Did you know that a healthy sexual drive is associated with youthfulness, vitality and emotional balance?

Sexual intimacy plays a vital role in human reproduction, enabling fertilization and the transmission of genetic material to future generations, thereby sustaining life on our planet. A healthy sexual life also contributes significantly to overall well-being and quality of life. However, modern lifestyle changes such as increasing digital dependency, sedentary habits, poor dietary choices, and environmental pollution have led to a surge in various health issues. These factors have impacted nearly every aspect of human life, including sexual health and fertility.

Understanding libido

Libido means the natural desire for sex. A decrease in libido, often termed low libido, indicates a reduced interest in sex.

Chronic illnesses can diminish your sex drive. Let’s explore how and why this happens.

This article explores the concept of libido, the common chronic illnesses that can lead to low libido, the physiological and psychological mechanisms involved, practical measures to manage and overcome these challenges, with an emphasis on lifestyle modifications, medical support, open communication, importance of awareness among the public and healthcare professionals to recognize and address libido related concerns with sensitivity and evidence-based guidance.

Sex drive plays a vital role in maintaining both mental and physical health. However, it can be influenced by various life experiences, including past trauma, ageing, chronic illnesses, and medical treatments. Sexual function operates optimally with proper balance and coordination among the neurological, vascular, and endocrine systems. A person’s sexuality is influenced by several psycho-social factors, including family and religious background, sexual partner, interpersonal intimacy, communication, and individual characteristics such as self-esteem, self-image, and self-concept.⁶

The occurrence of chronic illnesses with increasing age is inevitable. The Center for Disease Control and Prevention Report published in 2011 reflects that about 80% of elderly adults are suffering from one chronic medical illness, and approximately 50% of them are affected by two chronic diseases.²

How do chronic illnesses affect libido?

Chronic illnesses are those conditions that persist for one year or more and require ongoing medical treatment, limit daily activities, or both.⁶

Chronic illnesses affect libido negatively in two ways:

• Directly by changes in vascular, respiratory, nervous, and hormonal systems
• Indirectly by changes in self‑image, self‑esteem, mood, energy, and pain. 

Low libido can cause anxiety, loss of confidence, and depression, thus ruining interpersonal relations.²

Sexual response undergoes the following phases: Desire, Arousal, Plateau, Orgasm, and Resolution.⁵

Chronic illnesses can disrupt the desire and arousal stages of the sexual response cycle. People usually experience low libido or may become sexually inactive as they lose their confidence to get intimate with their partner because of misconceptions about the safety of sex, negative self-image, or sorrow associated with the diagnosis of their illness.⁵

Chronic illnesses commonly associated with low libido

Diseases can be communicable (transmitted from one person to another, like infections) or non-communicable (can not be transmitted to others, like Diabetes, hypertension, etc.). The underlying mechanism in all chronic illnesses is the activation of inflammation in our bodies. Inflammation is the result as well as a risk factor for chronic diseases, which affects our sexual life. There is an exhaustive list of chronic illnesses which can cause loss of libido, a few to mention are:

Diabetes mellitus: 

Diabetes Mellitus negatively affects patients’ body image and self-perception as a sexual being.⁵ Erectile dysfunction occurs in 50% of diabetic men under 60 years. These patients frequently report decreased libido, impaired ejaculation, sexual dysfunction, and feelings of inadequacy.²

Obesity, metabolic syndrome, and dyslipidemia: 

Prolonged inflammation in these disorders leads to reduced blood flow to the genitalia through the production of inflammatory mediators such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP).¹

Cardiovascular diseases: 

Heart diseases are often associated with atherosclerotic plaque formation, which blocks our blood vessels, leading to raised blood pressure. These plaques induce inflammation and disrupt blood flow to the genitals, impeding erectile function, arousal, vaginal dryness, painful coitus, clitoral sensation, and orgasm.¹ 

The following measures can be helpful in such a situation:

