Sometimes the thrill is gone because sex drive, aka libido, can’t peacefully coexist with stress, anger, or marital discord. Or we miss out on the fun of sex because we have unrealistic expectations. (Big reasons: We don’t know as much about our sexuality as we think we do, or we’ve read one too many bodice rippers.) And then there’s the physical stuff: Sex routinely gets shelved when we’re low on sleep, and perimenopause can send hormones plummeting, leading to painful intercourse. Face it, we’re complicated. “There’s not going to be one panacea—one cream or spray or nasal delivery system—that cures all women of sexual dysfunction,” says Laura Berman, PhD, a sex therapist, director of Chicago’s Berman Center. “The pharmaceutical companies would love a panacea. That’s what they’re in the market for. But it’s not going to happen unless they work into their drug delivery algorithm a way to assess whether a woman has emotional problems.” Some sexual problems require outside help; some may require drugs. But if you’re unhappy in the bedroom, the remedies will likely be as varied as changing your birth control and learning to have orgasms without a partner. What follows are two of the most common sex-life saboteurs—“I’m not in the mood” and “I’m not having fun”—the real reasons behind them, and expert advice on how to handle them.
I’m Not In The Mood…
There’s a bulging grab bag of reasons why your libido could be flagging, including fatigue, boredom, and low testosterone, the male hormone that experts suspect may contribute to a woman’s sex drive, too. …Because I’m too tired. No matter what causes it—insomnia, working the late shift, a new baby—exhaustion is no aphrodisiac. All you want to do in your bed is sleep. How do you perk up your love life when you’re anything but perky? Make the time “How important is sex and, because they’re related, how important is your marriage?” asks Janet Hyde, PhD, a professor of psychology and women’s studies at the University of Wisconsin-Madison. “Everyone says they’re busy. But my husband and I make time for sex. Things that are important should come first.” So, turn off Law & Order reruns and turn each other on. If you have to, says Hyde, make a date that morning so you both can think about it—and each other—all day. Do it after exercise For some people, exercising too close to bedtime makes it hard for them to sleep. Take advantage of that found energy. “After 35 to 40 minutes of moderate exercise, everything in your body is going right,” says Hyde. “Your blood is circulating, your nervous system is firing, so scheduling sex right after you exercise makes for good sex.” Compromise If your partner comes on to you after a particularly grueling day, you’re likely to get angry because he doesn’t see how exhausted you are, says Marianne Brandon, PhD, cofounder, with Andrew Goldstein, MD, of the Sexual Wellness Center in Annapolis, MD. If you reject him, he’s likely to get needy and press you more, or leave you alone, feeling isolated. “Offer a compromise,” recommends Brandon, also the coauthor, with Goldstein, of Reclaiming Desire: 4 Keys to Finding Your Lost Libido. “There are things you can do for your partner other than intercourse that are less draining but still satisfying, such as oral sex or holding or caressing him while he masturbates.” …Because I’m angry with you. Relationship problems are often the uninvited trois in your ménage. “Some disputes between partners are disguised as sexual problems,” says Leonore Tiefer, PhD, a clinical associate professor of psychiatry at New York University School of Medicine and author of Sex Is Not a Natural Act. “It’s easier to say, ‘I’m not interested’ or ‘I have a headache,’ when the truth is, ‘I’m mad at you.’ " Some problems may be serious enough to warrant couples therapy (if there’s an infidelity issue, for example). But if your problems are garden-variety and don’t make you wonder why you ever took up with him in the first place, don’t try to deal with them by shutting down sexually. If you do, you’ll both end up suffering. Use words “Women often use sex as a way of communicating their anger,” says Brandon. “Communicate with words as opposed to behavior.” Let your partner know that you want to talk about something important. “If he doesn’t have advance warning, he may feel blindsided,” she says. “You can say, ‘There’s something going on. I want to talk about it and get your thoughts. What’s a good time?’” Pick a time when you won’t be interrupted, i.e., when the kids are asleep. Listen Pay attention to what your partner is saying—don’t use the time while he’s talking to think up a snappy rebuttal. Remember, you’re trying to reach consensus, not win. And don’t expect an immediate resolution, says Brandon. “What’s important is to stay in touch so no one feels isolated. You need an ongoing dialogue.” MORE: 13 Tips For Seriously Better Sex
I’m Not In The Mood…
