Posted by Dr. Valerie Raskin on May 29, 2002, at 18:11:59
In reply to Re: Great Sex for Moms » Dr. Valerie Raskin, posted by wendy b. on May 21, 2002, at 19:25:37
Wendy,
Thanks for your kind words. I thought I had posted a reply last week, but it seems I missed the "confirm post" button. Let me try to recreate my reply.
As I understand it, you're asking about how to manage having no sex drive as a side effect of psychotropics. Loss of orgasm ("anorgasmia") and/or loss of libido are common side effects of SSRI's, but can occur due to mood stabilizers, anti-psychotics, anti-anxiety medications, and tricyclic antidepressants and MaoI's. Please understand that any advice below should be discussed with your prescribing physician before considering making changes.
Restoring climax is easier than restoring sex drive, perhaps because libido is so complex--self esteem, body image, relationship issues, partner sexuality and technique, early childhood messages about sexuality, mood, etc. all impact libido.
In my practice, I've found that these may be successful libido restorers/enhancers: 1) Using the lowest effective dose (sometimes in the dose escalation phase, we go too fast in order to bring symptom relief, and less may work as well without the sexual side effects); 2) Co-medication with a multitude of different agents, 3) Co-medication with gingko biloba. My patients have found that the long acting form found in some drugstores and many internet sites works best. Others note that the ginkgo should include both whole leaf and purified extract. Effective doses range from 120 to 480 mg, and it may take several weeks to kick in. Gingko is potentially unsafe if you are taking blood thinners or have a bleeding disorder. 4) Correction of underlying endocrine (hormone) problems. Examples include low testosterone (the ovaries make small amounts of testosterone), and low levels could be a problem in peri- and post-menopausal women, and high prolactin, which many anti-psychotics cause as a side effect. See the book I'm Not in the Mood for more info.
Improved sexual technique may help, too, because it's only natural to want sex more if it's more enjoyable. Kim Catrell's new book Satisfaction is a very explicit how-to guide to better sex for women.
I hope this helps! Best to all.
Dr. Raskin
> Dear Dr. Raskin:
>
> Sorry, in between offending each other and getting off topic, we really do want to say thank you very much for adding your comments to the discussion of intimacy and women's issues dealing with the sexual fallout from psychopharmaceuticals. I felt your comments were very frank and supportive, i.e., we shouldn't feel singled-out or alone if we experience negative sexual side effects from the drugs. 40% of the general population, before counting our sub-population, is a staggering number.
>
> I guess the other part of the discussion here focusses on breaking through more than sexual doldrums, but simple disinterest in sex. There are no easy answers, but if you have any specific suggestions (besides your very helpful book) for the women who have posted particular questions on this thread, I'm sure your inuput would be greatly appreciated. Your time is obviously limited, but if you are inclined to keep reading this thread, we'd love more words of wisdom.
>
> Sincerely yours,
>
> Wendy
>
>
>
> > > Thanks for supporting the topic!!
> >
> > Not to mention supporting my book! <vbg> Dr. Bob invited me to stop in and say hello. I hope the group doesn't mind.
> >
> > I can't encourage you strongly enough to feel entitled to good medical information and support for dealing with the sexual side effects of psychotropic medications. Sexual issues are much more common than is generally acknowledged--close to 40 % of the unmedicated population has difficulty with low libido or other isseus of sexual dysfunction, and the drugs we psychiatrists prescribe all too often make things very much worse.
> >
> > As one of the posts noted, often times when men have a sexual side effects of SSRI's, etc, they can more readily ask for advice, because they can focus on the function. "Doctor, things don't work" is often an easier thing to say in a quick med check than, "It isn't fun anymore." Women who can't climax because of drugs have to have a more difficult discussion: the pleasure is gone, but ability to have intercourse isn't impaired. In a society in which women's sexual pleasure is still highly taboo, that can be intimidating. But be brave! There are medical interventions that often help.
> >
> > One of the things I really like about this thread is the discussion about non-medical ways to overcome sexuality problems, whether they're caused by drugs or caused by life circumstances. Making sex more interesting, taking more time, and then more time, and using fantasy, vibrators, and whatever spice suits your fancy are all ways to deal with the sexual doldrums. It's said that the biggest human sex organ is the mind, and I agree.
> >
> > Best to all!
> > Valerie Davis Raskin, M.D.
poster:Dr. Valerie Raskin
thread:23803
URL: http://www.dr-bob.org/babble/social/20020523/msgs/24853.html