Rachel Grumman
Is sex the last thing on your mind these days? Does it take you forever to get aroused? Or has reaching orgasm become a herculean task? If so, you may have female sexual dysfunction - and you're not alone. An estimated 43 percent of women reported experiencing sexual dysfunction, according to findings published in the Journal of the American Medical Association, with problems ranging from not being able to have orgasms to having zero sexual desire.
Many things can interfere with sexual pleasure and function, from medical causes, such as certain medications, to psychological issues, such as relationship strife. Most often, sexual dysfunction is born out of a combination of the two. To help you pinpoint what's taken the sizzle out of your sex drive, we've pulled together 10 top libido killers and what your next steps should be to get your sex life back on track.
1. Oral contraceptives: The trouble with the Pill is that what keeps you from getting pregnant - stopping ovulation - is also what can sap your sex drive. "The medication puts your ovaries to rest for three out of four weeks each month, but there other functions of ovaries beside making eggs - and that is making hormones," says Irwin Goldstein, MD, coeditor of the textbook Women's Sexual Function and Dysfunction: Study, Diagnosis and Treatment. The second problem is that the Pill causes the body to produce a protein called sex hormone binding globulin (SHBG), which binds itself to sex hormones, in particular testosterone, essentially sucking them up. Testosterone plays a role in vaginal blood flow and sensitivity in the opening of the vagina, so lower levels of the hormone can lead to sexual problems. What's more, the thinking was that once you stopped the Pill your body returned to its original settings, but Dr. Goldstein's research shows the Pill's effect and the SHBG protein production can continue to be higher in former Pill users than in non-Pill users.
What you can do: If you've noticed your sex drive isn't what it used to be and suspect it may be because of your birth control pill, talk to your gynecologist. He or she may switch you to another type of Pill (especially if you're on an ultra low dose, or 20 microgram, pill, which is one of the biggest offenders) or a different birth control method, such as the Mirena IUD or condoms.
2. Medications:Antidepressants - in particular, selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Paxil - are one of the best-known offenders for low libido and impaired orgasm. "Certain chemicals in the brain stimulate sexual activity, such as dopamine, norepinephrine and oxycontin, while other chemicals are inhibitory, such as serotonin," says Dr. Goldstein. SSRIs raise serotonin in the blood, which can affect libido. (Case in point: SSRIs are used "off-label" to treat men with premature ejaculation since it slows down their sexual excitement, according to Dr. Goldstein.) Other culprits include prescription blood-pressure-lowering drugs, which can interfere with nerve signals, and antihistamines, which dry up not only a runny nose but your vaginal lubrication as well, making sex uncomfortable.
What you can do: Talk to your doctor about your sex drive. He or she may be able to adjust your medication regimen, for example, keeping you on the antidepressant while adding Zestra (zestraforwomen.com), an over-the-counter topical botanical oil that, when massaged into the clitoris, labia and vaginal opening during foreplay, enhances arousal and orgasm, suggests Susan Kellogg-Spadt, PhD, CRNP, director of sexual medicine at the Pelvic Floor Institute at the Graduate Hospital in Philadelphia. The oil has been tested and found to be effective on SSRI patients. Your physician may also be able to switch you to a different antidepressant medication, such as Wellbutrin, a dopamine reuptake inhibitor, which often improves sexual function. However, Wellbutrin can have its own side effects, including insomnia, changes in appetite, heart palpitations and dry mouth. If your antihistamine is to blame, try using a water-based lubricant during sex.
3. Depression: This mood disorder is characterized by feelings of sadness, emptiness, worthlessness and fatigue that interfere with everyday life, as well as changes in sleep and eating habits. One of the hallmarks of depression is a lack of interest in sex. Although it's not fully understood why depression affects sex drive, part of the reason may be that not feeling good about yourself and your worth, in addition to having low energy levels, dampens the desire for pleasure.
What you can do: Seek help right away, especially if you have thoughts of death or suicide. Exercise can help with mild to moderate depression by boosting mood, self-esteem and energy levels while improving blood flow, including to the genitals. For moderate to severe depression, professional counseling and prescription antidepressants can help, says Dr. Kellogg-Spadt. The irony is that some of the same medications used to treat depression can reduce your sex drive (see "Medications" above). Let your physician know if your lack of sex drive doesn't change (or worsens) with treatment.
