The pronounced ebb and flow of the female sex drive is something that women (and their partners) know well. While men tend to remain mostly in the "on" mode, for women desire is often more elusive. I don’t think many men or women would disagree that the female libido is acutely sensitive to the stresses of life -- work, parenting, financial concerns, family friction and more. Whether or not this is a "problem" that women need to "fix" is perhaps a more controversial question -- and I think the discussion is well worth having.
The FDA has just declined to approve the latest libido-boosting drug for women, flibanserin, originally designed to be an antidepressant, that was being promoted as a way to boost female sexual desire and satisfaction. While studies showed that it created a modest uptick in a woman’s sex drive, possibly by affecting the brain’s balance of neurotransmitters, the FDA ruled that its benefit wasn’t significant enough to offset its drawbacks, including potential side effects (such as nausea, dizziness, diarrhea and urinary tract infections) and as yet unknown safety risks.
I’m sure, however, that this isn’t the last we’ll hear about drugs (including some already in the clinical testing stage) meant to treat what’s being called Hypoactive Sexual Desire Disorder (HSDD)... so I sought out Barbara Bartlik, MD, psychiatrist and sex therapist in New York City, to discuss what women can do that does not involve medication -- which, as you know, I rarely believe in as a first-line therapy.
Is It a Problem For You?
Acknowledging that some people are quite satisfied with a sex-free lifestyle (see "Can Life Without Sex Be Happy?" Daily Health News, December 14, 2009), Dr. Bartlik said that she believes that there is, in fact, some basis for identifying a substantially diminished sex drive in certain women as a "disorder." And she believes this in spite of the long continuum in what we consider normal sexual drive and the many life situations that can cause fluctuations in a woman’s libido. She estimates that about 20% of her patients are women who are greatly disturbed by their loss of interest in sex and its effect on their partners. "These women are suffering... their relationships are suffering... their partners feel unloved and unwanted, and this feeling even leads some partners to have affairs," she says. "Sexual problems in a relationship make everything else even harder."
I asked whether these women object to having their low libidos labeled, and Dr. Bartlik told me that they don’t -- in fact, many are actually relieved to hear their problem described as a disorder. "Having a name for it helps patients better identify the problem and understand what is going on, rather than just feeling inadequate and abnormal," she says, adding that it also provides them with a specific focus for their work in treatment.
What’s the Cause?
For most women, a low libido starts with a stress-filled life, Dr. Bartlik said. She describes a typical patient as "very upset, working too many hours, feeling that she has little control over her life and burning the candle at both ends." Living under such intense stress can cause a woman’s testosterone levels to sink, leading to biological changes as well as to the emotional toll that stress takes.
But what about a romantic escape to, say, the Caribbean to get a couple’s sexual energy flowing again? "How many people have that option?" Dr. Bartlik asked -- and, besides, she said, what women may need to feel more sexual often has nothing to do with sex. So, for a woman who seeks therapeutic help with this problem, she says the initial goal is to carve out time (usually in negotiation with her partner) to be away from the usual stresses so that she can rejuvenate herself emotionally and physically.
To get patients started on this path, Dr. Bartlik has the following advice:
- Think through and identify what flips your sexual switch to "on." For instance, perhaps reminiscing about why you and your partner fell in love... dressing up for a special occasion (even if it’s just dinner at a local restaurant)... dancing at a party or a wedding... even flirting with your partner may wake up that "loving feeling." What other types of thoughts, feelings, activities and behaviors make you feel desired and desirous?
- Next, articulate them -- ideally to your partner. "Verbalizing your thoughts not only reinforces them within your own mind, but has a wonderful effect on your partner. Your partner may start to reciprocate, which may have a beneficial effect on you. Before you know it, you are ready to have some fun."
- Engage in activities just for you, ones that make you feel good. Sure, some women may enjoy activities with an obvious connection to sex -- like taking a class in belly dancing -- but others would rather do yoga or Pilates, have a makeover, go to a spa or have nights out with their girlfriends.
- If you are overweight, get help taking off pounds. Being significantly overweight is, well, a huge issue in diminished sexual drive, says Dr. Bartlik. Not only does it make you feel uncomfortable and perhaps embarrassed by your body -- it also reduces testosterone levels that fuel sexual desire.
- Change your diet. Eat more whole foods -- this will of course help you lose weight, but there’s an additional benefit. By getting rid of additive-filled junk foods that contribute to toxicity in the body, you will have more energy, including what it takes to want sex as well as to have it.
- Consider adding erotica to your personal library or relaxation rituals. Many women enjoy erotic literature, and there is a whole category of sexually oriented books and movies intended for women that may be enjoyable and helpful in enhancing desire. Whatever you find that helps you relax and boosts your feelings of sexuality is likely to escalate your libido, even potentially triggering the release of hormones involved with sexual response, says Dr. Bartlik.
About That Pill...
All that said, Dr. Bartlik pointed out that low libido in women is considered a disorder only when it causes a patient marked distress and difficulty in her relationship. In other words, those who are comfortable with little or no sexual desire do not suffer from HSDD. For those who are experiencing real difficulties, a pill seems to offer an easy solution -- but, as with all medications, it really isn’t that simple. It’s important to get at what’s really going on inside you and inside your relationship.
Source(s):
Barbara Bartlik, MD, psychiatrist and sex therapist in New York City.
