Rewiring Sexual Desire

Age-related sexual dysfunction has historically been underrecognized and undertreated. Within the paradigm of functional and longevity medicine, sexual vitality is not merely optional but a biomarker of systemic health and a determinant of successful aging and vitality. Early diagnosis and advanced interventions can mitigate the otherwise negative impacts of sexual dysfunction on health, well-being, and longevity.

FEMALE SEXUAL HEALTH AND AGING

For women, the most common sexual concerns involve low desire or hypoactive sexual desire disorder (HSDD).¹ Low libido may be associated with other health concerns, including problems with sleep, mood, and resiliency, as well as hormonal changes that accompany the menopause transition. The progressive nature of vulvovaginal atrophy associated with the low-estrogen postmenopausal state further contributes to sexual dysfunction. This condition is referred to as genitourinary syndrome of menopause (GSM) and manifests with vaginal dryness, dyspareunia (pain with intercourse), lack of lubrication, and anorgasmia, all of which may intensify the lack of sexual desire.

Declining estrogen, progesterone, and androgens across the menopausal transition contribute to sexual dysfunction. Hypoactive sexual desire disorder (HSDD), arousal insufficiency, and anorgasmia are common diagnoses, but these conditions are understudied and underdiagnosed; to date, far too few approved treatments exist to address them in women.²

MALE SEXUAL HEALTH AND AGING

It is estimated that 50% of men by age 50 will experience erectile dysfunction (ED), which is a harbinger of cardiovascular morbidity and mortality.³ The progressive decline in testosterone occurring in midlife men, sometimes referred to as “andropause,” exacerbates sexual dysfunction by contributing to loss of libido, fatigue, sarcopenia, and mood disturbance.

Endothelial dysfunction, metabolic syndrome, diabetes, hypertension, and dyslipidemia are strongly associated with ED, reflecting the shared vascular pathophysiology between penile and systemic atherosclerosis. Indeed, ED is often the first clinical manifestation of silent cardiovascular disease, underscoring the importance of sexual function as a sentinel biomarker for male longevity and cardiometabolic health.⁴

Men may also suffer from problems with desire, arousal, and orgasm, though these are less frequently reported compared to ED. Contributing factors include declining testosterone, medication side effects (particularly antidepressants and antihypertensives), substance misuse, and psychological disorders such as depression and anxiety. Structural penile disorders, most notably Peyronie’s disease, further complicate sexual function by causing curvature, pain, and distress, leading to significant impairment in intimacy and self-image.

A MIND-BODY APPROACH TO REWIRE SEXUAL DESIRE

In both sexes, libido (or sexual desire) is a mind-body phenomenon that follows a bidirectional neuro-feedback loop. Thus, it is essential that a biopsychosocial model of care be implemented to rewire sexual desire, considering a combination of individual, partner, relationship, and situational factors (Figure 1).

THE SCIENCE OF DESIRE

Approaches to enhance intimacy and novelty, interventions to optimize arousal (eg, caressing or foreplay), and strategies to stimulate erotic zones can help situationally. But what about activating our sexual senses? Do pheromones and aphrodisiacs exist?

The question of pheromones has long linked our noses to our lust. Animals, plants, and even bacteria release chemical signals to attract mates. While no obvious pheromone signal has yet been found in humans, emerging research suggests that chemo-signals from the human bodies may subliminally influence potential partners. Variations in genes coding major histocompatibility complex (MHC) proteins imprint each person with a unique “odourprint.”⁵ The odourprint may confer an evolutionary advantage by helping to attract a complementary mate, potentially producing offspring with a more diverse immune system.

Our taste buds, too, can be triggered to send sexual signals. Aphrodisiacs are substances that increase sexual desire. Chocolate, long considered an aphrodisiac, contains 3 psychoactive chemicals, including phenylethylamine (PEA)—a “love chemical” that releases dopamine in the brain’s pleasure center.⁶ Other foods and herbs with alleged aphrodisiac properties include oysters (zinc), chili peppers (capsaicin), avocados, and ginseng.

