Treating diminished sexual desire - Alzheimer's disease and sexual behavior; birth control problems; coffee and fertility - from The Doctor's Casebook - column

Nutrition Health Review, Fall, 1989 by Edwin Flatto

Treating Diminished Sexual Desire From The Doctor's Casebook

Q: Are there medications or injections available to increase sexual desire in a 65-year-old man? A: There are many causes for impaired sexual ability as well as desire. At least 50% of the probable cause may be physical, and the rest may be psychogenic. There is no treatment that covers all possible causes. To try to treat a man psychogenically when the root cause of his problem is clogged penile arteries or nerve damage is just as foolish as operating on a man who has a psychological problem. Before any treatment is started, the etiology, or cause, of the complaint should be sought first. A recent case involved a man in his mid-sixties who took oral testosterone to increase his libido and performance. The testosterone was later blamed as an etiological factor in carcinoma of the prostate which later developed. Testosterone, either orally or intramuscularly, should be administered only when there are definite clinical indications for it and only under a physician's supervision. Q: Do you recommend sterilization for a woman in her mid-twenties who has an unhappy marriage and does not want to have more children with her husband? A: A tubal ligation cannot always be reversed. If the woman eventually gets a divorce she may remarry and want to have a child with her new husband. There are many safe and less permanent methods of birth control, such as the "sponge" and "diaphragm." Everything changes, especially a young woman's mind. No one can foresee the future. In my opinion, it would be a great mistake for this woman to have the operation. Q: Does Alzheimer's disease affect sexual behavior? A: According to a recent book, Dementia: A Clinical Approach, by J.L. Cummings and D.F. Benson (Boston, Butterworth, 1983), 5% of those over 65 years of age are severely demented and 10% to 15% are mildly or moderately intellectually impaired. Dementia of the Alzheimer type (DAT) is the most common type of dementia in the elderly, averaging about half of all cases. Although there are few studies on record regarding sexual interest and performance of those suffering from Alzheimer's, the medical journal Medical Aspects of Human Sexuality interviewed the wives of 26 male DAT patients and reported that: 1) Less interest in sex by eight of the DAT patients after onset of the disease. 2) Greater libido exhibited by four DAT patients who wanted more frequent sexual activity than before onset of illness. 3) Ten of the wives were "unable" to have sexual relations with their husbands even though the husbands wanted sex. The report also cited hypersexuality in several cases studied, such as a Mr. B, a 68-year-old accountant who exhibited progressive memory loss and was asked to retire. Three years after his first DAT symptoms appeared, Mr. B "demanded sexual relations four to six times a day, often awakening his sleeping spouse for the purpose of having sex." His approach also had changed. "He was no longer concerned about his wife's feelings, and she reported that he made her feel like a `sex object' rather than his wife." His behavior distressed her, and while she didn't want to deny him this aspect of her marital life, she found herself refusing his sexual advances. "In time, Mrs. B learned to redirect her husband's sexual advances to other activities, and she started to go to bed later -- after he had fallen asleep. These strategies allowed their relationship to continue less stressfully despite his altered behavior." Q: Is there a possibility that a medication I am taking for acne (tetracycline) affects my efforts in using the pill for birth control? I am experiencing intestinal bleeding. A: There have been cases where tetracycline has altered the bacterial flora in the intestines and thereby hinders absorption of the steroids in the oral contraceptives. Breakthrough bleeding is one of the symptoms indicating that the pill has lost some of its effectiveness. You may want to switch to the sponge, at least as long as you're taking tetracycline. Q: I can't take contraceptive pills and have had no luck with other methods of birth control. What do you think of the "sponge?" A: The "sponge" is not quite as effective in preventing pregnancy as the "pill," but neither does it have the "pill's" undesirable side effects. In a study involving 2000 women, the Today Sponge demonstrated an effectiveness rate of 89% to 91%. Unlike the diaphragm, the sponge provides continuous protection during multiple acts of intercourse without the need to apply additional spermicide. The sponge may also be inserted up to 24 hours prior to intercourse, thus providing a greater degree of sexual spontaneity. Q: Can coffee affect fertility? A: According to new research reported in the British Medical Journal (Lancet 1:1453, Dec. 24-31, 1988), even two cups of coffee a day may decrease a woman's chances of getting pregnant. According to the report, women who consume no more than one cup of coffee a day have twice the probability of becoming pregnant as those whose caffeine consumption is higher. It should be kept in mind that other beverages besides coffee, such as soft drinks and tea, may also contain caffeine.