My wife is 40, and she has had seven children. The last child was born over four years ago. Soon after the child was born, my wife had her tubes tied. It seems that she has no sex drive now. She thinks her hormone problems are a result of tying her tubes. Is there evidence to suggest that tying the tubes can cause problems with sexual desire, or any other medical problems?

-- Bert

There may be some change in blood flow to the ovaries as a result of tubal ligation, and that change in blood flow may produce some subtle hormonal changes. Approximately 10 percent of women will experience some sort of difficulty after a tubal, ranging from irregular periods to increased cramps to PMS; 90 percent or more have absolutely no problems after a tubal ligation.

At age 40 your wife may be entering perimenopause, a transition phase that precedes menopause and that may cause a host of symptoms, including a decrease in sex drive. I suspect the number-one factor in her decreased sex drive is seven children -- how can she possibly have any time to think about sex when she has such a large family to care for? I'm sure she is exhausted, and sleep may be a higher priority than sex. Most cases of decreased sex drive in women before menopause is not hormonal, but rather situational (too busy and too exhausted, financial or other worries, etc.) or due to a less-than-satisfactory relationship (husband doesn't help out around the house at all, is always critical, and so on).

If your wife's decreased sex drive stems from a hormone imbalance, that can be assessed by her gynecologist with blood tests; if testosterone levels are low then she may benefit form supplementation. Other conditions like thyroid disease should also be ruled out. The most likely cause, however, is simply doing too much and not making time for oneself.