Category Archives: Sex Drive

Female Sexual Dysfunction, Another Perspective

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Hey sex fans,

It appears that my posting of last week, Female Sexual Dysfunction Is A Fictional Disorder, caused quite a stir.  As you recall, I was answering a question from a woman who asked if FSD, or female sexual dysfunction is real or a fictitious “ailment” that is being promulgated to sell pharmaceuticals to unsuspecting women.  I replied; “I think that, for the most part, female sexual dysfunction, or FSD, is a fictional disorder. I also think pharmaceutical companies are trying to hit on a female version of Viagra to treat this imaginary disorder so they can make a bundle, just like they did with as the male version.”

Well, that didn’t sit well with some friends and colleagues. One among them, Dr. Serena McKenzie took the most exception. She sent me a little note: “Your blog on female sexual dysfunction being fictitious is – respectfully – fucking bullshit sir.” Ok then!

I invited Serena to make her case not only to me, but to all my readers. What follows is Serena in her own words.

Flibanserin, the first and only medication available for use in reproductive aged women with low libido, becomes commercially available this week after a rocky and controversial road that led to its FDA approval Aug. 18. The view on the medication whose brand name is Addyi (pronounced ADD-EE) ranges from a historical achievement in women’s health care to an epic failure of commercialized medical propaganda. Despite the lengthy debate that has surrounded flibanserin, what most people want to know is whether it will help their sex life or not now that it is here.

addyi


First Things First

While sexual concerns can be difficult to discuss for many women and their partners, it is important to acknowledge that sex and intimacy are some of the great extraordinary experiences of being human. When sex goes badly, which statistically it does for 43 percent of U.S. women, the consequences can devastate a relationship and personal health. One of the biggest applauds I have for the FDA is their statement of recognition that female sexual dysfunction is an unmet clinical need.

Sexuality Is Mind-Body But Not-Body?

Sexuality is usually complicated, and problems with sex such as loss of libido are multifactorial for most women. Antagonists to flibanserin cite psychosocial contributions such as relationship discord, body image, or history of sexual abuse to be the most pinnacle causes of a woman who may complain of problematic lack of sexual desire, and that sex is always a mind-body phenomenon. While these factors often implicitly correlate to loss of sexual interest for a woman, they don’t always, and you cannot advocate that women’s sexuality is all inclusive of her mind, body, and spirit — and assert simultaneously that a biochemical contribution which flibanserin is designed to address in the brain to improve satisfying sexual experiences does not exist.

(c) Myles Murphy; Supplied by The Public Catalogue Foundation

(c) Myles Murphy; Supplied by The Public Catalogue Foundation

The Biochemistry of Sex

Antidepressant medications that alter brain biochemistry are notorious for having sexual side effects which can be prevalent up to 92 percent of the time, and are known to decrease sexual interest, disrupt arousal, and truncate orgasm in some women. Ironically, flibanserin was originally studied as an antidepressant, and while the exact mechanism of how a medication can impair or improve sexual interest is unknown, it should not be difficult to consider that if biochemical tinkering can crush sexual function, it may also be capable of improving it.

Efficacy Data Dance

Flibanserin is a pill taken once nightly, and has been critiqued as showing only modest increases in sexual desire, with improvements in sexually satisfying events rising 0.4 to 1 per month compared with placebo. However just because flibanserin has lackluster efficacy data, that does not mean it is ineffective, and even small improvements in sexual function can be life altering for a woman struggling with disabling intimate problems. If only 1 percent of women with low libido were to improve their sexual function with use of flibanserin, that equates to 160,000 women, or the population of Tempe, Arizona.

Blue Sky Side Effects

Flibanserin has side effects, and the sky is blue. All medications have pro and con profiles, and for flibanserin the most common consequences of use include fatigue, dizziness, sleepiness, and a rare but precipitous drop in blood pressure. Women may not drink alcohol while taking this medication. Providers who will prescribe it and pharmacies that will dispense flibanserin must be approved through what is called a Risk Evaluation and Management Strategy, or REMS, which means they are educated on advising women on how to take flibanserin safely. While a REMS program is arguably overkill compared to numerous higher risk, common prescriptions which do not require a REMS, it is an excellent opportunity for clinicians who have a background in sexuality to be the main applicants since they are far more qualified to assess proper candidates for treatment as well as continue to endorse holistic measures alongside flibanserin. Women who are interested in trying flibanserin should only obtain it from sexuality trained professionals.

The Proof Is In The Sexy Pudding

If flibanserin is worthless, the marketplace will bury it in a shallow grave quickly. Women will stop paying for it, and conscientious medical providers will stop prescribing it. Yet 8,500 women taking flibanserin were studied, over a 1,000 of them for one year, and the data suggests it will help some. Women deserve to be educated on their options, because sexual health is worth fighting for.

