5 common conditions that can lower sex drive

Common conditions, like cancer, diabetes, heart disease, etc, not only affect patients’ physical health, but also their sexual health.

Despite this, sex remains a taboo topic in American culture. We don’t even know how to address it to children in schools. For instance, in the late 1990s, the US government adopted the abstinence-only-until-marriage (AOUM) approach to adolescent sexual and reproductive health. Public schools in 49 of 50 states accepted federal funding from this program. As a result, public school sex education focused on raising awareness of the risks of sex, like sexually transmitted infections and youth pregnancy, rather than balancing the risks with the scientifically supported benefits. What’s more, rigorous research showed that AOUM failed to achieve its goal of delaying sexual initiation, reducing sexual risk behaviors, or improving reproductive health outcomes.

The history of American inhibitions about sex is too complex to detail here. Suffice to say that because of these longstanding cultural mores, modern public discourse about sexuality is often described in a negative light, focusing on the risks and dangers of sex. Meanwhile, discussion about the physiological and psychosocial health benefits of sex is commonly ignored, according to a white paper from Planned Parenthood.

This discussion might be missing in physician’s exam rooms, too. Six in 10 American adults have chronic disease, but it’s likely that they aren’t receiving sufficient education to help them cope with the effects that their conditions can have on their sexual health, and how those effects can change their quality of life. The problem becomes more challenging when considering that cultural mores prevent patients—and physicians, too—from broaching the subject simply because it’s uncomfortable to talk about.

So, next time you suspect a patient has one of these conditions, consider spurning the taboos and help them understand its implications for their sexual health and overall quality of life.

Cardiovascular disease

According to the American Heart Association, decreased sexual activity and function are common in patients with cardiovascular disease (CVD), but not for the reasons you might expect. Patients with CVD often endure psychological distress because of their conditions, which is correlated with negative downstream effects on sexual function. In patients with coronary artery disease, heart failure, congenital heart defects, recent heart attacks, coronary artery bypass grafting, implantable cardioverter defibrillators, and cardiac transplantation, sexual activity frequency and satisfaction often decline because of the anxiety that sexual activity will worsen the underlying cardiac condition or cause death. That anxiety can lead to depression, an important contributor to erectile dysfunction (ED) and decreased libido.

While some patients with severe CVD may be putting themselves at increased risk for complications by having sex, doctors can clear many patients for sex after a simple physical exam or exercise test. For those with depression, anxiety, or decreased libido, physicians can recommend patient and partner counseling, refer to psychiatrists, or prescribe medication.

Diabetes

Long-term poor blood sugar control can damage nerves and blood vessels, inhibiting feeling and the blood flow that is necessary to maintain an erection, according to the Mayo Clinic. As such, some male patients with diabetes are likely to experience ED while managing their condition. Other conditions that are common in men with diabetes can commonly cause ED, like high blood pressure, heart disease, and depression.

Women with diabetes are also likely to experience decreases in sexual function, including reduced libido, decreased vaginal lubrication, and reduced or absent sexual response, including the ability to stay aroused, achieve an orgasm, or maintain feeling in the genital area.

The good news is that diabetes can be a preventable condition, and sometimes reversible in those who have already developed it. Many of the factors that cause symptoms that reduce sexual function and desire in patients with diabetes can also be reversed. Plus, many of the factors, like improving blood sugar levels, have the added benefit of helping patients feel better overall and improving their quality of life.

Obesity

While the health hazards of obesity have been thoroughly studied and are well known to most patients, its effects on sexual health are not frequently discussed. For instance, obesity in men reduces testosterone levels and increases the likelihood that men will experience ED. Moreover, obesity can have negative impacts on fertility—it has been linked to low sperm counts and reduced sperm motility, both of which have been shown to make men less fertile.

Women who are obese experience similar reductions in sexual health. Researchers have shown that obese women have lower sexual function scores, and that weight reduction seems to improve sexual function in young obese women. Moreover, obese women are 4 times more likely to experience an unplanned pregnancy than normal weight women, despite them reporting lower rates of sexual activity.

As with diabetes, the good news is that obesity is a preventable condition. And just like diabetes, reducing obesity will not only bring beneficial effects to sexual health, but to overall health as well.

Cancer

Many types of cancer can have detrimental effects on sex to varying degrees. “Some surgeries and treatments might have very little effect on a person’s sexuality, sexual desire, and sexual function,” according to the American Cancer Society. “Others can affect how a certain body part works, change hormone levels, or damage nerve function that can cause changes in a person’s sexual function.”

Doctors, caregivers, and partners can help patients with cancer confront issues of sexual health by maintaining discretion, helping to talk through emotional issues, helping address problems with self-esteem, and tracking side effects. 

On the upside, sexuality and intimacy have been shown to help patients with cancer bear the burden of their disease by helping them cope with feelings of distress.

Mental health disorders

Healthy and intimate sexual relationships are a key component of mental well-being. But, common mental health problems like anxiety, depression, personality disorder, seasonal affective disorder, and bipolar disorder can all have detrimental effects on sexual health.

Notably, a markedly decreased sex drive is a common indicator of major depressive disorder, according to Jennifer L. Payne, MD, director of the Women’s Mood Disorders Center, Johns Hopkins Hospital, Baltimore, MD.

“Change in sex drive is a key symptom we look at when deciding if someone fits the diagnosis for major depressive episodes,” Dr. Payne wrote. “A primary symptom of depression is the inability to enjoy things you normally enjoy, like sex.”

But mental health disorders don’t exclusively cause a reduction in sex drive and performance. Some individuals, including those with compulsive sexual behavior, can become consumed by sexual thoughts and an out-of-control sex drive. Like most addictions, when sex addiction and compulsive sexual behavior is left untreated, it can damage self-esteem, relationships, careers, and health. 

Time to have ‘the talk’

Both the patient and physician may feel uncomfortable in the exam room broaching the subject of sex. But, consider that studies have shown that most patients with CVD believe they haven’t been appropriately educated about their conditions’ effects on sexual health and desire more information on how to resume their normal sexual activity. Other patients with common conditions most likely feel the same way. 

Having an open discussion or referring patients to counseling can go a long way toward improving sexual health, which in turn can provide both physical and mental health benefits.

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