What Causes Lack Of Sexual Arousal?

Posted on Mon, 3 Mar 2014

Question: My wife XXXXXXX (aged 30 years) says she doesn't feel aroused these days(since 10 days) and sex becomes painful as she doesn't have enough natural lubrication inside vagina. she also has history of irregular periods(last period XXXXXXX 1 2014) with issues of having 02 fibroid in anterior wall of uterus (2.6X2.32 cms and 1.16X1.12 cms) and Paraovarian cyst(3.6X2.67 cms the size of which has remain unchanged since 2010). We had been having unprotected sex since last two years.I am enclosing her blood sample reports taken 2 days after periods in Nov 13 and USG test reports). Please advice accordingly as we are now planning to have a baby.

Answered by Dr. Madhuri N Bagde (40 minutes later)

Brief Answer: Do not worry Detailed Answer: Hi, I am Dr Madhuri, a consultant Obstetrician and Gynecologist. I am happy to answer your query. You have many issues and let me help you with each one separately; 1. lack of natural lubrication and lack of feeling of arousal; After seeing all the blood reports, she seems to have normal hormone levels and ovarian reserve. The lack of lubrication may be a temporary phenomenon. Infections as well as stress can cause this. Stress is also a major contributor towards decreasing sexual desires. Please check if you both are not inadvertently and unknowingly stressed about her reports and planning a pregnancy and try to correct these by mental relaxation techniques like yoga, light exercise and healthy literature or movies. The decreased lubrication can be easily overcome by using lubricant creams or glycerin easily available over the counter. 2. Irregular periods and fibroids as well as ovarian cyst; I am worried about one CA 125 report that is 115.4, but there was another report in real small print. Is seems to be 18. So these are contradictory as one report indicates a raised level whereas the other is normal. This is typical of this report as reproduciability is a concern. Neverthless, considering the ultrasound report, cyst is separate form ovary and size of cyst, it hardly appears that it is malignant. So, I suggest that there is no need to worry about it at present. Regarding the fibroids; They are a common finding in many women that walk into our clinic for reasons other than fibroids. Also, their sizes are too small so they do not need any treatment now. They may grow during pregnancy and cause some issues, but those can be dealt with easily. My only cause of concern is that you have been having unprotected sex since two years and not conceived yet. I am not sure if you have an idea of fertile period ? In women with regular cycle usually day 12-18 is considered the time when chances of pregnancy are higher. Please mention how are your wife's cycles. Do they come every 35 days or 45 or so on. For this I suggest that you get a semen analysis as well as a follicular study of your wife [ovulation study] done to detect ovulation and semen quality. If they are OK, you must see an infertility specialist for further guidance and treatment. I am always there to help you whenever you need it. I also suggest that your wife starts taking folic acid 5mg tablet daily for at least a month as this helps in preventing brain defects in the baby. So please remember that all the reports are normal except one CA125. Just repeat CA125 after 3 months if it is normal, no worries. There may be minor issues with ovulation as can be predicted from the irregular periods and they need some investigation as already suggested. Try decreasing stress and enjoy life. I am sure your wife will conceive. Hope I was able to help you. Thanks for using XXXXXXX Please feel free to ask any more queries that you may have. Dr Madhuri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Madhuri N Bagde (2 hours later)

Thank you Dr. for the prompt reply! I am XXXXXXX please read below for answers to the questions you have posed and for some more questions of mine. Which over the counter Lubricants do you recommend? Though we have been married for a couple of years we have been staying separately due to work commitments and have only moved in together one month back. Earlier we could only meet for a week or so in three -four months. The gap between periods are 40-45 days, when they are regular. Regarding the CA125 tests, the report with the measured data 18, was conducted after the previously detected high count. I hope this level is okay. Semen analysis was done last month and the summary of the report is as below: period of abstinence : 03 days sperm count : 25 millions/ml progr motility : 10 % non prog motitlity: 80% non motile : 10 % pH : 8.0 Vol: 5 ml Normal Morphology: 30 % Agglutination: Present This report was shown to a doctor and he said that this is typical of asthenozoospermia and suggested a repeat test after 3 months since this was tested during convalescence. Retest is due Early April. Do I need to approach a doctor for the follicular study or can this be done at a lab? One more concern is that I started my periods early, around the time I turned 9 years. Do you commonly see an early menopause too in such cases? How can I be sure of this? XXXXXXX

Answered by Dr. Madhuri N Bagde (57 minutes later)

