* Have you lost your libido?
* Are you concerned it will never return?
* Are you happy in your relationship?
* Can you talk to your partner openly about intimacy?
* Do you feel too tired or irritable for sex?
* Can you no connect with your partner on a spiritual level?
* Does it seem he just doesn't understand what
you're going through during peri/postmenopause?
* Do you avoid telling him how you feel?
* When you try to talk to him, does he listen?
* Do you no longer feel desirable?
* 43% of women report a sexual dysfunction.
* 1/3 of women report low libido.
* 50% of marriages end in divorce.
* 3000 couples get divorced each day.
* Infidelity estimates in US range from 20-50%.
* One estimate rates the % of Americans who would have an affair in their lifetime to be as high as 70%
* Depression affects twice as many women as men
* 1/7of women will suffer depression in their lifetime
* 73% of all psychiatric medications, including antidepressants, are prescribed to females
* 43 million women take antidepressant medications
* 62% of American women are overweight
* 4 million American women can be classified as problem drinkers
* 1/3 Americans are sleep deprived (sleep 6 or less hours per day)
* * * * * * * * * * * * * * * * * * * * *
Getting To Know Your Sex Drive
by Andrew Goldstein, MD
Dr. Marianne Brandon
* * * * * * * * * * * * * * * * * * * * *
For the vast majority (of women)...a decline in sex drive takes a
tremendous physical and emotional toll. These women speak of feeling
deficient, ashamed, sad, angry, anxious, or unfulfilled....
Over the years, experts in sexual health have struggled to define
sexual desire. Often they resort to primarily physiological indices,
such as vaginal lubrication or genital swelling caused by increased
blood flow; psychological indices, such as the perception of wanting
to make love; or a combination of the two.
Rather than attempting to generalize something so unique and personal
as sexual desire, we encourage you to define this state for yourself.
By creating your own measures, you can determine whether or not you
are personally satisfied with your sex drive.
When we look at women who have reached sexual maturity since the
sexual revolution of the 1970s, we find that as a group, they have
embraced a less restrictive view of their sexuality. This freedom has
allowed them to experience great sex and great sex lives. They have
known lust; they are comfortable with a strong libido. They know their
bodies and have confidence in their ability to satisfy themselves.
At the same time, women in this age group--between 20 and 50--
inevitably encounter countless physical and emotional hurdles
(marriage, career, and childbirth, to name a few). They may notice a
decline in their passion and sexual desire during these transitions.
Though it is unfortunate, it is common--almost universal.
Some women who lose libido dont particularly miss it. They seem to
live without sex quite contentedly. For the vast majority, however, a
decline in sex drive takes a tremendous physical and emotional toll.
These women speak of feeling deficient, ashamed, sad, angry, anxious,
or unfulfilled. Or they may oscillate between all of these emotions.
After years of enjoying an exciting and fulfilling sex life, a woman
may mourn the loss of what was an integral part of herself and her
relationship with her partner. Sometimes this loss leaves her feeling
confused and overwhelmed. At other times, she is so detached and
distant from her sexual self that she becomes convinced she no longer
cares about her lack of desire. But, clearly, she does.
The Many Faces of Sexual Dysfunction
Margaret sat in her dark kitchen, crying into the phone. Her closest
friend, Linda, listened silently on the other end, unable to help.
When Frank and I were first together, I was turned on just by looking
at him, Margaret recalled. His smile and sincerity were so sexy to
me. I enjoyed just being around him, and I loved turning him on. It
made me feel so good when he wanted to make love to me. But when I
look at him now, after being married for 8 years, I never think of
making love to him. I miss the closeness and the connection we used to
share, but I just cant seem to muster the will to want him. I know it
sounds terrible, but Id rather be left alone. I dont want to have
sex, but Linda, Im so afraid that Frank is going to have an affair!
A decline in sexual desire is just one type of sexual disorder that
affects women. Until recently, such problems went largely ignored in
medical and research circles. They devoted the lions share of their
attention to sexual dysfunction in men, developing and refining
treatment protocols for common male conditions like premature
ejaculation and erectile dysfunction.
We are happy to report that this double standard is finally changing,
as physicians and scientists have begun investigating female sexual
dysfunction. We applaud this change, which is bringing to light the
prevalence and severity of female sexual concerns.
