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Anita H. Clayton, MD Headshot

Women's Low Sexual Desire Is No Medical Myth

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Do you lack a desire for sex? If you're saying "no" while your partner reads this over your shoulder nodding "yes," you are not alone. Most women think it's natural for their sex lives to wane over time, and going from having sex several times a week to just a couple of times a month (if you're feeling lucky) is no big deal.

The reality is: It is a big deal. The 1960 approval of the birth control pill was supposed to be the beginning of the sexual revolution for women. But nearly half a century has passed, and Western society has still not caught up. Nevertheless, even in the face of society's longstanding disregard of female sexuality, it is viewed by most as a critical component to overall health and quality of life.

One of the central factors being debated with regard to women's sexual rights is the question of whether female sexual problems are actually real. Some argue that female sexual disorders, specifically hypoactive sexual desire disorder (HSDD), are simply a conspiracy perpetrated by the pharmaceutical industry to mislead women to feel that their sexual function is inadequate and that their problems are simple and easy to treat with drugs. Unfortunately, the result of this misguided message is to disempower women. Unintentional as it may be, this message invalidates the experience of those women who are having sexual problems.

The response of health care professionals, researchers, policy makers and activists should be to listen to women and respect what they are saying about their experiences. It is wrong to make women feel like they are defective when they do not feel that way themselves. However, it is just as incorrect to discount women's distress when they express it. Are we really going to revert to telling women who are suffering from sexual problems that ''it's all in your head''?

Instead, let's help women uncover their personal truth.

Sexual dysfunction, including low sexual desire, is a real medical condition. It is known as hypoactive sexual desire disorder, or HSDD, and occurs when there is an absence or lack of sexual thoughts, fantasies or interest in sexual activity, which causes distress and difficulty in a couple's relationship or communication. It is estimated that 1 in 10 women in the United States suffer from low sexual desire that causes distress. That's 16 million women who feel the loss of an integral part of themselves.

Women want to want but they often don't want to talk about it. Sexuality is an important part of who we are as women, but as many of us lead busy professional and personal lives as wives, mothers and caregivers, it's easy to put sex low on the priority list. When women talk honestly about their desire, they don't typically say "I can live without it." Instead, they talk about how they want to get it back. They want to want.

Unfortunately, talking about sex is still taboo, so much so that women and even health care professionals will avoid it. This gap in communication, along with the societal notion that it's normal or acceptable for women not to want sex, can stifle a necessary discussion about the real sexual problems women are facing.

Low sexual desire impacts more than just sex. It can be associated with significant distress that goes way beyond the bedroom and affects every aspect of life, including body image, mood, self-confidence and self-worth. Many women say they keenly feel the loss of desire, leaving them feeling disappointed, frustrated and inadequate.

If a woman routinely plans to go to bed after her partner falls asleep to avoid being approached for sex, her partner may feel at fault or undesirable and, simply put, they just throw in the towel. This results in a downward spiral of blame and avoidance, which equates to less sex, less intimacy and less connectedness.

It's not a simple on/off switch for women. Desire is the result of a complex interplay of social, psychological and biological components. If, for example, a lack of sexual interest is due to a cultural or religious belief system, it is socially rooted. If psychology is at the heart of low sexual desire -- for example, relationship issues -- talk therapy/counseling is the appropriate pathway for intervention.

If both the social and psychological components are not causing low sexual desire, then biology may be to blame. New science into women's sexual function has shown that there can be an imbalance of excitatory and inhibitory processes mediated through key neurotransmitters, or chemicals, in the brain that affect sexual drive.

There are no treatments currently available for low sexual desire in women. Male sexual dysfunction has been addressed for almost two decades now -- there are 23 FDA-approved treatments for either erectile dysfunction (ED) or low testosterone.* Yes, it may be easier to measure ED (does he have an erection or not?), but it's not okay to neglect women's issues, which unlike men may not be visibly identifiable, and then place the blame on stress, kids or time.

Having treatment options that address each of the social, psychological and biological components at play only seems logical. Let's face it -- we've had answers to the primary components for men for a while now. HSDD is just as much a problem in women, as ED is in men. In fact, more women than men voice some form of sexual complaint when asked -- 43 percent vs. 31 percent. Yet, after several attempts, no treatment for low sexual desire in women has been approved.

As a psychiatrist who has been treating women with low sexual desire for more than 20 years, I am excited about the advances in research that we've seen for women in recent years. Research has shown that women's loss of desire is not made up or a myth. But research isn't enough. If men are allowed to have a choice that will help improve their sex lives, women should be afforded the same. Let's take discussions about sex out of the bedroom, make a solution for HSDD widely available for women, and let women make the choice. Heck, we make the decisions about everything else, don't we?

*References:

There are 23 FDA-approved treatments for either erectile dysfunction (ED) or low testosterone: low testosterone treatments, PDE5 inhibitors and alprostadil treatments.