Better Sex Blog » low libido

DHEA…we thought so all along

Bat Sheva Marcus LMSW MPH PhD — Tue, 03 Jan 2012 17:15:50 +0000

A new small scale study out of Italy seemed to show that DHEA can be helpful with menopausal symptom and can also positively affect a woman’s sexual desire.

http://www.healthnews.com/en/news/DHEA-Hormone-Therapy-May-Be-Menopause-Magic/0UuHws6wf6pBU1vtwcDIcD/

So why is anyone surprised? The truth is that DHEA is a precursor hormone (or a “mother hormone” – but that title might suggest that it yells at you if you don’t clean your room and DHEA definitely does not do that!) which converts in your body to estrogen, progesterone and testosterone. So yes, taking DHEA every day is going to have an impact on your hormones. The fact that it is a hormone that is identified by the FDA as merely an “herbal supplement” is what should be surprising.

Be that as it may, for women who are suffering from the effects of low hormones, either with menopausal symptoms, low libido, dry skin or memory loss, DHEA might indeed give them relief. But keep in mind one caveat. It really and truly is a hormone. Don’t mess around with it alone too much. If you are serious about using it see your doctor, or better yet, see a specialist. Make sure you are having regular blood tests and someone is monitoring your hormones to make sure you are in a normal range and checking you regularly for side effects.

And keep your eyes out for more studies – it will be interesting to watch as DHEA comes of age.

Desire or ” I want you!”

Bat Sheva Marcus LMSW MPH PhD — Thu, 28 Jul 2011 13:44:17 +0000

“I want you.” Three simple words, but somehow they seem nearly impossible to define. Desire can be very complex and often seems mysterious to us. It appears as a magical equation of attraction mixed with physical attributes, eroticism, passion, simple physical need, or love.

And when desire is not there, in its place there is often a sense of emptiness, of an open yawning space, a chasm that can’t be breached and sometimes even a feeling of loss.

The most common complaint we see at the Center is low desire (also known as low libido). And no, honestly, it’s not all 50+ year-olds complaining that their libido has taken a nose dive. We hear it from many women in their 30s and 40s, and we also see young women who feel that they have never really had much desire at all.

What makes defining desire so difficult is that only part of it is sexual. When we talk about wanting someone, we often do mean that we want them sexually. But t he truth is, if you unpack the box a bit more, you’ll find that it’s that it’s not just about sex per se (at least the very literal interpretation we give to sex). It’s about wanting, or feeling wanted for the essence of who you are, for the ability to lie naked (both literally and figuratively) in someone’s arms and know that –even if it’s for a fleeting moment- the essence of who you are is desired. It is about letting someone in, again literally and figuratively, and it’s about feeling seen.

When a woman’s desire is low it makes it hard for her to connect with her partner in a physical way, and that can cause many effects that ripple throughout the relationship. It can have significant ramifications on her partner’s feeling about her, about himself, and about his own desirability. It can greatly affect her feelings about her role in the relationship, as well as the overall tone of the relationship itself.

We live in a busy world and many of us lead complicated lives. That means most of us will have stress and anxiety, less-than-perfect relationships, and almost never enough time to relax and regroup. This alone can wreak havoc on a woman’s libido. Some of the craziness of life can be controlled, but not all. A healthy libido can usually weather the normal ups and downs of a crazy life and bounce back after a relatively short “shut-down.”

But there are more complex reasons a woman suffers from a low libido. It can be influenced by physiological conditions in our bodies: hormone levels, vitamin deficiencies and neurotransmitter health. It can be a symptom of depression. It can hint at thyroid problems or anemia. It can be caused by problems in the relationship: lack of intimacy, lack of trust, lack of time. It can be caused by personal struggles of our own: a dislike of our bodies, a general unhappiness with our lives, a lack of time or energy.

The bottom line is, for so many reasons, a low libido should be taken seriously and examined appropriately. You don’t have to live with low sexual desire if you don’t want to—and don’t let anyone else tell you otherwise!

What Drugs Might be Causing a problem in Your Sex Life?

Bat Sheva Marcus LMSW MPH PhD — Thu, 23 Jun 2011 15:59:18 +0000

Let’s see. What drugs might be causing a problem in your sex life? There’s Prozac, Effexor, Lexapro, Celexa, all the rest of the SSRI’s, the NSRI’s, all birth control pills, the neuroplant, anti anxiety medications like Atavan, Valium, and the list goes on and on and on and on.

Here’s the deal. Many drugs can have a negative impact on your sex life. We are only now beginning to understand the complexity of drugs and how they affect a woman’s libido and functioning. That’s mostly because, quite frankly, most investigators didn’t really care much about how sex was affected by a drug. They certainly were not concerned with a woman’s sex life.