Female sexual dysfunction can manifest itself in a variety of ways.
The most common problems, as identified by the Diagnostic and
Statistical Manual of Mental Disorders, fourth edition, text revision
(or DSM-IV-TR), generally fall into one of four major categories:
sexual pain disorders, orgasmic disorders, sexual arousal disorders,
and sexual desire disorders. All significantly affect not only womens
sexuality but also their relationships and overall life satisfaction.
Although we will review the four categories of sexual dysfunction
below, the rest of the book will focus exclusively on low libido. We
want to note, too, that other types of sexual problems--such as
substance-induced sexual dysfunction and sexual dysfunction caused by
a medical condition--can occur in women. But these conditions are much
less common than the ones highlighted here:
Sexual pain disorders: Until recently, sexual pain disorders were
largely unstudied and misunderstood. Yet they affect approximately 7
percent of women, according to an extensive study of the prevalence of
sexual dysfunction in the United States, published in the Journal of
the American Medical Association (JAMA) in 1999. Theyve been linked
to a variety of causes, both physical (such as vaginal infections and
hormonal imbalances) and psychological (relationship problems).
Dyspareunia, or pain during intercourse, can result from poor
lubrication--perhaps because of lack of foreplay or diminished blood
flow to the vagina. Poor lubrication also can stem from a deficiency
of estrogen, which causes a condition known as atrophic vaginitis.
Certain factors can raise a womans risk of atrophic vaginitis, such
as surgical removal of the ovaries (oophorectomy); use of
contraceptives, including Depo-Provera and birth control pills; and
the decline in estrogen associated with perimenopause and menopause.
Some women may experience pain during intercourse because of an
underlying condition that causes tearing or scarring of the vulva or
vagina. Examples of these include lichen sclerosus and erosive lichen
Another sexual pain disorder, vulvar vestibulitis, affects the
vestibule--that is, the entrance of the vagina. In some women, the
vestibule has such a proliferation of pain nerve endings that any kind
of pressure--whether from a penis, a tampon, or even clothing--
triggers severe pain.
Vaginismus, which involves involuntary spasms of the muscles in the
outer third of the vagina, sometimes occurs in conjunction with other
sexual pain disorders. Or it may result from a psychological trauma
such as sexual abuse. In our opinion, doctors too often attribute pain
during intercourse to vaginismus, rather than pinpointing the true
A thorough discussion of sexual pain disorders is beyond the scope of
this book. If you experience pain during intercourse, we encourage you
to consult a physician who specializes in sexual pain disorders for an
accurate diagnosis. To find one in your area, start by checking the
resources on page 312.
Orgasmic disorders: This type of sexual dysfunction affects
approximately 25 percent of the female population in the United States
at some point in their lives. These women either have never
experienced an orgasm (primary anorgasmia) or seem to have lost their
ability to do so (secondary anorgasmia). Unfortunately, they may be
too ashamed to talk with their partners about their inability to
climax, choosing to fake orgasms. This can lead to more-complicated
problems over time, as secrets create distance between partners.
Like most sexual dysfunction in women, orgasmic disorders can have
both physical and psychological causes. For example, certain classes
of medications can impair a womans ability to climax. On the other
hand, some women become so uncomfortable at the prospect of losing
control during sex that they cant achieve an orgasm.
Sexual arousal disorders: The term sexual arousal disorder may be
confusing, as it seems to encompass low libido. In fact, it refers to
an impaired physical response when making love. A woman who has a
sexual arousal disorder cannot attain or maintain sufficient genital
lubrication for comfortable sexual intercourse. Her vagina remains dry
despite receiving adequate genital stimulation. Sexual arousal
disorders can result in painful intercourse, particularly if a couple
chooses not to use additional lubrication such as K-Y jelly.
According to the JAMA article cited above, sexual arousal disorders
affect approximately 14 percent of women in the United States. The
disorders may be more common among women at or past menopause, because
the decline in hormones--especially estrogen--can compromise vaginal
lubrication. Psychological problems, such as depression and anxiety,
also can cause sexual arousal disorders.
