Posts Tagged ‘low libido’

Different Roads

Monday, April 12th, 2010 by Bat Sheva Marcus LMSW MPH PhD

I am often struck by the varying and disparate ways in which we solve problems. I am fascinated by the variety of  routes people take on their way to a solution.

I saw a long time patient today whose situation provided such a great example of this concept. She is a 45 year old woman who is in a long term relationship. We had lowered her level of hormones looking toward the possibilityof weaning her off of them. She told us, in this visit, that her sexual relationship has become lack-luster once again. As she put it, “I’m back to wishing he’d have more of a life, that he’d go off to hang out with his own friends, that he’d go back to scuba diving. Somehow, when he’s more independent and less involved with me he appears more distant, mysterious and the sex is better.”

We talked about her going back into therapy to discuss some of these sexual issues more explicitly with her husband. Then she sighed. “Or,” she said,  “I could just go back on the higher level of testosterone. That worked too.”

She then went on to explain so poignantly and succinctly that when her general desire level was higher it didn’t seem to matter so much what was going on with her husband’s life. She wanted to have sex with him, the sex was hotter and, as a result the relationship was generally more passionate which kept the cycle going.

I can almost hear the naysayers shaking their heads… tut, tut, they’d say, you’re recommending drugs to wash away the real underlying problems. But I don’t see it that way. I see it as many roads leading to Rome.   Understanding the realities of the road allows an individual to find the one that they can best travel.

So my patient had a choice to make – as many of us do in so many areas of our lives.  There’s no one right way to handle things, just different routes.  And we have to choose the ones that work best for us and the day to day workings of our lives.

Libido flip-flop

Friday, April 9th, 2010 by Bat Sheva Marcus LMSW MPH PhD

This entry was written recently by a patient at MCFS following six months of treatment for low desire.  Her previous entry, written after her second appointment last October, was posted on April 5th.

Last night I kissed my husband’s ear and he did not move. He wasn’t in the mood and I was!

For some people this would be frustrating. For me it was amazing! Finally, our sex life is equal. We have an equal investment in pleasuring each other.  With almost equal interest in sex – it is no longer just about his needs and my succumbing (reluctantly). The mere fact that I was interested did change his mind, and a wonderful evening ensued, but it was a pivotal moment for us.  The last few months have changed our, and my, life. God had given the world the gift of sexuality and pleasure, and it was a gift that I never received, never really understood. I now know that I was missing out on huge piece of the beauty that exists in this world and missing out on a more meaningful and spiritual connection with my husband. I am eternally grateful to the MCFS for helping me find this gift.

Why I’m Not as Crazy as I Thought

Monday, April 5th, 2010 by Bat Sheva Marcus LMSW MPH PhD

The following is a blog entry written by a patient at MCFS.  Later this week we will post another entry by the same patient, reporting on her progress.  This was written in October 2009

For about 14 years now I have been told constantly that things are in my head. Stomach cramps-must be stress, acne- must be stress, extreme exhaustion-stress, canker sores- stress, breathing issues- stress, and most recently, no interest in sex - stress and depression. 

But recentl, for the first time in my life, someone found a real reason something was going wrong.  And I could not be happier. 

My life in general is amazing. I have a loving doting husband, two beautiful children, a wonderful home, and a fine job. And yet, depression, being overweight, exhaustion and a low sex drive have plagued my life. With some strong encouragement from my husband, who is tired of feeling physically and sexually rejected, I went to the Medical Center for Female Sexuality.  And,  for the first time, someone checked my hormone levels. No one before had ever thought to stick a needle in my arm and actually see what was going on in there. They just made me pop pills and sit in front of therapists and talk and talk and talk. None of which did much except put band-aids over the problems and cause me to doubt myself more and more. With each passing day I would feel less competent, less self-confident, and more sure that I was just crazy, that many of the simple pleasures in life were out of my grasp and this was my destiny.

But yesterday that all changed.

Yesterday 2 doctors sat me down and showed me my lab results. My hormones are a mess. My thyroid is inactive and I have almost no testosterone. There is something wrong with me! I cried the whole way home for the office, grateful to God that there is an end in sight.

The journey ahead will be difficult, hormone therapy will be tough and I’m not so excited about the potential side effects. But it will all be worth it.

“My husband Wants to have Sex Everyday” and other popular myths…

Friday, March 26th, 2010 by Bat Sheva Marcus LMSW MPH PhD

To be filed under the “I wish I had a nickel every time a patient said this to me.”

