His and Her Health

I've noticed an inordinate number of women with depression and/or anxiety who are seeking help with low arousal and/or desire.<P>The renewed interest in female sexual dysfunction has recently focused on biological aspects while personality and partner-related factors have largely been neglected. Low sexual desire is the most common presenting problem. The results of recent studies indicate that women seeking help for desire disorders exhibit marked signs of mood instability and a low and fragile self-regulation and self-esteem. In addition, they tend to be more worried, anxious, introverted and conventional when compared to sexually functional women. They conclude that overall, female sexual dysfunctions and low desire, in particular, cannot be conceptualised as discrete phase disorders, but rather as a global inhibition of sexual response together with a history of mood disorder, specific personality factors and an elevated level of psychological stress. This combination calls for broad-band treatment approaches where individual and interpersonal aspects can be taken into account simultaneously. In addition, the ubiquitous comorbidity, both with other sexual dysfunctions and with various personality and psychological problems, and the developmental sequence of the sexual problems must be adequately considered.<P><p>[This message has been edited by Bihag (edited 10 July 2003).]

I respect your comments immensely, because FSD is a widespread problem with many, many causes.<P>However, I must just add my own two cents here.<P>Many women who have issues with desire/libido have been told for years that it's all in our heads, and there is nothing wrong physically. We simply must work with our partners, go into therapy, address suppressed feelings, relax more, try to reduce our stress levels....and if we do all this, our libido is supposed to magically increase.<P>So...I, for one, am HUGELY grateful that the medical profession is finally beginning to recognize that there ARE physical causes to low desire and other FSD issues. <P>It's just like anything else...when a new idea takes the stage, other, more traditional views are pushed out of the limelight. Once the new ideas are not NEW anymore, the pendulum swings back to a more balanced view. This entire process takes a lot of time.<P>Yes, FSD often has psychological causes, and those should be recognized, however, please don't lessen the focus on the physical aspects. <P>FSD is more difficult to understand than erectile dysfunction in men, and it takes a lot more than a little pill to fix. BUT...at least the medical profession is FINALLY beginning to do a lot of research into the physical causes.<P>Sorry, I'm a bit touchy and sensitive about this right now, so please don't take my comments as a personal attack...they are just my rambling thoughts.<P>Tracie<BR>

I don't take your comments as a personal attack. As a matter of fact, I agree with you for the most part. Thank you for your thoughts.

A few ways to have more useful dialog on this (or any) board:<P>1) Please don't make sweeping generalizations. Not all women seeking help for FSD, low-libido or otherwise, are depressed, have low self-esteem, relationship issues, etc. As you will see, there are many women on this board who simply don't fit this mold. For details, please read the past posts.<P>2) The relationship and self-based issues of women with FSD are not being ignored as far most of those here can tell. They are just no longer seen as the only possibility. Actually, in most areas, they are often still seen as the only possibility. Most of the women on this board have been to counseling, with and/or without their mates, to no avail. If you read the board, and most of the posts, you will see the results of the "it's all in your head" theories that, in some cases, simply aren't psychological in nature. It's never good, and often leads to the problem getting worse because the women gets frustrated in her search for answers. There are many causes of low-desire and other disorders that definitely are medical, and can include a variety of medications and medical conditions. This can be elevated prolactin levels, estrogen or testosterone level issues, thyroid problems, diabetes, hormonal birth control, anti-depressants, blood pressure meds....the list goes on. Can it be your self-esteem, your relationship, or other life-factors? Of course! No one on this board that I've seen or heard advocates a medical-only approach. Even where issues are medical (and there are cases here that definitely are--please read some of the posts for the personal experiences of those with medical issues), dealing with the emotional aspects the condition has caused is imperative.<P>3) If you're going to give "facts," you need to site where you got them from so that the rest of us can research it on our own. This is a suport board dedicated to helping women solve their FSD issues and to educating them about their options. Stating things as "facts" with no proof is not well-recieved here.<P>4) Please tell us what prompted coming to this board for you. Those of us here enjoy a sort of "kinship" based on sharing our stories, what works for us, etc. Please share with us YOUR interest in FSD, and what prompted this particular post. If you are uncomfortable sharing your whole story, just a basic idea of your areas of interest and research are fine. It is common courtesy, if you are going to read and feel free to comment on our lives and issues, that you share something of why you are interested and where you do your research.<P>I hope this helps you understand what the members of the board have, in the past, expressed as the preferred way to communicate issues--directly, openly, and with full-disclosure of sources. Welcome to the board, and I am always interested in a new perspective that is presented with clarity, logic, valid and confirmable data and no hidden agenda. I look forward to hearing more from you about your interests in FSD, and the studies you've seen that show the dramatic trend you spoke of. It would be most intersting because it is so contradictory to what most of us here have experienced first-hand, and many of us would like to know where all the "medicalization" is taking place. So many here can't find a doctor who will even talk about it, so the information on doctors medicalizing the problem will likely be a hot topic!<P>A good example was that, for many years, impotence in men was considered to be largely psychological in nature, as was (and still is to a large degree) premature ejaculation and erectile dysfunction. Fortunately, as medicine has improved, it's become obvious that this isn't always the case and medications to help those with medical problems has been developed. This could also be seen as the "medicalization" of a problem; but, it's fairly clear that in some cases the cause *is* medical in nature, and all the psych counseling in the world wouldn't fix it. Do you think this could be the case with some FSD, too, or do you believe it is all psychologically based? If so, may I ask why you believe that? If you believe that some FSD could be caused by medical problems, while others could not be, would you mind sharing with me what research you've seen to prompt your opinions? I am always interested to hear new voices, and to see new research in this area.

