Ask Dr. H: A low libido and having only one ovary: A link?

Question:

I'm a 35-year-old female with no sexual desire. Could having only one ovary cause this problem? What type of intervention should I seek for this problem?

Answer: This is not a trivial matter; sexual fulfillment is an integral part of our emotional and physical well-being. In turn, the vast majority of sexual problems are caused by a combination of medical, surgical, and psychological conditions. You didn't mention any underlying medical problems or changes in your life that might be responsible for your decreased libido.

There are many possible explanations: fatigue (busy moms often complain of this); stress; depression; unhappiness in the relationship; recent illness; diabetes; an underactive thyroid condition; use of medications like antidepressants and tranquilizers; and insufficient estrogen production causing vaginal dryness. Having one ovary could potentially cause your problem, if the remaining ovary isn't producing enough estrogen.

Women in the first few months after birth, especially if they're breast-feeding, produce high levels of prolactin, which blocks estrogen production and may suppress one's libido.

Motherhood alone can put a kink in your sex life. If your menstrual periods are irregular or have ceased, that would lead me to believe that hormonal replacement therapy (especially those that add testosterone) might reverse things. If the timing of your symptoms coincides with starting on a birth-control medication, switching to a progesterone-only pill might be worth a try.

A few studies suggest that ginkgo biloba extract, 120 milligrams twice a day, may be helpful in reversing some of the antidepressant-induced sexual dysfunction. Only when all medical causes have been excluded should a psychological cause be considered.

Q:

I'm a 65-year-old woman who developed breast cancer two years ago. I had a colonoscopy five years ago, which was normal. In light of my recent breast cancer, I wanted to have another colonoscopy because I was under the impression that I'm now at greater risk of colon cancer. However, my gastroenterologist said Medicare doesn't consider me to be at higher risk and won't pay for a colonoscopy until I'm 70. Is that right?

A: For years, the guidelines for colon cancer screening were that if a person had a history of breast, ovarian, or uterine cancer, he or she was considered to be at increased risk of getting colorectal cancer. But recent studies have shown differing opinions on whether there really is a heightened risk. There is no consensus on this, despite the Medicare guidelines.

The following are clear risk factors for colon cancer: age over 50; personal history of precancerous colon polyps; personal history of inflammatory bowel disease (i.e., ulcerative colitis and Crohn's disease), but not irritable bowel syndrome; family history of colon cancer in parent or sibling; being African American; being of Ashkenazi Jewish heritage; history of smoking; obesity; prior history of radiation to the abdomen; heavy chronic alcohol use; adult-onset diabetes; and a diet high in red meat and processed meats.

Despite the Medicare guidelines, if you're experiencing unexplained constipation or blood in the stool, a colonoscopy would be warranted.