Our Bodies, Ourselves (41 page)

I've come to a much more inclusive definition of erotica/porn and realized how valuable it is to have textual and visual stimulation as a way of exploring what turns you on. My girlfriend and I, before we were sexually involved, traded sexually explicit fan fiction (both self-produced and by others) and we've continued to enjoy erotic literature in our relationship.

I really enjoy porn, but only queer/feminist porn. I love Courtney Trouble's work. It's artistic and tasteful. I also love the Crash Pad series. The direction of those is brilliant as well and it's a black lesbian woman who does the directing. That makes me happy.

I reserve the viewing of porn for the times I want to indulge in self-stimulation. I just try to avoid the parts of porn that disgust me—like the excessive spitting on genitalia and close-ups of male ejaculation. It also drives me nuts that women are rarely shown having real orgasms, so I appreciate those that do depict this, since I know it happens in real life. When I find one I like, it's all about the scene for me. If I can imagine what something might feel like to give or receive, or remember a time that I did something similar in my personal experience, it turns me on.

What it comes down to at a personal level is that what some women consider arousing, others may consider unappealing or demeaning. As with fantasies, what you see in erotica/porn may help you explore and enjoy an aspect of your sexual desire without having to act on it.

CHAPTER 8
Sexual Challenges

F
or many women, sexual pleasure can be compromised by physical or emotional challenges. The difficulties can be even harder to bear when medical providers find no underlying cause or do not offer suggestions for relief.

This chapter looks at a wide range of issues, including variations of desire and difficulties with arousal, causes of painful penetration that can make sexual intercourse and other forms of insertive sex difficult if not impossible, and the sexual challenges sometimes experienced by women with specific chronic illnesses and disabilities. The chapter also addresses the influence of medications and hormones on physical responses to sex and sexual pleasure.

Stories from women illuminate what has and what hasn't
worked for those of us who wish sex were something that we could enjoy more fully and without hesitation.

Pick up any magazine or read a sex survey, and you're likely to hear how much sexual desire you should have. It's essential to remember that there is no one right amount. Chances are your sex drive fluctuates: Sometimes you want a great deal of sexual activity and can't get it out of your mind, and other times you aren't nearly so interested. Maybe you were sexually quiet for decades and now have strong sexual feelings that make you eager to masturbate, or find a partner, or have sex all the time. Maybe ten years ago you wanted sex every night and now it takes effort, even though you tend to be glad when you do.

This fluctuation is true for many of us. Our levels of desire—in terms of both wanting sex and getting aroused—can shift over the years, or from week to week or partner to partner. For some of us, a lack of sexual desire and an inability to get aroused or to orgasm are long-lasting problems that seem unchangeable and cause us distress. Good medical research on the causes of and treatments for these problems is crucial.

I want safe, dependable treatment to be available in case I need it. The rush of sexual desire is too delicious to give up.

How sexual I feel at any given time depends a surprising amount on how much sleep I'm getting, how my partner and I are getting along, whether I'm feeling depressed, what level of antidepressant I'm taking, and a bunch of other even less tangible factors. On those days or months when my desire seems to have dried up, all I seem to be able to tolerate are small, boundaried kisses, and I feel almost smothered if she meets me with a soft-lip, mushy, wet one.

A number of pharmaceutical companies (and medical researchers associated with those companies) have worked over the past two decades to discover medications that enhance women's sexual desire. You may have heard this referred to as the “search for a female Viagra.”

This research is crucial for those of us for whom low sexual desire is a result of a physiological problem that might respond to a medical approach. However, we need to be aware that once a product is found, drug companies, in an effort to increase profits, will try to expand the
market for desire-enhancing medications by encouraging more women to question whether their level of desire is normal.

A particularly problematic aspect of this effort is a new practice of defining all low sexual desire in women as female sexual dysfunction (FSD), a medical disorder deserving treatment. If your levels of desire don't match some cultural norm (if you don't have sex twice a week, for example), you may be encouraged to think that you have a medically significant sexual dysfunction.

