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Female Sexual Dysfunction, Another Perspective

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

The Thrill Is Gone

Name: Billy
Gender: Male
Age: 46
Location:
I have heard it’s normal for sex drive to diminish as you age. I’ll run this by you. I’m a 46 year old male and the last time I was at a strip club with bare boobs bouncing around me, you may as well have rolled a grapefruit across the floor. Actually, I can see more use from the grapefruit. I don’t recall the last time I did it, and jerking off was almost disgusting. My tool has shrank to nothing. I barely touch it and it just dribbles, it doesn’t fire off anymore. I don’t even like to touch it to go piss anymore. I’ve had to shave around it, so I actually find it, to keep from pissing my pants. Is this normal?

No, Billy, this isn’t normal. I think you already know that too, right?

andropauseDo you know anything about andropause? If not, you ought to. Here’s what I suggest. Use this site’s search function in the sidebar. Type in the key word: “andropause” and you will come up with a wealth of information about this issue.

You can also use the CATEGORY pull down menu. Look for the subcategory: Sex and Aging, under the main category: Aging. Everything is alphabetized.

But for the time being, here’s a typical question and response —

Name: Wilson
Gender: male
Age: 58
Location: Lancing MI
I’m a successful entrepreneur, in decent health (I could stand to lose a few pounds.) I have just about everything a man could want in life, but I’m miserable. I have no energy and I feel like I’m sleepwalking through my life. I have no sex drive at all; my wife thinks I’m having an affair…I wish. Even Viagra doesn’t do the trick anymore. Is this just old age, or what?

Old age, at 58? Middle age, perhaps! Regardless what we call it, you sound like you’re in the throws of andropause — male menopause — ya know, the change of life!

Never heard of such a thing? You’re not alone. It’s only been recently has the medical industry has begun to pay attention to the impact changing hormonal levels has on the male mind and body. Most often andropause is misdiagnosed as depression and treated with an antidepressant. WRONG!andropause-1

Every man will experience a decrease testosterone, the “male” hormone, as he ages. This decline is gradual, often spanning ten to fifteen years on average. While the gradual decrease of testosterone does not display the profound effects that menopause does, the end results are similar.

There is no doubt that a man’s sexual response changes with advancing age and the decrease of testosterone. Sexual urges diminish, erections are harder to come by, they’re not as rigid, there’s less jizz shot with less oomph. And our refractory period (or interval) between erections is more pronounced too.

While most all of us have heard of a mid-life crisis, and it’s tragic consequences — red convertible sports cars, comb-overs, and the trophy wife or lover — fewer have heard of andropause. A mid-life crisis is essentially a psycho-social adjustment to aging — bored at work, bored at home, bored with the wife or partner — that sort of thing. Andropause, although it may coincide with a mid-life crisis, is not the same thing. Andropause is a distinct physiological phenomenon that is in many ways akin to female menopause.

Unlike women, men can continue to father children after andropause, but like I said, the production of testosterone diminishes gradually after age 40. I suppose you know that testosterone is the hormone that stimulates sexual development in the male infant, bone and muscle growth in adult males, and is responsible for our sexual drive. But did you know that by the age of 55, the amount of testosterone secreted into our bloodstream is significantly lower than at 45. And by age 80, most male hormone levels have decreased to pre-puberty levels.

Men, are you over 50? Are you feeling weak, lethargic, depressed, and irritable? Do you have mood swings, hot flashes, insomnia, and decreased libido, like our buddy Wilson, here? Then you too may be andropausal. You need to get some lead back in your pencil!

mutateAll kidding aside, andropausal men might want to consider Testosterone Replacement Therapy (TRT). Ask your physician about this. Just know that some medical professionals resist testosterone therapy, mistakenly linking Testosterone Replacement Therapy with prostate cancer. Even though recent evidence shows prostatic disease is estrogen-dependent rather than testosterone-dependent. However, before starting a testosterone regiment, insist on a complete physical, including blood work and a rectal examine. Mmmm, rectal exams!

Testosterone is available in many forms — oral, injectable, trans-dermal and by way of implants. The oral form is not recommended because of the high risk of liver damage. But injections, patches, pellets, creams and gels might be just the answer. I encourage you to be informed about TRT before you approach your doctor, because the best medicine is practiced collaboratively — by you and your doctor.

Good luck

Mellow With Age

Name: Bob
Gender: Male
Age: 54
Location: Laguna Beach
As an older man, I’ve started having performance problems. Unfortunately there’s no decrease in my libido. I think some of my problem is psychological. I’m also HIV+. And I find myself worrying about transmission even with condoms. But some of the problem is physical. I do wear a cockring and that helps I guess. Is there anything else I can do to increase my performance to match my libido?

