Busyness – Sex Killer | Better Sex For Women

Too Busy For Sex | Better Sex For Women

Are you too busy for sex?

Work, kids, church, groceries, dinner, laundry, Bible study, small group, friends, family, Facebook….sleep. Who has time or energy for sex? Even on vacation, we’re running from one activity to the next. Finding time or mental focus for romance is harder than it sounds.

Previously we discussed how fatigue kills your sex drive and what to do about it. Is it possible though to be simply too busy for sex? Of course it is!

There are only 24 hours in the Day

There are only so many hours in a day. Never enough to get done all the things there are to get done. There are, however, enough to accomplish all the things that are important to God that you get done. Where do you think your marriage fits on God’s priority list?

True or False

A strong relationship with your husband is more important than:

Catching up on what your girlfriend made for dinner on Facebook?

Folding the towels?

The latest episode of The Voice?

Clean bathrooms?

Saying “yes” to volunteering at that church event so you won’t disappoint anyone?

The kids getting to do all the activities they want?

Good vs Best

For some people time wasters like TV, Netflix, and social media consume a huge chunk of their time that could be better spent elsewhere. For most of us, though it’s not the “time wasters” that keep us from God’s best for us, it’s all the “good” things. There are far more “good things” than there is time: Kids activities, volunteer opportunities, friends/family with needs, Bible studies, etc. All these things are “good” – but they can still cause your life to be out of balance such that the most important things get neglected. You can have too much of a good thing.

There’s enough time in your week to allow for each priority God has for you its “fair share” of your time. If you’re giving too much to any one area it is robbing from another. Every “YES” is a “NO” to something else.

Is sex really all that important?

YES! By God’s design, sex is one of the primary ways a man emotionally bonds with his wife. It’s normal, because of the way your hormone cycle effects sex drive, for you to only feel like initiating sex a couple days a month. Your husband likely needs more than that to feel close and connected with you. It’s a huge part of his identity. Imagine if he only spoke to you a couple days a month. How close would you feel to him?

Check out this article for more details: Why Sex Is So Important to Men

Do It for the Kids.

More than activities or even a home cooked meal, your kids need their mom and dad to have a solid relationship. Where else will they learn what a healthy marriage looks like? How else will they know how to relate to their spouse someday?

There is No Substitute for Quality Time

Your relationship is like a tomato plant. All the conditions for growing plump, delicious tomatoes can be perfect: great sun, fence to keep the animals out, soil with just the right mix of nutrients, spray to keep the bugs away – but if you don’t water it, it won’t grow.

You can’t dump 100 gallons on your tomato plant once a year and expect it to not need water the rest of the time (think vacation). The ground can only soak up so much at a time and the rest rolls off. There’s also no such thing as “super wet water” that only requires minimal application because it’s so super quality (we don’t spend very much time together, but we make sure it’s “quality” when we do). No, you’re tomato plant is going to need regular, daily watering if it’s going to bear fruit. Without water the flowers will die, the leaves will wither, and before long there will only be scorched earth.

So it is with your relationship and quality time, there’s no substitute.

Minimum Quality Time for a Healthy Relationship

As a rule of thumb, I recommend the following quality time schedule for all couples as a minimum for keeping their relationship healthy:

15-20 min a Day

At some point in the day, every day, make some time to give your spouse your undivided attention and meaningful conversation. This could be morning coffee together, pillow talk before bed, or any number of other forms. It’s best to have a bit of a ritual though to make it a habit. Having it be a habit will increase the likelihood of it happening consistently. Try to keep it up even when apart by Facetime or phone call.

2-4+ hours a week

Date night is what most couples call this, though it could be breakfast, lunch, dinner, late night dancing. When our kids were young going to the grocery store without children felt like a date! The important thing is that it’s a time of relaxed “hanging out” without kids. Have fun together and enjoy some adult conversation without interruptions every 2 seconds.

An Overnight once a Quarter

An overnight or weekend getaway where you spend a full day or two with your honey enjoying life as lovers and friends is so very important to staying in love. Whether it’s a romantic getaway to somewhere tropical, or a staycation at a local hotel – having a relaxed time to enjoy each other’s presence without children is key.

