Friday, February 27, 2015

Female Desire Pill, interview with Ellen Barnard

2/27/15 update: I interviewed Ellen Barnard about the female desire pill on 2/2/14. I'm bringing this post to the top because of the attention that "Nothing Is Wrong With Your Sex Drive" (published today in the New York Times) is getting. 

I plan to write more about this myself, and there's a good section already in The Ultimate Guide to Sex After 50: How to Maintain – or Regain! – a Spicy, Satisfying Sex Life which I hope you'll want to read. -- Joan 

Desire in a pill? 
(originally published 2/2/14)

Researchers are working on drugs to treat low desire in women. Could a desire pill really work? Do we even want it? 

To learn more, I interviewed one of the top sex educators, Ellen Barnard, co-owner of A Woman’s Touch Sexuality Resource Center.

JP: What’s the state of current research into a female desire drug?

EB: A variety of drugs are being investigated in clinical trials, most in phase 2 trials. No drug has been approved for the treatment of low desire for women, also known as Hypoactive Sexual Desire Disorder (HSDD).  See this summary of the current state of the research.

JP: How are these drugs supposed to work?

EB: Some of these drugs work on brain chemicals; some are sex hormone-based (testosterone); others primarily work to increase physical arousal through an increase in blood to the clitoris. Most of the medications that are being investigated are designed to either overcome inhibition or lack of motivation, or flood the person with such strong physical sensations that she cannot ignore them easily. Or they manipulate the reward system of the brain in ways that increase the drive toward that sexual jackpot.

The question is whether a drug that pushes a woman into being more interested in sex is safe, healthy, or would even be effective over the long term. Many of the drugs being investigated have a variety of side effects, and some are quite undesirable. Testosterone can cause excess hair growth, acne, lowering of the voice, and a decrease in good cholesterol, for example. Other drugs show the potential for abuse, either by the woman herself or by a partner who hopes to have a more willing lover.

JP:  Why is sexual desire so complicated for women and seemingly so easy for men?

EB: It isn't, actually. Men have troubles with desire too, and their issues have many of the same origins as women's do. However, we live in a culture that reinforces men for a high interest in sex, and generally does not see a high interest in sex to be a positive thing in women, unless a woman is less interested in sex than her partner, and that lower interest causes tension between them or distress in her. But even with culture condoning high desire for men, approximately 20% experience low desire. For more info, here isa good overview

JP: How does female desire work?

EB: Desire is the cognitive recognition of sexual interest. So it's an idea, not a physiologic process, though it results in a combination of brain and body responses. Desire may be first recognized as a thought, or it may be a thought in response to a physical feeling. Many women believe that we should feel something first, that sex starts with a twinge in the vulva or elsewhere in the body, that she interprets as sexual interest and then allows to blossom into more sexual interest and then maybe into sexual activity. If physiologic signal is not as obvious because of aging, health, or stress, she may no longer get the signal, and so she does not notice the thought.

Women who have experienced sex as painful have a feedback loop that tells them that sex will hurt, and so they shut off any thought of sex to avoid the pain. If a woman is able to get rid of the pain, she will still have to convince her subconscious that sex is safe. Once she does that, her thoughts of sexual interest often become more frequent.

The same would be true of relationship health. For a woman in a healthy, rewarding relationship, the thought of sex is a safe thought and is likely to mean that she will experience pleasure if she acts on that thought, so she pursues sexual activity. Sex requires the feeling of safety. When there is tension, distrust, fear, anger, etc., the mind does not perceive sex as safe or pleasurable, so will not express desire.

When you think about how complicated desire is for women (and men as well), you can see that it's pretty complicated to consider a medication to address the root causes of most of these issues.

JP: What’s the bottom line?

EB: The bottom line is that drugs do best when there is a single, knowable cause for a symptom and the drug directly addresses that cause by reducing or removing it. Sexual desire is complicated, varies a lot from person to person, and has many moving parts. The idea that a drug could be developed to change desire is pretty far-fetched once you understand it that way, and one of our biggest fears is that you end up with a drug that has pretty wide effects and some nasty, unintended side effects.

We would prefer to address desire issues in ways that give individuals more control and more understanding of their mind and body connections so that they can do their own problem-solving and not be reliant on a pill or a doctor. Most people can increase their experience of desire through a combination of getting healthy, having a good body image, having a safe and trusting intimate relationship, getting enough sleep, lowering stress and distractions, reducing pain, and learning how to have pleasurable sexual experiences on a regular basis.

Saturday, February 14, 2015

"How we write about love depends on how old we are"

Brian Rea for The New York Times
"How we write about love depends on how old we are," observes Daniel Jones in his Modern Love column in The New York Times, Feb. 5, 2015. He explains:

The young overwhelmingly write with a mixture of anxiety and hope. Their stories ask: What is it going to be for me?

Those in midlife are more often driven to their keyboards by feelings of malaise and disillusionment. Their stories ask: Is this really what it is for me?

And older people almost always write from a place of appreciation, regardless of how difficult things may be. Their message: All things considered, I feel pretty lucky.

This last point hit home with me. As a sex educator, I hear people's problems all the time. But I also hear the good parts -- the humor and joy and sweetness of what happens when we love at our age. Those of us who are lucky enough to have found love at this time of our lives are radiant with joy telling our love stories -- even if that joy is tempered with the sadness of loss.

I know I feel that way. On this Valentine's Day, I'm remembering how my dear Robert made Feb. 14 a true celebration of love for seven years with gifts, cards, whispered endearments, languid lovemaking, and lots of laughter.

As sad as I am that I will never hold Robert again on Valentine's Day or any other day, that feeling has nowhere near the power of the joy I feel that this love was in my life. It feels like a miracle that we ever found each at all, let alone so late in life.
Joan and Robert 2001

What if he had never wandered into my line dance class that eventful night? We might never have met, never have crossed paths.

What if I hadn't been assertive (aggressive?) about making the first moves? He was content to see me as his dance teacher (which in itself is bizarre, since he had formal training as a dancer since the age of two, and I had no formal training at all), and he thought that was an uncrossable boundary.

What if I hadn't dared to proposition him? (You didn't know that part of our story? Read it in Better Than I Ever Expected: Straight Talk about Sex After Sixty!)

What if we had never realized one of the most important themes of our love story: that the ways we were the most different were the ways we most wanted to grow.

You see, at first, we saw our personality clashes and independence as proof that we were too different to ever come together as a couple -- it would be too much work, too many compromises, and besides, we were satisfied with the way we were, thank you very much.

Robert and Joan 2006
But over the few years we had together, this attitude changed. The closer we got, the more we came to respect our differences -- even laugh about them -- and the less we felt we needed to resist change. In fact, we discovered that compromise led to change in directions we each wanted to grow.

Once we saw our differences as an opportunity to grow in ways that would be as good for us individually as they were good for us as a couple, we stopped resisting, reframed what we were willing to do for each other, and we blossomed together and apart.

What did you learn about love and about yourself in later life? I hope you'll share your experiences.