But thankfully that is changing and we are beginning to understand more and more about how drugs impact us.

We are very clear that any drugs that affect your brain functioning or your body chemistry can affect your sexual functioning. That doesn’t mean it will. It just means that you need to keep an eye on it. In the end, you are by far the best judge of what is happening in your body. If you feel like something is off, it probably is. Trust your judgment. Discuss it with your practitioner and make sure they are listening.

Drugs can and do affect your sex life. Only you can be the best monitor!

The Pill and Libido

Ilene Rosenthal, Marketing — Tue, 12 Oct 2010 18:00:51 +0000

The website SheKnows.com handles a lot of tough issues from love and sex, to home and garden, to parenting and health.

When considering the connection between the pill and your sex life and the role of hormones in a woman’s libido, there is a lot of reliable research to support this link. The question is: birth control! For some women, finding another avenue for birth control is a bigger deal than saying yes when they mean no in the bedroom. Read more on the She Knows site.

Response from a patient on the “medicalization” of female sexuality debate

Ilene Rosenthal, Marketing — Tue, 27 Jul 2010 15:33:16 +0000

We received an unsolicited response to Dr. Marcus’ position piece on the “medicalization” of female sexuality from a patient. Her words speak for themselves.

“The last time I was in the office I told Dr.Marcus that she will be remembered for her contribution to Female Sexuality the way that Margaret Sanger was with birth control.

I read the article (in the latest e-newsletter from the Medical Center for Female Sexuality) and I could not agree more. It took a great deal of courage for me to pick up the phone and make that first appointment. I had spoken with a psychotherapist at length about the problem itching. discomfort and pain in my vagina; loss of desire that had nothing to do with my attraction to and love for my partner and finally my inability to achieve orgasms after being someone who previously had no sexual problems and certainly no problems achieving an orgasm. As I was in a new relationship my therapist said it was just a matter of getting comfortable with a new person. I know my body and I knew she was wrong. I tried the ‘herbal cures”, specifically Thandia from Native Remedies. Three months and I felt no difference.

I have been on Dr. Marcus’ s treatment regime for less than a month. The vaginal dryness and discomfort ended the first week. My level of sexual desire has returned almost to the level it was before I noticed a change and this weekend I had an orgasm that was as good as some of the ones I had at 30. So, I am a firm believer that there is no “magic pill” but a complex mixture of supports that Dr. Marcus has developed for each patient. You saved my sexuality and thus my relationship which is a huge part of my ongoing happiness.”

“M”, July 2010

Debate: the “Medicalization” of Female Sexuality

Bat Sheva Marcus LMSW MPH PhD — Fri, 23 Jul 2010 14:13:55 +0000

I hope you’ll forgive the lengthy perspective below, but this is an issue I am extremely passionate about.

If I hear one more time that women’s sexual dysfunction is a myth created by the media, and that the search for medical solutions is merely a thinly veiled way for the pharmaceutical companies to fleece innocent and gullible women, I may shoot someone.

The Numbers

Ask around: women have long been complaining to each other and their physicians about various sexual problems that present issues in their relationships and with their own quality of life: ”I have pain.” “I don’t get turned on.” “I can’t have an orgasm.” Even if you do believe that the pharmaceutical companies are looking for ways to keep their shareholders happy, it is difficult to find fault given these statistics.

Current studies indicate that 43% of women express dissatisfaction with their sex lives at some point in time. Hmmmm. Let’s say the “real” number is being inflated by 100% — that would still leave us with one quarter of all women suffering from these conditions and their unhappy consequences.

How real is this? For the skeptics, let’s say that number is still inflated and the real, discounted number is only 10% of all women who are experiencing female sexual dysfunction. Even that would 30 million women in US alone! Do the math: 21% would be 60 million women. And 43% would be 120 million.

Are we painting a clear picture here? Whether it’s 30, 60 or 120 million women suffering from female sexual dysfunction, it’s only reasonable to accept that it’s a problem worth addressing.

Big Bad Pharma

Now let’s talk about the big bad pharmaceutical companies accountable to their shareholders. Profit and share-price are the motives for making a product which works and will sell to a large patient population driven. No question.

When they look at the statistics they must be salivating! What a huge group of prospective users! An effective drug that solves low desire, for example, would be a boon!

So what’s wrong with that?

What if the motivation for studying a solution for millions of women is profit? Personally, I don’t really care what their motives are as long as they are working on the problem. If Big Pharma is trying to produce a drug that may help low desire or arousal, good for them! This may also be good for some my patients, which is the point, isn’t it?