….Because we do the same old thing over and over. “Relationships can settle into patterns that don’t support a healthy sex life,” Brandon says. “For example, couples can become more like friends than lovers and can lose that sexual spark.” Even a routine repertoire of lovemaking techniques can make you feel ho-hum about sex. Here’s how to spice it up: Resurrect great memories Remember the best sex you ever had? Spend some time thinking about it and then re-create it. “If you can recall what sparked you before, it can spark you again,” says Brandon. Make time every day to fantasize about having great sex with your partner. “When you imagine enjoying sex, it helps you get your body aroused,” she adds. Try some risky business Do something you thought you’d never do. Jessica Lange and Jack Nicholson had their steamiest tryst in the remake of The Postman Always Rings Twice on a flour-dusted kitchen table. Find a new position—or a new location—that thrills you both. (Try one of these mind-blowing sex positions tonight!) Slow it down Has sex gotten a little perfunctory? “Quick sex offers next to no pleasure most of the time,” says Brandon. “It’s like eating ice cream: If you gobble it down, your experience will be much less pleasurable than if you savor every bite. Slow it down until it takes three times longer than it usually takes.” Initiate sex talk “In loving couples, there’s often an exaggerated fear of hurting the other’s feelings if you say, ‘I’ve never liked that position,’” says Tiefer. “Often couples have different ideas of what sex is for: One feels that it’s for romance and bonding; the other feels that’s much too serious, and it’s just about having an orgasm.” Talk about your feelings in a neutral place (not your bed) with the idea that you’re working on a project (your sex life) as colleagues, not negotiating a settlement like two sides in a labor dispute. Remember, says Tiefer: “Sex is a lot like dancing. There’s the same type of cooperating, making mistakes, and correction and praise back and forth before you get it right.” …Because I’m taking care of the baby. “Most OB/GYNs don’t tell you that one in six marriages ends in divorce within a year after the birth of the first child,” says Goldstein, who is also an instructor at Johns Hopkins School of Medicine and director of the Center for Vulvovaginal Disorders in New York City and Washington, DC. “Roughly 86% of women have some sexual dysfunction in the first year after they have a child.” Fatigue and the delirious love you feel for your new baby play a role in sidetracking your sex life, but much of it is hormonal. “Nursing can affect your libido and your ability to be aroused, and it can even make sex painful,” says Goldstein. Breastfeeding lowers your body’s production of the three chemicals you need for a healthy sex life—the hormones estrogen and testosterone and the brain chemical dopamine—as it turns all the body’s attention, via the hormone prolactin, to milk production. You lose your desire for sex and your body isn’t able to prepare for it even if you do get the urge. Without enough estrogen, your vaginal walls thin out and don’t produce the lubrication you need for intercourse, so sex can hurt. (A similar problem occurs during menopause.) “Also, women often take a progesterone-only Pill during lactation, and progesterone is one of the main sexual saboteurs,” says Goldstein. There’s not a lot you can do while you’re nursing, except remember that this lull is temporary and… Lubricate, Lubricate, Lubricate Lubricants, which coat the vagina and are designed to be used just during sex, include Astroglide and K-Y Warming Liquid. Longer-lasting products such as Replens and K-Y Silk-e Vaginal Moisturizer also relieve other symptoms of vaginal dryness, like itching and irritation. These over-the-counter products are a good second-best to your own natural juices to help prevent painful sex. While you’re nursing, you may even be able to use a doctor-prescribed vaginal estrogen cream such as Estrace or Premarin; the 3-month vaginal ring, Estring; or the suppository, Vagifem. Very little of the estrogen they contain is absorbed into your body, so it won’t pass on to your nursing baby, but it will help thicken your vaginal lining and promote lubrication. MORE: 8 Eco-Friendly Sex Toys
I’m Not In The Mood…
…Because my hormones are crazy. Nursing isn’t the only thing that can wreak havoc with your hormones. Taking the birth control pill, going through menopause, or having your ovaries removed can disrupt the delicate balance—sometimes dramatically. “All birth control pills can increase the hormone called sex hormone-binding globulin,” says Goldstein. “SHBG binds to the testosterone in your bloodstream, inactivating it. Birth control pills reduce acne because they lower testosterone. For the same reason, they lower libido.” Testosterone levels also start declining naturally in women in their late 20s, and are significantly decreased by the time a woman is in her 40s. “It’s not a menopausal thing,” explains Goldstein. What is menopausal: The cessation of ovulation and gradual decline of estrogen from the ovaries. The drop-off of testosterone lowers libido while lack of estrogen further exacerbates the problem by reducing lubrication and thinning vaginal walls, making sex painful. Having your ovaries removed, a surgery called oophorectomy, sends you into abrupt menopause because the ovaries are your body’s most prolific producer of estrogen. Testosterone also plummets after an oophorectomy. Your