TREATING SEXUAL DYSFUNCTION

Therapeutic options for sexual dysfunction require a personalized, holistic, and sex-specific approach. For men, phosphodiesterase-5 (PDE5) inhibitors are the mainstay of therapy, but testosterone replacement and advanced peptide therapy may serve as adjuvants.^7-8

For women, only 2 FDA-approved pharmacologic treatments for sexual dysfunction exist, both with limited evidence and potential risks. Bremelanotide (Vyleesi, Cosette Pharmaceuticals) is a synthetic injectable peptide (PT-141) and melanocortinergic agent approved for women and men. Flibanserin (Addyi, Sprout Pharmaceuticals) is a dual neural receptor modulator approved for treating women with HSDD. Testosterone therapy for women, administered at approximately 10% of the male dose, has strong clinical support.⁹ The preferred form is a transdermal cream applied to areas rich in androgen receptors (eg, inner thigh). PDE5 inhibitors show limited benefit for women, with weak evidence for enhancing clitoral engorgement and arousal. This class should be used only as adjunctive therapy alongside hormones and approved treatments.

Treatment of GSM is crucial to prevent pain, increase lubrication, and enhance the sensory experience of intercourse. Treatments include vaginal estradiol and/or estriol, vaginal dehydroepiandrosterone (DHEA), vaginal testosterone, silicone dilators, moisturizers, and energy-based modalities such as radiofrequency and laser. Biological regenerative therapies—including advanced peptides, platelet-rich plasma (PRP), secretomes, and exosomes represent a promising frontier.¹⁰

Table 1 and Table 2 summarize therapeutic options for treating sexual disorders and promising peptide therapies on the horizon.

CONCLUSION

Sexual dysfunction is not an inevitable consequence of aging but a modifiable dimension of health. By integrating guideline-based pharmacologic and hormonal interventions with regenerative modalities and mind-body strategies, practitioners can rewire sexual desire, restore intimacy, and promote systemic longevity. 

1. Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. J Sex Med. 2021;18(5):849-867. https://doi.org/10.1016/j.jsxm.2021.02.012

2. Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A, Parish SJ, Pfaus J, Simon JA, Kingsberg SA, Meston C, Stahl SM, Wallen K, Worsley R; Expert Consensus Panel. Hypoactive sexual desire disorder: expert consensus panel review. Mayo Clin Proc. 2017;92(1):114-128. https://doi.org/10.1016/j.mayocp.2016.09.018

3. Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633-641. https://doi.org/10.1016/j.juro.2018.05.004

4. Jackson G, Rosen RC, Kloner RA, Kostis JB. The Second Princeton Consensus on sexual dysfunction and cardiac risk. Mayo Clin Proc. 2006;81(5):766-778. https://doi.org/10.4065/81.5.766

5. Binns C. Pheromones and the human sexual response. Scientific American. Published February 1, 2023. Accessed September 2, 2025. https://www.scientificamerican.com/article/pheromones-sex-lives/

6. Salonia A, Fabbri F, Zanni G, et al. Chocolate and women’s sexual health: an intriguing correlation. J Sex Med. 2006;3(3):476-482. https://doi.org/10.1111/j.1743-6109.2006.00236.x

7. Gruenwald I, Kitrey ND, Appel B, Vardi Y. Low-intensity extracorporeal shock wave therapy in vascular disease and erectile dysfunction: mechanism, clinical and basic aspects. World J Urol. 2015;33(10):1651-1657. https://doi.org/10.1007/s00345-015-1569-y

8. Buvat J, Maggi M, Gooren L, Guay A, Torres LO. Endocrine aspects of male sexual dysfunctions. J Sex Med. 2010;7(4 Pt 2):1627-1656. https://doi.org/10.1111/j.1743-6109.2010.01781.x

9. Scott A, Newson L. Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. Br J Gen Pract. 2020 Mar 26;70(693):203-204. doi: 10.3399/bjgp20X709265.

10. Benson R, McClelland S, Alom M, et al. The role of platelet-rich plasma in sexual medicine: a scoping review. Sex Med Rev. 2022;10(3):368-380. https://doi.org/10.1016/j.sxmr.2021.12.003