, limitations, because she nearly begged me to put her back on it. It made my week, and I was happy to prescribe it again of course.
posted by Slarty Bartfast at 5:40 PM on April 4, 2007

I just realized that I just suggested what might be causing the problem without answering the question you actually asked!

If significant weight gain did not occur before or throughout your loss of libido, when you go to see a doctor (or nurse) and explain the problem, begin by explaining that you know you are overweight but your weight change didn't cause or precede your loss of libido. Start out with this before they have a chance to mention it.

Make your point and objective clear: Your loss of libido seems to have come out of nowhere and you are frustrated and would like to regain your normal level of interest in sex. Let them know that you are looking for a solution, you won't be satisfied with suggestions about what might be causing it.

If they mention age, ask them what that has to do with it. Remind them that regardless of your age or marital status, you are an adult in a healthy relationship and would like to have a healthy sex life.

All that said, if they take you seriously and still suggest diet and lifestyle, it might be worth investigating. Not in terms of "lose weight, try weight watchers," but changes in diet (for instance, eating much more fat, much more sugar or much more processed food) might be the culprit. Also, if your lifestyle has become more sedentary, that might be zapping your energy and libido as well. Limiting processed foods and/or increasing activity might help things. YMMV, but that has been my experience.
posted by necessitas at 5:58 PM on April 4, 2007

Uh, no one has mentioned Wellbutrin? A little known secret is that many people use the drug to increase their libido. It is somewhat of a panacea (ADD, depression, stop smoking) ... and someone I met has a problem with none of these. They did notice a general horniness and increased sexual pleasure.

I thought this was just because Wellbutrin tends to offset side effects from other antidepressants. At least that's why my doctor has prescribed it for me - to counter the drowsying effects of another antidepressant. It hasn't fired up my sex drive at all, now that I'm back on the pill (it's convenient, sigh). It has, however, done other wonderful things for me (e.g. made me a LOT less apathetic about the world).

But I'm not a medical professional, and Slarty appears to be, so I mean, talk to your doctor about it. I just haven't experienced that positive side effect.
posted by tastybrains at 6:52 PM on April 4, 2007

This may sound weird, but you might also consider taking your boyfriend along for these appointments.

Disgusting but true. Take it from me. After coming out of surgery once, my doctor refused to answer my questions about the pain meds he put me on and instead directed sarcastic commentary about my pain response directly to my boyfriend.

It's a sad truth that many doctors (no offense, in-thread doctors! I'm sure you're all fine!) don't take women's health concerns very seriously, either because they think we're incapable or whining or who on earth knows what. It's a tangled web of crazy. So use their behavior against them -- take your boyfriend along.

The nurses aren't much better sometimes (see: the one who threatened to keep my boyfriend away from me in recovery unless I stopped crying [in pain]).
posted by bitter-girl.com at 7:39 AM on April 5, 2007