The nature of sexual desire: Why less sex does not mean less love

2015-10-28

• Dr Deepak K Jumani

  In our country, one out of every three married couples struggle with problems associated with mismatched sexual desire. This leaves one person feeling routinely rejected and the other incessantly hounded and perpetuates a nasty cycle of resentment. Different sex drives can wreak havoc outside the bedroom too. This sort of breakdown has put several marriages at risk of infidelity and divorce.

  The reason humans desire sex is due to the hormone testosterone, which is a predominantly male hormone. It’s also the desire hormone, or the drive hormone or libido hormone. Men and women are different, not better or worse, just different.

  

  Due to low free bioavailable testosterone, many women feel that they no longer have any interest in sex or sexual pleasure as they used to in the past, or maybe the clitoris is just not as sensitive as it used to be or it may even be painful to stimulate. There is no exact level of testosterone that correlates with good sexual functioning and appropriate levels of sexual desire. As men age, there is a steady decline in testosterone levels. In women, testosterone is present about one tenth of the amount usually found in men. Since testosterone maintains erectile tissue and part of a person’s desire for sex, it helps support the clitoris and its adjoining erectile tissue as well as a woman’s libido. As a woman ages, her ovaries gradually decrease production of both estrogen and testosterone and almost completely stop doing so at menopause. If a woman has her ovaries removed, the decline in hormones is abrupt and more drastic. Thus, women may find it difficult to lubricate when they are sexually aroused. If, after considerable amount of stimulation, a woman is still experiencing any of these symptoms as well as a significant change in her level of sexual desire, she may benefit from having some testosterone replacement. But even some women who are far from reaching menopause may face difficulties because of low testosterone.

  The most common cause of this in today’s society is hormonal birth control. This includes the pill, cervical rings, injections, and hormone-coated IUDs. All of these raise the level of protein that attaches to estrogen and testosterone, leaving less of the free bioavailable hormone to circulate and have its effect on the tissues of the body. Since testosterone is bound very tightly to this protein, even a small increase in the protein’s production can drop the level of free testosterone (bioavailable testosterone) to problematic levels. Many a time, it is advisable to use alternate modes of birth control. Other biological desire killers are depression; estrogen producing tumours, hepatitis, low thyroid, high prolactin levels, stroke, epilepsy and pituitary gland diseases, and certain drugs that affect desire like blood pressure lowering drugs, cancer medications, tranquilizers, anti-depressants, ulcer medications etc.

  For a spouse low on desire, agree to compromise on the frequency of sex so it can be viewed as “win-win”. You need to begin thinking and feeling differently about the role of sex and sexuality in your life. Recognise that the partner with low desire always dominates and sets the pace for frequency and intensity of sexual relations. If you are not interested in sex because something in the relationship is wrong, try counseling. If the desire killer is not a relationship issue, it may be a medical problem. Try and get the medical problem corrected. Under proper medical supervision, precursors of testosterone like DHEA (dehydroepiandrosterone) or low dose of testosterone in the form of creams, pill, patch or drops, has helped countless individuals begin to feel some fire for sex in their relationship. Many Nutraceuticals combine L Arginine with Ginseng, Gingko Biloba, and Fenugreek in saponised form with minerals like Zinc and Magnesium to prove very promising. Regular exercise, 7-8 hours of good quality sleep every day, not having excess fat tissue, eliminating chronic stress, and having a good diet rich in zinc, are all natural ways to increase testosterone.

  Lastly, it is important to separate desire problems from relationship problems. Being supportive and trust is a fundamental building block in a relationship; however, it is important to have trust in oneself. By building a basic level of trust within oneself, one can begin to experience more satisfying and emotionally close relationships. Be honest about the root of the problem. People usually blame sexual disinterest on being “tired” or “stressed,” which often isn’t the full story. Adjust your expectations, older couples, in particular. Do something new and fun outside the bedroom, be it hiking or viewing an art gallery, watching a play, yoga, dance, meditation etc,  which can make you feel closer and pull you back in the mood. Instead of saying “no,” say when. Telling a partner, “Not now, but after dinner,” or let’s not do it today, but let’s hold each other and sleep together, is received much better than a flat-out rejection.

