The Guide to Getting It On (122 page)

Whatever your sexual problems or concerns, the absolute first thing to do is to make a list of all the medications you are taking—from simple over-the-counter drugs to prescription medications to herbal teas and vitamin concoctions to heroin, cocaine, pot, poppers, ecstasy, meth, or alcohol. Then check these over with a pharmacist. Medications may not be the cause of the sexual problem, but they’re the first and most obvious thing to rule out.

The Warning that Should Be on Paxil, Prozac, Zoloft & The Other SSRIs

According to the Journal of Sexual Medicine, any person who has been given a prescription for an SSRIs should be given a warning such as the following:

“There is a high probability of sexual side effects while on SSRI medications. There are indications that in an unknown number of cases, the side effects may not resolve with cessation of the medication and could be potentially irreversible.”

SSRIs are antidepressants that include Prozac, Zoloft, Paxil, Lexapro, Luvox, Celexa, Effexor, Serzone and Remeron.

A Question of Desire

Some people think that “low desire” is a sickness like the flu that a woman needs to get over. They assume that she’s cured of her low desire if she can happily hop on her partner’s erect penis. But low desire can mean different things, some of which require a reworking of the relationship outside of the bedroom before there will be any changes between the sheets. The mind-set of trying to recreate what the woman was like in the past is not productive. None of us are the same as we were a few years ago. Our sexuality needs to reflect our current situation, and in some cases of low desire, that is exactly what it is doing.

It is also possible that low desire can result from physical causes or metabolic changes. For some women, taking birth-control pills or certain medications can cause changes in desire that last after they discontinue the pills or medications. We know that anti-depressants can do horrible things to a person’s sex drive.

Drug companies are trying very hard to get products containing testosterone approved for women with low sexual desire. This might be helpful if a woman has had her ovaries removed or if she has a metabolic disorder, but women should be cautious about these preparations. Their use as an elixor for low desire is controversial. For more about drugs for low desire, see Chapter 72:
The Panty-Dropping Pill
.

Highly Recommended: Remember the finger that you used to masturbate with? Why not put it to use by turning the pages of books like
Wanting Sex Again: How to Rediscover Your Desire and Heal a Sexless Marriage
by Laurie Watson, Penguin, 2012, and Kathryn Hall’s helpful book
Reclaiming Your Sexual Self: How You Can Bring Desire Back into Your Life,
John Wiley & Sons, (2004). These book treat low desire as a messenger rather than as a disease. Men and women both will be able to find approaches to help them better understand and give meaning to lost desire. Neither author is beholden to the drug companies. They realize the short-sightedness of automatically throwing pills or patches at whatever ails you.

When Excitement Is Too Much

Some of us can’t tolerate much excitement. Somewhere along the line we got the feeling that sexual excitement is dangerous or disorganizing. As a result, we experience conflicts when becoming sexually excited. People with this problem sometimes numb themselves between the navel and the knees. That way they don’t have to face the anticipated dread that sexual excitement holds in their imagination.

Those who want to work through excitement problems need to experience pleasurable feelings slowly and without goals such as having an orgasm. Pressure to feel sexual takes them out of the moment and makes them feel numb. With time and effort, sexual excitement can be tolerated in the here and now, assuming that’s what you want.

Some people have trouble managing sexual excitement when they are alone. They can’t masturbate or even feel sexual on their own, but do just fine when they are with a partner. Perhaps they need to experience a partner’s excitement about them before they can feel their own excitement.

Orgasm Fears & Tears

Although orgasms are usually welcome events, this is not always the case. Young girls or boys who are having their first orgasms can sometimes feel that they have done something wrong or broken something inside.

Adults can have mixed feelings about their own orgasms, especially when sadness, loneliness or guilt are triggered by the orgasm. The sadness can be about a former real-life partner, or maybe the orgasm taps into a deep emotional pain that suddenly gets released. Some people cry after an intense orgasm because it touches a sadness that’s deep inside.

There are also people who treat their own orgasms with cold detachment, especially when they feel a need to masturbate. Perhaps the need for sexual relief brings up feelings of weakness or self-loathing. Whatever the case, they are not particularly gentle or tender when handling their own genitals. There are also people who dislike orgasms because they experience them as a form of losing control. It’s a fine testament to the power of orgasm that more people in our society don’t have problems with them.

Painful Intercourse

The 2010 National Survey of Sexual Health and Behavior found that 30% of women reported some pain during their last intercourse. It is likely that the kind of pain that the majority of these women are experiencing is because they were not adequately aroused during intercourse. The causes can be everything from clumsy lovemaking to relationship conflicts.

However, there’s another kind of sexual pain that happens to some women regardless of how much she wants to have sex or aroused she might be. This kind of pain can happen to men as well, but more often to women. The pain is not necessarily limited to the vulva, vagina, or bladder, but can also result from problems in the floor of the pelvis.

If you are having pain during intercourse, be sure to check with a physician or physical therapist who specializes in pelvic pain. If you are a woman, try to determine whether the pain is at the opening of the vagina or is caused by deep thrusting. Deep-thrusting pain is sometimes caused by constipation or pelvic inflammatory disease. Shallow-thrusting pain has a larger range of possible causes, from adhesions under the clitoral hood or episiotomy scars to yeast infections, herpes sores, or vaginal changes associated with menopause. Other questions to explore about painful intercourse include whether it happens all the time, how long it has been happening, if it happens with all partners or just one, and if added lubrication helps.

This kind of pain is very real and it can have horrible effects on a sexual relationship. The woman (and couple) who is experiencing it needs the same kind of support as anyone who is experiencing a chronic-pain disorder.