Sexual desire disorders: This category of sexual dysfunction includes
sexual aversion disorder and hypoactive sexual desire disorder. In
sexual aversion disorder, a woman is so repulsed by sex that she
avoids all sexual contact. Just the prospect of sex may trigger a
response ranging from moderate anxiety to intense psychological
distress. Many experts attribute sexual aversion disorder to some sort
of psychological trauma, such as past sexual abuse.
Hypoactive sexual desire disorder (HSDD) is an elaborate name for low
libido. The DSM-IV-TR defines HSDD as persistently or recurrently
deficient (or absent) sexual fantasies and desire for sexual
A woman who has HSDD exhibits little motivation to seek sexual stimuli
and little frustration at thwarted opportunities for sexual
interaction. HSDD is the most common sexual disorder in women,
affecting an estimated 22 to 43 percent of the female population in
this country.To receive a diagnosis of HSDD, a woman must experience
significant distress or interpersonal difficulty because of her low
libido. This is an important point, because if a woman doesnt want
sex but isnt bothered by it, she is not considered diagnosable.
When deciding on treatment for a case of HSDD, most experts consider
three core characteristics of the disorder. The first relates to
onset--whether a woman has had low libido all her adult life or
whether she has lost interest in sex over time. The second asks about
occurrence--whether the woman experiences low libido all the time
(generalized) or only in certain circumstances, such as when shes
with a particular partner (situational). The third involves cause--
whether the disorder results from psychological factors alone or from
a combination of physiological and psychological factors.
Note that virtually all cases of HSDD have a psychological component.
Even when libido declines because of a physiological problem, such as
a hormonal imbalance, it is likely to produce secondary psychological
symptoms such as anxiety or impaired self-esteem.
As you might imagine, HSDD often occurs with other types of female
sexual dysfunction. For example, if a woman experiences pain during
intercourse, she may lose interest in making love. Or if she
repeatedly tries and fails to have an orgasm, she might feel bad about
herself and eventually avoid sex altogether.
Lack of Balance May Be to Blame
When women come to our Sexual Wellness Center seeking help for low
libido, they invariably ask the same question: Whats wrong with me?
In our experience, a decline in sexual desire seldom has a single
cause. The collection of factors that influences a womans sex drive
is as unique as the woman herself. This is why we believe so strongly
in a holistic approach to treating low libido. If we were to focus on
just the physiological or psychological components of sex drive, we
likely would overlook other underlying issues that might prevent a
woman from fully recovering her sexual desire.
As we explained in chapter 1, our approach involves creating a profile
of a womans libido by assessing what weve identified as the four
primary dimensions of sexual wellness--physical, emotional,
intellectual, and spiritual. All of these dimensions contribute to a
healthy libido and an active sex life.
For example, to desire sex, a woman must be in good physical health.
Her hormones of desire (estrogen, testosterone, and dopamine) must be
in balance. The skin and nerves of her vagina, clitoris, and nipples
must be sensitive to arousal. She must know her body and her erogenous
zones. She must be able to have sex without pain.
Beyond physical health, a woman must possess the emotional hardiness
to acknowledge and experience the full range of feelings that come
into play in an intimate relationship. They may be sexual or
nonsexual, pleasurable and positive, or uncomfortable and negative. An
emotionally healthy woman easily moves through her full range of
feelings without fixating on one or avoiding another. She can be
passionate, empowered, desired, vulnerable, open, and loved.
Intellectual health, our third dimension of sexual wellness, is not
measured by level of education or IQ. It is much more complex than
that. A woman who is intellectually healthy feels stimulated and
useful in her life. She perceives herself as competent and
appropriately challenged. This filters into all aspects of her life,
including her sexuality. Her thoughts about sex, and her sexual
expression, are positive and reaffirming.
A womans spiritual beliefs and needs play a powerfully influential
role in her libido. In its broadest sense, spiritual health refers to
a womans ability to find meaning and worth in herself and her life.
Of course, this means something different to everyone. It is personal
and specific to a womans unique psychology and belief system. It may
or may not revolve around a relationship with God or a higher power.
Bringing spirituality into an intimate relationship enhances desire
and the overall sexual experience. It allows for a sense of
transcendence, as well as a deeper and more meaningful connection
between a couple. The act of making love becomes richer and more
desirable when physical pleasure is not the only component of what a
woman gets for herself and shares with her partner.
