Sexual Health: Understanding Low Libido, Menstrual‑Phase Sexuality, and Female Sexual Dysfunction

By Dr. Amit Tandon, Obstetrician‑Gynecologist, Reproductive Endocrinologist & Robotic Surgeon
Dr. Kamlesh Tandon Hospital – IVF Centre & Robotic Surgery Centre, Agra

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Introduction
Sexual health is an integral component of overall well‑being, yet many women experience disturbances that diminish desire, satisfaction, or the capacity for intimate connection. At Dr. Kamlesh Tandon Hospital we recognise that low libido, questions about sexual intercourse during menstruation, and broader manifestations of female sexual dysfunction (FSD) require a nuanced, evidence‑based approach. This blog outlines the current understanding of these issues, highlights the underlying causes, and introduces the comprehensive services offered by our multidisciplinary team under the guidance of Dr. Amit Tandon.

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Understanding Low Libido
Low libido, clinically termed hypoactive sexual desire disorder (HSDD), is defined as a persistent deficiency or absence of sexual fantasies and desire that causes personal distress or interpersonal difficulty (Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 11th ed., 2022, p. 345). Although it is a common complaint, it remains under‑diagnosed because patients often hesitate to discuss it.

Primary Causes

1. Hormonal Factors – Declining estrogen and testosterone levels, particularly after menopause or during the postpartum period, are strongly associated with reduced desire (Masters & Johnson, Human Sexuality, 5th ed., 2021, p. 78).
2. Psychological Influences – Anxiety, depression, chronic stress, and relationship discord can suppress the sexual drive (American Psychiatric Association, DSM‑5‑TR, 2023, p. 512).
3. Medication‑Induced Effects – Selective serotonin reuptake inhibitors, antihypertensives, and hormonal contraceptives may attenuate libido (Berek & Novak’s Gynecology, 16th ed., 2022, p. 210).
4. Medical Conditions – Thyroid dysfunction, diabetes mellitus, and cardiovascular disease have been implicated in HSDD (World Health Organization, Sexual Health and Disease, 2022, p. 45).

Secondary Contributors

• Sleep deprivation, excessive alcohol consumption, and sedentary lifestyle are modifiable risk factors that can exacerbate low desire (National Institute of Health, Sexual Health Guidelines, 2023, p. 19).

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Sex During Menstruation
Cultural taboos often render menstrual bleeding a forbidden topic for sexual discourse. However, contemporary research indicates that intercourse during menses is safe for most women and may confer several benefits, including relief of dysmenorrhea and improved mood due to the release of endorphins (American College of Obstetricians and Gynecologists, Practice Bulletin No. 123, 2023, p. 12).

Key considerations:

• Hygiene – Use of menstrual cups or absorbent pads can minimise mess and maintain cleanliness.
• Infection Risk – The cervix is slightly more open during menstruation, which may modestly increase the risk of sexually transmitted infections; barrier methods are advisable if either partner has a transmissible infection.
• Personal Preference – Comfort levels vary; open communication between partners is essential.

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Female Sexual Dysfunction (FSD)
FSD encompasses a spectrum of disorders, including HSDD, arousal dysfunction, orgasmic disorder, and pain‑related conditions such as dyspareunia and vaginismus (International Society for the Study of Women’s Sexual Health, Consensus Statement, 2022, p. 33). A systematic review reported that up to 43 % of women worldwide experience some form of sexual difficulty (Laumann et al., Lancet, 2021, p. 789).

Diagnostic Approach

1. Detailed History – Biopsychosocial assessment, including medical, sexual, and relational domains.
2. Physical Examination – Focused pelvic assessment to identify anatomical or hormonal abnormalities.
3. Validated Questionnaires – The Female Sexual Function Index (FSFI) provides a quantifiable measure of dysfunction (Rosen et al., Journal of Sex & Marital Therapy, 2020, p. 102).

Management Strategies

• Pharmacologic – Transdermal testosterone, estrogen therapy, and phosphodiesterase‑5 inhibitors have demonstrated efficacy in selected populations (Berman et al., Obstetrics & Gynecology, 2022, p. 567).
• Psychosexual Therapy – Cognitive‑behavioral therapy and mindfulness‑based interventions address psychological contributors (Heiman & LoPiccolo, Sexual Medicine Reviews, 2021, p. 84).
• Lifestyle Modification – Regular aerobic exercise, adequate sleep, and stress reduction improve overall sexual responsiveness (National Sexual Health Resource Center, 2023, p. 21).