Thanks for your comment and question. Your concern is a familiar one. Men regularly present this problem in my private practice and I also have a personal familiarity with the issue in my own life.

Diminished performance, at least in terms of a perpetually stiff dick, is a natural occurrence as we age. There was a time when I thought this was a major problem. I don’t think like that now. These days I’m helping my older clients (and myself) appreciate the full range of sensuality that is the unique purview of us more seasoned lovers. I’ve always felt that as gay men we are too genitally focused, especially when it comes at the expense of all the other pleasure zones our bodies have been gifted with.Kedori - Eileen Gray Bibendum Armchair

The rushed, hormonally driven sex of my youth has matured into a slower, more relaxed and sensual sexuality that I am thoroughly enjoying. This has been one of the very best gifts of the aging process. It’s even having an effect on my younger partners and they are appreciative.

So I no longer equate performance with a stiff dick. For those times when I absolutely need a rock-hard hardon a cock ring does just fine. I’m aware that I may need more time to achieve this kind of erection, but I’m not just twiddling my thumbs while I’m waiting, if ya know what I mean. I am no longer frustrated by this natural phenomenon, because I no longer have unrealistic expectations.

I realize that many men are using with an erection-enhancing medication such as Viagra, but I suggest that this be reserved for those who are truly experiencing erection dysfunction.

I’m also concerned with the alarming rise of younger men, men in their 20’s and 30’s who are using Viagra or another similar drugs recreationally. This is very troubling. If your young body is having difficulty producing an erection, then you need medical attention ASAP, or maybe you just need some sleep. However, if you’re abusing Viagra just so you can have an erection that lasts for hours that’s a real bad idea for several reasons. Not least of which is your body will habituate itself to that stuff and you will find that, in time, you won’t be able to get it up at all without ever increasing doses of Viagra.

viagra cartoonThis is gonna fuck up your cardiovascular system big time. In fact, you may very well be inducing the very sexual dysfunction the drug is supposed to help. Consider the person who overuses eye drops or lip balm or any number of otherwise innocuous health and beauty products. Their body will stop making the natural substances that these over the counter products are intended to assist. It’s counterproductive and it’s ill advised. If this is a problem with relatively harmless over the counter products, you know you are playing with fire when you’re abusing powerful prescription meds.

Whoops, sorry Bob, I went off topic there for a minute. It’s just that every opportunity I get to put out a message that will dissuade someone from hurting one’s self, I just launch into it.

So back to you. It is clear from what you tell me, your performance problems do, as you suggest, also have a psychological component to it. You have a fear that, despite being responsible in your sex play and even though you play safe, you could accidentally pass on HIV.

It’s true; one’s brain can indeed override almost every function of our body. For example, we draw each and every breath we take without even thinking about it. However, if a situation dictates our brain can and does override that essential pulmonary function and we can hold our breath. The same is true with our sexual response cycle. Sometimes we can become sexually aroused without really thinking about it. However, if for one reason or another our brain assisted by our conscience interferes with or even shuts down the sexual arousal, that’s pretty much, all she wrote.

Your scruples about the possibility that you could accidentally pass along HIV are interfering with your sexual response cycle. No cockring or an erection-enhancing medication is going to change that darlin’!

In other words, the problem is not in your cock, the problem is in your head. This is something you’re gonna have to wrestle with and finally resolve. This tension between your head and your dick is actually a good thing. Your body is providing you an opportunity to align your moral values with your sexual performance. How will this resolve itself? I couldn’t say. But I know for sure resolution is possible.

I do suggest, however, that you not try to do this in a vacuum. Reach out to a HIV support group or a sex-positive therapist for the help you need in making peace between your head and your cock.

Good luck

Tricks Of The Trade – Part 2

Today I continue the series I started on Monday.  You will remember from Monday that a friend of mine, who is writing a book about male sexuality for women, asked me if I could be her go-to-guy for a bunch of questions she had about pleasuring a man which she wants to include in her book. I think it is only fair that you, my loyal audience, should get this information before anyone else does.

PORN SECRETS

What are some porn industry secrets to keeping men harder longer while shooting a film? I assume they use editing tricks (like repeating the same shots over and over), Viagra (or other ED drugs). Do they still use fluffers? What else?

Yes, editing, lots and lots of editing!

But nowadays, it’s “better living though chemistry!” No, fluffers are no longer necessary. Pity!

Loads of guys use CAVERJECT.  This will give a guy 8 hours of wood, regardless what he is doing. He could watch his mother get hit by a train and he would still have a boner. As you can imagine, this has nothing to do with being aroused, it’s simply a matter of circulatory mechanics. It’s just one more thing that’s faked in the industry.