4. Poor body image:Feeling self-conscious about your curvy hips or less-than-ample breasts can diminish your sexual drive. "It doesn't matter if your guy is telling you you're the hottest thing," says Dr. Kellogg-Spadt. "Oftentimes the partner is raring to go and completely attracted. But if you don't feel beautiful, you're not going to be into it."
What you can do: Do a cuing analysis. Think of a time in your life when you felt sexually at the top of your game. What did you wear (for instance, your favorite little black dress or low-rise jeans), what was your workout routine, how did you eat, what perfume did you wear, what shoes did you slide on - and when was the last time you wore that, did that, ate that, etc.? These cues can help you get back into the mindset and habits of your sexy self. And if the little black dress doesn't fit anymore? It might be time to buy another dress you feel good in at your present weight or get back into an exercise routine. "Exercise has a direct effect on the chemicals in your brain that affect mood," says Jennifer Berman, MD, director of the Berman Women's Wellness Center in Los Angeles and coauthor of For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. In addition, working out will shape up your physique and give you more energy. If these changes don't help improve your body image, it's time to consider professional counseling to get at the root of the problem.
5. Menopause:Menopause is marked by a whole host of changes in your body. There's a decline in ovarian function that leads to an abrupt drop in estrogen levels, which play a role in vaginal lubrication. What's more, testosterone production drops by up to half, which can trigger a sudden dip in your sex drive as well as diminished sensitivity in the clitoris and a weakened ability to climax, according to Dr. Berman. Growth hormone levels, which are associated with sexual function, energy, memory and mood, also decrease. "Touch perception changes and alters as we age," adds Dr. Berman. "It takes a little more touch to feel the same amount of erotic arousal." Add to that weight gain, fatigue and difficulty sleeping, and sex can become the last thing on a menopausal woman's mind.
What you can do: First and foremost, speak with your doctor to check for a medical cause, such as high blood pressure or cholesterol. If that's been ruled out, there are many options, including starting a doctor-approved exercise regimen to improve blood flow, using the botanical oil Zestra during foreplay, self-pleasuring to promote genital blood flow and incorporating fantasy work, such as doing some erotic reading or watching erotic videos 20 to 30 minutes three times a week. "This doesn't have to be done in the presence of your partner - sometimes it's better not to - but it's to put erotic thoughts back into your daily thoughts," says Dr. Kellogg-Spadt. To combat vaginal dryness, start exercising to improve blood flow and use a water-based lubricant that feels natural to you. Your doctor may prescribe a topical estrogen therapy, which increases vaginal lubrication and elasticity. Have open communication with your partner and explain to him that your body is changing. "Let him know that it doesn't mean you're not turned on by your partner just because you have to use a lubricant," she says. Using a vibrator, which is more intense than the human hand, can also help with dulled arousal. In some cases, physicians may prescribe testosterone (in pill, cream, suppository or lozenge form) to older women with low levels of the hormone who experience a loss of well-being. Oral and topical testosterone may help increase sexual urges, although no preparations are FDA-approved yet.
6. Medical conditions: Health problems such as high blood pressure, high cholesterol, diabetes, thyroid disorders and autoimmune disorders like lupus can all change a woman's sexual desire by affecting blood flow, nerve signals and hormone levels. A recent study of 417 sexually active women ages 31 to 60 found that women with high blood pressure were twice as likely to have sexual dysfunction than women with normal blood pressure. What's more, the older the women were and the longer they had had high blood pressure, the greater the chance of sexual dysfunction.
What you can do: Let your doctor know that you are feeling a change in libido. He or she may prescribe medication to treat the health condition, which generally limits sexual side effects. In the aforementioned study, women who took drugs to treat their high blood pressure but did not reach their target goal were more likely to experience sexual dysfunction compared with women who were not taking medication. However, women who had good control of their blood pressure through medication were much less likely to have libido problems. Your doctor may also recommend lifestyle changes, such as exercising regularly and eating healthfully, which may allow you to cut back on medication. To counter vaginal dryness, use a water-based lubricant or talk to your doctor about using a topical estrogen.
