Female Desire Pill, interview with Ellen Barnard

2/27/15 update: I interviewed Ellen Barnard about the female desire pill on 2/2/14. I’m bringing this post to the top because of the attention that “Nothing Is Wrong With Your Sex Drive” (published today in the New York Times) is getting. 


I plan to write more about this myself, and there’s a good section already in The Ultimate Guide to Sex After 50: How to Maintain – or Regain! – a Spicy, Satisfying Sex Life which I hope you’ll want to read. — Joan 





Desire in a pill?
(originally published 2/2/14)
 
Researchers are working on drugs to treat low desire in
women. Could a desire pill really work? Do we even want it? 
 
To learn more, I
interviewed 
one of the top sex educators, Ellen Barnard, co-owner of A Woman’s Touch Sexuality Resource Center.

 

JP: What’s the state of current research into a female
desire drug?
EB: A variety of drugs are being investigated in clinical
trials, most in phase 2 trials. No drug has been approved for the treatment of
low desire for women, also known as Hypoactive Sexual Desire Disorder (HSDD).
JP: How are these drugs supposed to
work?
 
EB: Some of these drugs work on brain chemicals; some are sex hormone-based (testosterone); others primarily work to increase physical arousal through an increase in blood to the clitoris. Most of the
medications that are being investigated are designed to either overcome
inhibition or lack of motivation, or flood the person with such strong physical
sensations that she cannot ignore them easily. Or they manipulate the reward
system of the brain in ways that increase
the drive toward that sexual jackpot.
The question is whether a drug that pushes a woman into
being more interested in sex is safe, healthy, or would even be effective over
the long term. Many of the drugs being investigated have a variety of side
effects, and some are quite undesirable. Testosterone can cause excess hair
growth, acne, lowering of the voice, and a decrease in good cholesterol, for
example. Other drugs show the potential for abuse, either by the woman herself or
by a partner who hopes to have a more willing lover.
JP:  Why is sexual desire so complicated for women and
seemingly so easy for men?
EB: It isn’t, actually. Men have troubles with desire too,
and their issues have many of the same origins as women’s do. However, we live
in a culture that reinforces men for a high interest in sex, and generally does
not see a high interest in sex to be a positive thing in women, unless a woman
is less interested in sex than her partner, and that lower interest causes
tension between them or distress in her. But even with culture condoning high
desire for men, approximately 20% experience low desire. For more info, here isa good overview.
JP: How does female desire work?
EB: Desire is the cognitive recognition of sexual
interest. So it’s an idea, not a physiologic process, though it results in a combination
of brain and body responses. Desire may be first recognized as a thought, or it
may be a thought in response to a physical feeling. Many women believe that we
should feel something first, that sex starts with a twinge in the vulva or
elsewhere in the body, that she interprets as sexual interest and then allows
to blossom into more sexual interest and then maybe into sexual activity. If physiologic
signal is not as obvious because of aging, health, or stress, she may no longer
get the signal, and so she does not notice the thought.
Women who have experienced sex as painful have a feedback
loop that tells them that sex will hurt, and so they shut off any thought of
sex to avoid the pain. If a woman is able to get rid of the pain, she will
still have to convince her subconscious that sex is safe. Once she does that,
her thoughts of sexual interest often become more frequent.
The same would be true of relationship health. For a woman
in a healthy, rewarding relationship, the thought of sex is a safe thought and
is likely to mean that she will experience pleasure if she acts on that
thought, so she pursues sexual activity. Sex requires the feeling of safety. When
there is tension, distrust, fear, anger, etc., the mind does not perceive sex as
safe or pleasurable, so will not express desire.
When you think about how complicated desire is for women
(and men as well), you can see that it’s pretty complicated to consider a
medication to address the root causes of most of these issues.
JP: What’s the
bottom line?
 
EB: The bottom line
is that drugs do best when there is a single, knowable cause for a symptom and
the drug directly addresses that cause by reducing or removing it. Sexual
desire is complicated, varies a lot from person to person, and has many moving
parts. The idea that a drug could be developed to change desire is pretty
far-fetched once you understand it that way, and one of our biggest fears is
that you end up with a drug that has pretty wide effects and some nasty,
unintended side effects.
 
We would prefer to
address desire issues in ways that give individuals more control and more
understanding of their mind and body connections so that they can do their own
problem-solving and not be reliant on a pill or a doctor.
Most people
can increase their experience of desire through a combination of getting
healthy, having a good body image, having a safe and trusting intimate
relationship, getting enough sleep, lowering stress and distractions, reducing
pain, and learning how to have pleasurable sexual experiences on a regular
basis.