  It’s not just about different sex drives, but a complete lack of empathy about being in the other person’s shoes that causes problems. Couples could save themselves grief if they discuss expectations for sex as they plan their lives together, just as they discuss values around children and finances. But people mistakenly believe that sex is something that should naturally fall into place. Sex is not a personal decision, it’s an interpersonal decision. And, like everything else, low desire, has to be looked at as something that’s nurtured and can be managed. One must understand that less sex doesn’t necessarily mean less love.

  Dr Jumani is an MBBS(Bom), FIAMS, ACS(USA), Ph D. He is also a Diplomate American Board Certified Clinical Sexologist and Sexual Health Physician and Counsellor attached to Mumbai Police. You can contact him at deepak.jumani@gmail.com 

Pill for Low Libido in Women Goes on Sale on Saturday

2015-10-20

SOURCES: Holly L. Thacker, M.D., FACP, director, Cleveland Clinic Center for Specialized Women’s Health, and professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Elizabeth Kavaler, M.D., urologist, Lenox Hill Hospital, New York City; Aug. 18, 2015, news release, U.S. Food and Drug Administration; Fred Wyand, spokesman, American Sexual Health Association; Keesha Ewers, Ph.D., chief medical officer, Functional Sexology Institute

Copyright © 2015 HealthDay. All rights reserved.

Can Penile Implant Surgery Cure ED?

2015-10-12

Though ED medications are successful in 85% of cases, there are drawbacks. They have to be taken at a certain time. Some cannot be taken with food. And sex has to be planned around them, making it less spontaneous and for many couples, less fulfilling. Injections work in about 15-20 minutes. But this is still less than ideal for those who enjoy getting intimate when the mood strikes. Now many urologists are offering another option: penile implant surgery.

Such implants have been around since the early 70’s. They are often used in cases of treatment-resistant dysfunction. Once ED drugs made their way to the market in the late 90’s, implants were cast aside. But now advances in technology are once again making them popular. Each year 25,000 of these procedures are performed, with a satisfaction rate of 94%.

This is a 45 minute procedure. Though an urologist may perform it, it is often handled by an implant specialist. The surgeon makes a tiny incision. Next, a small pump is placed within the scrotum. This draws sterile water from a reservoir which is placed against the wall of the abdomen. When the pump is pressed the water fills two cylinders on either side of the penis, causing an erection to occur. There is a little bit of pain associated with the surgery. But most patients find that it is minimal, and the end result, worthwhile. Medicare along with most other insurance companies cover the procedure. There is a risk of infection but it is low, a mere 5%. It usually takes about four weeks after the operation for the patient to be ready to try it out. Performance is not limited to one orgasm. In fact, a man can engage in intercourse as many times as his partner likes. Speak with your doctor or an urologist if you are interested in a penile implant, or if you are experiencing any degree of ED.

The Impact of Sex on Heart Disease

2015-09-30

Those who suffer from cardiovascular disease (CVD) have to worry about a lot of things like their diet, exercise, their stress level and their sex life. Lots of us have read a news story or saw a scene in a movie where someone has died of a heart attack during sex. So is it safe for those with CVD to have intercourse? According to guidelines set by the American Heart Association (AHA) if your condition has stabilized, it’s probably safe to have sex. Glenn N. Levine, M.D. was the lead author on the association’s scientific statement on the matter. He is professor of medicine at Baylor College of Medicine in Texas. Levine said sexual activity is an important quality of life issue for those wrestling with CVD and their partners. Those scenes where a heart attack during intercourse ends someone’s life are mostly fiction. In truth, such cases are extremely rare.