Sex 1-2x a Week

Every couple is different and this isn’t intended to be a hard and fast rule, but most couples find an average of 1-2 times a week for sex is a good minimum for staying connected. This could be in the morning before work, afternoon lunch quickie, in the evening after we get the kids in bed, or on the weekend.

For more tips on staying emotionally connected with your spouse, check out the article: Emotional Connection | Better Sex For Women.

Put it on the Calendar!

Planning ahead and scheduling time together highly increases the chances that it will actually happen. If you don’t put it on the calendar, there’s a really good chance it won’t happen consistently enough.

Some object to the idea of scheduling a time to connect sexually, feeling it removes the spontaneity or fearing they won’t be able to perform. The truth is that blocking out the time allows for great variety and creativity as you plan ahead, looking forward to the time. Your body is designed to respond to sexual stimuli, so you don’t need to worry about whether or not it will become aroused. It also lends itself to some fun, playful flirting throughout the day.

Plus, just because you’ve planned a time to connect, doesn’t mean you can’t connect spontaneously at other times as well. Planning just ensures that at least we’ll connect at this frequency.

Quality time and sexually connection are important to the health of your marriage – make it a priority.

Take the first step towards a better tomorrow, today.

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Sexy=Dirty? | Better Sex For Women

Low Sexual Desire | Better Sex For Women.jpg

Does being sexy feel dirty to you?

Growing up we can sometimes receive the message that sexual desire is lust and only promiscuous girls want sex. This belief that sex is slutty/dirty and that you are bad for having sexual feelings, especially as a single person, leads us to feel bad about the sexual part of ourselves. Pleasing God and being horny are seen to be incompatible.

This is especially true for those who grew up in a very religious home. Sometimes the message that “sex is holy” is interpreted to mean that sexy feelings or the desire to engage sexually any way other than “missionary style” is a sinful corruption of God’s design for sex.

What follows is feeling bad about yourself any time you experience sexual feelings. So you learn to shut down your sexual feelings. This tends to get in the way of desire for sex.

God Made You Horny

Who designed your body? Who’s idea was it to wire your neurology and hormones to give you sexual feelings, desires, thoughts?

Truth: God made you horny. From a physiological standpoint, it is an undeniable fact that God wants women to enjoy sex even more than men. Take for example, that a woman’s clitoris has more nerve endings than any other part of human anatomy male or female. Further, it serves zero functional purposes other than a woman’s sexual pleasure. In contrast, a man’s penis is a multi-functional tool. It aids him in urination and reproduction in addition to being an instrument of pleasure.

It doesn’t stop there. Women possess at least three separate neuropathways associated with sexual pleasure, to a man’s one. Women are capable of enjoying a variety of orgasmic experiences whereas men really only have one. Male orgasm may vary in intensity, but it is basically the same feeling and geographic location. Even more, women have the physiological capacity for an unlimited number of consecutive orgasms. There is probably a world record out there somewhere, but I wouldn’t recommend googling it. Men, on the other hand, get just one followed by a waiting period ranging from minutes to hours.

Conclusion: God wants women to enjoy sexual pleasure!

Distortions of Sex Displease God

Distortions of sex displease God. This includes the distortion that comes from well-meaning church people who make sex and sexual feelings out to be something evil or bad. It’s the ditch on the other side of the road from the secular hedonism that says there are no boundaries for sex, do whatever you please, with whomever you please, whenever you please.

In a world full of secular distortions of sexuality, where perverts and sexual predators lurk, it’s no wonder we the church are afraid of sex.

We are afraid of…

. . . the controversy.

. . . being thought of as a sexual predator.

. . . being misunderstood or misportrayed.

. . . offending people.

. . . being controlled by our sexual passions.

. . . being like the perverted culture.

. . . exposing our own shame around our sexual experiences, past, struggles, failures.

The power and potential for destruction inherent in sex terrify us.

We are bombarded with unspoken messages that say “sex is dangerous to your soul and body.”

“If you think about sex or feel sexual desire – You are Sinning!”

“Sexual sin is the worst kind of sin. Be ashamed of your sexual struggles. Hide your weaknesses.”

“If you love Jesus enough, you will NEVER be horny, especially if you’re single.”

“Any expression of gender affirmation or insinuation that “I think your attractive” is flirting. Flirting is sinning. YOU MUST PRETEND YOU FIND NO ONE ATTRACTIVE.”