Changing The World, One Orgasm At A Time

We simply cannot overlook how astronomical of an achievement it is to even have a mediocre medication approved for female sexual dysfunction. Women’s sexuality has been ignored by medicine for most of history. At least now we have something to fight over.

The controversy about flibanserin is in fact magnificent, and frankly, the entire point. We must talk openly about sexuality and sexual concerns to improve them, personally for one woman at a time, but also uniformly to embrace female sexuality as a vastly larger societal allowance.

A satisfying sexual life is far more than the restoration of sexual dysfunction, it’s a thriving, multi dimensional, ever evolving weave of psychology, relationships, life circumstances, and yes can include a milieu of biochemistry and neurotransmitter pools.

Is a pill ever going to replace the vastly complicated arenas that fuse into our sexual experience? Of course not — it’s absurd and lazy-minded for anyone to suggest that is even being proposed. But it is necessary and inherently responsible to allow for all possible puzzle pieces to be utilized through the ever evolving navigation of sensuality, intimacy, and erotic fulfillment.

So will flibanserin make your sex life better? Maybe. But considering the conversation about it valuable as well as its use as merely one tool among many options to improve sex and intimacy would be the better bet. Ultimately, we “desire” sex that is meaningful, erotic, and dynamic. The journey of seeking sexual vitality deserves every key, crowbar, heathen kick, graceful acrobatics, or little pink pill that lends its part to the process, no matter how small or big, for the opportunity to discover and embrace a sexual aliveness.

Holistic physician, certified sexual medicine specialist, sex counselor, medical director of the Northwest Institute for Healthy Sexuality

Female Sexual Dysfunction Is A Fictional Disorder

Name: Sharon
Gender: female
Age: 30
Location: PA
I’ve been reading a lot lately about FSD, or female sexual dysfunction. Is there such at thing? It strikes me as a fictitious “ailment” that is being promulgated to sell pharmaceuticals to unsuspecting women. What are your thoughts?

I share your skepticism. I think that, for the most part, female sexual dysfunction, or FSD, is a fictional disorder. I also think pharmaceutical companies are trying to hit on a female version of Viagra to treat this imaginary disorder so they can make a bundle, just like they did with as the male version.

body as art

So much of female sexuality is caught up with the cultural context of a women’s role in society — family obligations, body image and patriarchal views of marriage, etc. For the most part, men aren’t nearly so encumbered. So when one talks about female sexuality, particularly when the notion of a condition or a disorder arises; ya gotta ask yourself, what’s going on here?

I too have been noticing a lot of discussion in the popular culture lately about female sexual dysfunction. My first response is to ask myself, who’s raising the issue and why? Sure some women, like some men, experience difficulties in terms of desire, arousal and orgasm, but what of it? Is it a syndrome? Is it really a dysfunction? I personally don’t think so. The sexual difficulties most people experience can be explained and dealt with in a less dramatic way then with drugs?

And here’s an interesting phenomenon; the repeated appearance of the term female sexual dysfunction in the media lately actually gives the concept legitimacy. I’m certain the pharmaceutical industry is hoping that it will. If they can make the connection in the public mind between what women experience in terms of desire, arousal and orgasm concerns and what men describe as erectile dysfunction, then most of the work is done. In other words, I think the entire effort is a marketing ploy.

female sxualityI think we can safely say that, in order to determine what female sexual dysfunction might be, one has to clearly understand what a “normal” sexual response is for a woman. This is where we traditionally run into problems. Sex science is notoriously lacking in this endeavor. One thing for certain, although both women and men have a discernable sexual response cycle, a woman’s sexual response is not the same as a man’s. Even though we can’t say with certainty what “normal” is, therapists are famous for turning difficulties into disorders. And once you have a disorder it becomes the basis for developing a drug therapy. So you can see how this becomes a self-fulfilling prophecy.

Currently there’s a real buzz among clinicians concerning the efficacy of Addyi, the so-called “female Viagra”. But most sexologists, myself included, are unimpressed. Basically, the drug in question is an antidepressant. When I heard that, red flags began to fly. Antidepressants are notorious for their adverse side effects, especially in terms of sexual arousal in both men and women. The second problem with the study was the whole notion of desire and distress. Lots of women experience diminished sexual arousal but are not distressed by it. But if there’s no distress, clinically speaking, then it can’t be considered a disorder. You see where I’m going with this, right? If there’s not a “disorder” there’s no need for a pharmaceutical intervention.FUCK

According to the research some of the women in the clinical studies leading up to the approval of the drug claimed they were less distressed by their “condition,” Hypoactive Sexual Desire Disorder, than they were at the beginning of the study. According to clinical trials of Addyi held in 2013, only 8% – 13% of the women experienced “much improved” sexual desire and only about 2 more satisfying sexual encounters per month were had. In other words, when behaviors were studied, the actual number of satisfying sexual episodes reported by these less distressed women hardly changed of all. This indicates to me that the antidepressant helped lift the spirits of the distressed women, but did nothing to increase their satisfaction with their sexual outlet.