7. Relationship problems: Resentment is the number one relationship issue that affects arousal and orgasm, according to Dr. Kellogg-Spadt. "It's the unspoken unhappiness and anger that lead to resentment," she says. "Men may get upset about their wives' spending habits or having to alter the amount of nights they go out with their friends or play sports, while women may resent having to move because of their man's job." All of that buried anger toward your partner can throw a wet blanket on passion.
What you can do: First speak with your health-care provider to find out if there's a physical cause behind your lagging libido. Whatever the cause, deal with the problem before there's an emotional crisis from the lack of sex and intimacy. "Don't wait until you're pressured or your partner is threatening for divorce, because then medical intervention may not be as effective under stress," says Dr. Berman. "You need to feel safe, comfortable and happy." Even if it's an old argument or slight that's cooling your passion, you and your partner need to open up the lines of communication and discuss it so you can put the grudges - and yourselves - to bed. Pick a time to talk in a quiet place where you can both air your complaints and listen to each other. If you're both too resentful to make your talks worthwhile, consider seeking professional counseling to overcome your issues.
8. Stress: When you're stressed about paying bills and meeting a deadline at work while trying to juggle your role as wife and mother, feeling sexual often falls by the wayside. Part of that is because stress is a distraction - it's hard to focus or enjoy sex when you're mentally still at work. In addition, when stress strikes, the hormone cortisol goes up, which alters the hormones (testosterone and estrogen) that influence your sex drive.
What you can do: The irony is that having sex - in particular, orgasms - is a known stress reliever. "Chemicals, such as oxycontin, are released during sex, which combat those high cortisol levels," says Dr. Kellogg-Spadt. But if you're too wound up to hit the sheets, find another way to calm anxiety, such as by exercising, which increases blood flow all over your body, including your genitals, and gives you a mental boost. Yoga and meditation are also great stress relievers. Also, make time to transition from work mode into intimacy mode with your partner by giving each other a massage, chatting after dinner, having a glass of wine or holding hands, suggests Sandra Leiblum, PhD, director of the Center for Sexual and Relationship Health at the UMDNJ Robert Wood Johnson Medical School in Piscataway, NJ, and coauthor of Getting the Sex You Want: A Woman's Guide to Becoming Proud, Passionate, and Pleased in Bed. In addition, "recognize what your conditions need to be in order to relax and enjoy sex," says Dr. Leiblum. "If at 11pm you're exhausted and worried about catching a 6am train to work the next day, that's not conducive to sex. Maybe it's better for you in the morning or the afternoon on a Saturday."
9. Childbirth and breastfeeding: Pelvic nerves and muscles may become damaged during delivery, reducing genital sensitivity, while breastfeeding lowers levels of estrogen, which keeps the vagina lubricated and flexible, making penetration painful. Breastfeeding also increases the hormone prolactin, which curbs sexual desire and lowers testosterone. Some women may have postpartum depression, which also lowers libido. What's more, having a baby is an exercise in sleep deprivation, which can leave you too exhausted just for motherly duties, never mind sex.
What you can do: Talk to your physician about your change in libido and have him or her rule out a physical cause as well as postpartum depression. If breastfeeding is to blame, know this is a temporary situation. Give yourself time to adjust to the new schedule and lack of sleep that come with a new baby and find ways to stay connected to your partner, such as by communicating and cuddling.
10. Routine in the bedroom: There's a reason people say that variety is the spice of life. Without it, anything, even sex, can get monotonous. "The novelty of a new relationship and the thrill that comes with infatuation cannot be sustained," says Dr. Berman. "All relationships go through ebbs and flows and ups and downs, so it's important to make the relationship a priority since often other things - work, the house, the kids, the in-laws - come first."
What you can do: Explore new positions through the use of erotic books or videos. "You don't have to be swinging from the chandeliers and doing Kama Sutra every night, but just be aware of not falling into a routine," says Dr. Berman. Try changing the time of day you have sex: Instead of being intimate before bed like clockwork, have a quickie before work in the morning or in the afternoon on the weekend. Even if you're not exactly in the mood, sometimes having sex can turn you on since sex itself increases blood flow as well as the emotional connection between you and your partner. Always make time to reconnect with your partner, even if it means hiring a babysitter and having a date night once a week.
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