Hot Summer Sex: Regain Your Libido

WebMD Live Events Transcript

As the seasons change, the temperature outside rises, but what about your bedroom? Is it a cold place to be? Break the ice and get tips for turning up the flame on your libido from Andrew Goldstein, MD, and Marianne Brandon, PhD, co-authors of Reclaiming Desire. They joined us on June 9, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Goldstein and Dr. Brandon. What are the primary causes of loss of libido in women?

BRANDON:
This is a very complicated question. Low libido is extremely common in women, and it has profound effects on women, their self-esteem, and their relationships. There's no need for a woman to be afraid of a low sex drive. Usually it indicates an imbalance in a primary aspect of her life, either her physical self, her emotional self, her intellectual self, or her spiritual self.

GOLDSTEIN:
In the medical realm, there are several medical reasons why a woman may have a decreased libido, including the natural decline in the hormones of desire that are estrogen, testosterone, and dopamine, as well as many medications that women take that can cause decreased desire, such as birth control pills or antidepressant medication.

MEMBER QUESTION:
How can we fight the loss of hormones? I thought taking hormones was bad for you?

GOLDSTEIN:
It is possible to replace the hormones of desire in very low doses and monitor this very closely so it can be done safely and without the risk of hormones, as outlined in the Women's Health Initiative. Testosterone can be given without causing side effects such as hair growth or acne, and estrogen can be given in very low doses, such that the risk of breast cancer and other complications are not raised. This can be done by closely monitoring blood levels of these hormones to stay within normal ranges.

MEMBER QUESTION:
Why isn't there a woman's version of Viagra?

GOLDSTEIN:
Viagra works by increasing blood flow to the genitals, specifically the penis in men. For most women, blood flow to her vagina and clitoris is not the problem. Most women who have problems with their sexual function have a decreased libido. A woman's libido is much more complex than just blood going towards her genitals. However, there are some medications to improve a woman's sexual desire that are currently being studied, and are going through the clinical trial process.

MODERATOR:
You mention four areas of a woman's life that may be out of balance. How do you determine what is causing low libido in a woman?

BRANDON:
That's a great question. We evaluate each specific quadrant in a woman's life for balance and look for places where a woman is feeling like something isn't right:

  • From the physical perspective we look not only at the hormonal balance, whether or not her body is healthy, but also issues such as whether she can relax and connect with her sensuality, how much sleep she's getting, and whether she can feel pleasure in her body.
  • From an emotional perspective we look at her mood, stress level, her self-esteem, and feelings about her partner.
  • From an intellectual perspective we explore the beliefs she holds about sex and her body that she probably learned from her family, her religion, or our culture. We also examine her thoughts about sex and the content of her fantasy life.
  • Finally, we examine the spiritual perspective . Let me explain what we mean by spiritual: We're not referring to religion necessarily, although for some women it is the way of experiencing spirituality, but we use the word spirituality in a greater context relating to her sense of meaning and purpose in her life and in her partnership.

GOLDSTEIN:
We have a self-test in our book, Reclaiming Desire , that helps a woman evaluate all these four quadrants and can help her focus on what areas may be out of balance.

MEMBER QUESTION:
I used to have a rich fantasy life. Now my fantasy life is dead. How can I regain that aspect of my sexuality? I don't want to watch or read porn.

BRANDON:
There are many ways to stimulate your fantasy life. You may find it easiest to start with movies and scenes in movies that you enjoy. Find the elements that strike you as sensual and build on that for yourself. Another option is to think back to the most exciting sex you've had and determine what made those experiences so terrific. Then incorporate those elements into your fantasy life now.

MEMBER QUESTION:
I am 23 and six months pregnant with my first child. Normally my libido is very high, and my husband's is on the low side of normal. However, his libido has stayed the same but mine has decreased significantly. I was wondering if there is anything that would be recommended for me to do to bring my libido back up to where it was. I do enjoy performing oral sex on my husband, but he does not like performing it on me, so I was looking for other options.