Through the rest of the book, we will further explore each of these
four dimensions and their respective effects on libido. In general,
when they are optimized and in balance, a woman will find happiness
and fulfillment in her life and in her intimate relationships. But if
something disrupts this equilibrium, a womans sex drive will suffer.
How Relationships Influence Libido
Dawn knew she couldnt say no again that night. It had been weeks--no,
months--since she and her husband, Eric, had made love. She was all
too familiar with the routine; they had fallen into it maybe 15 years
before. First, Eric would go down on her for 3 minutes or so. Did he
really enjoy that, or was he just doing it to get her wet? She had no
idea. Then he would climb on top of her and thrust for about 2
minutes. Eric would come, and then Dawn could sleep. Should she take a
risk and suggest they try something different for a change?
She briefly recalled how exciting sex was in the first years of their
marriage. Oh, who really cares, she thought. Ill just plan what I
need to pick up from the grocery store tomorrow.
Just as internal issues rooted in the four dimensions of sexual
wellness--things like hormonal imbalance, repressed anger, and poor
self-esteem--can undermine libido, so can external factors. Chief
among these is the relationship dynamics between a woman and her
Through our interaction with clients at the Sexual Wellness Center,
weve seen firsthand how a decline in sexual desire can be a direct
and natural consequence of the challenges inherent in an intimate
relationship. Because a womans libido is so incredibly sensitive, it
responds to a wide range of these challenges--some obvious, others
quite subtle. As long as they are ignored or unresolved, libido is a
When a woman loses interest in sex, she may begin to doubt the
rightness of her romantic partnership or marriage. It is not unusual
for women to wonder whether they still love their partners, especially
if their experience of making love has deteriorated over time. They
may feel that sex is not worth the effort or is just plain bad.
Indeed, women with low libido often describe their sex lives as
monotonous, uninteresting, or unstimulating. Worse, they feel bored,
angry, and alienated from their partners because of bad sex. At the
same time, they feel they cant do anything about it. They worry that
opening up about their dissatisfaction will hurt their partners, or
theyre convinced that their partners wouldnt want to try to change
Most couples consider sex to be an important part of relating--though
this isnt true for everyone. We know partners who dismiss sex as an
unimportant or unnecessary aspect of their bond with one another. They
are comfortable with making love very rarely, or even not at all. They
prefer a certain amount of space in their relationships. If they love
each other, they find less personal, nonphysical ways to share
intimacy and feel connected.
These couples are the exception rather than the rule. Most of us
believe that in a reasonably solid relationship, wanting to make love
is a natural and expected outgrowth of our connection with our
partners. And if we dont get that urge to have sex, we are left
feeling demoralized, distressed, and somehow defective. Our lack of
desire becomes an albatross around our necks. It is a dark secret that
slowly and insidiously taints our perception of ourselves and weakens
our relationships with our partners.
For women, the insecurities that arise from not wanting sex with a
partner become worse with the experience of feeling turned on by other
men. Fantasizing about someone other than a partner can lead a woman
to wonder whether her body is telling her that she is no longer in
love, or that she and her partner have lost their ability to connect
meaningfully. Though this may be true, more than likely her low libido
means something altogether different. In fact, her body could be
telling her that she and her partner share a tremendous capacity for
intimacy that they havent fully explored--perhaps because they fear
being so close to another person, as much as they desire it.
It is easy to blame your partner if you are not enjoying sex. You may
even be able to identify why your partner turns you off, or at least
why your partner no longer sparks your sex drive. The truth is, it is
more fruitful to look within yourself to understand your lack of
desire. This is because any change in your self-understanding and
behavior will have an impact on your partner, ultimately influencing
the dynamic between the two of you. Besides, giving someone else the
responsibility for your satisfaction is never a good idea.
This doesnt mean that your criticisms of your partner are not valid.
They very likely get to the heart of the relationship issues that the
two of you need to address. However, if you put your goals in someone
elses hands, you probably will never reach them. Nowhere is this more
apparent than in the bedroom.
While were on the subject of relationship dynamics and libido, we
want to mention that one partners struggle with sexual dysfunction
can weaken the others sex drive. For example, if a man struggles with
premature ejaculation or erectile dysfunction, sex can become more
emotionally stressful and less physically pleasurable for both
partners. As a result, the woman may lose interest in making love.