“Asexual = Godly”

All of these messages, and many more, either spoken or implied through silence, result in beliefs about sex that do not come from God or the Bible. They don’t represent God’s revealed thoughts, as expressed in the Bible, about sex.

The Bible Celebrates Sex

Would it surprise you to know there’s an entire book of the Bible dedicated to the romantic sexual pursuit of a man after a woman and her desire for him (Song of Solomon). The flirtatious, romantic desires that draw a woman and man towards each other with longings for each other, leading to marriage, is God’s design.

The physical realities of our sexual desire are a metaphor for the longing that God has for His people. God desires to be one with us, indwelling us by His Spirit as we share an intimate love affair together. He describes Himself as a husband and we His special creation, as a bride, Whom He is passionate about and longs to be intimate with.

Consider, that according to Christianity, unlike any other religion, when we approach God giving our self to Him, the Bible says the Spirit of God literally indwells our body. The vulnerable, intimate act of intercourse between a husband and wife is a physical revelation of that spiritual truth. Further, God’s drive to be with us is constant and unrelenting…kind of like some husbands.

God’s loving pursuit of us and our enthusiastic response to Him shows us what a healthy sexual relationship in marriage is supposed to look like. Likewise, God appreciates and enjoys when we too initiate times of intimate connection with Him.

How To Embrace Positive Feelings About Sex

Before you can embrace positive feelings about sex, you first have to identify your negative ones. Often we’ve been so submerged in negative messages about sexuality that we aren’t even consciously aware of the misbeliefs that we hold about it.

Trace It Back

Take a sheet of paper and create a timeline of all the things you learned about sex and whom those thoughts came from.

How was nudity handled around your house?

How were your genitals talked about?

What reactions did your parents/adults have when you touched yourself as a child?

Did your parents discuss sex openly?

How did you learn about the “birds & the bees”?

What did you learn from siblings, family members, friends, the locker room at school?

What were the messages you got from the church/youth group?

When do you first remember having sexual feelings or thoughts? What was your response to them? How did you feel about them?

Did these experiences help you have positive feelings about sexuality or negative?

Write a Sexual Fantasy

Take a sheet of paper and create a sexual story about you and your husband. Make it as romantic and arousing as you can imagine.

What feelings are provoked just by reading the above two sentences? Positive or negative? Do you find yourself not wanting to do the exercise?

By this point, you probably accept, in your head at least, that God views sexual passion between you and your husband as positive. So what is getting in the way of you letting yourself imagine, think about, and look forward to sexual experiences together?

At first, you probably won’t be able to identify it. Keep trying to do the exercise and keep thinking about the feelings it stirs and bring them into conscious awareness by writing them down.

Challenge Distortions with Truth

For each of the negative feelings, thoughts, or beliefs that you identify in these exercises create a counter statement that affirms the positive nature of God’s thoughts about sex. Write down the truth statements.

Examples:

Distortion: I feel dirty.
Truth: Sex and sexual feelings are a beautiful gift from God.

Distortion: I feel ashamed or guilty?
Truth: God designed me to have sexual feelings and desires, He wants me to enjoy them and pursue them with my husband.

Distortion: I shouldn’t want these things?
Truth: Any mutually respectful and pleasurable sexual act between husband and wife, that doesn’t bring in a third party, is permissible to experiment and play with. God loves variety and creativity.

Experiment

Experiment with intentionally being flirtatious and sexually forward with your husband. Make a point to be receptive / respond positively to your husband’s advances. Notice the feelings you have as you think about and try doing so. Use the truth statements you have formulated to combat negative and anxiety producing thoughts/feelings. Talk about them out loud with your husband. Pray together, thanking the Lord for the sexual part of yourself and relationship. Ask for God’s help in experiencing as GOOD what He has created to be good for you.

Take the first step towards a better tomorrow, today.

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Top 10 Reasons Married Women Don’t Want Sex

Top 10 Reasons Married Women Don't Want Sex

Why Married Women Don’t Enjoy Sex

As a sex therapist I spend a lot of time with couples that are having difficulty in the sexual part of their relationship. Most of the couples I see are coming to me, at least in part, because the wife is not interested in connecting sexually as frequently as her husband (though 1 out of 5 times it’s the opposite). 
When I start assessing the situation I usually find a combination of the following 10 causes for low sexual desire in women. They are all generally related to violations of the pleasure principle. Fortunately, they can all be treated with a high degree of success. 