GOLDSTEIN:
There are hormonal aspects of pregnancy that cause a woman's libido to diminish during her pregnancy and in the post-partum period. Unfortunately, these hormonal changes are not under our control and we would not want to do anything to affect the hormonal balance that is necessary for a healthy pregnancy. However, there are several ways to focus on the wonders of your body during this special time to increase desire in that way.

BRANDON:
Be gentle with yourself. There's no need to get too worried about a decreased libido during pregnancy; it is very common. There are lots of changes going on in your body and life, and also in your relationship as a result of both partners becoming parents.

So the best advice I would have is to communicate your fears and any concerns you have with your partner so that you're not alone with them. And look for ways to be intimate that may not involve intercourse that may feel pleasurable to both of you. It could be massage, or maybe taking a bath together, or other ways to just feel your bond and feel your connection.

"There are many ways to stimulate your fantasy life. You may find it easiest to start with movies and scenes in movies that you enjoy. Find the elements that strike you as sensual and build on that for yourself."

MEMBER QUESTION:
Can you offer some tips for a happy but bored married couple on introducing "toys" into the mix to spice things up? How to get and use toys without feeling like perverts!

BRANDON:
There are many web sites that offer a huge variety of sex toys in a respectable way.

GOLDSTEIN:
Many of these sites are run by women for women.

BRANDON:
The one that I suggest to my clients that seems to be the most tasteful is called The Woman's Touch, and the web site is www.touchofawoman.com.

GOLDSTEIN:
There's also goodvibes.com. And there are erotic films made by women, such as Candida Royale, that are more in line with a woman's sexual fantasies as opposed to most erotic videos.

MEMBER QUESTION:
My sex drive naturally increases during the summer. Is that normal?

GOLDSTEIN:
It is natural. As the days get longer, the amount of serotonin and dopamine in your brain increases. Specifically dopamine is a hormone that stimulates libido. And of course, we should not forget the fact that we're wearing less clothing and showing off our bodies more, and often that can be a subconscious or conscious signal.

BRANDON:
If you feel more relaxed in the summer it's more likely your libido will respond, as well.

MEMBER QUESTION:
What do you think of these new herbal treatments that are being advertised to treat libido problems, i.e. Amlivil?

GOLDSTEIN:
Amlivil and other herbal supplements claim to have pro-sexual properties; however, there is very little evidence that these herbs do in fact help libido. Their claims have not been substantiated by experts in the field of female sexuality, and their claims do not have to meet the rigorous controls outlined by the FDA that drug manufacturers have to meet. Many of these supplements have very slick advertising campaigns that make them look like they're drugs or medications and have undergone the type of clinical trials that other medications have. This is not the case, and I have found most of them to be of little use to help improve a woman's libido. They are very expensive for what you get.

BRANDON:
Also be aware of the placebo effect possible from these herbs, meaning essentially a woman may expect the positive reaction and thus have one for a brief period of time.

MEMBER QUESTION:
As someone who has lost a lot of my libido while on the pill, is there anything I can do to try to increase the sex drive? I've tried different pills without any difference.

GOLDSTEIN:
All birth control pills function to lower sex drive by lowering the amount of testosterone in a woman's bloodstream. All birth control pills do this. Therefore, it is unlikely that switching between different brands will make much of a difference. There are nonhormonal methods of contraception, such as condoms or diaphragms or the IUD that do not affect a woman's libido; however in my experience, no brand of birth control pill is better than another.

MEMBER QUESTION:
If all birth control pills work to decrease sex drive, why has mine significantly increased?

GOLDSTEIN:
While all birth control pills lower testosterone, you may have a naturally high level of testosterone and it has not dropped below a level necessary for good libido. In addition, removing the possibility of unwanted pregnancy from this equation often improves libido. Obviously, all women are different and not one explanation is the same for everyone. We are talking generalities.

"What happens when couples get into patterns is they get bored and they speed the process up. Slowing down will allow you to be in the experience in a much more sensual way."

MEMBER QUESTION:
My husband and I are trying to conceive. How do you keep it enjoyable when you are having sex so often and for another purpose?