options for these hormonal problems: Switch to another contraceptive If you want to stay on the Pill, try Yasmin, which, one study found, didn’t dampen libido, or look for Pills that contain the progestins levonorgestrel or norgestrel, derived from testosterone, which may also have less impact on your sex life. Otherwise, the copper-containing intrauterine device or a new IUD called Mirena are just as effective as the Pill and don’t interfere with libido. Ask about testosterone Most doctors currently use compounding pharmacies to mix testosterone creams in dosages for women. But a testosterone patch for women, manufactured by Procter & Gamble, is now through clinical testing and could be on the market as early as next year. In a recent trial of the patch in women who had their ovaries removed, researchers reported that the women experienced a 56 percent increase in sex drive and a 74% increase in satisfaction. (Studies of naturally menopausal women are being completed.) “What’s interesting is that it didn’t just raise sex drive; it improved orgasm and arousal and all the other things that contribute to a satisfying sexual experience,” says Goldstein. …Because I had pelvic surgery. The most common pelvic surgery is hysterectomy, and in some cases it can contribute to an inability to become aroused and to have an orgasm, says Goldstein. “It can lessen blood flow to the vagina and clitoris. It can actually cut some of the nerves, including autonomic nerves that cause dilation of blood vessels and increase lubrication.” What you can do: Talk to your doc about these products Because pelvic surgery can reduce blood flow to the genitals, this is one problem for which Viagra and its ilk (which increase blood flow) are appropriate treatments for women. The FDA has approved a device called the EROS Clitoral Therapy Device, a vacuum pump that provides gentle suction over the clitoris to increase blood flow and sensation. It needs to be used three or four times a week, and for some women, it may take several weeks of use to notice an improvement in the ability to become aroused and achieve orgasm. Goldstein also suggests a botanical product called Zestra. A small study reported in the Journal of Sex and Marital Therapy found that this oil, which contains borage-seed and evening-primrose oils plus angelica and coleus extracts, was more effective than a placebo for enhancing arousal when applied to the genitals.
I’m Not In The Mood…
…Because I don’t have orgasms (or have them rarely). If this is you, you may be surprised to learn that most women don’t have orgasms during intercourse. “The majority of women have trouble reaching orgasm from penis-vagina intercourse,” says Hyde. “It’s not the most efficient way to stimulate the clitoris, which is what women need.” Here’s what to do: If you never have orgasms… The best way to get them started is by giving them to yourself through masturbation, suggests Hyde. It will help you experience the sensation and learn what—and where—works for you. Experts, including Hyde, recommend sex therapist Lonnie Barbach’s book For Yourself: The Fulfillment of Female Sexuality as the best self-help manual for getting in touch—literally—with your own feelings. If you only have orgasms sometimes… Do you only have orgasms during oral or manual stimulation? “You may be setting unrealistic goals for yourself by expecting to have them during intercourse,” says Hyde. “If you can orgasm from oral-genital sex, why worry?” Get educated “Look for advice books that aren’t medically focused,” suggests Tiefer. There are also websites that Tiefer recommends like Betty Dodson, Toys in Babeland, or Eve’s Garden. (Be prepared: They’re racy enough to get snagged in your Internet controls.) “The ultimate,” says Tiefer, “is to have a group discussion with other women. Make a confidentiality pact, agree to meet once a month, and candidly share your experiences with one another. You could even make it a book group. Pick a book and discuss it. It can be an icebreaker for building rapport.” Check your pillbox Any antidepressants in there? Selective serotonin reuptake inhibitors (SSRIs), a class of drugs that includes Prozac and Zoloft, “are probably the number one cause of anorgasmia [inability to have an orgasm],” says Goldstein. They short-circuit your pleasure center by decreasing levels of the brain chemical dopamine (one of the sexual triumvirate, along with estrogen and testosterone). “People on SSRIs can lack that full range of emotion. They don’t get very depressed about anything, but they don’t get very excited about anything, either,” says Goldstein. If that zombielike feeling is torpedoing your love life, ask your doctor to switch you to Wellbutrin, a drug that raises dopamine levels (preliminary studies show it may improve sexual desire in nondepressed women). One con: Wellbutrin can cause anxiety, which is common in depressed people. If you’re taking a shorter-acting SSRI, such as Zoloft or the serotonin-norepinephrine reuptake inhibitor Effexor, you may be able—with your doc’s okay—to take a short drug holiday. “If you don’t take it Friday morning, on Friday night and Saturday you can have intercourse and have an orgasm,” says Goldstein.
