Sexual Dysfunction, Free of Gender Politics

May 28, 2013

libidoSexual dysfunction strikes terror into the hearts of both sexes. We don’t want to lose our mojo, as our identity is often closely aligned with our sexuality, especially for men. Nor do we want our partners to lose their sexual appetites – something that nearly always is experienced as rejection, even when the underlying cause is unrelated to a partner’s desirability.  As research into human sexuality continues apace, we’re beginning to gain some understanding of our own sexual responses, though this science is essentially still in its infancy – there are many questions, but as of yet few answers. 

In addition, there is a battle being waged among researchers, with the evolutionary psychologists, who rely heavily on innate sex differences for their theories, on one side of the battlefield, and gender theorists, who rely heavily on cultural influence, on the other. The latter group posits that men and women are very similar in their sexuality, usually adopting a sex-positive stance (see Sex at Dawn) that implies promiscuity is the natural inclination of both men and women. Some researchers have noted that sociosexuality is highly variable within both sexes, half heritable and half cultural. In this view, the population of both sexes lies on a spectrum of promiscuity. And there are those whose work reflects elements of all of the above, such as Helen Fisher, who relies heavily on evolutionary psychology but also believes that both sexes seem programmed to couple with someone new every four years or so, in the interest of genetic diversity. 

Daniel Bergner, who penned There May Be a Pill For That. in yesterdays NYXs magazine, is in the Sex at Dawn camp. The article includes much more speculation than fact – it’s got a strong flavor of propaganda. Ha, something new and different for the New York Times. 😛  Despite various errors and misinformation, the article is fascinating and does include some worthwhile topics for discussion. 

Who Doesn’t Have a Boner?

The clinical name for lack of lust is HSDD – Hypoactive Sexual Desire Disorder. Bergner cites its prevalence among women at 10-15%, and notes that women who “don’t quite meet” the criteria drive that number up to “around 30%.”

WebMD puts the male incidence of HSDD at 20-25%. According to sex researcher Irwin Goldstein, MD:

Many, many men — about one in five –have such low sexual desire they’d rather do almost anything else than have sex…almost 30% of women say they have more interest in sex than their partner has.

 According to the Daily Mail, a survey in the UK had similar findings:

But a recent survey for online pharmacy found 62 per cent of men turn down sex more frequently than their female partner, with a third admitting they had lost their sex drive.

Another poll revealed one in four men is no longer having sexual intercourse at all – and the figure rises to 42 per cent for men over 55 – while a quarter said they had been affected by erectile dysfunction at some point in their lives.Studies show that when men are surveyed about erectile dysfunction, 10% say they’ve struggled with it in the past year, and 30% of men report difficulty with premature ejaculation during the same time period. Because virility is such a culturally significant part of male identity, researchers believe these numbers are underreported, and that men often delay or avoid seeking treatment when problems arise. 

The causal relationship between ED and PE with HSDD is not known, but it seems likely there is some correlation.

It should be noted that Bergner does not correlate HSDD with infidelity. The lack of lust may be present and problematic in couples deeply invested in their relationship. Indeed, one woman he interviewed felt like sexual prey at bedtime, even though she cherished her husband and saw him as tender. 

Potential Culprits

Bergner cites a factor that may explain a great deal of HSDD for both sexes:

For a sizable segment of the undesiring, the most common antidepressants, the selective serotonin reuptake inhibitors, can be the culprit. Millions of American women are on S.S.R.I.’s, and many of them would have good use for a pill to revive the libido that has been chemically dulled as a side effect of the pill they take to buoy their mood.

Helen Fisher has been sounding the SSRI alarm for some time:

Rutgers University anthropologist Helen Fisher, for one, believes SSRIs are wreaking havoc on human courtship. SSRIs alleviate depression by upping the levels of serotonin in the brain and curbing the production of the neurotransmitter dopamine. Unfortunately, dopamine is also responsible for the feelings of elation and ecstasy that accompany falling in love. By suppressing dopamine, Fisher argues, drugs like Prozac block your ability to have these feelings, thus making it harder to fall in love and stay in love.

..Even if you’re one of the lucky ones who manage to find love while taking SSRIs, you still have some obstacles to overcome, says Fisher. You may lose the ability to orgasm, and this could cause long-term relationship issues. Orgasms trigger the release of the hormone oxytocin—one that has been linked with pair bonding.  

 Fisher has actually referred to the SSRI effect on women as a “chemical clitoridectomy.”

In addition to the treatment for depression, there’s depression itself. A common cause of low sex drive is psychological, in the form of stress, anxiety and depression.

