She says low libido can be a side effect of necessary medications like antidepressants, anxiolytics, antipsychotics, antacids, and even ones for blood pressure, not to mention a result of anxiety and stress, concerns about body image, and discord in your relationship. Grover points to vaginal atrophy, which can cause pain and dryness during intercourse, as another significant physical roadblock for libido. Less blood flow means less vaginal lubrication, difficulty with or an inability to achieve orgasm, and decreased sensation in the vulva during sexual activity. “The decline in estrogen impacts sexual behavior in women due to its connection to genital arousal,” says Leah Millheiser, MD, an ob-gyn and chief medical officer for menopause telemedicine company Evernow. “Testosterone is the main hormone responsible for a healthy sex drive and libido,” says Monica Grover, MD, an ob-gyn and chief medical officer for sexual-health spa VSPOT, adding that a decrease means less signaling to the genital system to increase sensitivity and response. First there are diminishing hormones, particularly estrogen and testosterone. That physiology can change dramatically with age and the menopause transition and have a ripple effect on sex drive, libido, and arousal. “The Western medical establishment-specifically how medicine is taught and practiced-is still broadly illiterate when it comes to female sexual anatomy and physiology, as conceptually distinct from our ability to reproduce,” says Wheeler. Medical textbooks are often missing anatomical drawings of this clitoral anatomy and aroused vaginas, leading to a major knowledge gap, says Carolyn Wheeler, cofounder of sexual-wellness brand Vella. “When doctors showed us that chart, I was like, Oh, my God, I had no idea how large the clitoris was-it really shouldn’t be that hard to find,” quips Anne Fulenwider, cofounder, along with Monica Molenaar, of Alloy Health. Look at a diagram comparing the anatomy of the clitoris to that of the penis (women’s health start-up Alloy Health handily offers one on their website) and you’ll be struck by the similarities. “If we’ve only understood the shape of the clitoris for 18 years, it’s not a surprise that we’re behind in understanding female sexual pleasure compared to male pleasure.” Helen O’Connell, if you can believe that,” says Amy Killen, MD, a regenerative- and sexual-medicine practitioner. “The full anatomy of the clitoris wasn’t published until 2005 by Dr. That the clitoris is connected to women’s pleasure is at the heart of the issue. Indeed the story cracked open a topic that has been woefully overlooked, not just culturally but also medically. “This!” one friend texted me with a link. Why Don’t Doctors Study It?” That was the attention-grabbing headline of a story published by The New York Times last October that quickly made its way across many women’s group-chat threads.
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