The FDA is holding open meetings in October to obtain patient and doctor input on female sexual dysfunctions, specifically low desire. Now since it is the FDA, they are hoping to gain momentum on developing a medication that can treat lack of sexual desire. Which makes those of us who work with people struggling with sexual concerns sigh with frustration, “As though it is that simple.”
Sexual desire is complex. So much so that we can also say it is mysterious. Why we crave what we crave, why we crave it sometimes and not other times, why we are drawn to certain people, all questions without clear answers. And why we can’t just convince ourselves to want sex when it the person, place or time are convenient? That is a question that many people ask themselves. Low sexual desire is only a clinical issue when someone wants to want sex. But wanting to be sexual is not the same thing as desiring sex in that moment. And so many people are seeking their sexual desire spark to reignite.
There are physical issues that come into play with low desire, certainly. Hormones, brain chemistry, stress levels, exhaustion, side effects from drugs, general health and more should be considered. But so should emotional stressors, lifestyle, religious or spiritual conflicts, body awareness and acceptance, beliefs about sex and pleasure, traumas and fears, self image, lack of sex education, ability to enjoy sexual stimulation, and on and on. And I haven’t even started listing all the ways the relationship the person is in may affect their level of sexual desire. An issue that starts from one stimulus, say back pain, can lead to a pattern of saying no to sex, which leads to distance and resentment in a partner, which leads to less desire to be with them, which leads to less positive thoughts about sex…You can see how things interplay.
Even if the FDA can create a pill that motivates sexual desire would we want to take it? There is a creepy factor in feeling as though your sexual desire is manufactured. What invites us to ask ourselves, what is “real” desire. Desire is not just physical, nor just emotional, or relational. Our sexuality is interlaced with all aspects of our lives; that is one reason it is so potent. Sexual happiness can heal us on many levels and sexual unhappiness can trouble us on many levels. Desire draws on multiple aspects of Self, and my sense is that many of us want it that way.
There is a group specifically challenging the medicalization of sex, called the New View Campaign. Let’s keep our approach to sexual health diverse and multi-dimensional.
Karen started having a deep burning sensation with intercourse a few months into her first long-term relationship. Sex had never been comfortable for her but she had a few times when it felt easy and fun. But over years the burning gradually got worse and her fear of it increased until sex and pain became linked in her mind. Sometimes now her boyfriend Jon is unable to penetrate her because her vagina is so tight it feels like it is cramping. Even oral sex and touch have become intolerably painful, although sometimes Karen tries to push through it. Sometimes Jon is understanding, sometimes he is frustrated, but mostly both Jon and Karen are confused. Why is this happening? Why can’t sex be easy like it is for other people? Karen’s gynecologist says there is nothing wrong with her, but the pain is very real.
Sexual pain is rarely talked about but it is not uncommon. The type of pain I described here, called Vestibulodynia, affects some 17% of women in their lives. It can last for many years, even decades, and sadly often goes untreated. Factors such as genetics, hormones, infections, allergies, inflammation, and tiny tears in the tissue can contribute. And there are several other common diseases that can cause sexual pain, adding to the numbers of people suffering a major loss to their sex lives. And there are conditions that cause sexual pain for men as well, equally unspoken.
One incredibly challenging aspect of any chronic pain is the isolation involved. There is no way to measure pain objectively, no one else can truly understand or monitor your pain except for you. This can cause people to question themselves. For sexual pain, every woman I have worked with had been told by a doctor that there was nothing physically wrong, leading to years of self-doubt and distrust that anyone could help. In fact, the people that we generally go to for sexual health questions – our gynecologists – are simply not well informed or trained in sexual functioning issues. Sexual pain is a specialty and practitioners can be hard to find but when you do they can often diagnose and treat disorders that a majority of doctors will miss.
And treating sexual pain includes sex therapy. Not because it is all in your head, as it may have been treated in the past, but because ongoing pain, particularly pain that affects such a valued part of your life as sex, is traumatizing. It can lead you to feel alienated from your body, from pleasure, from your partner, from the universe or god or anyone who didn’t help. It may have reinforced past sexual abuse memories or negative beliefs about sex. You may have stopped seeing yourself as a sexual person. There is grief over what you have lost and about the ongoing worry about if the pain will return. Recovery requires new relaxation skills, new attention to sensation and lots of communication with future partners. Reflexive tightening and anxiety about sex can make things worse so it is important to get support as you prepare to reengage with sex.