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12 February 2007
Sexual Showstoppers
by Serena Mackesy
As Tolstoy said: "Happy families are all alike; but every unhappy family is unhappy in its own way." Keep that in mind when you read a recent statistic which suggests that 64 percent of Americans are "satisfied" with their sex lives. Which means, of course, that 36 percent aren't. What the associated study doesn't show, however, is where these people cross-over in the great Venn Diagram of Life, or, indeed, how much sex any of them are getting. How many of the 64 percent are living with the 36 percent? "Satisfied" means basically "I am having as much sex of the type I like as suits me."
"Dissatisfied" can cover a lot of ills, from; "my husband has a higher sex drive than I do and I sometimes feel coerced just to keep the peace" through " we haven't done it since our four-year-old was born" via "we do it plenty but I never have an orgasm" to "I want it nightly but my husband only seems to want to do it six times a week."
Sexual satisfaction is one of the things that's as long as a piece of string. Sexual desire ebbs and flows like the tide - by the week as well as by the year; women, for instance, are far keener on sex when they're ovulating - in even the happiest of set-ups. But sometimes, our concentration on a fulfilled sex life as a yardstick for measuring the health of a relationship can mask the fact that there are plenty of physical reasons for loss of libido. So if you find you just can't work up the enthusiasm and there are no obvious reasons such as resentment, tiredness, stress or lack of privacy getting in the way, it's worth knowing what the other primary blockers are - and that though sexual dysfunction may be frantically embarrassing to you, to your doctor it's just another case. The health issues that affect libido and sexual function include:
Medication
Despite the fact that side-effects are almost as common as the medications themselves, people often fail to put two-and-two together when it comes to medication and loss of sexual function. Common treatments for conditions as varied as depression, seizures, heart conditions, blood pressure, endometriosis, and many others all cause libido problems. Remember, also, that herbal medicines are still medications and can also have side-effects - especially if you're taking them in combination with other drugs without consulting your doctor. The stereotype of the sex-crazed junkie is also somewhat misleading: if you indulge in recreational drugs such as cannabis it's worth bearing in mind that they do have effects beyond the immediately obvious ones. Also, ironically, Gestrinone, a non-estrogenic low-dose contraceptive, has also been linked with low libido, which I guess at least makes it doubly effective. Virtually all of these side-effect problems can be helped with dosage adjustments and combination treatments.
Heart problems
Both the problem itself, and the fact that it can cause erectile dysfunction. The good new is that sex is actually a very good, relatively gentle form of exercise - unless you try and do it on a jogging machine or something. Though some people might need to restrict sexual activity immediately after a heart attack or pacemaker implantation - events that personally I would have expected to be a bit of a short-term libido-squasher in themselves - but long-term, it's undoubtedly a Good Thing. And the other good news is that a 2004 study by the University of Alberta showed that Viagra, originally suspected of being counter-indicated for those with congestive heart problems, is actually extremely helpful in combating the emotional impact of heart problems.
Depression
To take the Prozac or not take the Prozac? Though depression meds can affect libido, they don't always do so by any means, and there are many, many meds to choose from until your doctor gets the balance right. In the meantime, I have yet to meet someone who was suffering from depression who also expressed much enthusiasm for chandelier-swinging.
The Demon Drink
Alcohol. You know what? They don't call it Brewer's Droop for nothing, and booze can affect the female function as well. Regular heavy boozing, while it may give a man a lovely full head of hair, will usually render people incapable of much by way of fun and games. And while a couple of glasses can oil the wheels, as it were, heavy alcohol consumption dulls the senses all over and will lessen your capacity for pleasure. Furthermore, you're far more likely, what with lowered inhibitions and unrealistic levels of confidence, to attempt things your body isn't physically capable of. And there are fewer things more likely to put you off the carnal act than a slipped disc.
Stress
It's distracting. It lowers your immune response. It detracts from your ability to empathize with your partner and their needs. Generally speaking, if you're living long-term with stress you need to work out some way of changing your lifestyle. If it's impacting your sex life, chances are it's impacting all sort of other areas of your life as well.
Pregnancy
The hormone rush can have all sorts of knock-on effects. Levels of desire, like investments, can go down as well as up. Levels of lubrication can alter. Furthermore, women can become negative about their appearance and inhibited about showing themselves (I don't know what you do about a man who is turned off by pregnancy; probably just wish you hadn't let him knock you up in the first place). Changing body shape can make things awkward. And despite vast tracts of evidence to the contrary, people can still be afraid that intercourse will somehow harm their developing offspring. All of these issues can be addressed with imagination, good humor and help from your pharmacist. Unless specifically advised not to by your doctor, go ahead and enjoy yourselves.
Childbirth and parenthood can also cause problems of their own, of course. Again, a lot of these are emotional - from simple exhaustion to change-related fear and alteration of self-image - but these can all be addressed, sometimes with the application of simple time and patience. Some women, though, also experience pain on intercourse due to episiotomy scars and so forth, which is hardly a turn-on. Again, these problems can - and should - be addressed with your doctor. There are very few reasons why they can't be sorted out.
Menopause
Another hormone-related issue, this time a drop rather than a rush. Interestingly, some women report an improvement in their sex lives after menopause, what with the spontaneity and loss-of-responsibility that not having to worry about pregnancy brings with it. Menopause, though, can cause dyspareunia (the medical term for "ouch!") through shortening and loss of vaginal elasticity and loss of secretions and thinning of the epithelial layers. All of these can be helped along with topical estrogen cream, lubricants and/or HRT.
Body Image and Self-Esteem
According to Pamela G. Rockwell, assistant professor of family medicine at the University of Michigan Medical School, these issues have a surprisingly widespread impact on sexual pleasure. OK, so they're ultimately emotional ones, but, particularly for women, they inhibit and disincline. There are, of course, physical things you can do to help yourself other than do some serious work on your self-esteem, even if it does sound anti-feminist to say it, and they involve getting fitter. You don't have to be stick-thin to be sexy, but hating the sight of yourself in a mirror is pretty unsexy, too. As is running out of breath when you should be panting for other reasons, or not being able to support yourself with your arms. “Some studies show that as little as five pounds of weight loss can greatly improve a woman’s sexual satisfaction,” says Rockwell. That, and reminding yourself that those size-zero honeys who make you feel so bad also have no-fat twinkles. And believe me, no-one loves a no-fat twinkle.
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