I’m Not In The Mood…
…Because I’m in pain. Any kind of pain, including arthritis, can make sex seem irrelevant. But the pain we’re talking about here is centered mainly in the genital region. The most common cause: lack of lubrication, which can make intercourse torturous. It can be brought on by lack of arousal, or estrogen decline during nursing and menopause, or after oophorectomy. Some serious medical conditions—endometriosis, ovarian cancer, interstitial cystitis (inflammation of the bladder)—can also cause pain during sex and at other times. By some estimates, as many as 16% of women may have an ailment called vulvar vestibulitis, or vulvodynia, characterized by chronic pain and inflammation at the opening of the vagina. Some women may also have pelvic floor dysfunction, a syndrome that can include painful muscle spasms, often precipitated by childbirth, scoliosis, or lower-back problems that lead to misalignment of the pelvis. Your options: Visit a specialist See your OB/GYN about your pain and discuss estrogen options. If you think you may have vulvodynia or pelvic floor problems, look for a vulvar-pain specialist or a urogynecologist specializing in pelvic floor disorders. For vulvodynia, you can get a physician referral after joining the National Vulvodynia Association; to find a urogynecologist, contact the American Urogynecologic Society; for pelvic pain in general, contact the International Pelvic Pain Society. You may be referred for biofeedback or physical therapy. If your problem is caused by muscle spasms, talk to your doc about Botox. Now used cosmetically to reduce wrinkles, Botox is currently under study as a treatment for chronic pelvic pain (it works by relaxing muscles). Don’t touch that yeast-infection drug Unless you’ve had recurrent yeast infections—diagnosed by your doctor—don’t treat every ache, pain, or itch “down there” with those handy over-the-counter yeast treatments. “Women have limited ability to self-diagnose vaginal infections,” says Goldstein, who cites a study in which researchers asked women about to buy medication at a drugstore to undergo testing—and only 30% had a yeast infection. Using the drugs in the absence of an infection can backfire because they can cause painful irritation. Avoid these, too The thong has to go. “Thongs expose the vulva to detergents and fabric softeners that can cause irritation or allergic reactions and ‘wick’ bacteria and yeast from the rectum into the vagina,” says Goldstein. He also recommends avoiding perfumed soaps, bubble baths, and feminine hygiene sprays because they, too, can irritate the vagina.
Are You Alone?
Experts aren’t even sure how to define women’s sexual problems, let alone estimate how many women have them. The diagnosis female sexual dysfunction disorder covers four conditions: lack of libido, known as hypoactive sexual desire disorder; lack of sensitivity or ability to be aroused, called female sexual arousal disorder; inability to have an orgasm, known as female orgasmic disorder; and pain during sex—which itself is divided into a number of categories. And the diagnosis comes with one caveat: It’s not a dysfunction unless a woman who has one or more of these problems is distressed about it. If you can’t have orgasms and don’t care, it’s not necessarily a problem. One oft-cited 1999 study in the Journal of the American Medical Association suggested that 43% of women suffer from some form of sexual dysfunction. But that statistic is as hotly contested as a presidential election. “The idea that 43% of American women have a sexual dysfunction is crazy,” says Cynthia Graham, PhD, research scientist at the Kinsey Institute for Sex, Gender, and Reproduction at Indiana University. She, like other critics of the JAMA study, points out its glaring omission: Although researchers asked women if they’d had sexual problems that persisted for a few months, they failed to ask those women how they felt about it. When another study probed women’s emotions—a 2003 survey of nearly 1,000 conducted by former Kinsey Institute director John Bancroft, MD, and his colleagues—only 24% said they had distressing sexual problems. Why the discrepancy? Graham argues, “You can have sexual problems, but you can recognize them as being very much dependent on circumstances—like being tired, stressed, having a new baby—without feeling that you have some kind of sexual dysfunction,” she says. “These women didn’t think that this lull in their sex life was a major source of distress.” The truth is, when it comes to sex, normal is what’s normal for you. Additonal reporting by Barbara Loecher. MORE: Don’t Let Arthritis Kill Your Libido