Levine said that there are couples who avoid sexual activity even when it is safe to do so for fear of disturbing one person’s condition. “On the other hand, there are some patients for whom it may be reasonable to defer sexual activity until they’re assessed and stabilized,” he said. If you have severe CVD symptoms, seek treatment and wait to have sex until stabilization has occurred. Some people avoid talking to their doctor about their sex life when they have a heart condition. But this is an important conversation to have. Don’t wait for the physician to bring it up. Perhaps the doctor should. But he or she may be so preoccupied with other aspects that they forget to ask about it. If you have had severe CVD ask your doctor when it is okay to engage in normal sexual activity. Also discuss with him or her about taking part in a fitness program. Regular physical activity has been proven to lower the risk of complications after a heart attack, heart failure or cardiac rehabilitation. If you have experienced sexual dysfunction, speak with your doctor and see if it is related to your condition.

How Does Marijuana Effect Male Sexual Functioning?

Nearly half the states in the U.S. have legalized medical marijuana for serious illnesses. A handful of others have legalized recreational marijuana. Most medical experts agree that occasional consumption is safer than alcohol for adults if used in moderation, though not enough studies have been conducted to ascertain the actual health effects on the body.

Case in point, marijuana’s impact on sexual functioning, something that is a concern for the vast majority of men, is still debated. Lots of guys want to know how marijuana affects them, and if it’s use could lead to ED. That’s a tricky question. One study published in the journal Clinical & Developmental Immunology found that compounds in cannabis actually reduced the risk of erectile dysfunction.  Here, Swiss researchers discovered that elements in marijuana targeted CB2 receptors. These are found throughout the body. One common cause of ED is a buildup of cholesterol which clogs arteries including those which cause the penis to become erect.

Here two cohorts of mice were used. One received treatment with cannabis the other was a control group. After a period of three weeks each mouse was tested for fibrosis or tissue buildup that inhibits normal blood flow. Those exposed to marijuana had far less buildup than those who did not. But the debate as to whether marijuana use causes or cures ED remains ongoing. Other research has focused on the short-term results. Though many consider it an aphrodisiac, other studies have shown that elements in cannabis interfere with the CB1 receptor which may inhibit the creation of an erection.

A previous review published online in 2011 in the in the Journal of Sexual Medicine, found that long-term marijuana use may lead to sexual dysfunction in men. But these investigators also admit that there were few, high quality studies to choose from. One experiment involving rhesus monkeys gave researchers an indication that pot smoking could cause ED. Still, more research is sorely needed for a definite answer can be reached. With a trend toward liberalization, one hopes definitive results shouldn’t be too far off.

11 Men Sound Off on Why It’s Empowering to Give Oral Sex

By Jenny Kutner September 18, 2015

At a certain point in their sex lives, many straight men have a critical realization: Vaginas aren’t gross. Neither is cunnilingus.

In fact, contrary to stereotypes that most straight men hate going down on ladies, for many men giving oral sex is just as good as getting it. According to data from the National Survey of Sexual Health and Behavior, a majority of millennial men reported having performed oral sex on their female partners in the past year — and it wasn’t just for reciprocity’s sake.

Debby Herbenick, one of the survey’s researchers and an associate professor at Indiana University, told Mic that “the vast majority” of young men enjoy cunnilingus quite a lot. “In new, not-yet-published data from a recent college student survey I conducted, 64% said [they enjoyed performing oral sex] ‘very much’ and 24% said ‘somewhat,'” Herbenick said.

Men’s reasons for loving a little tongue action are manifold, but they mostly stem from the same fundamental (and not totally shocking) truth: Women like being eaten out, making that in itself a worthwhile pursuit. For many especially enthusiastic men, though, cunnilingus is about way more.

Mic asked millennial men why they enjoy performing oral sex on their female partners, whether they think it’s important to having a vibrant sex life and whether they think they’re any good at going down.

Here’s what they had to say.

Mutual pleasure is the best pleasure.

