Web Chat on Women with Low Libido with Dr. Candace Brown, PharmD. (The following is an edited transcript of questions and answers from a web chat held on Wednesday, November 6, 2002 on News Channel 3)

Hello. I am Dr. Candace Brown. I specialize in women's health problems - particularly female sexual disorders. These disorders may be low sexual desire (libido), low arousal, inability to have an orgasm, or pain on intercourse.

Today, I will focus on women with low libido. One out of 3 women in the US suffer from low libido (sexual desire). This includes lack of interest in sex.

Q: How do you know if you have low libido? What's normal?

Dr. Brown: If you are not interested in having sex - you do not fantasize or think about sex - and you tend to avoid your partner - you probably have low sexual desire. Particularly if you are post menopausal (estrogen no longer being produced in your ovaries)

Q: My doctor says I'm pre-menopausal, getting close to menopause. Could that be the cause?

Dr. Brown: You must be naturally menopausal, between 40-70 years of age, have low sex drive, and have been receiving hormone therapy. You must be concerned about your lack of sex drive.

Q: What does "naturally menopausal" mean?

Dr. Brown: Naturally menopausal women are those that have not had surgical removal of their ovaries. You no longer have regular periods, have hot flashes, which are generally treated with estrogen replacement therapy.

Q: Hi, you said you wanted "natural" menopause. I had a hysterectomy 12 years ago.

Dr. Brown: Many women who have hysterectomies have low libido. You can be clinically treated atUT Medical Group, 901-347-8320, or ask your doctor about medications that may help you.

Q: I can't take hormone therapy and take Evista. I do have a low libido though and was wondering if there is something out there for someone like me. I have tried testosterone shots---didn't work. Don't trust these on-line products.

Dr. Brown: There are products on the market - but not are approved by the Food and Drug Administration. Such products as Estratest have been used with some suggest. Either your doctor or the OB/GYN clinic at Germantown (901-347-8320) can help.

Great , thanks.

Q: What about age? I'm only 43?

Dr. Brown: Many women who have had their ovaries removed have low libido - regardless of their age. Whenever the surgery occurred - the low libido often follows.

Q: Does the Evista and age play a part in the low libido? I still have one ovary, but I don't think it's working.

Dr. Brown: Women naturally lose about 1/2 of their estrogen and testosterone from the ovaries when they become menopausal. Women who have had their ovaries removed have even a greater loss. We believe that testosterone increases libido and a sense of wellbeing.

If you are having irregular menses, hot flashes, low libido - that one ovary may not be providing enough hormone. Menopause can occur between 45-55. The most common age is 52.

Q: Do these patches that you are trying cause facial hair growth and other symptoms of testosterone use?

Dr. Brown: These patches provide just enough testosterone to match that of a reproductive-age woman. This should not cause increased facial hair, but if it did occur - it is reversible when you stop taking the patch.

Q: How do you know you're in menopause? I'm 46.

Dr. Brown: You know you in menopause if you have had hot flashes, night sweats, irregular menses, insomnia and vaginal dryness. Are between 45-55. Are taking hormone replacement therapy.

Q: I've had low sex drive all my life. Can the patch help that too or is it just for menopause?

Dr. Brown: If you have a low sex drive all of your life - it may be a little more difficult to treat. In that case - it may have worsened with menopause because of the lower hormonal levels.

Q: This may be a stupid question, but what is clinical treatment versus a doctors appointment.

Dr. Brown: Clinical treatment would be the same as a doctor's office visit.

Q: I am 32 years old. I had the tubal ligation done in 1991 but since then I was placed on the depo shot because I was having very bad cramps with my menstruate cycle. During and after the treatment I lost my sex drive. How can I get it back?

Dr. Brown: A number of medications can have an adverse effect on libido. Depo Provera may have done that to you. You may wish to ask your doctor about another type of hormone therapy.

Q: If I get in the study, how long does it last? If the patch works can I keep getting it after the study?

Dr. Brown: The study lasts 6 months. After the study, there is an extension phase where you are guaranteed of receiving the real patch for 6 months. The patch will probably not be available for commercial purchase for a couple of years. We would need to try something else for you, if it seemed like the patch worked - after the study is over.

Q: What else would you try?

Dr. Brown: The Food and Drug administration has not approved any medications currently for low libido. Doctors often try Estratest or Testosterone vaginal creams off label.

Q: Do herbal medications work for low sex drive? I've seen a lot at the health food store.

Dr. Brown: Some herbal medications that have been investigated are DHEA and L-Arginine. The only problem - is you don't always know if you are getting the proper amount of medication - because herbal products are not regulated like prescription products.

Q: Can I get them from the doctor and get the right amount?

Dr. Brown: The only way you could get the right amount would be for your to try testosterone vaginal cream and have a pharmacist compound it for you. There is no guarantee on herbal tablets how much you are getting.

I would recommend your OB/GYN first. If your OB/GYN does not have the information, you could call the UTMG Germantown Office at 901-347-8320.

Do you have no interest in sex, avoid your partner, feel sex is a chore? Give us a call - we may be able to help.

Q: What kind of doctor do you need to see for this. It's embarrassing.

Dr. Brown: Having a low sexual drive can be "embarrassing" because you are discussing one of the most intimate aspects of your life. It is important that you feel comfortable with your doctor, and that you know that you are not alone. 1 out of 3 women report low libido.

Q: My husband makes me feel bad about it.

Dr. Brown: Relationship problems are one of the hallmarks of low libido. It is important that your spouse is knowledgeable about this disorder. Perhaps he could come in with you when you visit your doctor. Being educated about the disorder can be very helpful.

Q: He says I just don't want to have sex with him.

Dr. Brown: Not wanting to have sex with your spouse sounds a lot like low libido. Are you attracted to him - do you have sufficient time for sex - is the relationship going well?

I'm always tired.

Dr. Brown: You may want to address why you are tired. Are you stressed out? Working too much? Depressed?

Yes.

Dr. Brown: It is important to see your doctor so that all the medical, psychological, and medication issues can be sorted out. Good luck

News Channel 3: Thanks for joining the chat today. Be sure to join us each Wednesday for more health chats!

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