Twice the FDA rejected Addyi for its severe side effects and marginal ability to produce the effect that it is being marketed for. And despite the fact that the drug is now available, those side effects still exist. Women who take the pill are likely to experience dizziness, nausea, drowsiness, fainting spells, and falling blood pressure. Coupled with alcohol and even hormonal contraceptives the odds of these potential side effects occurring increase. Persons with liver ailments, or taking certain other medicines, such as types of steroids are also at higher risk. On the other hand Viagra has very mild side effects that may include headaches, indigestion, blue-tinted vision and in some cases a stuffy nose.

While a man can pop Viagra an hour or so before he plans to have sex, women who are looking for increased sexual desire need to take Addyi daily for up to a month before they should expect to see any effects.

Good luck

Early December 2012 Q&A Show — Podcast #356 — 12/05/12


Hey sex fans,

Sorry about last Monday you guys. As you know I had intended to get this Q&A show earlier in the week, but technical difficulties prohibited that. Not to worry, because here we are now. I have a bunch of very interesting correspondents who are ready to share their sex and relationship concerns with us. And I will do my level best to make my responses informative, enriching and maybe even a little entertaining.

  • Duke wants to experiment with getting butt fucked, but is afraid to make the first move.
  • Ed ain’t gettin’ laid anymore and his wife doesn’t want to talk about it.
  • Mike wants some information about milking machines. Yeah, you heard me.
  • Bubble Butt Barber has a horny and pervy client that wants a spanking.

BE THERE OR BE SQUARE!

Check out The Lick-A-Dee-Split Connection. That’s Dr Dick’s toll free podcast voicemail HOTLINE. Don’t worry people; no one will personally answer the phone. Your message goes directly to voicemail.

Got a question or a comment? Wanna rant or rave? Or maybe you’d just like to talk dirty for a minute or two. Why not get it off your chest! Give Dr Dick a call at (866) 422-5680.

DON’T BE SHY, LET IT FLY!

Look for my podcasts on iTunes. You’ll find me in the podcast section, obviously, or just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Today’s Podcast is bought to you by: The Perfect Fit Brand!

The Dog Days of Summer 2012 Q&A Show — Podcast #344 — 08/20/12


Hey sex fans,

My, my, my! It’s been six whole weeks since our last Q&A show. That’s not good. Because, ya know what? I have a huge backlog of very interesting questions from the sexually worrisome. And this time around, all my correspondents are men. Why, that almost never happens. I trust you will find my responses will educate, enrich and maybe even entertain. With a little luck, I’ll even have just enough time to do a product review. Sound fun? I think so too.

Tyler is straight but has the urge to stuff his ass.
Paul has polio, but he still wants to jerk-off.
Robert and his partner are having big time relationship problems.
John need more sex than he’s getting at home.
Steven is pulling his pud a lot, now some of the sensations are gone..
Mike is having extreme muscle spasms after he cums.
Finally we review the Fat Boy Cock Sheath.

Today’s podcast is bought to you by: Dr Dick’s Sex Advice and Dr Dick’s Sex Toy Review.

BE THERE OR BE SQUARE!

Check out The Lick-A-Dee-Split Connection. That’s Dr Dick’s toll free podcast voicemail HOTLINE. Don’t worry people; no one will personally answer the phone. Your message goes directly to voicemail.

Got a question or a comment? Wanna rant or rave? Or maybe you’d just like to talk dirty for a minute or two. Why not get it off your chest! Give Dr Dick a call at (866) 422-5680.

DON’T BE SHY, LET IT FLY!

Look for my podcasts on iTunes. You’ll find me in the podcast section, obviously, or just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Touched for the very first time, Part 2

Look for Part 1 of this two part series HERE.

Let’s pick up where we left off last week, on the perils young people face as they navigate the expectations of virginity and sex, and begin to consider their first forays into partnered sex.

Teenagers face enormous peer pressure when it comes to sex, yet there’s precious little education afforded them in terms of the fundamentals of human sexuality. This dearth of clear, unambiguous information on how our bodies work is just the first way we let down our children. There’s almost nothing available to teens to emotionally prepare them for partnered sex.

Mariana is 17. She writes:

I lost my virginity yesterday, but I did not bleed. Why is this?

Hold on there, missy! That’s it? That’s all you’re gonna say about your first time at bat? Is there anyone else out there who is as perplexed by this as I am?

