"Not Tonight, Honey. I Have a Headache."

 One of the most difficult conversations that I have had with my patients is one that is related to sexual dysfunction.  It is often a topic that a patient may bring up just as I have my hand on the door knob to walk out of the room.  She might approach the conversation by saying, "My husband wanted me to talk to you about the fact that I have no desire for sex anymore."  Then, the conversation, often involves her crying and expressing the anxiety that her lack of desire is causing her.

You see, the problem is often not an issue of the woman falling out of love with her husband which is often the message perceived.  The problem is one that is complex and often difficult to verbalize.  The woman often feels sad that she is not able to maintain the same desire that she once had for that special, intimate moment with her husband. 

This blog is the first in a brief series on female sexual dysfunction.  It is not meant to be a comprehensive review of the subject.  My hope is to shed some light on a topic that many physicians do not have time to address in a normal visit.  I also hope to let those of you who are experiencing female sexual dysfunction know that you are not alone.

According to the American College of Obstetricians and Gynecologists (ACOG), there are four basic types of sexual dysfunction.  In order to remember these types of dysfunction, I have created an acronym for you, P.A.I.N.


P: Sexual Pain

A: Impaired Arousal

I: Inability to Achieve Orgasm

N: No Desire. 

This blog will focus on "N: No Desire". 

An ACOG practice bulletin entitled Female Sexual Dysfuction, describes two main dysfunctions related to desire.  They are called hypoactive sexual desire disorder and the other is sexual aversion disorder.  In simple terms, hypoactive sexual desire disorder refers to a decreased desire in sexual activity that causes distress in the woman or in the relationship.  Sexual aversion disorder is an aversion to genital contact that causes distress in the woman or the relationship.  In both cases, the key is that the lack of desire or the aversion (strong dislike) is persistent, recurrent and causes distress. 

Hypoactive sexual desire disorder is the most common hypoactive sexual desire disorder.  It usually occurs in women who are between the ages of 40 to 60 years old.  It can occur in younger women as well.  Sometimes the basis of the disorder is in a situation or a circumstance, such as a relationship problem, depression, the result of taking a medication (e.g., oral contraceptive pills or anti-depressant), gynecologic problem or hormonal problem.  Sexual aversion disorder may be the result of a traumatic experience.

There is a book that I discovered in my quest to help my patients called Reclaiming Desire.  It is written by Andrew Goldstein, MD and Marianne Brandon, PhD.  I have been really impressed with their ability to address the issue of hypoactive sexual desire disorder or what some call low libido in a simplistic and understandable tone.  I have not read the entire book cover to cover.  However, the more that I read I am learning how much a physician’s training is limited or even lacking in the area of sexual dysfunction.  Drs. Goldstein and Brandon create a framework for a holistic approach to reclaiming sexual desire.  I encourage you to buy the book and take the sexual desire self-test.  Their test is based on four components of sexual wellness: physical health, emotional resilience, intellectual fulfillment and spiritual contentment.  They assert that all four components must remain in balance in order to maintain sexual well being.  At the end of the test, you will have a score.  If your score is high in a particular area, that is the area where you have the greatest likelihood of imbalance.  That area should be your primary focus.  (I do not have a special interest in this book.  I also will not receive any benefit from you choosing to buy the book.  It is simply a resource that I would like to share with you.)

In my conversations with my patients, I would agree that imbalance in a woman’s life is a precipitating factor in creating a hypoactive sexual desire disorder. Creating balance requires exercise and healthy eating.  It also may involve meditation, counseling, therapy or even taking time to simply have fun and enjoy life.  The spiritual component should not be underestimated.  It is that spiritual connection between husband and wife that can be fuel that keeps the desire going and going and going.

So, if you think you have hypoactive sexual desire disorder or sexual aversion disorder, I dare you to take a chance.  I dare you to resist the temptation to possess complacency and rely on the age old excuse that you have a headache.  I dare you to take a directed approach to reclaiming and reawakening your sexual desire.  Like any goal you want to accomplish, you must have a plan.  First, you must have the courage to discuss it with your health care provider.  You physician cannot help you unless you tell him or her there is a problem.  Second, you must have the courage to discuss it with your spouse.  Your spouse needs to know that you are still very much in love but you are concerned that you have a medical problem that needs attention.  Request patience in the process.  Lastly, be assured that you are not alone.

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