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Clinical Review ABC of sexual health

Sexual problems associated with infertility, pregnancy, and ageing

BMJ 2004; 329 doi: (Published 02 September 2004) Cite this as: BMJ 2004;329:559

Rapid Response:

Zinc deficiency as a cause of sexual problems

Editor - I am surprised that a sex relation therapist Jane Read still
assumes women should be taking HRT or using oestrogen cream.1 The
randomised controlled Women’s Health Initiative HRT study results found
increases in strokes, dementia, heart attacks, breast cancer and
endometrial cancer with HRT. The decline in cognitive function with both
progesterone-dominant and oestrogen-alone HRT is even mentioned in today’s

The first story line for last night’s new GP soap on ITV was about
two men consulting the GP because of gynaecomastia. The woman they were
both having intercourse with was overdosing on vaginal oestrogen cream.
In reality the woman would also have had endometrial hyperplasia and
irregular bleeding, which is why oestrogen cream is not to be prescribed
to a woman with an intact uterus.

The contents of this Clinical Review remind me of the course in
Psychosexual Medicine which I attended in the 1960s. The psychotherapist
apparently had no knowledge of the importance of relevant biochemical
investigations. I was so unimpressed I organised some research and found
that loss of libido and depression with progesterone dominant/ low dose
oestrogen oral contraceptives related to high endometrial and platelet
levels of monoamine oxidase.3

Read still dwells mentions the same comical anatomical anecdotes but
does not mention the best known aphrodisiac – oysters, which are
exceptionally high in zinc. Exogenous hormones also cause zinc deficiency
and raise copper levels. Zinc and magnesium deficiencies are major causes
of unexplained infertility, pregnancy complications and loss of libido and
vaginal dryness.4 Zinc deficiency causes blocks in essential fatty acid
pathways which also causes dry skin and mucous membranes. Progesterones in
particular cause endometrial atrophy, vaginal dryness and dyspareunia.5
The women most likely to be referred to me for sexual dysfunction are
usually 20 year olds who have been taking progesterone-dominant
contraceptives since their teens.

The commonest causes of unexplained infertility and recurrent
miscarriages are nutritional deficiencies and undiagnosed infections in
the hundreds of preconception couples I have assessed. It is about time
Psychosexual Medicine evolved into using biochemical and microbiological

1 Read J. Sexual problems associated with infertility, pregnancy, and
ageing.BMJ 2004; 329: 559-561

2 POEM*: Postmenopausal oestrogen does not improve cognitive
function. BMJ 2004;329, doi:10.1136/bmj.329.7465.0-f

3 Grant ECG, Pryce Davies J. Effect of oral contraceptives on
depressive mood changes and on endometrial monoamine oxidase and
phosphatases. BMJ 1968; 3: 777-80

4 Grant ECG. Nutritional supplements to prevent pregnancy
complications., 16 Jul 2004

5 Grant ECG. Biochemical and microbiological investigations needed
for female dyspareunia., 4
Jun 2004

Competing interests:
None declared

Competing interests: No competing interests

03 September 2004
Ellen C G Grant
physicain and medical gynaecologist
20 Coombe Ridings, Kingston-upon-Thames. KT2 7JU, UK