Makindo Medical Notes

📖 Introduction

Loss of libido (reduced sexual desire) is a common presentation in both men and women, affecting quality of life, relationships, and sometimes reflecting underlying medical or psychological illness. It is multifactorial — influenced by biological, psychological, and social dimensions. Clinicians must approach sensitively, with a biopsychosocial lens, to identify reversible causes and provide appropriate support. 🌟

🧬 Basic Physiology of Libido

• 🧠 Central Regulation: Libido originates in the brain, particularly the hypothalamus and limbic system, which process reward, mood, and sexual desire.
• 💉 Hormonal Influence:
  • Testosterone (in men, and also in women in lower amounts) is key for maintaining sexual drive.
  • Oestrogen (in women) maintains vaginal health, lubrication, and mood stability, contributing to sexual function.
  • Prolactin (raised levels) and thyroid hormones (hypothyroidism) can reduce libido.
• 💓 Vascular and Neurological Systems: Adequate blood flow and intact neural pathways are required for arousal and performance.
• 🧠 Psychological & Social Inputs: Stress, mood, body image, cultural or relationship factors all influence desire and expression of sexuality.

🧾 Aetiology – Broad Categories

• 🧠 Psychological: Depression, anxiety, relationship conflict, trauma history.
• 🧬 Endocrine: Hypogonadism, hypothyroidism, hyperprolactinaemia, menopause.
• 💊 Medication-induced: SSRIs, beta-blockers, hormonal contraceptives, antipsychotics.
• 🩺 Chronic Illness: Diabetes, cardiovascular disease, chronic pain, renal or liver disease.
• 🍷 Lifestyle: Alcohol, smoking, recreational drugs, poor sleep.

📝 Clinical History

A thorough history is crucial in determining the underlying cause of peripheral oedema or ankle swelling.

1. ⏳ Onset & Duration: Sudden vs gradual onset of libido change.
2. 💑 Relationship Factors:
   • Quality of the patient’s relationships
   • Recent conflicts, stressors, or life changes
   • Communication patterns with partner(s)
3. 🧠 Psychological Factors:
   • Depression, anxiety, or other mental health issues
   • Work, financial, or family stress
   • History of trauma or abuse
4. 🩺 Medical History:
   • Chronic conditions (e.g., diabetes, hypertension, CVD)
   • Hormone-related problems (thyroid disease, hypogonadism, menopause)
   • Reproductive history (e.g., pregnancy, postnatal, menopause)
5. 💊 Medication History:
   • Antidepressants (esp. SSRIs)
   • Antihypertensives
   • Hormonal therapy or contraceptives
6. 🏃 Lifestyle Factors:
   • Alcohol, smoking, or substance use
   • Sleep pattern and fatigue
   • Diet and exercise levels

🩺 Physical Examination

1. 👀 General Inspection: Body habitus, BMI, nutritional status.
2. ❤️ Vital Signs: BP, HR, BMI.
3. 🧬 Endocrine Examination:
   • Hypothyroidism → dry skin, bradycardia, weight gain
   • Hypogonadism in men → gynecomastia, testicular atrophy
4. ⚕️ Genital Exam: Only if symptoms suggest pathology or atrophy.

🔬 Investigations

1. 🩸 Blood Tests:
   • Hormone panel: Testosterone (men), Oestradiol/FSH/LH (women), Prolactin
   • Thyroid function (TSH, free T4)
   • HbA1c or fasting glucose (if diabetes suspected)
2. 🧠 Psychological Assessment: Screen for depression/anxiety.
3. 🧲 Further Imaging: MRI pituitary if prolactin high (rule out prolactinoma).

🧩 Possible Causes of Loss of Libido

• 🧠 Psychological: Depression, anxiety, relationship strain, trauma history.
• 🧬 Endocrine: Hypothyroidism, hypogonadism, hyperprolactinemia.
• 💊 Medication-related: SSRIs, SNRIs, beta-blockers, hormonal contraceptives.
• 🍷 Lifestyle: Alcohol, drug misuse, poor sleep, low exercise.
• 🩺 Chronic illness: Diabetes, cardiovascular disease, chronic pain.

🛠️ Management

1. 🎯 Treat underlying causes: Optimise medical, psychological, or relational contributors.
2. 🧑‍⚕️ Psychological support: Counselling, CBT, sex therapy.
3. 💊 Medication review: Switch or adjust offending meds; consider HRT or testosterone replacement if indicated.
4. 🏃 Lifestyle: Exercise, sleep hygiene, reduce alcohol/substance use, balanced diet.
5. 📅 Follow-up: Regular reassessment and adjust plan.

📊 Causes & Management Table

🔎 Cause	🧪 Tests	💡 Management
🧬 Hormonal imbalance	Testosterone, LH/FSH, TFTs	Hormone replacement, endocrine referral
🧠 Psychological (depression/anxiety)	PHQ-9, GAD-7	CBT, therapy, cautious antidepressant use
💊 Medications (SSRIs, beta-blockers)	Medication review	Switch/adjust meds with specialist advice
🩺 Chronic illness (diabetes, CVD)	Glucose, HbA1c, ECG, lipids	Optimise disease control, lifestyle changes
🍷 Alcohol / substances	Substance screen, LFTs	Counselling, cessation support, addiction services
💑 Relationship issues	History, partner discussion	Couples therapy, open communication