Brief Answer: Get an ovulation study done Detailed Answer: Hi XXXXXXX Thanks for writing back. Regarding the lubricants moods or sensuous smooth or any other can be used depending upon availability. Just check that it does not contain a spermicide or sperm killer substance. The above can be used if available at your place. It is reassuring to know that you have not had much opportunity for regular sexual contact as this decreases the chances of actually having a problem. If you have 45 days cycle, these are delayed more than normal or shall we say just at the upper end of normal cycles. If they are regular 45 days, the fertile days would be most likely between day 25-31. But it is difficult to be sure as the cycles are prolonged. Hence I suggested the Follicular /Ovulation study. get it done at any radiologist. It is done to demonstrate if ova are developing and egg is actually getting released as well as the uterine lining [endometrium] is responsive enough for pregnancy to occur. You will need to go from day 10 after the first day of your periods. The radiologist will decide further dates according to the condition of the follicle at the time of scan. So repeated visits are needed. Regarding the semen analysis: Just get it repeated and if the abnormalities still persist consult a surgeon and he will examine your husband and prescribe medications that usually are needed for 3 months. The report is not discouraging as the count is OK. Regarding early menarche: This is a common finding nowadays. There is no way to be sure that the menopause will occur early. Other factors like stress, radiation and drugs are more responsible. You have a good ovarian reserve so there is no need to worry about menopause now. The CA 125: the level is normal and the cyst is not growing so no need to worry. But sometimes these cysts influence hormones and cause irregular menses. At present I would not suggest any treatment for this. What you need on a preliminary basis is regular contact every alternate day [ not daily as semen quality drops] from day 13 or 14 to day 31 of the cycle. Try this for 1-2 cycles and simultaneously get an ovulation study done. Rest of the treatment will be decided according to these reports. Hope I was able to satisfy your queries feel free to ask more. best of luck and take care. Dr Madhuri

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Madhuri N Bagde (21 hours later)

Dear Dr., Thanks for the reply! I did my pregnancy test early this morning. I used the commercially available pregnancy test kit, Velocit. I tested with the morning urine sample and did not immediately observe a line across the test T, however when I rechecked within 7 min., I observed a line in the T area, though the color was not as intense as the one in Control region. This is the second test in a week with similar results. How do I interpret this?

Answered by Dr. Madhuri N Bagde (11 hours later)

Brief Answer: This may be pregnancy Detailed Answer: Hello XXXXXXX I understand that the pregnancy test is giving ambiguous results. It is difficult to comment that this is a positive result as it has been read after 7 minutes. In positive cases, the second line comes immediately. However the chances of pregnancy are there as the test does not usually give such results unless small amounts of HCG hormone are present. Just check to see if you are having pregnancy related symptoms like nausea, vomiting, weakness, increased frequency of urination etc. If they are there the chances of pregnancy are high. Your LMP was 1st january. So it is 10 days overdue today. But as you has irregular periods, there is a possibility that the conception occurred late. So this may be a delayed pregnancy and hence the ambiguous test. Another possibility is that the test result is inconclusive [happens sometimes] that is a false positive test or it is a missed abortion meaning that pregnancy occurred but the baby is not viable. There are two alternatives now to confirm pregnancy. 1. Wait for 7 days and repeat the test with an early morning sample. If it is a live pregnancy, you will get a clear result. 2. Do a serum HCG estimation and it will help in confirming pregnancy if it is there. 3. An ultrasound may help now but may give a negative result if the pregnancy is too early [as it may be a delayed conception]. So you can either wait for 7 days, start taking folic acid tablets and repeat test [using pregcolor or any other kit] after 7 days. Or have a serum HCG done to confirm pregnancy if you do not want to wait. If either of the test is positive an ultrasound will help determine the condition of the baby. I would also like to advice to refrain from sexual activity for next 7 days until results of test are available as if it an early pregnancy, uterine contraction initiated by sex may disturb it, so we tend to be extra cautious. Wish that this is good news for you and may the test come positive. Let me know the results and stop thinking much about it as stress is a major deterrent in issues related to fertility. So just enjoy till then. Have a good day and feel free to ask any more queries. Dr Madhuri Bagde

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Madhuri N Bagde (37 hours later)

Dear Dr., Thanks for your reply! I got my serum HCG (beta HCG) done today and the value is 1896.6. I have also started taking folic acid tablets, Folvite 5 mg. Is a single pill okay for a day? How long do I have to consume these? Thanks, XXXXXXX

Answered by Dr. Madhuri N Bagde (13 minutes later)

Brief Answer: congratulations Detailed Answer: Hi, Congratulations. These levels suggest pregnancy. Take folic acid once daily till you complete 12 weeks of pregnancy counting from your last menstrual period, or better still by doing an ultrasound as you have irregular cycles. I suggest you get an ultrasound done after a 10-14 days. It will help in determining the exact gestation as well as condition of the baby. These early sonographies determine the delivery date with more accuracy as compared to ultrasound done after 12 weeks. Also try to take rest during the afternoon, avoid prolonged standing. Eat everything that you like and as much as you like except papaya seeds. Avoid sexual activity till atleast 10-12 weeks of pregnancy as yours is a precious baby and it is better not to take any risks. Congratulations once more and have a good day. Dr Madhuri Bagde

Above answer was peer-reviewed by : Dr. Yogesh D