Mindfulness and cognitive therapy can be introduced by specialists to address distraction and low sexual desire.

“so that's something I might like if and then if I if and then the other thing we didn't mention is sometimes I discover like a really deep-seated and important psychological issue that's linked to this like like an unfortunate scenario would be someone who's sexually traumatized and like every time they get into us or they develop even like a general aversion right there used to be something called sexual aversion disorder that's been kind of removed from the DSM for a variety of reasons but there every time they enter sexual encounter they'll have an intrusive thought I don't know maybe there's mixed in with PTSD or there was very strong religious prohibition or cultural prohibition and then if I pick that up I really send them right to a psychological person to work with that because it's something that's now they understand or come to realize maybe interfering with their sexual quality of life and their happiness so we didn't say that but at the onset that that's much more primary right okay uh let's go back to the two drugs that we didn't talk about besides testosterone just just to make sure we close the loop on that yeah I think I'm glad the whole point about office counseling so a lot of what we're talking about before we move to the drugs is that there's office counseling like I would do looking and we didn't get into this so explicitly but I look at like what's the relationship What's the timing what's the lifestyle Factor so that's I was thinking we were going to go there with that 39 year old or whatever we decided she was it I call it the rant right so she'll come in and she'll say oh I'll say well tell me what's going on they'll be like well I have two kids there's homework there's dinner there's there's I work all day there's the house there's the laundry it's then I have to answer my email at 12 o'clock and then it's one in the morning and the partner wants to have those whatever partner it is wants to have sex like I'm too tired you know I I mean it's just and they're not healthy sometimes they're not helping me gets thrown in there right and so well a lot of what I do is dissect this back I'm sure you do this too in your work is help people look at how they're lifestyle is so that's that so when someone comes to me with low desire and I look at these lifestyle factors we look at some of the other medication factors we look at whether there's another sexual dysfunction like contributing to low desire and they have hypoactive meaning distressing low desire that's clinically diagnosed and I don't see another modifiable Factor that's where in post-menopausal women I might think okay do we need to add androgens right so we we should say like first you do a biopsychosocial assessment before you use a pharmaceutical and you look at these factors you look for a relationship counseling factors you look at referrals for Psychotherapy or Sex Therapy and you look at modifiable medications other things you can change and then if you reach the point where you're like I want to use something explicitly for sexual desire in post-menopausal women you can use testosterone like that's an option we didn't talk about who the candidates are and when you would use that the biggest hitters are people who've had olophremes at a young age or early menopause post-menopausal women with distressing low desire um and then you know you have to of course do informed consent when you do that”