Pleasure Principle

All barriers to sexual desire for married women are usually related to the universal Pleasure Principle. The pleasure principle is simply this: We desire to engage that which we enjoy. We do not desire to engage what we do not enjoy. 
It’s because of the pleasure principle that I never have a deep burning desire to be poked in the eye. I don’t enjoy it, so I don’t crave it. Each of the barriers to a women’s sexual desire make sex not enjoyable for her. If it’s not enjoyable, why would a woman want it?
Side note: To help you understand these 10 reasons I need to define for you the 2 types of sexual arousal. The first is subjective arousal. This is the awareness or feeling of being horny / sexually aroused. The second is physical arousal this refers to the physiological changes that happen in the body as it becomes sexual aroused (dilation of the pupils, increased heart rate, blood filling the genitals, increased body temperature, perspiration, increased genital sensitivity). It is possible to have one kind of arousal without the other, and each can lead to the other.  

1. Fatigue

Men and women are different. One of the differences is in the way fatigue effects sexual arousal in women. Both men and women’s physical arousal is effected by fatigue, but women’s bodies are effected to a much greater degree. If a woman is exhausted physically, her body wont respond with physical arousal, which means she wont want or enjoy connecting sexually. If you don’t enjoy connecting sexually – you wont want to connect sexually. 

2. Hormone Cycle

A woman hits her sex hormone peak in late teens to mid-twenties. As this starts to trail off over time, there’s usually still a hormonal surge that happens 1-3 days a month right around ovulation. The body says “Hey, I’m about to drop an egg, go find your man so you can fertilize it.” 
It’s pretty normal for a mature married woman to only experience what we call initiating desire (ie. a spontaneous desire out of the blue) a few days a month during this hormonal surge. The rest of the month it is very normal for woman to connect sexually out of receptive desire. We’ll discuss these further in an article on overcoming the Hormone Cycle for better sex. 

3. Anorgasmia

An inability or difficulty achieving orgasm, that’s what Anorgasmia means. If you’re not experiencing sexual climax and release when you connect sexually, that significantly impacts the pleasurableness of the experience. That’s not to say you can’t enjoy sex at all or that it’s even normal to orgasm every time you connect sexually. Sexual frustration from a lack of release, however, does diminish the sexual experience- especially if it’s chronic. If unaddressed it will likely leave you feeling less and less interested in sex as time goes by.

4. Lack of Emotional Connection

Sex is an emotional experience. God designed sexual desire to lead a women into an emotionally intimate relationship and to enjoy sexual expression in the context of an emotionally safe and connected relationship- i.e. Marriage. If a women’s marriage doesn’t feel safe or if she doesn’t feel emotionally connected to her husband, she’s probably not going to feel a desire to be sexually vulnerable with him. 
Being disconnected doesn’t necessarily mean you have a bad relationship. Couples who love each other very much and our safe with each other can get emotionally disconnected just from the busyness of life getting in the way. If we’ve been to busy to nurture the relationship, then we’re probably emotionally disconnected. 
If we do have serious communication difficulties or breaches of trust in the relationship, it’s unlikely that we will ever have a healthy, passionate, sexual relationship until this is addressed. 

5. Physical Pain

Does anybody desire physical pain? If you do, you should probably see a counselor about that, it’s not healthy. If sex hurts, I mean really hurts not just a little rough in a playful way, you’re not ever going to desire it. Nor should you. In fact, if you “play through the pain” you can do serious long term damage to your sexual relationship by pairing pain with all things sexual and romantic in your brain. That pairing can even bleed into an association with your spouse in general, which can lead to resentment and loss of respect for your spouse. 

6. Trauma

If you have had negative emotional experiences associated with sexuality, this can significantly impact your sexual desire. Examples of sexual trauma that might impact your sexual desire include:
  • Feeling pressured by a boyfriend to have sex when you weren’t comfortable doing so. 
  • Being sexual in ways that left you feeling guilty or ashamed at an earlier time in your life. 
  • Having been touched or made to act in sexual ways as a kid that made you feel uncomfortable by friends, siblings, baby-sitters, a parent, or another adult.
  • Sexual experiences that have been painful physically or emotionally. 
  • Being forced to engage sexually when you didn’t want to by any one, including your spouse. 
  • Exposures to pornographic material as a kid. 

