Dr. Shulman:
Well, decreased libido is a very difficult thing to diagnose because there are numerous causes of decreased libido. Everything from relationship issues, to hormonal issues, to neurological issues, vascular issues; what makes libido diagnosis a challenging issue for the clinician regardless of which clinician it is, is that we tend to look at libido, as well as other sexual problems, as problems that are amenable to single therapy. Give a pill, refer for counselling, and everything will be fine. The problem we have with libido is that sometimes libido is the causative agent and sometimes it is the reactive agent, and the clinician either who is identifying this or the clinician who is involved in evaluating and treating it, has to determine whether or not it is a multivariate problem, whether it is a single-issue problem, whether it is a causative or reactive problem.
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