Let’s talk about sex. To be more specific, let’s talk about enjoying sex, especially if you’re a woman. Because the sad fact is, a lot of women really don’t enjoy it, especially as they get older, even if they’re in a loving relationship with a caring partner who knows how to take care of them sexually.
(Here’s an on-topic but off-colour joke for you:
Q: What’s the difference between a clitoris and a pub?
A: 99% of men can find a pub.)
There are many reasons why women may experience a persistent loss of interest in, pleasure and satisfaction from sex, including:
- Fatigue e.g. from juggling multiple roles, interrupted sleep due to taking care of babies and young children at night, or from chronic illness;
- Hormonal changes e.g. during pregnancy, breastfeeding and menopause (although some women report an increased sex drive during some or all of those life stages);
- Stress, depression and anxiety;
- Relationship difficulties e.g. feeling resentment toward or betrayed by their partner;
- Medications, especially antidepressants (unfortunately, the effects on sexual function can persist long after discontinuing the drug, and they may be permanent), isotretinoin (Roaccutane), high blood pressure drugs, the oral contraceptive pill, Depo-Provera, cimetidine (Tagamet), diphenhydramine (Benadryl) and numerous others;
- Illnesses including heart disease, diabetes, cancer, IBS, MS, arthritis and thyroid conditions.
Yet there’s one very common condition associated with female sexual dysfunction that a lot of apparently well women have, and yet hardly anyone knows about it: hyperlipidaemia, defined as high LDL cholesterol, low HDL cholesterol and/or high triglycerides.
A team of Italian researchers studied sexual function in premenopausal women who were free of cardiovascular disease or any other known cause of female sexual dysfunction, and found that those who had hyperlipidaemia were more likely to experience problems with sex than women with lipid levels in the healthy range.
How much more likely? Well, the researchers used the Female Sexual Function Index to measure the 6 key dimensions of women’s sexual function:
- Sexual desire,
- Arousal,
- Lubrication,
- Orgasm,
- Satisfaction, and
- Pain.
Each domain was scored from 0 or 1 to 6, giving a total possible score of 36, with a higher score representing better sexual function.
Using the generally-accepted cut-off of 26 on the FSFI scale, they found that a staggering 51% of women with hyperlipidaemia reported sexual dysfunction, compared to only 21% of women with normal cholesterol and triglyceride levels.
Using more conservative criteria – the lowest 25% of FSFI scores – 32% of hyperlipidaemic women vs only 8% of women without hyperlipidaemia were affected by sexual dysfunction.
The domains of sexual function that were most affected by an unhealthy lipid profile were arousal, orgasm, lubrication and satisfaction.
How might hyperlipidaemia mess around with your sex life? It’s been known for many years that men with cardiovascular disease are far more likely to suffer erectile dysfunction than men with healthy hearts and arteries. Hyperlipidaemia causes atherosclerosis, a build-up of plaque which can clog up the penile artery; and may also interfere with the function of endothelial and smooth muscle cells in the penis. The end result is an ability to achieve or maintain an erection.
What about women, though? Women don’t need to have erections to have sex… or do they? It turns out that the first phase of the female sexual response involves engorgement of the clitoris, a process essentially identical to the male erection. Both clitoral erection and the blood flow that prompts vaginal lubrication, which is a key element of sexual arousal, are regulated by the same biochemical pathways in women as erectile function is in men. So atheroslerosis in the arteries supplying women’s sexual organs has essentially the same effect on their sexual function as we see in men.
Who is at risk of hyperlipidaemia? Pretty much anyone eating the Standard Australian Diet which draw most of its kilojoules from animal foods and refined carbohydrates. Even vegans can end up with high triglyceride levels if they eat too much refined carbohydrate, including soft drinks, fruit juice, alcohol, sweets, and refined flour products, although eating whole fruit appears to be beneficial.
Here’s what you need to do to prevent or reverse hyperlipidaemia:
- Eat a wholefood, plant-based diet, drawing most or all of your dietary intake from whole fruits (not juice), vegetables, whole grains, legumes, and a modest amount of nuts and/or seeds;
- Avoid or minimise alcohol, refined flours and sugars;
- Reduce fat intake (saturated fat is worst for triglyceride levels, but even monounsaturated fats such as olive oil raise triglycerides and impair insulin sensitivity);
- Get regular moderate to high intensity aerobic exercise (this can lower triglycerides by up to 20%);
- Avoid drugs which raise triglyceride levels, including oestrogens (oral contraceptives, HRT), androgens (testosterone), some blood pressure medications (thiazide diuretics, beta blockers), steroids and isotretinoin (Roaccutane).
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