Women with low libidos always think their husbands want to have sex every day. When I am doing an intake with a woman who is having sex (because she feels obligated) say, once every 3 weeks, I will ask her how often  her partner wants to have sex. Invariably she looks at me like I am the village idiot and says “My husband wants to have sex everyday…  of course.”    The subtext being that all men want to have sex every day.

 Sorry, but I must disabuse you of this notion. Most men over the age of 19 really don’t want to have sex every day. They get tired too, you know. However, men who are not having any satisfying sex, or men who feel like their partners never want to have sex, often feel as though they want to have sex every day.  It may be on their minds constantly; they may be worried about it all the time and every night they may be thinking… is this the night I’m going to get to have sex?!

Think about it. If you love chocolate fudge and you had a box of it sitting there which you couldn’t eat and you didn’t know when you’d finally be able to have a piece, you’d probably be thinking about the fudge all the time! But that doesn’t mean if the fudge was readily available whenever you wanted it, you’d eat it all day long!

 The same is true about sex. When these women’s libidos are back to normal, and they are happily having sex, they aren’t having sex every day.  Their perfectly human husbands want sex regularly, but not every day.  If you doubt this, here’s a suggestion: try initiating sex every night. It never fails, by the end of week two your partner will be looking at you funny and asking if it’d be okay to wait until tomorrow night. 

And for a woman whose libido is back in check, tomorrow is perfectly ok!

desire and depression

Friday, March 19th, 2010 by Shannon Bertha, ACS, PhD

Sometimes, when women come into the center with low desire we talk to them about anti=depressants.  The reaction isn’t always good:   “You think I’m depressed? I’mhere to talk about my lack of sex drive!”

Life situations and hormones can play a role in depression.  Serotonin, the hormone normally associated with depression, isn’t the only culprit.  Testosterone may also have an effect on mood.  As an essential hormone needed for desire, low Testosterone levels may contribute to mild feelings of depression as well as low desire for sex.

 So it would make sense that if a women is experiencing low desire, she may also have low testosterone levels and that may be affected her moods. 

If your relationship is unstable lately, or if life is stressful and you haven’t had appropriate time to give to yourself and your partner, you may feel ‘down’ and exhausted from dealing with this.    You may miss the comfort of a loving connection, you may feel lonely and estranged. You may wonder when you’ll have the chance to focus on sex in your life without the myriad interruptions we experience.  Who wouldn’t be a little depressed!

When we prescribe treatment for low desire, after conducting significant blood work and a physical exam,  we investigate levels of testosterone along with other hormones.  Depending upon the patient, treatment will be individualized; but the message is same:  your depression may or may not be the ‘I can’t get out of bed’ kind of depression, but mild or low grade depression can go hand in hand with low interest in sex .  Although people may have a negative association with depression and anti-depressants, it is completely normal to experience some depression with a lack of desire. 

So, don’t be afraid to bring up the issue of low desire with your practitioner.  You may find yourself solving more than one problem when you when you do.

The Whole Picture

Thursday, February 18th, 2010 by Bat Sheva Marcus LMSW MPH PhD

Good Housekeeping recently had an article Your Sexiest Self – Get It Back (February, 2010). It poignantly described one woman’s loss of libido for all of the usual reasons: overwhelmed with life, kids entering the picture, relationship getting “old,” she was getting older.

So the writer and her husband saw noted psychologist and sex therapist David Schnarch for a three hour session.  Presto! Whammo! In one afternoon  their primary issues were identified and addressed and she was back in the game.

Okay, so I’m oversimplifying things. But the author did comment on the fact that once her husband was able to be “real” with her and get “angry” and not always be “so nice,” she experienced real desire for him for the first time in a long while.

That is great.

I mean it.

I’m skeptical it will last, though. Really intense emotions and sudden epiphanies and moment of deep connection are important and no doubt do wonders for the short term sex drive. They really help. And some times, honestly, kick-starting the sexual relationship with a short term energy blast can make all the difference and turn things around again.

But I think that often, when the ongoing, slow simmer of a regular sex drive is gone, it’s important to get the whole picture, that is the physical stuff as well as the psychological stuff.

So if you’re one of those people who’ve been able to  create moments of deep passion through sex therapy, but have wondered why these moments don’t seem to sustain themselves, don’t give up. Get the whole picture.

