08/15/2012 03:42 pm ET Updated Dec 06, 2017

Fifty Shades of Grey Might Be Your Best Bioidentical Hormone Therapy (Part 1: Why This Gynecologist Believes It's Good For You)

If you don't feel much when your husband flashes his love lights, you just might need a dose of Fifty Shades. When you push your hot button, is the result less than toe-curling? If sex with your partner feels like yet another obligation on your to-do list, log onto Amazon because it's time for Fifty Shades therapy. Doctor's orders.

In case you've been ignoring the latest book sensation, or you're a man, allow me to explain. Fifty Shades is an erotic trilogy that took the female world by storm this past year. The fastest-selling paperbacks of all time -- now hitting more than 40 million units in sales -- Fifty Shades reflects a meme of female sexual hunger that is hidden, and based on my 20 years of taking care of women as a board-certified gynecologist, universal.

Fast Forward to My Gynecology Office
My office provides a different foil from which to view the phenomenon of Fifty Shades fever. This week, Jill came to see me to adjust her bioidentical estrogen, progesterone and thyroid hormones, which we began a few months ago for her waning energy and sex drive. Jill is a busy lawyer, mother of two, and 49 years old. She arrived, clutching Fifty Shades to her chest, breathless, with a gleam in her eye that I hadn't seen before. "Dr. Sara, my libido has been low for a decade. But if my husband was more like Christian Grey, I'd be chasing him around the bedroom and swinging from the chandeliers."

Need the backstory? Fifty Shades explores a kinky sexual relationship between a young woman just as she is graduating from college, and a dreamy but, well... damaged billionaire sadomasochistic meister. Yes, that's right: It's about a dominant looking for a new submissive. Yes, thin plot. Yes, the writing is repetitive, poorly edited and at times, unbearable. Still.

Here's what fascinates me: Why would a book about bondage/discipline, dominance/submission and sadomasochism (as condensed into BDSM, in the parlance of the times) be wildly popular among the ladies? Why would nearly every woman I know, regardless of age, read the trilogy in two days? (OK, I have a few high-brow friends who haven't read it, but honestly, I feel they're missing out and might need an intervention.)

Clearly the Fifty Shades books have struck a nerve.

Rewire to Stress, Not Pleasure
But Fifty Shades has done more than hit a nerve -- author E L James' erotica has captured the entire neurohormonal dashboard of women. Women are waking up from the hallucination that the sex on the menu is enough. Women are waking up from the hallucination of productivity that our culture favors -- that we must be always-on, always overproviding, always overachieving, in order to succeed. Women are finally waking up to the fact that in our pursuit of gender equality, we've rewired our bodies and minds to stress, not pleasure. No wonder 26 percent of American women take a prescription drug for mental health.

We hardly even recognize pleasure anymore. As a scholar of all the things that can go right with the female body, and board-certified in all the things that can go wrong with the female body, I recognize this problem as an epidemic. You may have it and not know it. Signs include depression, anxiety, overwhelm, burnout, fatigue, sugar cravings -- and of course, low sex drive.

Antidote from a London Working Mom? Really?
Fortunately, there's a powerful antidote, and it only costs $9.57. The author is a London mom who produces TV and draws inspiration from... the Twilight love affair of Edward and Bella.

Don't really want to set foot in a Red Room of Pain? Or to get cuffed? That's okay, neither do most American women. I could be wrong, but I don't believe most readers of Fifty Shades are signing up as a dom any time soon. And it is also perfectly okay to imagine that kinky sex, and to imagine being the sort of person who might like kinky sex and how that would feel. Especially while you or your partner is pleasuring you. It is called fantasizing, and I am convinced that fantasy is the secret of Fifty Shades' record-breaking success.

Your Kink is OK with Me
One thing is clear. The libido of the American woman is not dead. It was only sleeping. The fantasy kiss or perhaps flick of a riding crop from Christian Grey woke it up.

I can just see the eye-rolls from Gloria Steinem and Susan Faludi. Seriously? We fought so hard, articulated your tedium, isolation and revered your gifts, and it's come to this?

Is it the power play? I bet what makes women so ecstatic about 50 Shades is the fantasy of not being in control. We modern superwomen have to take so much control all the time. Women, studies say, make all the major purchasing decisions in their households. We rock the boardroom, and we're still running the household. So who gets blamed if something goes wrong? That gets old. Women still do way more housework and childcare than their male partners even if both work full-time. Exhausting. Rushing from the meeting to after-school childcare center. Giving the kids their baths while still in your business suit. And we're supposed to look like supermodels, and have the sex drive of teenagers. We don't need patriarchy anymore as we've internalized it. And it causes a constant leak to our collective energy tank.