With age comes maturity, and with maturity comes the knowledge that sex usually just isn’t as fun when only one partner gets off. One of the primary reasons men say they love giving oral sex is partly selfish: Making women feel good makes them feel good.

“I only get off if my partner gets off. It’s a two-sided coin, and I don’t want to have sex to solely get my rocks off. I fully enjoy watching a woman enjoy my skills.” — Curtis*, 31

“I think part of it is getting some vicarious pleasure through my partner. Knowing that it’s hot for them turns me on, and eventually just the act itself turns me on. I like to imagine what it must feel like.” — Alec*, 24

“The best sex is where both partners give and receive, and both partners take control and take a back seat at different points. I feel like mutual oral sex is a big part of that.” — Robert*, 23

It makes sex more intimate.

Getting up close and personal with a vagina is an extremely intimate act. That intimacy often translates to the rest of a sexual encounter, which can improve a couple’s overall chemistry.

“I love [giving oral sex] because it seems to be one of the most pleasurable things you can do for a woman. To hear and feel her reactions from that incredibly intimate point of contact is both bonding and super sexy, for me.” — Logan*, 22

“[Going down on a woman] is awesome. Especially when the sexual, physical and spiritual connection is there, it’s like two bodies connecting and expanding into a universe of sensation. It’s just all around awesome.” — Alan*, 33

Sometimes, oral sex is the only way women get off.

Many men have learned by now that many women can’t orgasm from penetration alone (as few as 7%, according to one estimate). That makes oral sex all the more crucial to a mutually fulfilling sex life.

“[Giving oral sex] is a key piece of being an all around good lover. Some women prefer or need penetration to reach orgasm, but I have found that many prefer cunnilingus and clitoral stimulation to get there.” — Simon*, 26

“It really turns me on. I love the actual act of it; the smell, the taste, etc. It’s also the most reliable way to make a woman orgasm. Most of the women I’ve been with said they find it hard or impossible to orgasm purely from sex.” — Zachary*, 33

Receiving oral sex can make partners more relaxed and open-minded.

That said, not all men are willing to perform oral sex — which means some millennial women who haven’t previously had partners who want to go down might view it as an adventurous new act. Tackling this new adventure can make many women more open to trying other new things during a sexual encounter.

“I notice that sex tends to be more fun — wilder, dirtier, rougher — if I kick things off with cunnilingus.” — Martin*, 27

“If you get good at going down on a girl, the sex is more intense. They are more relaxed, which is always good if you want to try other things. I don’t know a guy who wouldn’t want to have lots of sex with a girl that loved to get off. So help her get off!” — Curtis

“I don’t ‘give to get’ but I do think that being able to pleasure your partner better improves both people’s pleasure.” — Ricky*, 23

It gets her in the mood to get down to business.

Cunnilingus before intercourse can significantly improve both partners’ experience because, to put it simply, it’s better when it’s wetter. (Plus, she’ll probably be more inclined to reciprocate, if you’re into that sort of thing.)

“In a long-term relationship, the sight of your dad bod, which she has seen literally thousands of times, is not going to be enough foreplay to make penetration enjoyable. Cunnilingus goes a long way in bridging the gap between a man’s ‘instant on’ and woman’s need to gradually build up to sex.” — Christian*, 26

“Nothing has gotten me laid more than going down first, without any goading or suggestion.” — Blake*, 28

“There’s a noticeable difference in the quality of sex if the order is rip off clothes and go down. I feel like women get so used to dudes just lying back and expecting head that it becomes routine and a little boring, despite it being inherently new and exciting.” — Martin

Being good at going down can improve self-esteem.

We all like being good at things. (Remember how awesome it felt to get a gold star on that fourth-grade math test?) That sentiment also applies to sex: Being told how good you are at giving head is a pretty big ego boost.