I'm not sure if that was directed towards me...but the idea of the medicalization of FSD is of great interest to me! Just the fact that people are talking about it, realizing that medications can influence desire/libido, and that there are a couple of new drugs on the market for women...JUST WONDERFUL!!!!<P>Anyway, thank you for your comments! I appreciate an update of the etiquette of this board, as I would never want to step on any toes!<P>I'm very new to this board, but hope to become a very active member!<P>Tracie<BR>

Hi Bihag...<P>I have been reading and re-reading your post and just cannot figure out what this means...<P>"In addition, the ubiquitous comorbidity, both with other sexual dysfunctions and with various personality and psychological problems, and the developmental sequence of the sexual problems must be adequately considered."<P>Any way you could put this into common language for me?<P>Tracie<P><p>[This message has been edited by t_mccray (edited 10 July 2003).]

traci,<P>Oh, no, my post wasn't directed at you at all--it was to help our latest poster Bihag, the one who started the thread, get a good foot off on this board. I know that sometimes it's hard to get a feel for what posters on the board will ask for, so I thought I'd give him/her a head's up. And, I am curious about the studies he/she mentioned, as well.

Well, if my hypothesis is correct, this supports my viewpoint. There hasn't just been a welcome medicalization of female sexuality, there has been a welcome medicalization of mental health. I believe that testosterone levels and serotonin and dopamine levels have a tremendous effect on female sexuality. They also have a tremendous effect on mental outlook. High testosterone will give a woman more self confidence and higher self esteem. High balanced dopamine and serotonin levels will help keep a woman from feeling depressed (no matter what her life circumstances), and will make a woman feel less "worried, anxious, introverted and conventional."<P>Of course my personal view is to improve these levels through natural means. And if by "partner-related factors" you mean male bumbling and ignorance, I say sex ed for everyone. And certainly counselling has its place--I just think that counselling will be lots more effective if both people in the relationship have their neurotransmitters and hormones functionally optimally and know enough about sexual technique to fully please themselves and their partners.