Medical treatment and psychotherapy

Strikingly, you most often hear complaints about the “medicalization” of female sexual dysfunction from psychotherapists. Many seem horrified at the possibility that physiology may be at the root of female sexual dysfunction, and claim that practitioners will push suffering women into spending their hard earned dollars on questionable medical treatment.

In our practice, we have the opportunity each week to refer some of our patients – including some who have found medical treatment for their fsd – to local psychotherapists for longer term counseling connected with their experiences with sexual dysfunction. We recognize that the priority is getting patients the help they need in whatever way best suits their temperament, medical condition and wallet. Even though we believe that our approach of integrating the psycho-sexual with the physiological is powerful, we accept that some women will decide on traditional talk therapy to address their needs. Just because there may be a physiological reason for a particular sexual condition, does not mean that there cannot be related psychological – or even psychiatric – dysfunction that needs to be addressed by a specialist. But let’s be fair – the reverse is also true.

And finally, as part of the health care debate it’s hard to disagree with effective medical treatment that carries an annual cost of less than $2000, particularly when compared to upwards of $7000 per year for psychological counseling alone. So, factoring in the cost of different treatment options must be part of the equation for every patient.

“Quick Fix” vs. the “Long Haul”

To women who experience ongoing sexual difficulties, the choice between a quick fix and an interminable journey is unhelpful. Calling medical treatment for female sexual dysfunction a “quick fix” undermines the hard work patients do to face their condition head on. Patients will often overcome great embarrassment and insecurity to seek treatment. They may try unfamiliar or even uncomfortable procedures to address their problems. They may need to involve a disappointed or resistant partner in order to make progress. None of this describes a “quick fix” and the psychotherapeutic community’s knee-jerk assignment of that term demonstrates disrespect for women who are sincerely struggling with an untenable situation.

Two key questions remain at the fore when a patient considers treatment options: will it work and is it safe? After that, the next question is often: how long will it take (the adult version of, “Are we there yet?”)? Of course, the fact that medical treatment of FSD often resolves problems within a few months may alienate therapists who believe in a longer-term process. That, we believe, needs to be left up to the patient.

At the root of this argument is another assumption: that intimacy and sex are the same. The sooner we recognize that this is not true in every case, the more open the psychotherapy community will be to considering other channels to help patients find complementary paths to solving the distress of FSD.

A “quick fix” for the media

As we watch the media respond to the news regarding Flibanserin, Boehringer Ingelheim’s drug to improve sexual desire in women currently in clinical trials, we see how desperate they are to find a pithy, newsworthy way to present an issue. That’s where “Flibanserin, Viagra for women” comes from.

Such a synopsis ignores the different way the medications work (vascular for Viagra, hormonal/neurotransmission for Flibanserin) and disregards the complexity of sexual dysfunction for women. The lack of depth in describing the problem and its possible resolution is astounding and only reflects poorly on responsible media coverage.

“The consumer is not an idiot. She is your wife”

This quote is only one of many tenets of advertising and marketing proffered by David Ogilvy, considered the father of modern advertising.

To suggest that women will be sheep and buy whatever cream or pill is recommended, and keep using it even if it’s not working, is ludicrous and infantilizing. Women are smart consumers. When they have a problem they try a solution and they stop if it doesn’t work. I can list a slew of herbal “remedies” that have been on the market for sexual dysfunction. Some had significant marketing and PR dollars behind them, and nearly all of them are no longer being sold.

I have the utmost confidence in women who are seeking solutions to obstacles that stand in the way of their goals.

An intelligent, responsible person will evaluate treatment options with her own needs at the fore, and with an eye towards efficacy and safety and effort. She will not be convinced by phony claims, snake oil or an unsatisfying experience.

So, as you can see, this is not snake oil or fantasy, but a set of sound alternatives based on medical practice and fact. Virtually all conditions can be addressed in far less than one year with follow up assessment as needed. If you’ve ever met a young married woman who has been unable to consummate her marriage, a vibrant mom of teenagers who simply cannot find her libido, a post menopausal 55 year old who can no longer achieve orgasm, a young single woman who wrestles with her relationship because she cannot feel aroused, then you know how important it is to be prepared with all possible solutions. It is our job the help her have the sexual life she wants, regardless of what the critics say.

Dr. Bat Sheva Marcus interviewed by CBS News on female sexual desire

Ilene Rosenthal, Marketing — Wed, 26 May 2010 16:36:19 +0000

Last week, Dr. Bat Sheva Marcus, who has been the clinical director of the Medical Center for Female Sexuality for 10 years, was interviewed by CBS Channel 2 News in New York regarding the expected upcoming approval of a treatment for low sexual desire in women. Flibanserin, manufactured by the pharmaceutical company Boehringer Ingelheim, is expected to gain FDA approval in the coming weeks for the treatment of hyposexual sexual desire disorder, or HSDD.