Here are some of things that might be going on:

Vulvodynia:
this would be Latin for “a great big pain in my pussy.” Symptoms include discomfort or burning pain the vulvar area of unexplained origin, which means that no infections or neurological disorders appear to be present. Often described as a chronic burning or knife-like pain, this disorder is very complex and can be a serious challenge to treat. Most healthcare providers throw their gloved-hands up in despair, which means that the patient will need to do a lot of research and find a specialist who works with vulvodynia. Just to give you an idea of the complexity, vulvodynia can be broken down into pain that is generalized or localized, and these categories are further broken down into pain that is provoked, unprovoked or both provoked and unprovoked. While few physicians who specialize in treating vulvodynia believe it is the result of psychological problems, a lot of patients and their healthcare providers mistakenly do. This isn’t to say that stress and anxiety can’t make the symptoms worse, but the are unlikely the cause. For an excellent brief summary, see “Vulvodynia” by Goldstein & Burrows, Journal of Sexual Medicine, January 2008, pages 5-15, and “The Vulvar Dermatoses” in the February issue. See as well:

Vulvar vestibulitis:
a form of vulvodynia where the pain or discomfort is localized to the vulvar vestibule, which is the part of the vulva that’s between the inner lips. In some cases, the pain has been there since their first tampon or intercourse, in others it started long after. Could be from any of a number of different causes, including the use of oral contraceptives. An excellent resource to begin with is “Moving Beyond the Diagnosis of Vestibulodynia—A Holiday Wish List” by Andrew Goldstein, Journal of Sexual Medicine, 2009;6:3227–3229.

Vulvitis:
an inflammation of the vulva. There can be as many causes as there are vulvas.

Interstitial cystitis: pain or discomfort in the pelvis that is related to the bladder. Symptoms often include a persistent urge to pee or the need to pee frequently, as often as a couple times an hour. This is not called “painful bladder syndrome” without good reason, as the urge can feel quite extreme and it can be accompanied by spasms and pressure. People can have pain while urinating, pain while driving, and pain while having sex. In men, there can be painful ejaculation. The cause is not known, although a number of theories are on the table, and it could be there are different things that cause it. There are a number of different treatments, with one of the main goals being in decreasing the pain. People with this disorder are often very depressed as a result, in part due to the pain and discomfort, and in part because it causes such incredible interference in their lives.

PELVIC INFLAMMATORY DISEASE (PID):
inflammation of the female reproductive organs, often the Fallopian tubes, which is usually caused by a bacterial infection.

HIGHLY RECOMMENDED:
When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain
by Andrew Goldstein, Caroline Pukall, and Irwin Goldstein, Da Capo Lifelong Books, 2011. This book was written by three of the top specialists in the research and treatment of women’s sexual pain. If you or your partner is experiencing female sexual pain, there is no better place to start than with this book. Also, for an extensive list of resources on sexual pain, see the pelvic pain for women part of our links at GuideToGettingItOn.com.

Women’s Orgasm Problems

Plenty of women don’t have orgasms with thrusting during intercourse. This doesn’t mean that they have sexual problems. All it means is that both partners need to explore what gets the woman off and include it as part of their lovemaking, unless it happens to be the man’s best friend, though some couples might enjoy that, too. (See Chapter 23:
Intercourse—Horizontal Jogging
for more on stimulating the clitoris during intercourse.)

One of the first things therapists look for in women who don’t have orgasms is a history of sexual abuse. Yet plenty of men and women who never had a shred of sexual abuse still have sexual problems. Being raised in a highly religious household can cause sexual problems that appear similar to those of sexual abuse, including the person’s feeling vacant, depersonalized, or numb when having sex. Good luck having an orgasm with all of that going on. Books on this subject that are often recommended include
The Elusive Orgasm: A Woman’s Guide to Why She Can’t and How She Can Orgasm
(by Vivienne Cass),
For Yourself
(by Lonnie Barbach) and
Becoming Orgasmic
(by Julia Heiman & Leslie LoPiccolo).

Vaginismus — Gridlock in Your Groin

Vaginismus is a tightness in the vagina that causes discomfort, burning, pain, penetration problems, or complete inability to have intercourse. The muscles surrounding the vagina can close so tightly that they won’t allow anything to go inside. The reaction can be so severe that a woman can’t even insert a tampon. Vaginismus can result from many different things. These can include chronic pelvic pain that is unrelated to sex, psychological trauma, a bad experience at the gynecologist’s office, fear of pregnancy and childbirth abuse, and a sex-negative religious upbringing. And excellent source of information and help for vaginismus is Lisa and Mark Carter’s website and online community at
www.Vaginismus.com
.

Persistent Genital Arousal Disorder (PGAD)

This is an unusual and difficult disorder that has only recently been recognized. It is when a woman’s genitals are physically aroused for hours, days, weeks or longer, but she doesn’t feel any desire to have sex. Having sex provides no relief, and orgasms don’t help her arousal to reside. This would be similar to if a man had an erection for weeks at time, where he desperately wanted it to go down, but the most earth-shaking orgasm and ejaculation would not bring a smile of satisfaction or a dent in the tent in his pants. Some medications can be helpful, but there is no cure.

Based on what is currently known, PGAD is a syndrome with a wide array of possible causes. Areas that have been studied the most are 1.) PGAD as experienced by women who tend to be post menopausal and who appear to have a pudendal nerve neuralgia but no pre-existing psychological illness. This kind of neuralgia would impact the dorsal clitoral nerve; 2.) Women with PGAD who have a fairly extensive history of affective disorder, obsessive-compulsive disorder, and sexual assault. This type of PGAD is considered to be a psychosomatic illness, where the women misinterpret genital sensations and experience them as negative events; and 3) There has been an association of some cases of PGAD with restless legs syndrome and overactive bladder.