Sexuality, desire and sexual performance involve many interlocking and overlapping health, physical, social, interpersonal and psychological factors. As those factors shift and change throughout life, so does our sex drive and ability to have and enjoy sex.
David Cohen
Q&A with Dr. Lori Brotto
One researcher making contributions to the field of sexual health and longevity is Dr. Lori Brotto. She’s one of North America’s leading researchers on sexual arousal and desire, and sexual dysfunctions. We spoke with the respected Canadian researcher to learn more about the science behind libido, and natural ways to keep your sexual spark alive. Welcome, Dr. Brotto.
Q: How prevalent is low sexual desire or loss of sexual arousal in adults over 50?
A: Low sexual desire is probably the most common sex-related concern for people 50 and older. About 20-25% of women and 20% of men over 50 describe a reduction in their level of sexual desire or an altogether lack of libido. Contrary to popular belief, low desire is actually more common in men than erectile dysfunction, even though erectile dysfunction receives much more media attention.
Q: What are some of the causes of low sexual desire for men and women?
It’s difficult to determine in any one person what the exact cause is, but what we know is that mood is tightly associated with sexual desire. Symptoms of depression, anxiety and even day-to-day stress can wreak havoc on levels of sexual desire. We also know that there are a number of medical and biological contributors to low desire. Many of the medications commonly prescribed to control blood pressure, heart disease, diabetes and manage pain, affect sexual arousal.
In men, the causes of low desire tend to more medical or biological. In women, they tend to be related to mood and self-esteem, relationship happiness and conflict.
Q: In your practice, you meet with female clients with Hypoactive Sexual Desire Disorder (HSDD), a disorder that’s characterized by an ongoing lack of interest in sex. How is the disorder diagnosed? And what’s an abnormal amount of time to be disinterested in sex?
A: First, it’s important to recognize that there are changes in a woman’s level of sexual desire that aren’t cause for concern. For example, if a woman is going through a period of stress where she’s sleeping very little or adjusting to new medication, her sexual desire may be affected and that’s completely normal. We often refer to circumstances like this as adaptive changes in sexual desire. Once the issues or stressors pass, the woman bounces back.
In the case of a sexual desire disorder, such as HSDD, the woman’s level of desire never really bounces back. In more clinical terms, we require that a woman have ongoing concerns about low desire or absent desire for a period six months or more. Some of the hallmark features of a sexual desire disorder include no longer initiating sexual activity, not responding to a partner’s invitations, not thinking about sex, and not fantasizing about or having any erotic thoughts about sex.
A lot of women will say that they don’t have desire before a sexual encounter, but at some point during the encounter they start to feel excited. So, to begin, she may not be in the mood for sex but she begins to feel pleasure as the encounter continues. For a woman with a clinical diagnosis of a sexual desire concern, that doesn’t happen. Throughout the sexual encounter, she feels lack of pleasure, a lack of interest and quite frankly, her mind is somewhere else.
Q: Are hormonal changes to blame for low sexual desire in older women?
A: Indirectly. The reduction in estrogen and progesterone that come with aging tend to affect physical arousal rather than sexual desire. For example, a drop in estrogen levels can cause vaginal dryness, making sexual activity or sexual intercourse uncomfortable, even downright painful. If sex is painful or unpleasant, this will of course take a toll on a woman’s level of desire.
Q: Despite these and other challenges, how can a couple that has been together for many years keep their sex life exciting?
A: In my practice, what I hear often is: I love my partner…but our sexual relationship isn’t what it was like 30-40 year ago. How do we get that spark back?
In decades-long relationships, few things remain mysterious. The novelty, excitement and romance wear off in a lot of cases, and is replaced by things such as stability, comfort, companionship and security. And, ironically, those things can get in the way of desire.
I advise couples in longterm relationships to think about ways they can inject newness and novelty into their relationship, mimicking how things were in the very beginning. Surprise your partner with a gift or last a minute vacation; leave love notes with tempting and salacious messages for one another; be flirtatious. Around sexual activity, there are plenty of ways to infuse novelty. Don’t be sexually intimate in the same place, in the same way, or at the same time of day for the rest of your life. Be creative! Attend a sexual health workshop or read a book to inspire new and novel ways to spice up your sex life.
Q: According to the Centers for Disease Control and Prevention, Sexually Transmitted Infections (STIs) are on the rise among people 50 and older. Why?
A: It’s wonderful that older adults no longer believe that sex ends at age 50 or at menopause. In fact, many people relish in making sex an important part of their lives well into their 70s, 80s and beyond. However, what tends to happen is that because they’re at an age where they’re no longer at risk of getting pregnant, or getting their partner pregnant, they don’t use contraception.
But, to prevent STIs you must practice safe sex. One of the most effective ways to do that is to use a condom. It’s also important to have open and honest communication your partner or partners about the need for protection, and to get tested regularly for STIs.
Although there are treatments to manage symptoms of STIs, that’s not the case across the board. For example, syphilis is a very treatable bacterial STI, but left untreated, it can be fatal, or progress to the brain and cause complications such as severe cognitive impairment or heart attack.
Q: For more than 10 years, you’ve been studying the link between mindfulness meditation and sexual desire. Tell us about your research and your findings.
A: Over the last 15 years or so, our team at the University of British Columbia’s Department of Obstetrics and Gynaecology has been applying mindfulness meditation as a way to manage sexual dysfunction and increase or cultivate sexual desire.
We teach women in particular how to practice present moment, non-judgmental awareness. Mindfulness meditation trains the brain to stay in the here and now, fending off distractions and negative self-judgement. The brain is truly the largest sex organ. Attention and focus has been found to be mission-critical for cultivating a sexual response and sexual desire. Skills, such as mindfulness teach the brain to connect more completely with the body, allowing us to experience all of the sensations of sex. In my opinion, it’s the best treatment today for sexual dysfunction.
Editor’s Note: In April 2018 Dr. Brotto will release her book, Better Sex Through Mindfulness. A pioneer in the use of mindfulness for treating sexual difficulties, Dr. Brotto has helped hundreds of women cultivate more exciting, fulfilling sexual experiences. In this accessible, relatable book, she explores the various reasons for sexual problems and provides easy, effective exercises that readers can do on their own to increase desire and sexual enjoyment. Available for pre-order on Amazon.
