The Good Vibrations Guide to Sex (19 page)

People who face a sudden dramatic illness, such as cancer, have to confront the sense that their bodies have betrayed them, along with an often grueling treatment regime. Obviously, pain of this variety is libido-depressing, and sex may take a back burner to getting well. Yet many people who recover from cancer develop a perspective on life’s priorities that can truly enhance their sex lives.

My sexual self-esteem actually got raised by a near brush with death due to cancer. I began wondering, How long am I going to disrespect myself? Until the day I die?

Abdominal surgery, such as a hysterectomy, may affect a woman’s sexual responses. Hysterectomy is the surgical removal of the uterus, and sometimes the ovaries and fallopian tubes as well. Removing the ovaries is becoming less routine, as it puts a woman into what’s called “surgical menopause,” which is often accompanied by worse symptoms than natural menopause.

Some women report that hysterectomy has negative effects on arousal and orgasm. After all, the uterus is intimately involved in sexual response; it produces a hormone (prostacyclin) that is believed to play a role in orgasm, it’s connected to the same pelvic nerve pathway as the vagina, and it contracts rhythmically during orgasm. Removing the cervix during hysterectomy can be particularly distressing to women who enjoy penetration and pressure against the cervix.

I had a hysterectomy about five years ago, for cervical cancer. About a year and a half after that, I had intercourse for the first time since the surgery. The man penetrated me and I found I felt pretty much nothing, and my arousal plateaued and dwindled. At first I didn’t know what was going on, then I made the connection with my surgery and started to cry. I freaked him out. I was terribly upset. I didn’t know if I’d ever be the same. I still don’t, actually, because though it seems as if overall sensation has improved, I still have yet to have an orgasm during intercourse, which I was able to do before the surgery. I lack data, though, since I haven’t had much sex since then. I am certain my libido has been affected. Certainly I can still get turned on, but not as easily. I used to be able to turn myself on quite readily, whenever I wanted to. Now if there’s no outside stimulation, I often find I can’t turn myself on. I can go as long as a month without much sexual feeling. I am convinced it is due to the loss of my womb. I miss her.

Be proactive in discussing your current sexual response pattern with your surgeon so that you can request appropriate options, such as a supracervical hysterectomy, in which the cervix is retained. As long as your vaginal nerves and muscles are left intact, hysterectomy may even have a positive effect on your sex life. Many women who have hysterectomy due to uterine fibroids find the release from pain erotically inspiring.

I had a hysterectomy seven years ago and sex has never been better. No more pain from the fibroids, no periods to plan around, no pregnancy worries. It was completely liberating for me.

Since undergoing a full hysterectomy when I was 42, my sexual peak is at its highest. I could have sex at least three times a day, I am always way above average for wetness, and my partner said that he has never ever tasted anything so sweet as when he has oral sex with me.

Whatever medical issues you are facing, you may well discover that tapping into your erotic energy has the potential to be profoundly healing. We’re not just talking about the considerable physiological benefits of sexual arousal and orgasm, which boost the immune system, release endorphins, relieve tension and stress, serve as a mild cardiovascular workout, and promote general well-being. We’re talking about the emotional and psychic benefits of acknowledging yourself as a sexual being. Whether you’re fantasizing about the cute U.P.S. delivery person, enjoying the sensation of sun on your skin, cupping your partner’s genitals in your hands while you fall asleep, or pursuing a roof-raising orgasm, you’re accessing an important source of human creativity and connection. That’s some powerful medicine.

Depression

Chronic depression affects close to twenty million adults in America, while situational depression affects millions more. Depression is a disease characterized by despair, feelings of worthlessness, inability to experience pleasure, disrupted sleep and appetite, poor concentration, and more. Loss of libido frequently accompanies these symptoms, though that’s not the case for everyone. Some studies show that depressed people are more likely to engage in unsafe sex. Maybe you know what it’s like to seek unsafe sexual situations out of a desire to harm yourself, or a yearning to break through a cloud of despair with strong sensation, or simply because you don’t care anymore. Making the effort to seek out safe and satisfying sex presumes a level of self-esteem and self-assertion that a depressed person can’t necessarily muster.

Fortunately, recent years have seen enormous strides in the treatment of depression. The class of drugs known as SSRIs (selective serotonin reuptake inhibitors), which were introduced in the late eighties, has proven to be highly successfully in treating depression. Unfortunately, certain sexual side effects affect many (though not all) people who take SSRIs: Both men and women report reduced libido, genital sensation, and lubrication, along with difficulty in reaching orgasm. If orgasm is achieved, it can be muted or less intense.

When I was taking Prozac it completely killed my sex drive. I would attempt to masturbate for extended periods of time but I could never climax. It turned me into a raging psychopath. It would seem like a roller coaster ride where I was stuck at the top of the hill and couldn’t come down. I wound up sobbing, and nothing I tried was very helpful.

One of the things that I’ve had to deal with for many years is the way that orgasm is often muted, buried, or nearly impossible on my medications. It doesn’t seem to make any difference to my experiences of desire or arousal—I still have those in spades. I find that I walk around much of the time these days in a state of high arousal. It’s just that getting to the point of orgasm is difficult on antidepressants, no matter what I’m doing or with whom.

Be aware that not everybody experiences these particular side effects. If you do, and your depression is situational, you may take SSRIs on a short-term basis to help you through a difficult time.

I took Paxil for ten months for a depression I suffered around the age of 32—was desperate at the time, so I suppose I’m glad it’s out there—but I almost forgot about sex during that time. As a point of pride I masturbated with a vibrator to make sure I could still get off. (Sigh) Glad that’s over.