The frustration of Sex Therapy.

Friday, January 15th, 2010 by Bat Sheva Marcus LMSW MPH PhD

I had a patient yesterday who has zero sex drive. Zero. She has never masturbated. She has never fantasized. She has never been turned on as far as she can tell. She is sad and frustrated and it is effecting her marriage.

She spent the last two years on sex therapy. The first year was with a sex therapist who spend the entire time having her discuss the fact that she was raised by a step father, a warm, nurturing man and the only one she ever knew as a father since he married her mother when she was pregnant. Not surprisingly this didn’t help her sex drive a whole lot.

The second sex therapist did similarly. But they also spend a great deal of time talking about a dentist who paid too much attention to her and  kissed her on the cheek when she was 15. This didn’t seem to affect her sex drive much either.

 ENOUGH.  At some point we need to get smarter about the time  (and money) we are spending  on therapy.

Consider the following possibilities:  Perhaps some problems have a physical component. Maybe some are genetic. Some problems simply cannot be helped. Spending time in sex therapy grasping at straws because the therapist needs something to address,  is not only useless but detrimental to patients. If you consider these likely possibilities and their relatively direct treatments, you will be a wise consumer and an educated patient. You know if you are being helped. If you are not, stop.

In sex therapy and treatment, sometimes just talking helps

Wednesday, December 9th, 2009 by Bat Sheva Marcus LMSW MPH PhD

I’m often struck, when first meeting with patients, how much help they get just by talking. During the first appointment, when I get a history I feel like patients relax so much. It’s like they finally had a chance to tell the truth (sometimes for the first time) to someone who doesn’t judge, doesn’t think they are strange and perhaps, for the first time, makes them feel like their concerns, habits, fears, likes and dislikes are “perfectly normal.”

In many cases, the stories patients are sharing with me, (how they masturbate, their preferred means of having sex, their “fetishes,”) are really quite common.

Then there are patients who tell me less usual stories or preferences. Again, they are often so very embarrassed about things which are not harmful and provide a source of pleasure to them.

I hope, as women explore their own sexual health, they come to believe and understand that there is just no “right” way to go about having sex!

www.centerforfemalesexuality.com

Is Sex Therapy Psychological or Physical? Yes!

Friday, December 4th, 2009 by Bat Sheva Marcus LMSW MPH PhD

 Often sexual problems are the result of both physical obstacles and emotional issues. Before committing to sex therapy to uncover the causes and stresses connected to sexual dysfunction, you may want to rule out any physical conditions that can be treated with relative ease and in a short time period.

In recent years, research into the area of female sexuality has become more focused. We are beginning to understand the complicated physiology of blood vessels and nerves in the pelvis and how surgeries, childbirth, illnesses, medications, hormonal changes and aging may affect a woman’s sexual experience.

When these conditions exist, in conjunction against the emotional backdrop change (marriage, childbirth, menopause or other lifestage developments), only an integrated approach to diagnosis and treatment will be successful.

So, yes.  Read more information on our full website: www.centerforfemalesexuality.com

"Just do it?"

Saturday, March 29th, 2008 by Melissa Ferrara FNP

I was recently having a conversation with an OB/GYN about low sexual desire in women.  We were discussing treatment options, when he said; “I tell my patients to do it the Nike way, you know, Just do it.”  I didn’t know what to say. I stood there in total silence, somewhat horrified and offended.  Shocked by his comment, I ignore the statement and moved on to another subject.  Afterward, I was replaying this moment in my mind over and over.   I was really upset with myself that I didn’t tell him how I really feel about his “Just do it” mentality.  It is demeaning, and it doesn’t work.  If it was that easy, don’t you think she would have figured that out herself?   Many women are embarrassed to discuss their sex lives with their health care providers, and when they finally get up enough courage to broach the subject, they are usually blown off, or worse told to get over it and “Just do it!”  There are many different factors that could contribute to low libido.  It could be hormonal, it could be intercourse is painful, it could be related to decreasing arousal, or inability to have orgasms, it could be relationship difficulties, it could be all of these.  Many providers don’t have the time to really find out the true story, so it is much easier to say, “Just do it”.  If they only knew what a disservice they are doing to their patients. 

If you find yourself in this situation, where you feel you are not taken serously, or your feelings are minimized, ask yourself, is my provider adequately addressing my needs? If not, don’t be afraid to ask for more help or seek another opinion.