Where did my sex life go?
How often do you hear this scenario?
You meet someone, and you are wildly attracted to them. You can’t keep your hands off each other. You have amazing sex that lasts a few months, maybe a year, maybe longer. You take your relationship up a notch. You move in together, make financial commitments, maybe even decide to have kids, and tie the knot. You both get more involved with your work, the stress of raising a family, and having it all. There are chores to do, and the world is crazy. OMG, it is so overwhelming.
And then, all of a sudden, like that, you no longer want to rip each other’s clothes off. There are dishes to do and bills to pay. And when you finally get into bed, the idea of some extra sleep is so much more appealing than a few moments of mediocre sex.
You may be cool with this, or not. But what we know for sure is that this relationship transition is very common. It is unusual to find a relationship where all members of the team are on the same page. In a recent study, out of 50 premenopausal women, only 2 reported a desire to have sex more than once a week, and 23 reported sexual interest once a month or less.
What is the normal amount of sexual desire anyway? Unfortunately, there is no good answer to this question. We define our desire as good or bad, too much or not enough, when we compare ourselves to our partners, our friends, and what we have learned from society, porn, and other forms of media.
If you do not experience desire discrepancies with your partner and you are both satisfied, then congratulations! You are having the right amount of sex, whether it is twice a year or twice a day.
However, most relationships do not fit into this nice, concordant pattern, and desire differences are ubiquitous, with each member thinking the other has the problem. Desire differences cause much distress in relationships, and it is the number one reason people seek sex therapy—approximately 40% of the population shares this concern.
People often tell me their partners complain that they have a low sex drive. I have to clarify this concept. Sex is not a drive. To paraphrase Emily Nagoski from her book Come As You Are, “nobody died from not getting laid”. A drive is a system of motivation to act so you will not die, like responding to hunger or removing your hands from hot flames. Sex is not like that. To fully understand desire, we need to take a biopsychosocial approach.
As a sexuality counselor, I treat people who have desire concerns from a biopsychosocial perspective with an emphasis on the “bio,” which differs from therapy that focuses on the “psychosocial.”
In the medical world, there is a diagnosis for low desire called Hyposexual Desire Disorder (HSDD). The definition of HSDD includes experiencing distressing, low sexual desire for at least six months in duration, with the inability to explain it by some other condition, such as a relationship issue, a health problem, or the use of drugs or medication.
In my practice, I start by taking a comprehensive health history. It is important to know how you are feeling about yourself both physically and emotionally, what medications you are taking, whether you have a history of trauma and adverse childhood experiences, how your self-care is, and how your relationship and your ability to communicate with your partner are.
In addition to a history, a physical exam can reveal some clues as to why you may be having issues with desire. If you are experiencing dyspareunia (painful penetration) or pain and discomfort from body changes, having a sex aversion is a plausible reaction. Also, lab work may be indicated to uncover some causes of decreased desire, like fatigue from anemia or early signs of other chronic health problems.
It is important to note that, unfortunately, there is no silver bullet to treat desire. No one size fits all. Sexuality counseling as well as therapy uses an individualized approach to care in partnership with each client.
Gaining a better understanding of how and what was included in your sexual education is a good place to start. Sex education is not mandated in the United States, and if it is taught, it does not have to be evidence-based. People may express shame about not having a good grasp of sexuality, but can you blame them? This lack of knowledge easily leads to unrealistic expectations and stress. Due to this reality, my treatment approach includes “sex ed for grown-ups”. Providing a safe space to discuss and learn about sexuality is invaluable.
In addition, there are medical and lifestyle treatments available. Managing the five sacred pillars of health: diet, movement, sleep, stress management, and exposure to toxins can have a significant impact on your desire for sex. If you feel crappy from eating too much sugar and processed foods, from a sedentary lifestyle, and you feel tired and wired, the last thing you want is to be touched by anyone. There is a relationship between how you feel about yourself and how much sex you want to have.
You also have to look at how your lifestyle choices affect your brain. In fact, your brain is your most important sex organ. How much time are you reviewing and ruminating on life events versus your ability to be mindful and let go? Certain neurotransmitters, which are chemicals that are produced by the brain and nervous system, are modulators of mood and desire. Dopamine is essential for pleasure, attraction, and desire, while serotonin inhibits sexual desire. Dopamine can be increased by eating foods that contain tyrosine, such as meat, nuts, beans, and eggs, and reducing serotonin can be achieved through a high fiber, plant-based diet. Also, going back to those pillars: sleeping, meditating, spending time in nature, and finding joy raises dopamine levels.
Hormones, which are also chemical messengers that target different organs in your body, also play a role in desire. Cortisol, which is secreted from the adrenal glands during times of extreme stress, reduces sexual desire. Who can think about sex when you are constantly trying to escape from that saber-tooth tiger? Unfortunately, there are too many tigers around these days.
Everyone produces estrogen, testosterone, and DHEA, which are all enhancers of sexual desire. As these hormones decrease due to age or medical events, desire can decrease as well. Hormone therapy is an intervention used to increase desire. Recently, a global consensus supported the use of testosterone in postmenopausal women who experience HSDD. There is data showing support for estrogen and DHEA therapy as well.
Investigating how you absorb and metabolize hormones through testing is important to do before taking hormone therapy. It gives you a window into your anatomy and physiology and may provide answers on how to increase desire. Becoming more in touch with your hormones and neurotransmitters can go a long way because, as you will see, there are very few medications and supplements to treat desire in female-bodied people.
In the last several years, a couple of medications for newly acquired, generalized HSDD have been FDA-approved. One is Flibanserin (Addyi), also marketed as the “little pink pill”. Unlike its counterpart, “the little blue pill”, Flibanserin works to disrupt serotonin and enhance desire, not sexual function. The good news is that it shows a statistically significant increase in desire. The bad news is that it can produce side effects when used with alcohol or certain medications like birth control pills and SSRIs.
Another medication that was approved for premenopausal women last year is called Bremelanotide (Vyleesi). It activates melanocortin receptors in the brain, but how it works on desire is not totally clear. Bremelanotide is an injection given 45 minutes before a sexual encounter.
If you go online, you will find an endless number of supplements for “sexual dysfunction”. Most are for sexual arousal, not desire. However, there is limited evidence that a few supplements can enhance desire. These include Maca, a plant found in Peru, and Tribulus Terrestris which is a plant that has been used for centuries in Ayurveda and Chinese traditions. Some studies have found that Cannabis improves sexual desire, especially with the right proportion of CBD to THC.
If you know of other therapeutic agents to increase desire, I would love to hear from you. But in the meantime, try to REALLY prioritize you and your relationship and find the time for self-care, communication, and to feel your best. You are not selfish for needing time for yourself. If you are not happy, then no one will be happy. Start loving yourself so you can spread it to those in your life.
Thanks for reading this, and be in touch.
Best,
Susan
Susan Kamin is a certified nurse midwife and a certified sexuality counselor. After many years of helping people give birth and be born, she is now providing personalized integrative well body care at Lifecycle Women's Health in Readfield and Brunswick, Maine. She sees people across the lifespan with a focus on care during midlife/menopause and sexual health. She enjoys sharing her wisdom in the hopes of helping people find pleasure, knowledge, and empowerment in their bodies as they go through all of life's transitions.