7. Fear of Pregnancy

If you really don’t want to become pregnant sometimes the fear of becoming pregnant can get in the way of desire. This can be true even if you are taking steps to prevent pregnancy. 
8. Body Self-Consciousness
Feeling attractive / sexy is an important driver for a women’s sexual desire. If you don’t feel sexy, you’re probably going to have difficulty desiring to engage sexually. This is different than men, who are more driven by how attractive they find their spouse then how attractive they think they themselves are. 
If you feel uncomfortable with your body or believe it is unattractive this is going to get in the way of you wanting to be naked with your spouse. This can also take the form of you lacking confidence in engaging sexually. If you are afraid your attempts at being sexy will come off as awkward and embarrassing, you are more likely to avoid sexual encounters. 

9. Sexy = Dirty

Growing up we can sometimes receive the message that sexual desire is lust and only whores / prostitutes want sex. This belief that sex is slutty / dirty and that you are bad for having sexual feelings, especially as a single person, leads us  to feel bad about the sexual part of ourself. Pleasing God and being horny are seen to be incompatible. 
This is especially true for those who grew up in a very religious home. Sometimes the message that “sex is holy” is interpreted to mean that sexy feelings or the desire to engage sexually any way other than “missionary style” is a sinful corruption of God’s design for sex. 
What follows is feeling bad about yourself any time you experience sexual feelings. So you learn to shut down your sexual feelings. This tends to get in the way of desire for sex.

10. Busyness

Work, kids, church, groceries, dinner, laundry, Bible study, small group, friends, family, Facebook….sleep. Who has time or energy for sex? Even on vacation we’re running from one activity to the next. Finding time or mental focus for romance is harder than it sounds. 

You’re Not Alone and There is Help.

If you find yourself in any of these bullet points, you’re not alone. There is a reason they are on a top 10 list – because they’re common. They’re also treatable. Many people just like you have struggled with these things getting in the way of their sex life. As sex therapists, we know how to trouble shoot your difficulties and help you with a plan to overcome them. 
Stay tuned for upcoming articles on how to overcome each of these common reasons for low sexual desire. 
Curious why sexual desire seems to change for a woman after marriage? Check out this article: Why Women’s Sex Drive Declines After Marriage

Take the first step towards a better tomorrow, today.

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Wives Sexual Desire | What you need to know.

wives sexual desireWives sexual desire is a subject misunderstood by nearly all men and most women.  In recent years, one of the hottest topics in sexology has been female sexual desire disorders. For the past four decades, women have been pathologized for not being like men. For instance, according to University of British Columbia psychiatrist Rosemary Basson, “sexual difficulties are particularly prevalent among women seeking routine gynecological care.2 In population surveys, some 30%–35% of women aged 18–70 have reported a lack of sexual desire during the previous 1–12 months.3,4”

The traditional assumption for both men and women has been that desire precedes sexual arousal. Therefore, if a woman is no longer experiencing desire, it is assumed that she now has some sort of sexual hang up or disorder. While this may be true for men, research in the past 10 years reveals a different pattern for women.

Men tend to be more like a loaded gun ready to fire. All that’s needed is someone to pull on the trigger. A man’s libido acts as a drive similar to hunger or thirst. For the past hundred years, sex professionals have assumed that a woman’s libido was at least similar, and that if a woman didn’t feel desire something had to be wrong.

Contributing to the problem are the messages delivered through media. Women are sexually portrayed in books, movies, articles, and even in church circles as men in female form. This mistaken belief concerning female arousal and response patterns has left generations of men and women believing something that’s false. Hardly a day goes by that some couple doesn’t come in to my office arguing about the wife’s lack of sexual desire. This leaves women feeling that they are somehow flawed because they don’t share the same sexual interest as their husband.

But what if desire does not precede arousal?

That is exactly what Basson discovered after interviewing hundreds of women. Contrary to the conventional model, for many women desire is not the cause of lovemaking, but rather the result. Basson’s research revealed that women often begin sexual experiences feeling sexually neutral. But as things heat up, so do they – and eventually desire is experienced.