• Sexual activity in a familiar and comfortable environment puts the least stress on the heart² 
• Consuming nitroglycerin before sexual relations if sex precipitates chest pain is beneficial⁵ 
• If the patient can climb two sets of stairs, it means they can tolerate the cardiovascular demands of sexual activity. However, if the patient is fearful of sex, alternative forms of physical intimacy can be encouraged like holding hands, hugging, kissing, massage, use of a vibrator, mutual masturbation, and intimate verbal communication.⁵ 

Chronic respiratory illness: 

The Chronic inflammation in respiratory diseases leads to persistent immune activation and tissue damage, which worsens respiratory health and impacts sexual function by disrupting vascular, hormonal, and psychological processes.¹

The issues can be effectively managed by:

• Use of an inhaler before coitus and use of less active positions (semi-reclining, on-the-bottom, and seated positions) can reduce stress on the cardiovascular and respiratory systems⁵
• Physical rehabilitation programs to enhance the muscle tone and strength can benefit these people.⁵

Musculoskeletal disorders like rheumatoid arthritis and gout: 

Gout: 

Gout is a medical condition related to increased uric acid levels(termed hyperuricemia), which cause painful joints. Consumption of red meat, organ meats, seafood, and certain alcoholic beverages (especially beer), genetic predisposition, and certain medications (eg,beta-blockers, diuretics) raise uric acid levels. Hyperuricemia itself is a risk factor for heart problems as well as causes sexual dysfunction through a chronic inflammatory state, and psychological distress.¹

Rheumatoid arthritis:

Fatigue, pain, muscle spasms, stiffness, reduced flexibility and mobility, depression, and loss of self‑esteem negatively impact libido in rheumatoid arthritis.^2,5

The sex drive can be improved in such painful conditions by discussing with a partner, practicing relaxation techniques, fantasizing about sex positions before coitus, using painkillers, placing pillows/pads under joints, warm bath to relieve pain, exercising, and changing position during sex.⁵

Chronic Kidney Disease (CKD): 

CKDs can lead to hormonal imbalance and can result in sexual dysfunction, decreased libido, erectile dysfunction, dysmenorrhea, irregular menstrual cycles, and infertility.²

Gastrointestinal disorders like Crohn's disease and ulcerative colitis:

Fatigue, fear of faecal urgency, or fear of passing flatus during sex makes the person reluctant to enjoy sex. These people can also suffer from erectile dysfunction because of performance anxiety.²

Mental health illnesses:

Chronic illnesses are often associated with depression. The antidepressants and several psychiatric drugs may negatively impact sexual function during and after treatment. Hence, sexually neutral antidepressants that possess sexual benefits with minimal adverse effects are needed.^1,3

Anxiety disorders are also linked to orgasmic or arousal disorders.

Similarly, Obsessive-compulsive disorder (OCD) is particularly associated with orgasmic difficulties.³

Cancer: 

Cancer treatments like chemotherapy or radiotherapy alter the sense of smell, taste, and touch. These procedures usually cause bad breath, which decreases sex drive. Removal of the breast (mastectomy) and subsequent chemotherapy or radiotherapy triggers pain, disability and disfigurement, which lowers the confidence of people assigned female at birth (AFAB).²

The issue can be addressed by the following measures:

• Breast-sparing procedures and plastic surgery can alleviate the negative effects of cancer on body image in people AFAB suffering from breast cancer⁵
• Use of lubricants can stimulate sexual desire and reduce pain during coitus⁵
• Some people AFAB experience pain during coitus due to a lack of estrogen; thus, local application or systemic use of estrogen can prove to be beneficial³
• People suffering from chronic illnesses usually build their negative self-image by repeating thoughts in their mind like ‘I am not sexually attractive’, ‘no one will want me, if intercourse is impossible’.The practice of mindfulness and cognitive behavioral therapy can prove to blessing for such people³

Sexually Transmitted Infections (STIs) like Chlamydia, Gonorrhea, Syphilis, Trichomoniasis, Hepatitis viruses, Herpes, and Human Immunodeficiency Virus (HIV): 

