SEXUAL PROBLEMS: DECREASE SEX DRIVE
Question: I am a healthy middle-age male, but just don't have the same interest in sex that I used to. Does sexual drive decline as men get older?
Answer: Many men report decreased interest in sex as they age. In a national survey of adult sexual behavior, 14-17% of men reported lack of interest in sex. Men over age 40 were two to three times as likely to report lack of interest compared to men under age 30.
Sexual desire ("libido") is one of several ingredients of male sexual function. The others include the ability to have and sustain an erection, to ejaculate, and to have an orgasm. Many factors influence sexual desire. An adequate level of the male sex hormone testosterone is necessary for normal libido. Many medications can decrease sexual interest, including diuretics, antidepressants, blood pressure medications, and some medications for treating ulcers. Nonprescription drugs, including alcohol, depress libido.
Psychological factors are thought to play a prominent role in decreased sexual desire. Conflict with your sexual partner may decrease sexual interest and performance. Performance anxiety commonly interferes with libido. Men who report sudden onset of sexual problems often suffer from performance anxiety, since most organic causes of sexual dysfunction develop gradually. Many men report decreased libido because they are distracted by financial, work, or other sources of stress. Finally, depression reduces sexual drive.
It is often difficult to sort out psychological from organic sources of sexual dysfunction. Failure to sustain an erection sufficient for intercourse can be due to a variety of organic problems, including diabetes, atherosclerosis, hormonal problems, medications. This, in turn, may lead to performance anxiety and depression. Once it was thought that most cases of impotence derived from psychological rather than organic causes, but now we know that the reverse is often the case.
If libido is a problem for you, talk to your doctor. He or she should do an assessment that may include laboratory studies, a physical examination, and screening for depression. If libido and erectile problems occur together, your doctor may recommend that you see a urologist with expertise in this area. If your doctor suspects that psychological issues play the prominent role, he or she may recommend evaluation by a mental health professional.
