Lack of desire for sex is a really common issue with fibromyalgia. Although it can be an awkward topic, lack of sexual intimacy can be a huge strain on relationships and quality of life, so it is important to find the specific causes and address them head on.
The top three fibro sex blockers are: - Fatigue - Pain with intercourse - Low libido or sexual desire
Generalized fatigue from any cause, including fibromyalgia, will wipe out interest in sex. Because when you are exhausted and foggy and climb into bed, activity of any type, even pleasurable, is not going to win out over sleep.
To lessen fatigue we have to first focus on that other important bedroom activity: sleep. Improving sleep quality is the foundational treatment to lessen fatigue in fibromyalgia (learn how to do this in The FibroManual). Less fatigue can translate into more energy for sexual activity. But there are two other major factors that can limit sexual desire and enjoyment in fibromyalgia—painful intercourse and low libido—that may need to be addressed to regain sexual inspiration.
Treating Low Libido in Fibromyalgia
Activate the relaxation response
Limit medications suppressing arousal
Look for and treat adrenal burnout and low testosterone levels
Treatments to boost libido like oxytocin
In fibromyalgia our nervous system is constantly in fight-or-flight or “danger” mode, and this really drains any sexual desire. There has to be a certain amount of relaxation in the nervous system to allow arousal feelings to arise. In fibromyalgia we may have to specifically activate our body’s relaxation response to convince the brain to let down its guard enough to allow sexual desire to arise. Deep breathing, gentle stretching, yoga, laughter, meditation, and taking a bath are all ways we can move our nervous system into relaxation mode.
Foreplay can also serve as a relaxation trigger. Ask your partner to touch you in gentle ways that feel good or comforting. Many of my patients find that it takes more foreplay before their bodies start to respond sexually. This can require a lot of communication and patience between sexual partners.
Medications that calm the brain such as sedatives and anti-anxiety medications can in low doses help to reduce the fight-or-flight response and lighten the brain’s arousal blockade. However, these medications can make someone so sleepy or groggy that they are not interested in sex anymore, so it’s a delicate balance! CBD (cannabidiol) can be useful here as a non-sedating option. I had one patient who felt CBD really improved her desire for and enjoyment of sex.
Some types of medications commonly used to treat fibromyalgia can block sex drive. In particular, antidepressant medications that raise serotonin levels in the brain can both lower sex drive and make it more difficult to orgasm. In that case, health care providers often will try changing to a different antidepressant or prescribe a second antidepressant such as bupropion (Wellbutrin) that works on different pathways to counter sexual side effects. Another option is the addition a medication to improve blood flow to the genitals such as sildenafil (Viagra) or tadalafil (Cialis). Although these medications are primarily used to treat erectile dysfunction in men, there are reports that sildenafil may also improve sexual problems caused by antidepressants in some women.
Hormones and Low Libido
Adrenal burnout, also called adrenal fatigue, is common in fibromyalgia and is a major libido stealer for both men and women. Our adrenal glands become overworked by the constant demands of the fight-or-flight nervous system and start to make less cortisol and testosterone. In addition to fatigue, the symptoms of adrenal burnout include anxiety, low blood pressure, nausea, and low libido. For any patient dealing with low libido along with other signs of adrenal burnout, it is important to test salivary cortisol and DHEA levels. Often testing will reveal low levels of DHEA, a building-block hormone the adrenals use to make sex hormones. Sometimes just adding a DHEA supplement is all it takes to get libido levels back up, and other times we may need more intensive adrenal support efforts. Learn more about treating adrenal burnout here and in The FibroManual.
Some medications have the side effect of suppressing testosterone levels, which can really interfere with sex drive in men and women. Long-term use of opioids can reduce testosterone levels, and has been coined opiate-induced androgen deficiency (OPIAD). I always check testosterone levels for my male patients on long-term opioids experiencing sexual dysfunction, and treat with testosterone gels or patches if appropriate. With women, the issue of testing for and treating low testosterone is trickier.
Females do produce testosterone, although at much lower levels than seen in males. And while testosterone has some effect on female sex drive it is not the whole story, as there are complex interactions between testosterone and estrogen and progesterone. A few studies suggest that low-dose testosterone supplementation improves the sexual function of women that are post-menopausal, but these were associated with some side effects such as increased hair growth and acne. Currently, no testosterone product is FDA-approved for use in treating female sexual dysfunction. Due to side effects, I have found it is a better approach with most women with low testosterone to address the issue indirectly by addressing adrenal burnout and supplementing with DHEA.
Part two of this post discusses boosting libido with oxytocin. Part three covers strategies to make intercourse less painful.