BRANDON:
This is a particular challenge. I would encourage you to start by slowing your sexual experience way down, because what happens when couples get into patterns is they get bored and they speed the process up. Slowing down will allow you to be in the experience in a much more sensual way. Obviously, the more creative you can become at this time the more interested you both will be. Try creating an experience that will be magnificent for your partner, because if you can make your partner interested his interest can spark yours.

MEMBER QUESTION:
I am 36 and I once enjoyed having sex on a regular basis. However, in the last seven to eight years my sex drive is next to nothing. I enjoy being with my husband; I just cannot seem to initiate sex. Help!

GOLDSTEIN:
Obviously this a complex question and there could be many reasons for this. The first place you could start is by taking our self-test in our book, Reclaiming Desire . This can help focus you on areas of your life and your sexuality that may be out of balance and that need some attention.

MEMBER QUESTION:
Which is more likely to increase my wife's libido: cleaning the bathrooms or lighting candles and playing soft music? I have a feeling you'll say cleaning the bathrooms.

GOLDSTEIN:
I'll give the male perspective. Obviously, while all women like candles and flowers, in today's society women are often overwhelmed with work and taking care of a house. In any relationship when a woman feels she is being supported she is much more likely to be emotionally connected with her partner. Women in general come to physical intimacy through emotional intimacy. Therefore, cleaning the bathroom, taking out the garbage, doing the dishes, all without being asked, will probably pay greater rewards than wine and flowers, because she still may be worried about the dirty bathroom.

BRANDON:
While I absolutely agree, your best bet is to ask your partner directly what will work for you.

MEMBER QUESTION:
How can I maintain interest in sex during perimenopause? I feel miserable.

GOLDSTEIN:
Perimenopause is a time of great hormonal flux. Specifically, both estrogen and testosterone are changing dramatically. As I mentioned before, it is possible to supplement these hormones safely to just replace what has diminished. Also, perimenopause is a time of changing bodies and emotions.

BRANDON:
Let's start with the fact that your body is changing so much that what feels pleasurable and what your body responds to will probably change, as well. So I encourage you to be gentle with yourself; these transition times frequently put women off kilter for awhile emotionally and physically. You can consider it an opportunity to relearn who you are and what you want for yourself sexually. This, of course, will take time.

MEMBER QUESTION:
I had a hysterectomy approximately three years ago. Approximately six months after the surgery I began experiencing several things, loss of libido, weight gain, hair loss, depression, etc. Is there a link to all of this and what can I do to make things better? I am currently undergoing therapy for subclinical hypothyroidism.

GOLDSTEIN:
Often a woman's ovaries are removed during hysterectomy. When this is done a woman's estrogen and testosterone drop dramatically and immediately. Even if a woman's ovaries are left in place, due to blood vessels that are cut during the surgery to remove the uterus the ovaries may go into an early menopause.

The symptoms that you have may be attributed to decreased testosterone, but the only way to tell would be to get an accurate blood test to determine your blood testosterone level. Not all testosterone tests are equivalent and there is a chapter in our book that will tell you how to get the most accurate blood testosterone test.

"Your low desire can be a healthy reaction to an unhealthy situation. And also remember, sex has to be worth wanting."

MODERATOR:
Is low desire always a bad thing? What if a woman is comfortable not desiring sex?

BRANDON:
We don't pathologize low libido. Just because a woman's sex drive is low doesn't mean we diagnose her. She has to feel like there's a problem in order for us to diagnose and/or treat. Your low desire can be a healthy reaction to an unhealthy situation. And also remember, sex has to be worth wanting.

MODERATOR:
We are almost out of time. Do you have any final words of wisdom for us?

BRANDON:
Remember that low libido is extremely common and there's no need for a woman to feel ashamed. It's normal to struggle with low libido at some point in your life and, as we said before, there's no need to be afraid of it. Usually it just indicates an imbalance.

GOLDSTEIN:
We encourage you to identify what may be out of balance in your life so that you can have not only a more fulfilling sex life, but also a more fulfilling relationship with your partner.

MODERATOR:
Thanks to Andrew Goldstein, MD, and Marianne Brandon, PhD, for sharing their expertise with us. For more information, please read their book, Reclaiming Desire: 4 Keys to Finding Your Lost Libido .



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