Last month, we discussed the causes and presentations of Female Hypoactive Sexual Desire Disorder (FHSDD), or low sexual desire. I stressed the fact that many of the causes are interrelated and can create a vicious cycle. For example, depression can cause low desire, which then worsens the depression, which results in lower desire and finally avoidance of sexual activity altogether.
I also mentioned the importance of raising your concerns with your medical provider so that they can refer you for an evaluation and treatment. This month, we will talk about some of the general aspects of treatment for FHSDD. Next month, I’ll talk in more detail about the treatment of specific causes of FHSDD.
1. It’s completely normal.
Medical conditions and disorders can lead to low desire or difficult or painful sexual activity. So once these conditions have been ruled out, the first general goal of treatment is to “normalize” the problem. I want to reassure you that what you are experiencing is common and nothing to be embarrassed or anxious about. Also, it’s manageable. You are not alone and you are not “broken”. Knowing that you don’t need to be “fixed” can go a long way toward restoring normal sexual function.
2. Desire doesn’t always work how we think it does.
The second general goal is to provide you with education about the problem. There is so much misinformation and unrealistic expectation regarding sexual desire and performance. We are tricked into believing we should be ready to go at a moment’s notice; that our desire for sex can be switched on by just pushing a couple of our sexual buttons, so to speak. This isn’t usually reality.
In the 1960s, Masters and Johnson’s model of female sexual response stated that women first experience desire, then arousal, then sexual activity followed by orgasm. This has been shown to not be accurate for everyone, and certainly not for women with FHSDD.
The latest research shows that arousal can actually happen first, and can then lead to desire. This means that you shouldn’t wait to spontaneously have the desire for sex before initiating it. It may have worked that way when we were in our 20s and 30s, but not so much as we get older.
The most important things in our lives are planned, and sex should be no different.
The most important things in our lives are planned, and sex should be no different. And though it can be extremely challenging in our busy, distracted lives, time needs to be set aside for nurturing our relationships. Planning for hours, even days, for a sexual encounter can allow for a long lead-up. A romantic dinner, suggestive talk, non-genital touching and foreplay can all start long before you even get to the bedroom.
Ironically, allowing these activities to be mutually enjoyed in and of themselves, without feeling the pressure of ultimately having to have sex, will more likely result in a satisfying sexual conclusion.
3. Your partner may affect your desire.
A third general goal involves a look at how you and your partner work together.
- Is your partner attentive to your needs and preferences?
- Is sex hurried or does it develop slowly with lots of foreplay?
- Do you feel pressure to “perform”?
- What is your partner’s attitude toward your low desire?
- Is your partner supportive, understanding and willing to help, or do they feel it is only your problem, which you need to fix on your own?
Simply put, if sex with your partner is unsatisfying for any of these reasons, you will probably not have much desire to continue to have sex.
While all of these issues need to be addressed during treatment, they may also speak to an underlying problem in your relationship, and referral to a marriage and family therapist may also be recommended.
Next month, I’ll talk about treatment for specific causes of FHSDD. In the meantime, feel free to leave your questions and feedback in the comments below.
Luigi D’Amato, MD, is a sexuality counselor who completed extensive training in sexuality counseling at the University of Michigan. A former obstetrician/gynecologist, he has more than 35 years of experience practicing medicine. Dr. D’Amato is available for sexuality counseling at the ProMedica Health and Wellness Center at 5700 Monroe St., Sylvania.