For the rest of us mere mortals, I always suggest the use of a cockring. Be sure to check out my tutorial: Cockring Crash Course HERE!

SEX GUILT

I will be discussing sex guilt and its repercussions. As a former Catholic priest, we’re sure you’ve dealt with your fair share of sex guilt either in yourself, your penitents, or your current sex therapy clients.

Yep, in all three!guilt-and-shame

What are some reasons behind sex guilt?

The truth is, there is very little sex related guilt without the accompanying shame. In my opinion, the shame comes first. Someone or some institution instills the sense of shame for the behavior; the individual experiences guilt when he/she engages in the shamed behavior. And, mind you, this stigmatized behavior could be anything from masturbation or eating pork.

How does sex guilt manifest itself?

In many different ways. It’s such a personal experience. For most people guilt reinforces and internalizes the shame that was engendered by someone or some institution outside of the person. (See my comment above.) A common response to sex guilt is hiding, suppressing thoughts and feelings, denying thoughts and feelings, avoiding triggers, or just shutting down. Others punish themselves, which can engender a vicious cycle self-hatred.

However, the most pernicious form of guilt actually reinforces the behavior. Here’s how that works. I do something I’m ashamed of; I feel a deep sense of guilt; then I punish myself for my transgression. This in turn makes the behavior all that more seductively attractive to me, which makes me do the behavior again, all so that I can punish myself again. And, as you can see, the punishment, not the pleasure, becomes the reward. It’s all really very insidious.

How can one overcome their guilt about sex acts?

One starts by unraveling the system that instilled the shame in the first place. One goes back to the source of the shame — church, parents, etc. He/she tries to understand the reason why the shaming was done — protect the sanctity of the body, a means of controlling human urges, etc. Then one demythologizes the shaming. Without shame there’s little to no guilt.

Have you heard these statements and how would you respond to someone who is dealing with these specific issues:
1. A women who go down on a guy is a whore.

I would help the individual see that statements like this are made by people who don’t believe that women should enjoy sex; they shouldn’t be active participants. Sex is for procreation, not pleasure. There’s only one way to have sex—particularly for women—they should be unengaged and passive receptacles, nothing more.cordially invited

2. Men who go down on women are unmanly.

I would help the individual see that this kind of statement is made by people who are trapped in a perverse sex-role stereotype. I mean, who gets to determine what is manly and what isn’t? The one who makes this determination wins the debate, right? Each individual ought to get to decide what is manly, womanly. There is no artificial norm.

3. Anal sex (between straight people) is wrong/dirty/gay.

I would help the individual try to take apart that statement. Wrong? Does that mean there’s a right way? Who gets to determine that? Dirty? Are some parts of the body more wholesome than others? Whose prejudices are at work here? Gay? Why must we demonize this particular class of people? Where do the phobic reactions to same sex behaviors come from? Are they legitimate things to be feared, or are they culturally induced? If they are culturally induced, what was the original motivation? See my response to your question: How can one overcome their guilt about sex acts?

4. The lady/whore complex that straight men may entertain.

Someone set up this dichotomy long before any particular modern straight man bought into it. Who set it up? And why did they set it up? At who’s expense? Who’s sexuality do they fear? Does preserving the male privilege have anything to do with it?

5. Pornography is evil/degrading/terrifying/wrong.

Again, why evil? That’s a throwback to an outmoded cosmology, right? And even if someone decided there is dirty magazinessuch a thing as evil, who gets to decide what evil is? What was evil 100 years ago, or in a different culture, may not be considered evil today, or in another culture. This suggests to me that “evil” is not a universal, but culturally determined. Again, who gets to determine that? And whose prejudices are at work when the determinations are being made? Degrading? Sure, porn can be degrading, but so can working at Walmart! If it is consensual and free of coercion, can it be degrading? And if porn is degrading why is it that we are not as concerned about all the other things that degrade human kind? Terrifying? I think comb-overs are terrifying. Wrong? (See evil above.)

ANAL SEX

Some people argue that the anus can suffer damage and begin to leak with too much anal penetration. Is there any biological basis behind this? Or is it just another “myth”?

Sure, one can injure him/herself with irresponsible penetrations of any orifice. But what is “too much” penetration, anyhow?

Any butt pirate, from the rank amateur to the power bottom, knows the importance of keeping their pelvic musculature in tiptop, no pun intended, shape. This is where Kegel exercises come in handy. Strong and toned PC muscles (pubococcygeus muscle) will allow you to enjoy ass fucking for a lifetime without the heartbreak of springing a leak.

PART 1 of this series HERE!   PART 3 of this series HERE!