Where's My Orgasm?

“I just don’t understand, doctor. I don’t have any desire to have sex with my husband anymore. Not since the baby was born. Do you think it’s my hormones?”

When I hear this, I want to give my patient a hug and invite her to a Sunday brunch with heavy mimosas and a group of like-minded women. I want to reassure her that nothing is wrong with her. This is normal and common. It’s a story I regularly hear inside the confines of my exam rooms. So many women, young and old struggle with this problem.

Instead, I ask questions about lubrication, sleep, pain, masturbation and relationship satisfaction. I take my notes and think, “How can I help?”

She wants an explanation. She wants to know why. She wants me to fix it. But how?

It’s not easy. Or maybe it is.

Last year, the Food and Drug Administration approved Addyi (also known as flibanserin) for the treatment of hypoactive sexual desire disorder in premenopausal women. 

I have mixed feelings about this new drug. It finally gives the gynecologist a pharmacologic tool we have desperately needed. But I have my doubts on its effectiveness.

In placebo-controlled trials, desire improved in 38 percent of women taking the placebo versus 51 percent of women taking the drug. The FDA says this is statistically significant, but it’s not significant enough to me to warrant prescribing an expensive pharmaceutical. Why not instead put patients on a sugar pill to introduce the marked placebo effect?

Addyi also has side effects and interactions, most specifically alcohol. A patient cannot drink alcohol and take the drug. How well is that going to go over?

Bringing sexy back is hard work. For most of us, the early romance butterflies don’t last forever and they can quickly disperse when kids join the family. But there are other ways to improve sexual health and intimacy.

Bringing sexy back is hard work. For most of us, the early romance butterflies don’t last forever and they can quickly disperse when kids join the family. But there are other ways to improve sexual health and intimacy.

Both partners need to be involved and engaged. Many women are cerebral beings. We need romance, enrapture, captivation and passion.

Often it’s hard to unwind and focus on the moment. This “switch” flips much easier for men. As women, we distract our passion for love-making with thoughts of the laundry that needs folding, the birthday present to be wrapped, the sleeping baby down the hall that will wake soon for a feeding. We continue down that path, we get lost in it. We tell ourselves it’s okay. And then, when we don’t feel like having sex again, we tell ourselves that he will understand.

But he doesn’t always understand. Studies have shown that the most common time for a man to cheat on his wife is while she is pregnant. Pregnancy is one thing, embracing our sexuality while in the depths of post-partum recovery and newborn care is wholly another. But, we cannot ignore our partners. They need us. And even if we’re not fully engaged in the idea of some “sexy sexy” after spending the day changing countless diapers, washing blankets and burp cloths, it’s probably best to put on the poker face and take one for the team. Papa needs our loving.

Marriage, partnerships and long-lasting relationships are work. They require investment from both parties. A little pill won’t fix that. But, there are some different tactics out there to help us feminine folk with enhancement of our sexual prowess. Here’s a list to get started.

• Date night is sacred. You have to get out, just the two of you, and spend time alone. Ask the neighborhood kid to babysit or enlist the help of a family member. Give each other undivided attention for a few hours every week.
• If you’re not having sex at least once a week, you’re probably not doing it enough. Designate time and mentally prepare yourself for it. Sometimes it is just the act of getting under the covers that needs to happen in order to get you in the mood. 
• For those interested in medical options, bupropion has been shown to improve sexual desire, especially in patients that switches from an SSRI anti-depressant drug. Testosterone supplementation has also been shown to increase sexual desire in women; however, talk to your doctor about side effects and long-term risks. Estrogen creams and pills can help with vaginal pain and dryness, if that is stopping you from sex.

Embrace your sexuality. We are sexual beings. Don’t be embarrassed or ashamed. Love yourself and your body. Sexual health thrives on your happiness with you.