These infections can cause pelvic inflammatory disease, ectopic pregnancy, infertility, chronic pelvic pain, genital lesions, genital tumours, adverse pregnancy outcomes, immune system dysfunction, liver disease, and even death.¹

HIV can lower the testosterone levels, leading to low libido and arousal. There is generalized wasting, fatigue, muscle aches, body pains, loss of sensation, and depression, which further contribute to low libido.⁵

Drugs associated with loss of libido

• Anorectics (drugs which reduce appetite)
• Diuretics
• Antiandrogens 
• Hormones
• Antiarrhythmics (drugs which are used to control the rhythm of the heart)
• Lipid-lowering agents
• Antilepileptics
• Antiallergy drugs 
• Anticancer drugs
• Antihypertensives 
• Opiates
• Antivirals
• Antipsychotics
• Anxiolytics 
• Recreational or illicit drugs
• Corticosteroids 
• Sedative-hypnotics⁵

Different medications interfere with different phases of the sexual cycle. For example, Antihypertensive drugs negatively affect arousal. 

Antipsychotic agents interfere with desire, arousal, and orgasm. 

Surgical procedures like transurethral prostatectomy, carried out for prostatic cancer, interfere with arousal and orgasm.⁵

Diagnosis and evaluation

Gathering clinical information about a patient’s sexual life is important, but it is often overlooked. Clinicians may hesitate to ask, and patients may feel uncomfortable initiating the conversation.

Several factors may contribute to the lack of discussion around sexual health in clinical settings. Many clinicians view sexual problems as common side effects of medications or assume that patients are too old or too ill to be sexually active. 

Personal biases may also influence their approach. For example, it is assumed that sexual dysfunction is expected in individuals with a history of substance abuse. 

Cultural barriers and refugee or migrant backgrounds can further hinder open communication. On the patient’s side, a common belief that sexual issues are untreatable often leads to underreporting, resulting in underdiagnosis and inadequate management.⁷

Management strategies

While chronic illnesses can challenge sexual health, effective management strategies can restore intimacy and improve quality of life.

Medication strategies:

• Consume painkillers (if needed) about 30 minutes before sexual activity
• Switch to alternate medications that don’t affect sexual functioning⁵

Dietary strategies:

• Include foods like fruits, vegetables, and omega-3 fatty acids in your diet as they have anti-inflammatory properties. Avoid processed foods and saturated fats⁵
• Engage in physical activity daily. As body mass index(BMI), weight, waist size, blood pressure and lipid levels decrease, quality of sex life improves¹
• Avoid tobacco and alcohol. Delay sexual activity until 2 or more hours after drinking alcohol or eating⁵

Environmental strategies:

• Plan sexual activity for a time when you are relaxed, energy levels are high and symptoms are less strong
• Maintain a cool and comfortable environment
• Try different sexual positions or use pillows for maximum comfort⁵

Psychological strategies:

• Use intimate touching for sexual arousal
• Discuss likes, dislikes, and needs with your partner
• Self-help books that cover issues of chronic illness and sexual activity can help⁵

Summary

Loss of libido resulting from sexual dysfunction associated with chronic illnesses can increase stress levels, which in turn exacerbate underlying conditions such as hypertension and diabetes. This occurs through hormonal imbalances and inflammatory responses that hinder effective disease management. Therefore, addressing sexual health issues not only enhances quality of life but also supports better treatment outcomes.⁴

The acceptance of disease by the patient and their partner is beneficial for the psychological health of persons with chronic disorders. Hence, the development of consulting, training, and empowerment programs, programs on lifestyle and sexual health can prove to be beneficial in improving sexual health.²

Patient education and reassurance are essential. Discussing concerns and fears can help to relieve psychological distress and anxiety related to sexual difficulties.¹

Clinicians should also be aware of sexual medicine; this should be included in their curriculum.⁷

A personalized, holistic approach that is innovative and non-invasive is essential to address both the physiological and psychological dimensions of sexual disorders. This approach should integrate traditional methods with modern technologies such as telemedicine, wearable devices, bioengineered treatments like platelet-rich plasma (PRP) therapy, and digital therapeutics.⁷