I have started seeing more and more women in their late 20s and early 30s who complain of loss of libido. Typically, they are in good health with normal results on screening labs, including those for thyroid function. These women have often been on birth control pills for years with normal menses and otherwise have no complaints. What diagnostic options and treatments do you recommend?—CYNTHIA ANN SMITH, CS, FNP, MSN, Sissonville, WVa.

Low libido can be one of the most challenging and frustrating clinical situations for both the clinician and patient. A thorough and sensitive social history may prove your most useful diagnostic tool. Relationship dissatisfactions, body-image concerns, a history of abuse, and/or life stressors often underlie a loss of sexual desire. Depression, alcoholism, and other mental problems should be ruled out, as should medication side effects from selective serotonin reuptake inhibitors or antihypertensives. Some women experience low libido while on oral contraceptives because of their impact on levels of sex hormone-binding globulin. Patients may experience relief if you change the progestin component of their pill to a formulation with higher androgenic activity; consult Managing Contraceptive Pill Patients by R.P. Dickey (2007) for guidance on pill selection. A change in birth control method to an intrauterine contraceptive or other nonhormonal method may help.—Lisa Stern, APRN (137-9)

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