Making Love Worth Wanting
All this talk about sexual desire begs the question: What makes sex
desirable? In other words, exactly what is good sex? Although every
woman must answer this for herself, we can identify certain elements
that seem to be essential for a pleasurable sexual experience. But
first, lets look at what isnt good sex.
Unfortunately, our society promotes the misguided view that good sex
is primarily dependent on superficial variables such as a womans body
type and weight. Of course, this cultural wisdom couldnt be further
from the truth. Whether or not a woman experiences good sex has little
to do with the size of her waist. But like any message we are
repeatedly exposed to, we come to believe it over time. In this way,
it inhibits a healthy libido--and good sex! It is so destructive
because it encourages women to feel ashamed when their bodies arent
perfect (whose is?), and it allows the truth about good sex to remain
ignored and unexplored.
Our society also buys into the notion that good sex always involves
intercourse and orgasm by both partners, preferably at the same time.
This approach to sexuality is restrictive and unrealistic. The most-
rewarding sexual experiences are much more rich, diverse, and
creative. They grow from powerful connections of hearts and minds.
Unfortunately, few of us seize the opportunity to explore the sexual
possibilities. Its no wonder so many Western women lose interest in
Truly good sex, however, begins with a willingness to be open and
vulnerable, to give pleasure freely and receive it fully. It also
depends on both partners commitment to shared intimacy, both physical
and emotional. Relying on just one form of intimacy without the other
is like trying to enjoy a movie without popcorn. Its pleasant enough,
but it isnt quite as satisfying.
Good sex, then, is a complex concoction of openness and secrecy, risk
and control, personal satisfaction and mutual fulfillment. With too
little of any one ingredient, sex is boring and not worth the effort.
Too much of one, and sex turns threatening--prompting discomfort,
anxiety, and shame. Above all, sustaining a healthy, balanced sex life
requires mindful attention to the physical, emotional, intellectual,
and spiritual dimensions of our selves, as well as our relationships
with our partners. We may be entitled to good sex, but we must earn it
through effort and commitment.
Rediscover Your Desire--And Yourself
Most of us have experienced the pleasure of sexual desire. The fact
is, many women with diminished sex drive simply have lost touch with
what feels like good sex to them. Sex went from easy and enjoyable to
a tangled mass of anxiety, frustration, and disappointment.
So many of our clients at the Sexual Wellness Center say that they
want to get their libidos back. But when they describe the sex theyve
been having, were not surprised that they lost their libidos in the
first place. Most healthy, mature women are not going to want mediocre
or bad sex. Why would they?
Somehow, we come to believe that we should want sex with our partners,
regardless of the quality of the lovemaking experience. This is an
interesting notion, but it doesnt necessarily translate well into
other aspects of our lives. For example, would we expect to desire a
massage with a mediocre masseuse? Would we expect to desire a dress
made from fabric that irritates our skin? These examples seem absurd
initially, but their point is clear: We want only what feels good.
Of course, what feels sexually enticing and exciting to one person can
be completely unappealing to the next. A loving, committed
relationship provides a safe and trusting environment where both
partners can explore and express their sexual needs and preferences.
The goal of our practice, and this book, is to help regain what women
know is inherently natural for them: a healthy sex drive. At the same
time, they can use the challenge of low libido to foster a deeper
understanding of themselves, their relationships, and their sexuality.
We encourage you to take advantage of your dissatisfaction with your
libido, seizing a rare opportunity for self-growth and greater self-
knowledge. Now is the time to identify and heal whatever is
interfering with your ability to get what you want from your life,
your relationships, and yourself. In this way, you can help revive
your libido--and create a more satisfying sex life to boot
The Power Surge Newsletter
disclaims any representation for the accuracy or completeness of information
contained herein. The sharing of information herein is not indicative of
Power Surge's personal endorsement of same. It is purely for informational
purposes. Health matters should be taken up with one's personal physician.
Nothing in the Power Surge Newsletters, chats, message base, bulletin
boards is intended as a substitute for professional medical advice. Opinions expressed are Dearest's and the authors who contribute to Power Surge and don't reflect the opinions of America Online.
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