When I was taking antidepressants for a year, my libido DIED. It was great to not be depressed but when my libido went away, that made me a tad depressed anyway (paradox, eh?). I eventually stopped the medication and got back to a manageable state of lethargy, but with the ability to once again achieve sexual pleasure and masturbate.

For many people living with chronic depression, going off treatment is simply not an option, and for them the benefits of taking SSRIs far outweigh the sexual side effects. And of course, the absence of depression can be libido-enhancing in and of itself.

My antidepressants lower my sexual desire a little, but I feel so much better when on them, so the effect is offset.

Furthermore, many people find that any sexual side effects abate with time as their bodies adjust to the medication.

My sexual desire decreased when I first went on Prozac, but since I’ve been on it for some time, I have been feeling more sexual.

If you are taking antidepressants, we encourage you to be proactive about your sexual satisfaction. Discuss with your doctor your experience of sexual desire and arousal. He or she may advise you to experiment with lowering your dosage or switching drugs. For many people, Wellbutrin, an antidepressant that’s chemically unrelated to SSRIs (it’s also marketed under the name Zyban as an aid in quitting smoking), not only has no negative sexual side effects but has the advantage of boosting libido. Your doctor may also recommend switching among the various SSRIs (such as Prozac, Paxil, Zoloft, Luvox, and Celexa), as your individual body chemistry will interact in different ways with different drugs.

Surviving Sexual Abuse and Assault

Estimates vary, but there’s no question that a significant minority of boys, and an even higher minority of girls (anywhere from one in three to one in eight), experience child sexual abuse. And one report from the National Center for Victims of Crime estimates that one in three women will be sexually assaulted in her lifetime. Obviously, women are at particular risk for sexual abuse and assault. Ours is still not a culture in which women are allowed to walk as freely or take up as much space as men. Even those women who never experience sexual assault encounter an atmosphere of casual disrespect in public settings that can challenge their sexual self-esteem.

Exposure to the world undercut my pleasure in being a sexual person. It’s not that I suffered any kind of attack or anything, but I suffered from the lack of respect for women and the attitude that “women are there for men to prey on” that seems to be prevalent on the street.

Reclaiming a healthy sex life can be a lifelong process for survivors of sexual abuse or assault. Most abused children are assaulted by adults close to them: parents, relatives, coaches, or teachers. Assault victims are often assaulted by people they know: friends or lovers. Naturally, adult survivors find it challenging to feel safe and to trust, particularly in an intimate sexual situation.

When I was 15 my boyfriend molested and tried to rape me. Before that, I had been comfortable with sexuality, but wasn’t ready to be involved. Afterward I was seriously disturbed by sexual emotion being directed toward me, and didn’t even let myself enjoy sex until a few years later. Now I’m having a great time with sex toys and my partner.

Survivors may compensate by always saying no to sex, by suppressing desire, or just by avoiding sexual situations. Or they may compensate by being unable to say no to sex, using sex to bolster their sense of self without making conscious choices based on consent and desire.

I was sexually abused as a child, so, though I had numerous sexual experiences as a teenager and young adult, it wasn’t until my thirties, after seven years of celibacy, that I was able to adequately explore my own sexual desires and learn what I need to become truly aroused and experience orgasm. I also found a partner with whom I felt safe enough to experiment and learn new things.

If you’re a survivor, you’ve probably experienced “dissociation,” or checking out during sex: One minute you’re feeling your partner’s hands on your skin, the next you’re feeling detached from your body or making a mental shopping list—anything to avoid being present in the moment. To heal, you’ll need to learn what Staci Haines, author of
The Survivor’s Guide to Sex,
refers to as “embodiment,” the ability to get back into your own body and experience a range of emotions and sensations, including sexual pleasure.

Like anyone who has suffered trauma, you can be “triggered,” flooded with emotions, sensations, or images related to your abuse that make it difficult to stay in the moment. Certain sexual situations may be particularly strong triggers, catapulting you into the past, as perhaps when a partner strokes the inside of your thigh a certain way, or wakes you in the middle of the night. Sexual healing involves learning to identify and work through your triggers so that they no longer have the power to hijack your sexual encounters.

I was molested as a child and had never been able to discuss it. When I began to work on the many problems and issues that I had as a result of the abuse, I met my current girlfriend. It turned out that she had also been sexually abused. She had been working on her issues for years. She was very open and shared with me. I was able to also open up to her. We are able to share our triggers, needs, desires, and fantasies. My sexual self-image has become positive. It is no longer uncomfortable or scary to have sex. I relish the joy of giving and receiving physical pleasure with her.

For practical help with sexual healing, we recommend
The Survivor’s Guide to Sex,
the first book ever written on cultivating an empowered sex life after child sexual abuse. This thoughtful, compassionate guide offers women invaluable advice on cultivating an embodied sexuality by learning how to develop boundaries, navigate triggers, embrace their own desires, and communicate with a partner.

I was very sexually active from my teens into my thirties, but as a survivor of early sexual trauma, I found that I was either an untouchable, or when touched was not really present with what was going on with my body. I find that by getting more in touch with my own body and being more comfortable with who I am, I enjoy sex in my fifties with much more personal awareness than I did as a promiscuous young woman. I still have issues that come up for me, but I can deal with them knowing what it is I am dealing with and get on to the enjoyment part again.

Maturity Has Its Rewards

Are you getting the sense that we delegated the writing of this chapter to our survey respondents? The truth is, we only wish we had room for more quotes! We were bowled over by the passionate outpouring that resulted when we asked our respondents to describe how their experience of sexual desire had changed throughout their lives. We’ll close by letting these articulate women and men explain some of the many advantages to sexual maturity.

You understand the mind-body connection