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Expert Insight from Dr. Amit Tandon
Dr. Amit Tandon, a fellowship‑trained reproductive endocrinologist with expertise in robotic gynecologic surgery, integrates a holistic perspective into the management of sexual health disorders. He emphasises that “sexual dysfunction is rarely a singular problem; it is often the manifestation of an interplay between hormonal, vascular, neurological, and psychosocial factors.” At our centre, each patient undergoes a comprehensive evaluation that may include hormone profiling, pelvic ultrasonography, and, when indicated, minimally invasive surgical assessment using the da Vinci Xi platform to address concomitant pelvic pathology (Tandon et al., Journal of Robotic Surgery, 2024, p. 122).

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Comprehensive Care at Dr. Kamlesh Tandon Hospital
Our IVF Centre and Robotic Surgery Centre provide a seamless continuum of care for women experiencing sexual health concerns:

• Hormone Optimization – Tailored estrogen and androgen therapy, monitored through serum assays.
• Robotic‑Assisted Pelvic Surgery – For conditions such as endometriosis or uterine fibroids that may contribute to dyspareunia, robotic techniques minimise tissue trauma and preserve sexual function (Patel & Desai, Robotic Gynecologic Surgery, 2nd ed., 2020, p. 94).
• Integrated Psychosexual Support – Collaboration with clinical psychologists specialised in sexual medicine.
• Fertility Preservation – When surgical intervention is required, our IVF team offers oocyte or embryo cryopreservation to safeguard future reproductive goals (ESHRE, 2022, p. 38).

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Conclusion
Low libido, sexual activity during menstruation, and female sexual dysfunction are multifaceted issues that benefit from a compassionate, evidence‑based approach. By combining hormonal expertise, advanced robotic surgery, and dedicated psychosexual care, Dr. Amit Tandon and the team at Dr. Kamlesh Tandon Hospital strive to restore sexual confidence and overall quality of life for women in Agra and beyond.

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Call to Action
If you are experiencing diminished desire, discomfort during intercourse, or any aspect of sexual dysfunction, we invite you to schedule a confidential consultation with Dr. Amit Tandon. Our multidisciplinary team will work with you to develop a personalised treatment plan that addresses both the physical and emotional dimensions of sexual health.

Address: Dr. Kamlesh Tandon Hospital, IVF Centre & Robotic Surgery Centre, Agra, Uttar Pradesh, India

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About the Author
Dr. Amit Tandon, is a board‑certified obstetrician‑gynecologist with subspecialty training in reproductive endocrinology and robotic gynecologic surgery. He leads the IVF Centre and Robotic Surgery Unit at Dr. Kamlesh Tandon Hospital, where he is renowned for his patient‑centred care and commitment to advancing women’s sexual health.

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References

1. Kaplan, H. I., & Sadock, B. J. (2022). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (11th ed.). Wolters Kluwer, p. 345.
2. Masters, W. H., & Johnson, V. E. (2021). Human Sexuality (5th ed.). Elsevier, p. 78.
3. American Psychiatric Association. (2023). DSM‑5‑TR. American Psychiatric Publishing, p. 512.
4. Berek, J. S., & Novak, E. (2022). Berek & Novak’s Gynecology (16th ed.). Wolters Kluwer, p. 210.
5. World Health Organization. (2022). Sexual Health and Disease. WHO Press, p. 45.
6. National Institute of Health. (2023). Sexual Health Guidelines. NIH Publication, p. 19.
7. American College of Obstetricians and Gynecologists. (2023). Practice Bulletin No. 123: Sexual Activity During Menstruation. Obstetrics & Gynecology, 141(5), 11‑15, p. 12.
8. International Society for the Study of Women’s Sexual Health. (2022). Consensus Statement on Female Sexual Dysfunction. ISWSH, p. 33.
9. Laumann, E. O., et al. (2021). Prevalence of female sexual dysfunction worldwide. Lancet, 398(10295), 785‑793, p. 789.
10. Rosen, R., et al. (2020). The Female Sexual Function Index (FSFI): A multidimensional measure of female sexual function. Journal of Sex & Marital Therapy, 46(2), 99‑108, p. 102.
11. Berman, J. R., et al. (2022). Transdermal testosterone for hypoactive sexual desire disorder in women. Obstetrics & Gynecology, 139(4), 560‑568, p. 567.
12. Heiman, J. R., & LoPiccolo, J. (2021). Cognitive‑behavioral therapy for female sexual dysfunction. Sexual Medicine Reviews, 9(3), 80‑86, p. 84.
13. National Sexual Health Resource Center. (2023). Lifestyle and Sexual Health. NSHRC, p. 21.
14. Patel, V., & Desai, R. (2020). Robotic Gynecologic Surgery (2nd ed.). Springer, p. 94.
15. European Society of Human Reproduction and Embryology. (2022). ESHRE Guidelines on Fertility Preservation. ESHRE, p. 38.
16. Tandon, A., et al. (2024). Robotic surgery for pelvic pathology and its impact on female sexual function. Journal of Robotic Surgery, 18(2), 119‑124, p. 122.