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Getting irregular periods and not interested in intercourse. Is it hormonal or psychological problem?

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Practicing since : 2003
Answered : 2190 Questions
Hi Dr. Grief,
I have been dating my girlfriend for approximately about a year now. We have had some sexual issues since we have been dating. At first i wasn't aware, but after a few weeks she told me that sex has never felt good for her, nor has she ever had any sexual desire/drive. She had been with 4 previous partners so I was hoping that ruled me out of the question. I was convinced that it could be attributed to her birth control that she has been on for 6-7 years. She went to her OBGYN and they took her off of birth control hoping it would help. It has been about 6.5 - 7 months and she said that she has seen very very slight improvement but nothing to get excited about. Interestingly enough, her first doctor basically just said she was inexperienced but the second doctor is the one that recommended she go off of it. Since she stopped birth control in early XXXXXXX it hasn't really gotten any better. She has no feeling in her clitoris and she says that sex only feels good for a few second when I hold still (this perplexes me). Her periods are irregular and she has skipped several periods in the process but gets them usually at 5 week intervals when they do come. To help the situation, we went to the health food store and they recommended XXXXXXX quai, a chinese herbal supplement to help balance her hormones. She returns to her OBGYN in 5 weeks or so. Our relationship is great, from both ends, and I understand that it could be partly psychological as well as physical. At this point we just do not know what to do and are very frustrated with the whole process. Is it hormonal? Is it psychological? I feel that she has become so frustrated that it just hasn't helped the whole process. Is there anything that she could take to help? I've been extremely supportive throughout the past year trying different condoms/oils and have been very mentally supportive for her, hoping that would eliminate some of the psychological mindset of it. My main concern is that she has no sex drive, absolutely zero, which leads me to think that it could be hormonal. Is there anything we can do? Anything that she could take to see if it is hormonal? We have also tried a women's libido supplement before as well, which didn't seem to work well; however, we only gave it two months. Any advice at this point would be greatly appreciated. She is still under her parents health insurance, and with little to no mental support from her mother, it has become very difficult to see a doctor other than her normal yearly checkup.
Fri, 14 Dec 2012 in Sexual Problems
Answered by Dr. Jonas Sundarakumar 5 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I understand that both of you are going through a distressing time with regards to the sexual aspect of your relationship. Now, a woman's desire for sex is based on a complex interaction of many components such as physical well-being, emotional well-being, past sexual experiences, beliefs, lifestyle and current relationship. Physical causes of decreased sex drive include hormonal problems, general medical conditions affecting sexual functions, side effects of medication (like certain anti-depressants) and other substances.

In your girlfriend's case, you mention that there are no obvious psychological factors or emotional problems, which may be hampering her sexual desire and functioning. Like you have said, there is indeed a likelihood that this problem could be due to physical causes such as a hormonal imbalance. You have also mentioned that she has irregular periods, which again could be an indicator of an underlying hormonal problem. Since this problem has been quite severe and causing significant difficulties for both of you, I would suggest its better that she has a proper medical evaluation done. This would include a gynaecological examination, basic lab investigations (like hemoglobin, blood sugar, urea / creatinine, etc.) plus some additional hormonal tests like FSH, LH, Oestrogen and Progesterone levels and a Thyroid function test.

Irrespective of the cause (physical or psychological), psychological and behavioural interventions can definitely be of help. For example, you have mentioned that she is able to experience sexual pleasure only with certain specific acts (like only when you hold still), which may be completely contrary to your ways of experiencing sexual arousal or pleasure. Moreover, past sexual experiences, childhood experiences, preformed distorted or negative notions regarding sex, etc. can all be sub-conscious factors which could be contributing to or worsening the problem. What I'm trying to say is that there's more to "psychological" factors than just obvious emotional stress or relationship difficulties. There are certain specific forms of "sex therapy" which can tackle such issues of inadequate sexual arousal. So, I think that it would also be worthwhile to consult a therapist (preferably a marital / sex therapist), for a detailed evaluation.

Further treatment should be according to the findings on evaluation. For example, if there are hormonal imbalances, then appropriate hormonal supplementation will be necessary. There are also certain specific types of anti-depressants (like Bupropion) and other medication (like dopamine receptor agonists), which can be effective in improving low sexual drive. But the decision regarding medication should be done only after a proper evaluation.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist
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