"Not all women seeking help for FSD, low-libido or otherwise, are depressed, have low self-esteem, relationship issues, etc."<P>I agree and you're misquoting me.<P>"A good example was that, for many years, impotence in men was considered to be largely psychological in nature, as was (and still is to a large degree) premature ejaculation and erectile dysfunction. Fortunately, as medicine has improved, it's become obvious that this isn't always the case and medications to help those with medical problems has been developed. This could also be seen as the "medicalization" of a problem; but, it's fairly clear that in some cases the cause *is* medical in nature, and all the psych counseling in the world wouldn't fix it."<P>I don't disagree.<P>"In men under 40, a high percentage of sexual dysfunction is psychological. However, in men over 60, 75 percent or more of sexual dysfunction is due to organic disease, and the older a man becomes, the higher the percentage of organic disease in general." (Andre Guay)<P>The numbers are likely similar for women. As for the psychological issues being "ignored", I see this as true on this board but not necessarily true in the doctor's office.<P>Most physicians aren't researchers. You can't expect the medical community to jump on the bandwagon with something that isn't proven. Especially when the few FSD specialists are in much disagreement amongst themselves.<P>I'm interested in the topic for personal reasons. I didn't post a link because I thought links weren't allowed, but I'll make an attempt. There's a good discussion of the limitations of the current consensus classification system as well as the limitations of traditional sex therapy techniques that are based on traditional theories, which do not adequately reflect real-life female sexual problems. Personally, I'm becoming a believer in Bancroft's theory of female sexual arousal and desire. I'll link one of her articles if you're interested.<BR><p>[Note: This message has been edited by NEWSHE Moderator]

Bihag,<P>Again, I totally respect your comments, but I felt that this comment was a little off base.<P>"As for the psychological issues being "ignored", I see this as true on this board but not necessarily true in the doctor's office."<P>I truly think that most of the women who find this board have been in therapy or have addressed the psychological issues. They're just not the problem in our cases. So, while you may see that we are ignoring these issues, I simply see this as us addressing the issues that are truly the problem.<P>And, as far as me expecting my doctor to be up to date on research in a particular area, I absolutely expect this. I don't care if he's busy or what, but when I come to his office and pay him to address an issue in my life that falls within his realm of expertise, I absolutely expect him to inform me of new research/findings in the fields. A doctor who ignores a whole piece of the puzzle is not my kind of doctor. Even if the data is not proven, or the hypothesis or whatever (sorry, I'm not in the medical profession), I expect him to present me with all available options. Ignoring a piece of the puzzle to me consititutes medical malpractice on a small scale. <P>Maybe my expectations are too high, but so far, my doctor is able to fulfill them. I'm also an advocate of my own health care, because nobody knows my body better than me. I may be considered "one of THOSE" patients who expect a certain level of care, consideration and time, but it's my health and I will advocate for it with all my will!<P>Bihag, not all of this was addressed to you, because you can see that it is a very personal issue for me.<P>I would be interested in reading some of the research that you referred to...by Bancroft.<P>Tracie<P>

But even if your doctor is up to date on the research in this particular area (I've found that mine usually are up to date), he still won't have a clear idea of what to do because the research is contradictory and/or inconclusive. We can't expect our doctors to perform tests and prescribe medications until they've been proven reliable, meaningful, safe, and effective. They don't use us as guinea pigs, unless they're researchers and are really using us as guinea pigs. This is why we have an FDA, right? If you read the article, it makes the point that more research is needed to refine our knowledge base and allow better theoretical concepts and treatment approaches. The traditional concepts and approaches (I see testosterone, the way it's being used now, more as a traditional approach than a new one) are too simplistic and inadequate.<P>This is my favorite line from the article:<BR>"As much remains to be learned, it seems important that researchers and clinicians do not yield to the temptation to concentrate only on endpoints, criteria, markers or outcomes. Instead, let us first talk to these women and their partners, let them tell us their individual stories and let us listen carefully."<p>[This message has been edited by Bihag (edited 10 July 2003).]

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2">Originally posted by t_mccray:<BR><B>I truly think that most of the women who find this board have been in therapy or have addressed the psychological issues. They're just not the problem in our cases.<BR></B></font><HR></BLOCKQUOTE><P>But this is the point. Most FSD specialists would agree that psychological issues are a huge component. The problem lies in the fact that traditional therapy is based on traditional diagnosis, which is based on traditional theories, that don't reflect women's experiences in real-life. In other words, because psychological therapy didn't work doesn't mean it must not be a psychological issue.<P>