The record-breaking success of Fifty Shades affirms that women still want to be cherished and occasionally, dominated and held. Not in a creepy or violent way, but where we define and know the terms and give our consent. Women like being on top but sometimes also want to relax and just be on the bottom -- to use the BDSM parlance. We want it both ways and with 50 Shades we can have it any we want it.

Maybe women want the seesaw, not the constant overdrive. They want to play the edge of power with their partners and shift the power back and forth in an interesting way, and stop accommodating everyone and everything in their sphere.

Why are these books such a turn-on for women? I can hypothesize several reasons, and I'd love to hear what you think.

1. Ana comes into her power. She doesn't agree to Christian's every weirdness. She finds her own path with him, and he meets her in the middle. His singular focus on domination/submissive personal relationships and power play evolves and grows to meet Ana and her needs.

2. Christian Grey is hot, skilled, and he wants Ana in a very direct, cherishing way. Is anything more of a turn-on? He's not fickle. There's no second-guessing. There's no "he's just not that into you." There's just pure desire, and that is highly erotic.

3. It's not vanilla sex. For many women, it's not that their sex drive is missing in action -- it's just that the sex on the menu is no longer very interesting. They want more.

Is Fifty Shades fueling fantasies that fan the flames of women's orgasmic experience? Maybe. The YouTube videos would agree. And I say that's a good thing. We know that stroking the female pleasure garden, particularly the clitoris, reduces activity in the parts of the brain responsible for anxiety and fear. As a result of decreased activity, specifically in the vigilance centers, the brain looks dark (that is, brain activity shuts down) during orgasm, and women enter a trance-like state.[1] That's a damn good thing for women, and resets their neurohormonal dashboard.

Toggle Your Way Back to Pleasure with Fifty Shades
This makes sense to me. Women can't simultaneously be anxious and have an orgasm. After an orgasm, it's nearly impossible to feel fear or depression. Fear and orgasm are a toggle switch; the two sides can't be on at the same time. Pleasure and orgasm raise oxytocin, which is known to lower cortisol and amplify bonding.[2,3] Those are the neurohormonal resets that women desperately need, and it's free.

Orgasm -- that shuddering release of tightly-held tension from your head to your toes -- is really your adrenal system doing a victory dance. Have enough of them and it just may help your daily mood, energy levels and perhaps may even help prevent stress-related impairment of memory and concentration levels.

Orgasm and Fifty Shades just might be the best natural hormone remedy women can find, and it's without side effects. Orgasm and Fifty Shades rewire you to pleasure, not stress.

That's why I recommend a nice, healthy orgasm -- either on your own or with a partner -- at least several times a week. Not in the mood? Keep Fifty Shades on speed dial in your Kindle. It will help you kindle the thoughts you need to get you where you need to go neurohormonally.

More on that BDSM stuff in the next post, and it's not as kinky as you might think. Perhaps that's the author's genius: She makes millions of women curious about a fringe sexual practice, probably because we identify with Ana's initial reluctance and fear, and also see that Christian keeps her safe (and defines a middle path with her).

Meanwhile, I would love to hear your comments!

Are there other reasons that you think women are flocking to this material? My book club members are correct -- it's not a literary masterpiece, yet it's captivated women of all ages for some very specific reasons.

What's your need that is not getting fulfilled?

Why do you love or hate this book?

[1] Portner M. "The Orgasmic Mind: The Neurological Roots of Sexual Pleasure." Scientific American (2008).

[2] Komisaruk, Barry R, Beyer-Flores, Carlos, Whipple, Beverly The Science of Orgasm. Baltimore: Johns Hopkins University Press, 2006.

[3] van Anders SM, Brotto L, Farrell J, Yule M. "Associations among physiological and subjective sexual response, sexual desire, and salivary steroid hormones in healthy premenopausal women." Journal of Sexual Medicine 6 (3) (2009): 739-51.

Sara Gottfried, M.D., is a practicing integrative physician and author of the forthcoming book, The Hormone Cure (Scribner/Simon &Schuster, 2013). You can follow Dr. Sara on Twitter, connect with her on Facebook, watch her videos on Youtube, and subscribe to her newsletter.

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