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?…”

I want to reach out and give my patient a hug and invite her for a Sunday brunch with heavy mimosas and a group of like women. I want to reassure her that nothing is wrong with her. This is normal and common. A story told regularly inside the confines of my exam rooms. So many women, young and old struggle with this problem.

Instead, I begin to ask questions about frequency, lubrication, sleep, painful intercourse, masturbation and relationship satisfaction. I take my notes and sigh to myself. How can I help?

She wants an explanation. She wants to know why. A reason. Not to mention, she wants me to fix it. A horny pill. A simple regimen to bring that sexy back. How do I help her?

It’s not easy. Or maybe it is.

FDA just recommended approval of Flibanserin for the treatment of Hypoactive Sexual Desire Disorder, also known as Female Sexual Interest/Arousal Disorder. They say that 7% of us suffer from it. I would guess that number is grossly underestimated. Most of us just don’t ask about it.

This new drug. I have mixed feelings about it. Yes, it will probably blow up (ie invest in stock now…) It finally gives the gynecologist a pharmacologic tool we have desperately lacked. But, perusing through the data, I have my doubts.

In placebo-controlled trials, desire improved in 38% of the placebos versus 51% for those taking the drug. They say it is “statistically significant”, but that’s not significant enough for me. Wouldn’t it be safer and more cost effective to put patients on a sugar pill first to introduce a placebo-effect, before prescribing an expensive pharmaceutical? And the drug has some side effects and interactions, most specifically alcohol. A patient cannot drink alcohol and take the drug. How well is that going to over? Hmmm…

Bringing sexy back is hard work. In most of us, the butterflies don’t last forever, especially when little people are introduced to the family. But, there are ways to improve sexual health and intimacy of a relationship. We have a few options such as testosterone creams and Wellbutrin, but the data is shoddy at best.

Most importantly, both partners need to be involved and engaged in the process. Comfort with spoken and unspoken communication and cues.

Women are cerebral beings (not to say men can’t be either). Porn just doesn’t do it for most of us. We need romance, enrapture, captivation, passion …

We have a hard time unwinding ourselves from our tasks, letting go and focusing 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.

1. Date night is sacred. You have to get out, just the two of you, and spend time alone. Ask the neighborhood kid to babysit, enlist the help of a family member. Give each other undivided attention for a few hours every week.
2. If you’re not having sex at least once a week and he is able to do it … you’re probably not doing it enough. Carve out time or designate days 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. Check out this link to learn more:  http://www.huffingtonpost.com/2012/08/21/marriage-and-sex-schedule-sex_n_1784519.html       http://www.everydayfamily.com/how-often-do-normal-couples-have-sex/?pg=2&internallink=how-often-do-normal-couples-have-sex#post-12063
3. A new device called Fiera (fiera.com) will be coming on the market September 2015. It is designed to ignite arousal. I’m intrigued.
4. Buproprion has been shown to improve sexual desire and libido, especially in patients that switches from an SSRI anti-depressant drug.
5. Testosterone supplementation has been shown to increase sexual desire in women, mostly post-menopausal women, but there are many undesirable side effects and risks associated with prolonged use. Talk with a doctor about these risks if you are interested in this treatment.
6. An investigational drug that would only be taken at the time of intercourse, called bremelanotide, is being studied in the Reconnect Study (reconnectstudy.com)
7. Estrogen creams and pills can help with pain and dryness in the vaginal area. In addition, a new oral medication, Osphena, is on the market to address this issue.

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.

Disclaimer: All medical stories are fictionalized.