It's essential to remember that there is no right amount of sexual desire, just what's right for you. What matters is
your
satisfaction with how much desire
you
feel, not whether your desire is high or low by someone else's standards. Your level of desire is a problem only if it causes you distress. If you're not unhappy with your level of desire, don't let anyone tell you that it's dysfunctional.

For those of us who are unhappy with how we feel, the first step is attending to other factors that can play a role, such as relationship issues or depression. Anxiety and sleep deprivation can also cause low sexual desire. Are you putting in more hours at work, or are you engaged in some other pursuit? You may think something's wrong with your sex drive because you can't even think about wanting sex right now, but your body may be trying to get through the extra level of stress it's been asked to manage. Give yourself time to deal with the stress before concluding that there's something inherently wrong.

If addressing potential underlying causes doesn't help, FSD as a diagnosis can be a welcome validation for those who have wondered what's wrong. Accessible, well-researched, and effective treatments are critical. Online communities and blogs discussing FSD are becoming more common as women seek a balance
between the development of necessary medications and an exaggerated medicalization of women's sexuality.

A cultural shift in how we think about desire may be overdue. Traditionally, desire has been understood as a spontaneous motivation to have sex. More recent models point to a nonlinear model of sexual response that incorporates emotional intimacy, sexual stimuli, and relationship satisfaction (see
for more discussion
).

Pharmaceutical companies are in the process of developing other types of medical products to address women's problems with sexual desire and functioning. For a while, they tested some drugs originally created for men, but the results were disappointing. Examples of drugs now sold to men to address erectile dysfunction problems include Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil). Products for women that have been tested in double-blind, placebo-controlled studies include nonprescription remedies such as Zestra (which contains herbal oils)
1
and ArginMax (a dietary supplement), and vibrating apparatuses such as Eros. These are all designed to increase blood flow to the genital areas. Some women have had good results with hormonal supplements such as testosterone, while others have experienced no improvement or even harmful side effects. Research continues to evolve in this area, and it is prudent to investigate the latest data available.

If you mention to your health-care provider that you are experiencing lack of sexual desire, problems with arousal, or difficulty being orgasmic, you may be offered testosterone treatment. Commercially available testosterone supplements were developed for men and have not been approved by the FDA for use by women. (Intrinsa, a testosterone patch for women made by Procter & Gamble, is available in Europe but has not been approved for U.S. use.) Though doctors can legally prescribe such drugs to women (a practice known as off-label use), they must guess at the right dosage when prescribing products developed for men and/or use a special compounding pharmacy that will mix lower doses for women. Some practitioners will prescribe an ultralow dose of a commercially available testosterone gel for men, such as AndroGel or Testim; specially mixed testoster
one cream or gel available from compounding pharmacies; or methyltestosterone capsules to be taken orally (not recommended, however, because of negative effects on lipid levels and the liver).

Measuring women's sexual satisfaction is difficult, so the science supporting the use of testosterone in women is limited. Some women want to try it, especially after exploring non-medical approaches without success. Be sure that you are screened carefully and your baseline blood levels are low in testosterone. Be on the lookout for signs of male hormone excess: Acne, increased facial hair growth, and decreased scalp hair are all indicators that the levels are too high. There are limited long-term safety data on testosterone for women. Testosterone readily changes into estrogen in the breast, so there is a theoretical concern that testosterone supplementation could promote breast cancer.

There are over-the-counter counter topical creams that claim to augment sexual pleasure by increasing blood flow into the genital region, and some practitioners recommend trying them. Avlimil is one example. The instructions say to apply the cream with your finger to the genital area for fifteen minutes—which might explain its effectiveness in aiding arousal.

The only factor consistently linked to sexual desire and satisfaction in studies—more so than testosterone levels—may come as a surprise: exercise. Whether this is due to endorphins, improved mood, or just feeling good about ourselves, exercise is worth a try.