“Guys generally worry about their dick size or sex skills, and would probably err on the side of caution that they are less than average at both (though they would probably never publicly admit it). If you become good at [giving head], you generally don’t have to worry about lacking in the other departments.” — Curtis

“I think it’s empowering because I take pleasure in knowing my partner is enjoying herself. It’s like, right in this moment, I have you completely. I like knowing I can take someone out of her own head. It makes me more confident in what I’m doing and usually means the rest of whatever we’re up to will be great.” — Martin

*Names have been changed to allow subjects to speak freely on private matters.

The secret sex lives of over 60s

It’s not often you see people over-50 having sex on screen. It’s so rare, in fact, that the sex scenes in 45 Years, the recent British film about the approaching anniversary of a retired couple, became one of the main talking points in its coverage.

And yet a sizeable minority of people continue to have active sex lives into their 70s, 80s and even beyond. A recent study found that a third of over-70s had sex at least twice a month. So why do we so often shy away from talking about or portraying something so common?

We should perhaps also reconsider what we think about as sexual activity A report published earlier this year found that those with a sexual partner tended to rate their quality of life as higher than those without one, although some have placed greater emphasis on relationship status and social engagement. When I interviewed a number of over-50s about their (heterosexual) sex lives for a qualitative study, I found that many who were still in sexual relationships rated them as very or extremely important.

The reasons for the participants’ emphasis on sex included strengthening their relationship with their partners but also pleasure. For some women, sex had improved with age, which they related to feeling more relaxed because they had more sexual experience and no longer feared becoming pregnant.

STIs in older people

Understanding the importance of sex to many older people has serious health implications. In the past, sexual health campaigns in the UK have focused predominantly on young people, who are more likely to have unintended pregnancies and sexually transmitted infections (STIs). But now a growing body of evidence tells us that older people in developed countries are increasingly diagnosed with STIs.

STIs among the over-45s increased across different diseases between 2009 and 2013, from an 11% increase in genital warts in men aged 45-64, to a 500% increase in syphilis in women aged over 65. The majority of diagnoses of all STIs in the older age groups were in men, but gonorrhoea and syphilis were highest among heterosexual women and men who have sex with men.

As a result, some sexual health campaigns are now being aimed at older people. This year’s Sexual Health Week in the UK is focused on sexual pleasure and well-being – and one of the campaign’s five strands is aimed at educating professionals and the public about the sexual well-being of older people.

Campaigns that promote sexual pleasure are new, even though the idea of incorporating pleasure into sexual health materials is not. Young people in the UK are only just seeing such messages so it’s great that the sexual pleasure of older people is now being recognised too.

But infectious disease is only one factor that can affect pleasure and well-being. Long-term conditions and some sexual difficulties are more likely to be diagnosed in our 50s or later. These include erectile dysfunction, which affects around 30 per cent of men aged 65-74, and uncomfortable vaginal dryness, experienced by 20 per cent of women in the same age group.

Changing habits

Another potential obstacle to having sex and the pleasure that comes with it is the availability of a partner, which can be a significant issue for older people who have experienced widowhood or ill health. There is evidence that some older people are embracing technology and going online to meet potential partners for a sexual relationship. One survey found that 38 per cent of people aged 50-59 and 37 per cent of those aged 60-69 had met their partners online.

We should perhaps also reconsider what we think about as sexual activity when it comes to older people. For one thing, many older people engage in masturbation for sexual pleasure, countering the notion that it is a sexual act pursued only by the young. But there is also evidence that ideas about what activities count as sexual become broader as we age. For some, actions such as playing footsie under the breakfast table can give the intimacy that sexual activity previously had.

While research into the sexual well-being of older people is growing, there are gaps that wait to be filled, particularly the ways that ageing intersects with gender identity, sexual orientation, social class, disability and ethnic group. Exploring these areas will develop our understanding of sexual pleasure in older age, and better inform services for those to whom sex is important.

Share your thoughts: would you like a more open discussion about sex for over 60s? Do you think attitudes need to change? 

Sharron Hinchliff is a Senior Lecturer, School of Nursing and Midwifery, University of Sheffield. This article was originally published on The Conversation. Read the original article.