Midlife women & sexual health : Viagra
Paulette Dunbar, 55, adores her husband. She loves his look, his scent, everything about him. So you might think that the couple’s sexual life is as hot as an August day in Mississippi. Well … not quite.While Ms. Dunbar definitely enjoys their lovemaking, it hasn’t always been easy, “I had to work at this,” she says of the couple’s current sexual relationship.Soon after they married, Ms. Dunbar, then 44, miscarried. Immediately thereafter, she started having hot flashes and night sweats, a sign of her body’s transition to menopause, and she and her husband adopted an infant. Between the baby and the night sweats (so bad she wore terrycloth pajamas to soak up the sweat), sexual desire was just a bittersweet dream.Over time, however, a hormone therapy patch toned down the flashes and night sweats and her son began sleeping through the night. With that came the resumption of her sexual life–albeit one different from the passion of her early marriage.Today, says Ms. Dunbar, a homemaker in Oconomowoc, WI, lovemaking is often not so much about the physical desire to have intercourse, as the emotional desire to please her husband and be close to him. “Once I get going I enjoy it,” she says, which is more than she could say for years past.
Ms. Dunbar has learned what many midlife women know but often don’t admit or understand–sex may take on a different hue as you age. It may become less frequent, it may become less physically satisfying, it may become less important in your life, or you may even feel more desire. And that might be just fine. Or, not.”The most important thing for women to understand is that there is no set sexual script they must follow,” says Susan Kellogg-Spadt, CRNP, PhD, director of sexual medicine at the Pelvic & Sexual Health Institute in Philadelphia. Up to a third of women experience a lack of sexual interest for several months or more out of the year. (10) This kind of “sexual slump” is fairly normal, she says, and as long as it doesn’t happen every month of every year, “you’ll probably get out of it.”But in a world obsessed with men’s sexual performance as they age, and a world full of magazine covers and television talk shows telling women how to have more and better sex, it can sometimes seem, says Dr. Kellogg-Spadt, that “the whole world is helping us feel abnormal about our sexuality.”Changing the View of Women’s SexualityAn explosion of interest in women’s sexuality followed a study published in the Journal of the American Medical Association in 1999. Researchers surveyed 1,749 women, finding that 43 percent reported some form of sexual dysfunction or problem.Women who reported any of the following–lack of sexual desire, difficulty in becoming aroused, inability to achieve orgasm, anxiety about sexual performance, reaching orgasm too rapidly, pain during intercourse or failure to derive pleasure from sex–were considered to have sexual dysfunction. Primarily a survey of numerous social and health behaviors, with very few questions specifically addressing sexual function, there were significant limitations to this research. For example, subjects were not asked if their problems were severe enough to cause personal distress–a marker for any definition of “dysfunction.”"If you ask a woman if she has alterations in her sexual desire, if she wishes it were stronger, 99 percent of the time she’s going to say yes because something can always be better,” says Dr. Kellogg-Spadt. That doesn’t mean she has a “problem” or sexual “dysfunction.”Too often, women’s sexuality is defined from a male perspective, says Jill P. Wohlfeil, MD, an ob-gyn who practices near Milwaukee and who is writing a book about women’s sexuality. Just as we’ve come to recognize gender differences in numerous health-related areas–heart disease, for instance–we also need to recognize gender differences in sexuality, she says.”We have to completely redefine what’s ‘normal’ for women as compared to what’s ‘normal’ for men,” Dr. Wohlfeil says. For instance, “the whole idea that successful sex means each partner reaching orgasm is a completely male view of sex.”The redefining has begun. A huge step was the 2000 publication of British researcher Rosemary Basson’s concept of the female sexual cycle. Dr. Basson turned the classic sexual desire cycle defined more than half a century ago by sex researchers Masters and Johnson–conscious sexual urging, thinking and fantasizing, followed by arousal, plateau, orgasm and resolution–on its head.Instead, Dr. Basson suggested that women’s sexual desire, particularly for women in long-term relationships, is governed more by a woman’s thoughts and emotions than by any feelings in her genitals. In her sexual cycle, experiencing pleasure triggers arousal, which subsequently triggers desire. (2)”Dr. Basson’s model suggests that emotional intimacy, not biology, drives the cycle,” explains Sheryl A. Kingsberg, PhD, associate professor of reproductive biology and psychiatry at Case Western Reserve University School of Medicine in Cleveland, OH.”So women shouldn’t think something is wrong with them just because they don’t have that initial ‘horniness’ when their partner wants to have sex,” she says. Generally, once a woman begins the sexual process, that feeling kicks in.Understanding DesireThere are three key components to a woman’s desire, or libido, says Dr. Kingsberg:* The drive, or biologic component. This is the part of you that tingles when you think about sex or see someone you think is “sexy.” You can have drive without desire. Your drive is primarily driven by testosterone, the sex hormone, with half of all testosterone produced in your ovaries.* Social or contextual beliefs and values. Religious and cultural values will contribute to levels of desire. For example, if your value system says that sex is not appropriate for a 60-year-old woman, then you’re not going to feel very sexual.* Motivation. This is by far the most important component, says Dr. Kingsberg. “It reflects all the psychological and interpersonal factors that create a willingness to be sexual.” These factors can be the quality of the relationship, whether you’re worrying about your children or work, and your psychological health. Depression and desire don’t mix, Dr. Kingsberg explains.”Most women are motivated to be sexual by the desire for emotional intimacy,” she says. “So while drive helps the cycle, it isn’t necessarily the primary or initial factor that gets a woman willing to engage in sexual activity.”What women (and men) really need to understand, says Dr. Wohlfeil, is that a woman’s libido is not something she can just turn on and turn off by taking a pill or by using a cream or by doing some kind of vaginal exercise.”It’s something that has to be nurtured,” she says. And that comes from setting priorities. It could be going to bed at the same time as your husband, writing out a list of your worries before bedtime so your mind is clear to think of other things, or scheduling a date for sex.Women who do these things, who put intimacy high on their “to do” list “are the kind of women I see who are doing much better in their relationships,” says Dr. Wohlfeil. “And whether you want to define intimacy as physical or emotional, if you completely turn it off all day long and then expect this little light bulb to turn on at 9:30 or 10 p.m., when you finally get to bed, it’s just not going to happen and that’s when women get frustrated.”The Search for the Little Blue PillEver since 1998, when the words “Viagra” and “erectile dysfunction” entered the national lexicon, the race has been on to find something similar to Viagra and its chemical cousins that could do for women what the little blue pill has done for men.And yet in the six years since Viagra hit pharmacies, the U.S. Food and Drug Administration (FDA) hasn’t approved any treatments for female sexual problems, even as it approved two additional Viagra-like drugs for men
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