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Sexual dysfunction


Perfectly Normal: Living and Loving with Low Libido

Perfectly Normal: Living and Loving with Low Libido
To explore the topic of female sexual dysfunction, I spoke with Robert Taylor Segraves, M.D, Ph.D., and his wife Kathleen Blindt Segraves, Ph.D.
Dr. Robert Taylor Segraves is a professor of psychiatry at Case Western Reserve University and chair of the Department of Psychiatry at MetroHealth Medical Center in Cleveland. His research includes how drugs influence sexual behavior.
Dr. Kathleen Blindt Segraves is an associate professor of psychiatry at Case Western Reserve University and director of behavioral medicine service in the department of psychiatry at MetroHealth Medical Center in Cleveland. She specializes in diagnosing and treatment sexual disorders in women.

Q. What are the most commonly seen sexual problems in women?

A. A recent survey (conducted by Laumann and colleagues at the University of Chicago) of American women (ages 18-59) found that the most common sexual problem in women is hypoactive sexual desire disorder (HSDD), more commonly referred to as low sex drive or libido (33.4%), followed by difficulty with orgasm (24.1%). Pain during intercourse--which occurs in 14.4% of women--was the only condition to show a relationship to age -- it decreases as women get older.
HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity, as defined by the American Psychiatric Association (APA). The definition is vague because the APA acknowledges that there can be significant differences in sexual interest levels among women. According to the survey mentioned above, 37% of women think about sex a few times a month and only 33% think about sex 2-3 times a week or more. Happier women seem to think about sex more often than unhappy women.

Difficulty with orgasm, or female orgasmic disorder, is a persistent delay or absence of orgasm. This definition is also from the APA and it again attempts to allow for individual variation by not giving a specific number or percentage to define a "normal" amount of orgasms. The survey states that 29% of women say they always have orgasms during sex and 40% say they are physically satisfied with their partners.

There are wide variations in sexual functioning, and there is no gold-standard that women should feel they must meet for their sexual functioning to be considered 'normal.' If a woman experiences a sexual problem that troubles her, then it is a problem that needs to be addressed and she should be encouraged to talk to her doctor about it to see how it can be improved.

Q. What causes decreased sexual desire in women?

A.Low sex drive can be caused by a range of factors, which vary from one individual to the next. Fatigue, the daily responsibilities and multiple roles women often assume, and many possible psychological causes can impact a woman's sexual appetite. It is also known that certain health conditions and medications can affect a woman's sexual desire. Depression and anxiety disorders can interfere with sexual desire, but so can some of the drugs used to treat these conditions. Many antidepressants, in particular Selective Serotonin Reuptake Inhibitors, also called SSRIs (e.g., Prozac, Paxil, Zoloft), have side effects that have a negative impact on women's libidos. Wellbutrin SR is a possible alternative, as it does not seem to cause sexual problems. Serzone, Remeron and Luvox may not cause problems with sexual desire either.
In addition, birth control pills, mood stabilizers, tranquilizers and other medications have been shown to decrease libido. If you notice a drop in your sexual desire around the time you start a new medication, talk to you doctor to see if there is a connection. Do not stop taking any medication without talking to your doctor first.