When the man no longer wants sex: guest post by Jason Kae-Smith

I often hear from readers of both genders who are unhappy about the lack of sex in their long-time relationships. Does sex have to go when we get older? What if it goes for one person, but not the other? 
We hear frequently about women losing the desire for sex in their relationships. Though not as commonly voiced, sometimes it’s the man who stops wanting sex with his partner. 
When I read sex therapist Jason Kae-Smith‘s article in Contemporary Sexuality on this topic, I emailed him immediately to ask for permission to excerpt it for you here. Your comments are welcome!
— Joan

He’s Just Not That Into It 

By Jason Kae-Smith, LMSW, CST 

Jason Kae-Smith

After months of his wife’s pleading and an eventual ultimatum, “Ted” (not his real name) found himself sitting somewhere he’d never imagined—the office of a sex therapist. The three-year journey leading up to this day was painful; a strained effort along a cumbersome path littered with resentments, accusations, and much confusion.

As Ted told his therapist, “I just don’t get it. I love my wife. She’s intelligent, she’s compassionate. She’s a wonderful mother to our children. She’s my best friend and I love hanging out with her. I just don’t want to have sex with her anymore.”

It turns out Ted isn’t alone. In the United States, there are an estimated 10 million men in sexless, heterosexual marriages. And while many would assume that women’s lack of desire is the main culprit, recent trends indicate that it is just as likely the men who have lost that loving feeling. Many sex therapists are seeing an increase in heterosexual men coming to them for problems with desire, some noting that the percentage of men with low desire now outweighs the percentage of women.

Calgary sex therapist David Hersh, EdD, observes, “When I first started and I would see couples with discordant desire, it was mostly the woman who wasn’t interested. Now about 55% of these couples are seeing me because the man has lost interest.” Several therapists queried confirmed a similar trend in their practices.

It’s not clear if there are actually more men experiencing low desire or if it’s just that more men are now seeking help. Hersh says he believes the latter is the case. “Now, men are more informed about the condition. Traditionally there was a double standard where ‘real men’ always wanted to have sex. But you’re not so strange anymore if you don’t want it.”

Ricky Siegel

Sex therapist Ricky Siegel agrees, stating, “I think there’s little doubt that the most obvious factor to the issue of low desire in men is that ‘Real men are not supposed to have low desire!’ So where it has become an acceptable script for women, it’s one of the things that men suffered about in quiet shame.”

In 2008, Bob Berkowitz and Susan Yager-Berkowitz published the results of their survey of over 1300 men who identified as no longer having sex with their spouses. The respondents listed several reasons for their loss of interest in sex, some of which included emotional struggles with things like depression and anger. Others reported they began avoiding sex because of problems with sexual functioning and eventually lost interest in sex altogether. And while many men initially suspect their loss of libido might be a result of low testosterone, research findings, such as those reported by Sari van Anders in the May, 2012 issue of Archives of Sexual Behavior, continue to suggest this is more often not the case.

Despite his assertion that everything was okay, “Derek” told his therapist that he reluctantly agreed to a session because, “I love my wife and I will do this if she feels it is important.” Derek’s wife “Cindy” was concerned because recently Derek had stopped initiating sex with her, something that she said was “unusual” for him.

Derek said was likely due to stress or perhaps “getting a little older” but when Cindy was invited to talk about experiencing her own sexuality, a different kind of narrative began to emerge. Cindy stated that in the beginning of her relationship with Derek, “Sex was okay but I was never all that into it.” But she added, “Lately, something happened. And now it’s like I can’t wait to jump on this man.”

 It turns out that “something” was her reading the best-selling 50 Shades trilogy. Cindy’s sister had turned her onto the books and to Cindy’s surprise the books turned her on, prompting her to embrace and embody her sexuality like never before. After some contemplation, Derek finally conceded that Cindy’s sudden interest in sex had a surprising blanketing effect on his desire for her. “I don’t get it,” he said. “I mean, this is what I always wanted. But when it happened, and all of a sudden she’s wanting to go to the sex store and buy toys and try new things—I don’t know, I guess it kind of turned me off.”

When it comes to treatment, experts often recommend a physical examination (just to be sure) and then consultation with a sex therapist. But what can therapists do to help men get their mojo back? Fortunately, those who practice and write about clinical sexology are continually developing ways for therapists to think about and respond to requests for help. The traditional model is to look at problems in the relationship first. One of the current trends in therapy is to go right to the sex.

As for Ted, the specific course of his future sessions will be guided by the choices he and his therapist make as their therapy conversations unfold. Today’s session marks a turning point in his journey, a change of direction toward the possibility of getting out from underneath the weight of low desire.

“This was good,” he told his therapist at the conclusion of their meeting. “It feels good to get this off my chest.” He added, “I guess I feel a lot more hopeful, like this isn’t just the way it has to be when you get married and are with someone for a long time.”

 Jason Kae-Smith is a certified sex therapist with a practice in Grand Rapids, MI. Among other things, he is interested in ways people are able to give value to sexual pleasure throughout their lifetimes. The article from which this is excerpted first appeared in Contemporary Sexuality, the journal of American Association of Sexuality Educators
Counselors & Therapists (AASECT).