The treatment works by increasing the production of dopamine, a chemical in the brain that contributes to sexual desire.

Experts acknowledge that female sexual desire stems from a combination of hormone levels, chemicals in the brain, blood flow and, of course, the quality of the intimate relationship between two people.

Dr. Marcus applauded the addition of Flibanserin in her “toolbox” of possible treatments for her patients, but cautioned that female sexuality is complex and no one treatment is a panacea for all women with low desire.

MCFS patient Gail Marien was also interviewed on CBS and spoke honestly about her journey from the virtual desmise of her libido following a hysterectomy to her satisfying sex life with her husband today.

View the video here

Did you know: the pill neutralizes your sex drive

Ilene Rosenthal, Marketing — Thu, 20 May 2010 14:17:40 +0000

Fifty years ago, the birth control pill gave women a freedom that previously eluded them: without fear of unwanted pregnancy, women could engage in romantic or recreational sex with relative control over the prospect of pregnancy.

I’m sure many of us would agree that this was a life-changing development, aligned with the women’s movement and a gift that allowed women to have children when they wanted to, and, yes, have sex when they wanted to, too.

We never imagined that this freedom would come with a side effect that was filled with irony, but a study has recently been released by the Journal of Sexual Medicine that connects serious declines in sex drive with hormonal birth control.

Bat Sheva Marcus, clinical director of the Medical Center for Female Sexuality in New York, had a lot to say about this in a recent article in The Daily Beast, the online newsstory outlet. Dr. Marcus was interviewed last week and asked to respond to the conclusions drawn in this study of over 1000 women. Her point of view is based on nearly eleven years in practice, treating women with different kinds of sexual dysfunction, low desire being the more common culprit.

Her response was declarative: “all hormones are suspect!” and estimates the pill is a contributing factor in 60 percent of the women she treats for low libido.

Read what real women say in the article and on the MCFS website

But things weren’t always like this….

Shannon Bertha, ACS, PhD — Mon, 10 May 2010 14:35:54 +0000

If I had a nickel every time a woman told me about her sexual situation with her husband and concluded with, “But it was never like that,” I would be a wealthy woman.

After being married for 10 or 15 years, people compare what is going on in their relationship currently with what it was like when they were 20 or 25 years old, and they are surprised that “things are just not the same”. As we age, there will be a number of changes our bodies will go through. Women may lubricate less; men may require more time in order to achieve an erection, some places on your body may not be as sensitive as they used to be, you may even prefer different positions than those that typically worked for the two of you.

But if you stop and think about this for a minute, this can be the fun part! You get to explore and experiment all over again! Communicating about these changes with your partner may be the hardest aspect of exploring new ways to enhance your sex life. What we find is, like a lot of things in life, taking the first step is hard, but then it feels good and you feel proud and you’re on a roll (think exercise, diet, etc). So raise the issue with your partner and, together, find what works for you. Adapting to these situations is essential to a healthy sex life, because they are changes we all will ultimately go through.

Oh What a Difference Some Testosterone Makes!

Bat Sheva Marcus LMSW MPH PhD — Thu, 15 Apr 2010 09:32:52 +0000

A female patient just told me the following story. She thought her husband of 15 years was having an affair. He hadn’t been acting suspiciously or working late. He just was less demonstrative, less loving and seemed way less interested in sex. They had always enjoyed a fun sex life. He usually initiated sex but sometimes she did as well and they would have sex about twice a week. Now he never initiated and when she did, he acted pressured or distracted. If she didn’t initiate two weeks could go by without having sex. She was confused and hurt and so, so sad.

She finally approached him and asked if he was having an affair. He was stunned and assured her that he loved her as much as always – but when she pointed out to him that their sex life had dwindled to nothing he seemed even more stunned. She was right and he somehow hadn’t noticed. He was pretty shaken up and tried after that to be more interested in their sex life, but it was a chore and it showed. We suggested that he see Dr. Werner and after a few months of gentle prodding he did go. Low and behold… he had low testosterone. (I could have told her that!)

Well, he’s been on testosterone now for 4 months and she said he’s a changed man. He is initiating and they are back to having fun sex. Even more, the teasing and the playfulness has returned to their marriage. They are both so much happier. Her face lit up as she told me this story. And once again, (I know that sometimes I sound like a broken record,) the sex has made such a big difference in so many aspects of their marriage and their lives!