Reader’s Question

I seem to be having some problems being as interested in sex as I used to be. I’m not planning on becoming a monk or anything, but I have a low desire to initiate sexual activity these days. I was injured a little over 3 years ago and have had debilitating back problems. As result, I’ve been on a wide range of medications and recently had surgery. I also take medicines for high blood pressure in addition to pain killers, anti-inflammatories, and antidepressants.

I’m not sure if my lack of sexual urge stems from the injury, all the medications I’m taking, or the fact that I’m simply getting older. I am a 36-year-old male, and it seems that prior to my injury I had a more normal sexual “appetite.” I don’t want my spouse to think I’m not in love with her or that I don’t think she is appealing to me anymore. I just don’t know what to do anymore. My doctor gave me a sample of the “little blue pill” and when it worked, it really worked! The physical side of things seemed to work when prompted, but it still seemed to take longer than usual to get the “motor warmed up.” I’m still concerned that I don’t have the desire to start anything I used to have.

Do you think my problem is physical, medical (medications), or psychological? I have had my testosterone level checked, as well as other factors, and all the blood work has come back fine.

Our Clinical Psychologist’s Reply

There is considerable agreement among both researchers and clinicians about the leading causes of diminished sexual drive. The most frequently cited causes, especially among men under age 50 are:

• Depression (for which you indicate you are taking medication)
• Medication side effects (including the side effects of the types of medication you indicate you are taking)
• Stress and trauma (medical and/or emotional — which you report)
• Endocrine system disorders and hormonal imbalances (which you indicate don’t seem to be an issue now, at least according to lab results)

So, as you can see, there are several likely contributors to your problem.

Probably one of the best things you can do in addition to discussing matters fully with your primary care physician is to supplement your antidepressant treatment with psychotherapy. Depression has many facets and contributing dynamics. Medication helps restore a more normal brain chemistry, but there is abundant evidence that medication alone is rarely the answer.

There are mental health practitioners who specialize in the treatment of individuals with depression and complicating medical factors. It might prove very helpful to you to seek out such a professional. Your medical doctor might also be able to find ways to modify your medication regimen if it should become apparent that medication side effects are a factor. With properly coordinated and comprehensive treatment, you’re likely to regain a sense of vitality, improved sexual interest, and a greater sense of confidence about your relationships.