This explains why Viagra doesn’t work for women, and why sex-boosting supplements are only minimally successful. Products that change the physiology of sexual arousal do not affect desire. At best, they can only increase blood flow into the genitals. It’s easy for men to be aware of increased blood flow because erections are hard to miss. From there it’s only a short step in a man’s mind from erection to the assumption that they have desire. Women, on the other hand, are often unaware of gentle blood engorgement, and even when they are aware of it they frequently report no feelings of arousal.

If women don’t experience a sense of desire, as most men know it, then most guys might wonder why a woman would even want to be sexual. According to research, women tend to be sexual for reasons that affirm their relationships, but their reasons are not inherently sexual. These might include wanting to please their lover, a desire to feel close, to prevent strife, to reconnect after a fight, or because they feel a responsibility. Research supports the old adage that men become intimate to have sex and women have sex to become intimate.

From this perspective, the critical question becomes not how do you ignite a woman’s desire for sex, but instead, what kind of interaction arouses women sufficiently to enable them to experience desire? The types of interaction that fuel desires in women are playful, leisurely, sensual (lovemaking based on whole body massage that can include genitals but certainly is not focused on them). In surveys, the primary complaints of women are about interactions with their husbands which are non-sensual, too rushed, too focused on breasts and genitals, and too quickly plunged into intercourse. Rushed lovemaking fails to give women the time most need to respond to become aroused enough to experience desire.

Further complicating the issue is the culture created by Viagra. Men mistakenly believe they are sexually aroused when they have an erection. Therefore taking Viagra and having an erection means they’re good to go. However, erections have nothing to do with psychological arousal. Any erectile medication can give a physical erection, but does it create an excitement to be with your mate and to experience the wonder of who they are? Far too often a man’s genitals on Viagra will be at 100%, but his psychological arousal remains at 10 or 20 percent. Once the erection is in place, he proceeds on to intercourse, skipping the steps which would create psychological arousal for both himself and his wife. This creates a growing sense of dissatisfaction for the woman since she is not experiencing the necessary relational interactions and arousal to make the experience pleasurable for her.

Research shows that many women do experience spontaneous desire and interest when they’re involved in a new relationship or when coming back together after long-term separation from their partner, but it also indicates that most women in long-term relationships rarely think about sex or experience spontaneous sexual desire. Therefore, women seem to operate more out of a point of sexual neutrality–where she is receptive to being sexual, but does not initiate sexual activity. Many women report that the goal of sexual activity is not necessarily orgasm but rather personal satisfaction, which is then experienced as physical satisfaction (orgasm) and/or emotional satisfaction (the feeling of closeness and connection with a partner).

This is important simply for the fact that there is not something necessarily wrong if a woman is not experiencing the same desire and arousal patterns as a man. Men and women are not the same.

Women need to quit being so hard on themselves if they don’t experience the same desire as their husbands. And men need to quit thinking there must be something wrong with their wife if she doesn’t experience sexual desire as he does.

If men or women experience a lack of desire in a marital relationship. Multiple factors need to be explored: The following is a list of factors from Rosemary Basson’s article.

Women’s sexual dysfunction: revised and expanded definitions

Interpersonal and contextual factors

In a recent national probability sample of American women 20–65 years of age, their emotional relationship with the partner during sexual activity and general emotional well-being were the 2 strongest predictors of absence of distress about sex. Women who defined themselves (using standard psychological instruments) to be in good mental health were much less likely than women with lower self-rated mental health to report distress about their sexual relationship (odds ratio 0.41, 95% confidence interval 0.29– 0.59). The healthier women were therefore 59% less likely to report distress about their sexual relationship. Feeling emotionally close to their partner during sexual activity decreased the odds of “slight distress” by 33% relative to “no distress,” and “marked distress” by 43%; in other words, the stronger the emotional intimacy with the partner, the less distress. Other contextual factors reported to reduce arousability included concerns about safety (risks of unwanted pregnancy and STDs, for example, or emotional or physical safety), appropriateness or privacy, or simply that the situation is insufficiently erotic, too hurried, or too late in the day.