Maybe I’m reading way too much into this. Maybe it is, after all, par for the course. For some young women, the externals of first-time partnered sex are the more important then the act itself. Maybe that’s because less than 5 percent of women have an orgasm the first time they have sex.

It’s clear that we do put more emphasis on the outward signs of virginity, which, in turn trumps everything else?

I guess, Mariana, I would have liked to know if congratulations are order? Was your first time enjoyable? Are you happy it happened? It’s so amazing to me that you didn’t mention any thing about your first intercourse other than that fact that you didn’t bleed. Maybe that’s your way of saying it wasn’t so special.

Sorry about the diversion there, Mariana, as you may know, the hymen is a mucous membrane that is part of the vulva, the external part of a woman’s genitals. It is located outside the vagina, which is the internal part of a woman’s genitals. Not all women have a noticeable hymen. You may or may not have had one to begin with. However, you are right in thinking that most women do. Simply put, having a hymen and/or having it rupture during one’s first coital experience is not necessarily a good indicator of virginity.

Many girls and teens tear or otherwise dilate their hymen while participating in sports like bicycling, horseback riding or gymnastics. This can also happen while inserting tampons, or while masturbating. A girl may not even know she’s done this, since there may be little or no blood or pain involved when it actually happens. The tissues of the vulva are generally very thin and delicate prior to puberty. Again, the presence or absence of a hymen (or its bleeding) in no way indicates whether or not a woman is a virgin.

Some hymens are elastic enough to permit a penis (or similar object) to enter without tearing, or they tear only partially, and there is NO bleeding at all. As I hope you know, when you are adequately aroused, your vagina will lubricate itself and become more flexible. For many women, it will stretch without discomfort. It’s even possible for a woman to have sex for years without “tearing” her hymen.

Tia, age 19, has a very unusual concern.

I have a problem. I’m still a virgin, but my bf thinks I’m not. It’s really my fault he thinks this, cuz I told him I was all experienced and everything. We’ve been going together for about eight months already, and I really want my first time to be with him, but how am I going to act all experienced when I don’t know what I’m doing.
HELP ME PLEASE!!!

That sure enough is a pickle you got yourself into, darlin’. You’ve got some “splainin’ to do, Lucy!”

Curiously enough, I’m more likely to hear from young women who are not virgins, but want to know how they can fool a new partner into thinking they are. I guess we can chalk up all this deception and confusion to the powerful associations every culture imposes on technical virginity.

And like most things sexual, there is a huge double standard between the cultural and personal implications of virginity for men and women. The cultural expectations regarding virginity are also tied to age as well as gender. For example, our society expects its 16-year-old girls to be virgins. To be otherwise at that tender age would be a scandal in most communities. But a 35-year-old woman who is still a virgin is considered an old maid—or worse, a (gasp) lesbian.

Of course, things are a bit more fluid when it comes to boys. On one hand, a 16-year-old boy who is not a virgin may raise eyebrows in some communities. But many others in those same communities would praise him for being a “stud.” On the other hand, a 35-year-old man who is still a virgin is not only the butt of jokes—or worse, a “queer”—but he’s also more of a disgrace to his gender than an old maid is to hers. Funny how that works, huh?

I hasten to add that there is a lot to argue with in terms of these arbitrary cultural norms, and I encourage ya’ll to argue away. God knows I do! And just because they’re there, and considered “norms” where you are, that doesn’t mean you have to buy into them. God knows I don’t! So make up your own mind.

But back to you, Tia. I’d love to know why you felt the need to deceive your boyfriend in the first place. Do the people you hang with prize sexual experience over sexual innocence for a woman of 19? And what are the expectations of your peer group regarding a 19-year-old guy? I’ll bet the expectation is that he be sexually experienced—right?

Well, you can see why a lot of people—and not just you—find this whole thing just too damned complicated. And rather than adding to the confusion or the deception, I encourage you to come clean with your boyfriend about the status, as it were, of your cherry.

Here’s why I think this is the best policy. First, if the boyfriend is sexually experienced, it will be very difficult for you to hide the fact that you are not. Besides, like you said in your message to me: “I really want my first time to be with him.” Tell him that! No man is gonna turn that down…ever. In fact, that may be the most sexually charged and treasured sentence in any language.

Begin the big talk with your boyfriend like this: “Baby, I got something real special to tell you. You know how I’ve been saying that I’ve been with other guys and everything? Well that was just my way of keeping all the other guys from pestering me for my junk. Baby, the truth is I haven’t had sex before now. And the best part of this is I’ve decided that I really want my first time to be with you. My cherry belongs to you, baby”

Clearing the air like this will also allow you to relax when the moment finally happens. And relaxation is the key to enjoying yourself. And you should enjoy yourself, because no one can do that for you.

Good luck!

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