"The results of recent studies indicate that women seeking help for desire disorders exhibit marked signs of mood instability and a low and fragile self-regulation and self-esteem. "<P>I am not misquoting you. This says that women seeking help exhibit these things. It doesn't say "some women," or "a high percentage," etc. It says, as a fact, that women seeking helpf for desire disorders exhibit marked signs of mood instability and a low fragile self-regulation and self-esteem. Perhaps you forgot to put in "most" or "some" or "often," and therefore thought I misquoted you?<P>Links are often not allowed here, unfortunately--you are definitely right about that. You can, however, always put the information about the study here (sponsor, dates, title, author or article, if it was run in a journal, etc.). We're not sure why the links are no longer allowed sometimes, but the moderator seems fine with this other information. Thank you for the link you did post--I look forward to reading it.<P>Again, I'd ask if you'd post the study you were speaking of regarding men and the high percentage of sexual dysfunction, and why you believe it will be the same for women? There are a great deal of differences in the sexes, so I am not (and this is simply MHO) sure that we can compare apples to oranges in studies like this. That said, I do agree that there probably is a high incidence of psych related FSD issues, and many traditional approaches don't work. For my part, I'd like to see the psych field, and it's methods in this area, revamped a bit. Yes, I have ideas on this, but this is probably the wrong board for them ) <P>And, statistics present a problem for me. You see, even if 80% of FSD cases are psych-based, that means that 20% are not. Having been through a situation that meant lots of meaningless stats were thrown at me in an attempt to justify rather horrible things, I don't believe that stats should be used to treat a patient. It leaves too many people falling through the cracks--men and women. Even if only 5% of FSD (or MSD) are medical, it is a shame to discourage the pursuit of things that would help those people.<P>The best suggestion, of course, is to address both sides of the matter. Since medical issues can lead to psych issues and vice-versa, it's important for women and their providers to know the options. Unfortunately, as you'll see here if you read through the posts, most of us are more up-to-date than our doctors (I am an exception in this, for which I am deeply grateful). Not perscribing treatment or medications based on new theories or technology is, of course, understandable until these things are FDA approved. Not admiting they exist, or even knowing about them to discuss them with a patient, is reprehensible. All to often, that is what we hear on the board. <P>The pendulum, as Zane put it, will swing back and hopefully stop in the middle. In the meantime, I am hoping the coverage FSD is now getting will make more doctors aware of the possibilities on the horizon--both medically and psychologically.<P>

You're quoting a summary of the study article I linked.

I am quoting the opening post of this thread, which may be a summary of the link you posted. Whether it is your summary or theirs, I had (and have, since I've not read it yet) no way of knowing because you didn't specify. You said I misquoted you--I didn't. Actually, I hadn't initially technically quoted you at all, but this is getting off track. <P>My point was that this statement stated that "The results of recent studies indicate that women seeking help for desire disorders exhibit marked signs of mood instability and a low and fragile self-regulation and self-esteem." They generalized and said "women seeking help for desire disorders," which is a problem for me. If they (or you, or whomever summarized this) had said "a high percentage of women," or "some women" or "in many cases women," I'd have left it alone. Sweeping generalizations that lump all women into one catagory are harmful, misleading, and counterproductive, so I took issue with it, regardless of who'se summary it was. <P>As a note, if you are cut & pasting someone else's notes/opinions/etc., it is often helpful for other readers if you put it in quotes, and site the author so we know if it's you or not. If it is yours, you might also let us know that if you think it may be unclear that it is you doing the summarizing/authoring/etc. It would make it easier for us to know how to respond productively.<P>I do have another question on your initial post, actually. What did you mean by: "I've noticed an inordinate number of women with depression and/or anxiety who are seeking help with low arousal and/or desire."? What about it seems inordinate to you? It's fairly well known that depression, and the meds that treat it, are common causes of low-libido and arousal problems. So, I assume the suprise wasn't at the number who complain of it, but the number seeking help? I guess the use of the word "inordinate" here confuses me, and I am wondering if it was simly a misuse of the word, or if you genuinely believe the numbers of women with depression/anxiety seeking help is unreasonable (inordinate: exceeding reasonable limits--Mirriam-Webster dictionary)? Inordinate has faily negative conotations in most circumstances, which is what is confusing me. Could you clarify this further for me? Should these women not be seeking help?<P>