Stress can cause a decrease in testosterone production, and an increase in stress hormones such as cortisol and adrenalin, which causes resistance to testosterone. There’s a clear link between stress and low libido. When a person is under severe stress they go into survival mode. Oxygen is diverted to the heart and lungs, and away from the sexual organs. Reproduction is the last thing the body wants to engage in.

Medical problems may contribute as well, suppressing testosterone levels. For example, half of men with Type II diabetes are testosterone deficient. 

Large studies done in America show that every decade there’s a decrease in testosterone levels by as much as ten per cent. 

Rising estrogen levels in the environment – caused by hormones from the contraceptive pill finding their way into the water supply and food chain – may have a counter-effect to testosterone. 

Research has also shown a link between exposure in the womb to gender bending chemicals such as bisphenol A and phthalates, (found in some food packaging and other plastics), and lowered testosterone levels.

Testosterone isn’t just important for men – it plays a starring role in the sex drive for both sexes. From Bergner’s article:

A number of …biochemical ingredients are critical to the most basic understanding of sexuality. But two of them — the hormone testosterone and the neurotransmitter serotonin — are especially important. Rising from the ovaries and from the adrenal glands that sit atop the kidneys, testosterone rides the bloodstream to the brain and, by means not fully known, stokes the production and release of dopamine.

…And then there’s serotonin, dopamine’s foil. It allows the advanced regions of the brain, the domains that lie high and forward, to exert what is termed executive function. Serotonin is a molecule of self-control…Roughly speaking, dopamine is impulse; serotonin is inhibition and organization. And in sexuality, as in other emotional realms, the two have to work in balance. If dopamine is far too dominant, craving can splinter into attentional chaos. If serotonin overwhelms, the rational can displace the randy.

In addition to the environmental question, scientists believe strongly that much of this hormonal activity is hardwired into brain chemistry, resulting in strong differences around sociosexuality, or the level of “unrestrictedness” of the sexuality of individuals. Discussing trials of medication, Bergner cites the importance of sociosexuality in diagnosing HSDD and treating it:

To help predict which women will most benefit from which drug, Tuiten has blood drawn from each subject and examines genetic markers related to brain chemistry. Tuiten also asks subjects questions about their comfort with sexual feelings and fantasies…He believes that the answers may provide clues about a given woman’s neurotransmitter systems, which he uses as part of his diagnostic method.

There’s one last potential culprit worth mentioning: the Soulmate Myth.

Esther Perel, a couples therapist and author of “Mating in Captivity,” emphasizes a separateness at the heart of longstanding passion. “Many couples confuse love with merging,” she writes. “This mix-up is a bad omen for sex. To sustain élan toward the other, there must be a synapse to cross. Eroticism requires distance.”

Bergner hopes that this merging will work out OK with the help of a libido drug:

Perhaps the fantasy that so many of us harbor, consciously or not, in the early days of our relationships, that we have found a soul mate who will offer us both security and passion, till death do us part, will soon be available with the aid of a pill.

I think this would be a disaster. Lust requires a strong sense of self, with identifiable wants and needs separate from that of your partner. Successful sex occurs when two people cross the distance between their own desire and the strong wish to satisfy their partner’s desire. The idea of an actual merging, of “two people becoming one” permanently rather than in that one moment, is a dangerous one, in my view. It creates a blurring of identity at best, codependence at worst, and neither of those leads to good sex. 

Discussion of sexuality in general and sexual dysfunction in particular is heavily loaded. Environmental factors, gender politics, the economy, and our stressed out, multitasking way of life may all be wreaking havoc on both our systems and the ensuing discussion. The odds are that at some point in your life you’ll confront a loss of libido in your relationship, whether your own or your partner’s. The worst thing you can do is avoid addressing it. Sexual dysfunction predicts relationship dissolution, not because the difficulty cannot be addressed in most cases, but because feelings of rejection and resentment take hold early on and build over time. 

Finally, Bergner suggests that “foreboding not only about sex itself but also about female empowerment may be expressed in a dread of women’s sexual anarchy.”

Gaining control of their reproduction in the ‘60s affected not just women’s sex lives but also everything from their social standing to economic empowerment. What might it mean for conventional structures if women could control, with a prescription, the most primal urge? So many things, personal and cultural, might need to be recalibrated and renegotiated, explicitly or without acknowledgment. The cumulative effect of all those negotiations could be hugely transformative, in ways either thrilling or threatening, depending on your point of view.

What Bergner fails to observe is that a quick fix for low libido wouldn’t apply to women alone. If a pill could control sex drive, and both sexes had the ability to choose just how far to indulge that primal urge, I believe what we’d see is a more pronounced magnification of what we have now. That is to say, a distribution of desires, values and preferences across the spectrum of human behavior.