Woman tolerates husband’s sexual advances, how to tell him what she wants?

A reader who calls herself “Hot Momma Frigid Lover” posted a comment on another post which contained a point that was so important that I decided to comment on it here. Here are excerpts from her comment:

… I have never had that much pleasure in sex… My husband, on the other hand, has had a very healthy sexual drive and I had a mother who taught me to be sensitive to that drive and take care of his needs. So…well…we have had a good marriage for 32 years.

… I am starting to resent his advances a little more. Not that I don’t want to give him pleasure any more but that he does so little to actually ‘earn’ it. He has always gone for my breasts as an ‘invitation’ to give him some sexual attention. Since I prefer sleep over sex, grabbing at my breasts is a rude awakening and definitely does not awaken any sexual desire.

I think I know what might help him to arouse me in a more romantic way but how can I tell this man (that I love so much) that he just doesn’t turn me on!

Here is what I wish he could learn from someone or somewhere else. If I am asleep (or if he thinks I am …lots of times I am pretending hoping he will arouse me awake)…I would love a good back massage. Some kisses on the back of my neck, some full body hugs (that don’t include his hand on any part of my sexual annatomy)some physical contact that says “I love you” before it says “I need sex”. In fact I wouldn’t mind hearing the words “I love you” that can be very inviting.

How can I help him to ‘learn’ this stuff without me having to teach him. Most of the information I have found is for help with sex itself … I am not interested in sexual pleasure…I just want a little physical love and attention before I give him the “sex” he needs.

I implore you, please talk to your husband about what would turn you on or at least make you feel receptive to sexual intimacy. Surely he would LOVE to know this! Instead of asking how to tell him that he doesn’t turn you on (that would be devastating to hear), why not tell him what you DO want from him?

If that seems really difficult to you, start by requesting the back massage, and let that turn into sexual intimacy if it feels right. Then, when you’re in a neutral situation (walking in the park, or sitting over coffee, not in bed), try saying to him, “It really makes me feel relaxed and loved when you give me a back massage/kiss me/ hug me for no reason. I love it when you do that.”

He needs to hear from you what you like and want from him, because he’s certainly getting the message that you’re not enjoying his sexual advances. Give him the opportunity to please you and show you his love.

I invite other readers to talk about what has worked to open communication in your relationships.

Beyond Sags and Bags: MSN.com

Thanks to Jeremy Egner for his enlightening article, “The New Definition of ‘Sexy'” on the men’s lifestyle channel at MSN.com.

Egner cites a recent poll of more than 10,600 American adults that found that “sexy is more an attitude than it is a perfect physique.” More than 76 percent said a woman can be sexy if she was a size 14 or larger (well, sure!) and that “women (84 percent) are much more likely than men (63 percent) to say sexiness derives from an intangible quality … rather than looks.

Egner interviewed me about how non-physical qualities become even more sexy as we age. On page 2, he writes,

But as we get older and gain status, emotional security and hard-won wisdom, we’re looking less for hotties and babymakers than for compatible mates that will help create durable and rewarding relationships, says Joan Price, author, blogger and self-described “advocate of ageless sexuality.”

Such considerations feed our personal ideas about what is sexy. Other factors include our awareness of our own changing bodies.

“We have wrinkles, sags and bags. If having perfect faces and unlined bodies was a prerequisite for sexiness, we’d be out of the story already,” says Joan Price, 63, who wrote about evolving sexuality in her book, Better Than I Ever Expected: Straight Talk About Sex After Sixty. “We yearn for the same touch and intimacy but we have to first internalize the changed idea of what sexy is. We have to see ourselves as sexy.”

Price recalls asking her 70-year-old husband Robert, whom she married last May, to explain exactly how he could consider her to be as beautiful as he claimed when she could plainly see all her lines and physical imperfections whenever she looked into a mirror. (So don’t expect those sorts of questions to go away anytime soon, guys.)

“He told me, ‘If I am to know myself and accept my own aging process, how could I want anything less from you?'” Price says. “I tell that story sometimes when I’m asked to speak somewhere and women always ask, ‘Does Robert have a brother?'”

“When two people who really accept themselves come together, that’s where good sex happens,” she adds. “The most powerful sex organ is the brain.”

With this article, though, is a slide slow of the so-called “Sexiest Women Over 35,” which I found very disappointing. Why? The oldest “woman over 35” is Elle Macpherson, who is just 44 (a teenybopper in our world). Why isn’t Sophia Loren (73) on that list? Julie Christie (66)? Lena Horne (88)? Or any of the other women listed on my post, How Old Are They Now?

Or does “over 35” have a nine year cut-off date?

This list is one more reminder of how much work is left to do in tearing down the stereotype of sexiness as synonymous with youth, and substituting real live role models of sexiness twice as old as the youngsters MSN.com chose as the “sexiest women over 35”!