Personal psychological factors

Frequently a woman’s arousal is precluded by the nonsexual distractions of daily life, but also sometimes by sexual distractions (e.g., worry about not becoming sufficiently aroused, reaching orgasm, a male partner’s delayed or premature ejaculation or a female partner’s lack of orgasm). Empirical studies have shown a high correlation of desire complaints with measures of low self-image, mood instability and tendency toward worry and anxiety (without meeting the clinical definition of a mood disorder). Differences between a group of 46 consecutive women with a diagnosis of desire disorder without clinical depression and a control group of 100 healthy women were significant for 6 out of 8 scales in the Narcissism Inventory (a standardized self-administered instrument). The scales indicated that the women with desire disorder had self-esteem that was weak or even fragile, emotional instability, anxiety and neuroticism. Sexual arousal and orgasm, especially in a partner’s presence, necessitates a certain degree of vulnerability, which is impossible for some women who cannot tolerate feelings of loss of control generally, and loss of control specifically of their body’s reactions.

Further inhibiting psychological factors include memories of past negative sexual experiences, including those that have been coercive or abusive, and expectations of negative outcomes to the sexual experience (e.g., from dyspareunia or partner sexual dysfunction).

Biological factors

The biological and pathophysiological underpinnings of normal and abnormal female sexual response are only recently receiving attention. Most of the basic science and animal experiments in this area are beyond the scope of this review. Some promising attempts are noted, however, in part because they relate attempts to ameliorate sexual dysfunction by means of off-label use of available drugs and to avoid the negative sexual side-effects of medications such as antidepressants.

Depression is strongly associated with reduced sexual function. Of 79 women with major depression surveyed before treatment with medication, 50% reported decreased sex drive; 50%, more difficulty obtaining vaginal lubrication; and 50%, far less sexual arousal when engaging in sex. Only 50% had been sexually active during the previous month. In addition, sexual dysfunction can constitute an adverse event of antidepressant use, especially among patients who had low levels of sexual enjoyment before the onset of their depression. When patients are specifically asked about sexual side-effects, they are acknowledged by as many as 70%.

Sexual dysfunction is also a common side-effect of treatment with antidepressants. Among women being treated, it has been found to be more common in those who are older, married, without postsecondary education, without full-time work, or taking concomitant medication (any type); those who have a comorbid illness that might affect sexual functioning, or a history of antidepressant- associated sexual dysfunction; those who deem sexual function unimportant; and those whose previous sexual engagements had afforded little pleasure.

Currently under scrutiny is the role of dopamine and other neurotransmitters in influencing sex hormone receptors and how the neurotransmitters are, in turn, influenced by sex hormones. Estrogenized female animals change their sexual behaviour when administered progesterone; studies have shown that the same changes can result from dopamine or the presence of a male animal. Among 75 non-depressed women with a DSM-IV diagnosis of hypoactive sexual desire disorder who received bupropion (a dopaminergic drug; average dose 389 mg/ d) or placebo, improvements in pleasure, arousal and orgasm were statistically significant for those administered the active drug. Interestingly, these changes were unaccompanied by increased desire.

Testosterone itself is being investigated as to its role in sexual function and dysfunction. About half of daily testosterone production in women is from the ovary. Some women with sudden loss of all ovarian production of androgens lose their sexual arousability. Supplementation to high physiological (as opposed to pharmacologically evident) levels of testosterone recently has led to increased arousability and more intense orgasmic experiences, but not to increased sexual thinking, fantasizing or spontaneous desire. Of 75 surgically menopausal women aged 31–56 participating in a randomized clinical trial of testosterone versus placebo, those given testosterone (300 μg transdermally) in addition to estrogen reported increased frequency of sexual activity, sexual pleasure and intensity of orgasm. So, reminiscent of the animal model, supplementation with a dopaminergic drug or testosterone can increase some women’s sexual arousability; but so too, as in the animal model, can environmental change (a new partner).

This may be far more information than you wanted, but I hope it helps you begin to understand the complexity of this issue.

References

Basson R. Female sexual response: the role of drugs in the management of sexual dysfunction. Obstet Gynecol 2001;98:350-353.

Basson, R. Women’s sexual dysfunction: revised and expanded definitions. CMAJ, 2005; 172:1267.

Whipple B, Brash-McGreer K. Management of female sexual dysfunction. In: Sipski ML, Alexander CJ, eds. Sexual Function in People with Disability and Chronic Illness. A Health Professional’s Guide. Gaithersburg, MD: Aspen Publishers, Inc.; 1997, pp 509-534.

Parts of this article were written by Rick Reynolds, LCSW and appeared first as Recovering from infidelity: Difficulties with Intimacy

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