Part 1: Oral Contraceptives

This is the first in a series of ten very common reasons why women may find themselves feeling low level of interest in being sexual: Use of oral contraceptives (OCs), otherwise known as "the pill."

Some women find that their sexual drive is decreased by using OCs. This is not always the case. Some women feel so freed up and relieved due to their not worrying about unintended pregnancy that it increases their desire to be sexual with a partner.

But, the unspoken problem (until just two years ago) is that OCs can really have impact on how sexually interested a woman may be. This comes to light particularly when she finds herself in an otherwise great relationship.

When there are relationship issues that decrease sexual desire, the impact of OCs may be blurred and it can become a "chicken and egg" dilemma. Here's how: A woman who goes on OCs can have a decrease in her desire. This can then cause conflict in the relationship with her partner. She and her partner may have no knowledge that the OCs may be responsible, so they start critiquing the relationship and criticizing each other -- all when it is physiological issue that caused the decrease of desire. Without this information, the couple is just going forward logically (unfortunately), but to the detriment of the relationship. And, there may be relationship issues that would have a negative effect even if OCs were not in the picture.

I sure do wish that OCs came with a disclaimer on the outside of the package (as visible as the Surgeon General's warning appears on cigarettes) that reads: "Warning! This may cause a decrease in a woman's sexual desire."

One of the mechanisms that seem to cause this change in sexual interest is connected to a woman's sex hormone binding globulin (SHBG). A rise in SHBG can occur while using OCs. That means that there is more of it. More of it is not a good thing for a woman's libido. SHBG combines with testosterone in a woman's body, the hormone that is largely responsible for sexual desire. That leaves less testosterone "free" in her body to cause sexual desire.

Are there better OCs to try? Ones that minimize that negative effect? I do not yet have the answer for that yet, but when I do, I'll be sure to pass it along here.

Just as a note: Among all the hormonal approaches to birth control (the patch, the shot, the ring, and the pill), some initial studies are showing that the vaginal ring seems to have the least negative impact on libido. Of course, we will look for other scientific studies to support that finding.

So, if you are having lowered libido and are on an OC, do consider trying another form of non-hormonal birth control (IUD, cervical cap, diaphragm, male condom, and female condom -- to name the most common) and see if there is a difference. You may need to allow a few months for normalizing. Have a blood test to measure your SHBG, free testosterone, and total testosterone if after a few months, there is no change in the desired direction.

Of course, always factor in any relationship issues when trying to unravel a situation of low sexual desire.

Related Topics: Boost Your Mood, WebMD Video: Exercises for a Better Sex Life

Technorati Tags: low libido, birth control, oral contraceptives

Top 10 Reasons Women Don't Want Sex

A common theme that runs through questions on the message boards, comments on the blog and other discussions across the Internet concerns the reasons that women are uninterested in having sex with their partners. In future entries at this blog, I'll be expanding on each of these ten common causes:

1. Use of oral contraceptives. Some women will find that their sexual drive is decreased by the Pill (or any of the other hormonal approaches to birth control -- patch, ring, and shot).
   
2. Use of antidepressants. Not everyone experiences a decrease in sexual desire, but many do.
   
3. Breastfeeding. Prolactin (the hormone that facilitates breastfeeding) decreases sexual interest.
4. Lack of sleep. For most women, sleep comes before sex once the relationship has been established.
5. Stress. Due to work, financial issues, educational stress, extended family, and other important issues in life. When stress is increased, many women do not see sex as a solution to it.
6. Disagreements with one's mate. Any relationship will bring with it the challenges of conflicting feelings and desires. That can play itself out in sex.
7. Low levels of free testosterone. While knowing the level of total testosterone in the bloodstream can be helpful, finding out the free testosterone is very essential to discovering the possible physiological causes of low sexual desire.
8. High levels of SHBG. A woman with high levels of sex hormone binding globulin (SHBG), may have low sexual interest. This is because it combines with free testosterone (making it "unavailable") and that decreases libido.
9. Fear of intimacy. The inability to handle the level of intimacy that sex brings and maintains in a relationship is a very common reason for a decrease in sexual desire for one's partner.
10. Body image. Women who view themselves as unattractive to their mate and/or in their own mind's eye.

Some of these issues can be addressed by doing some reading, soul searching, and communicating with one's mate. Others will require the assistance of professional experts such as physicians, labs, and sex therapists.

Related Topics: A Woman's Guide to Reviving Sex Drive, Guide to Perimenopause

Sex, Intimacy, Sleep Apnea and the CPAP

I very seldom say much about my own life on this blog or my message board, but a recent question on the message board about being intimate with a partner who has sleep apnea and uses a CPAP machine has drawn me out.

My husband sleeps with a CPAP also. He began using one when my youngest child was about two. It was quite an adjustment for me. Before my children were born, I could sleep through much noise. I lived in San Francisco for many years and it's sometimes tough to find total quiet there.

But, once my two children were born, my sleeping habits changed. My first child had a very bad case of colic that lasted four months. If he wasn't actually crying in the middle of the night, I would think that I heard him -- even when he was not crying. It got to the point that I could tell (by listening to the monitor) when he was making the preliminary noises before a crying episode. I was learning to "hear more" while sleeping.

Then, at the age of two, he began crying in the middle of the night again -- as much as five or six times. We finally discovered that adenoids and tonsils were blocking his breathing when his throat relaxed during his sleep. Surgery corrected that.

When my next son was born one year later, he was born with laryngomalacia, a condition in which the cartilage in the throat does not stiffen sufficiently. It causes a rattling sound. Sleeping vertically in my arms would stop the rattling for my son. The cartilage hardened at about four months.

At three months, he developed pneumonia. I slept with him (propping him up in my arms for yet a new reason) listening for his breathing. I could not distinguish the laryngomalacia rattling from complications from the pneumonia. I half-slept always with one ear open. This later led to asthma attacks for him.

You get the picture. All of this added up to my now being a generally light sleeper.

Then my husband got the CPAP.

I understand the hissing, the leaking, and the air blowing on one's face. I also understand that once the mask goes on, that is it for the night. Snuggling spoon fashion with my front to his back works. The other way does not.

And, it has made our communication about sex quite distinct. Less "just happens." We talk about it. We get our two kids to bed and have our time. Then we take our positions and fall asleep.

Yes, on some nights I give up and go to the couch because of all the noise. That occurs less now because after six masks, my husband seems to have found the one that fits his face best.

If you're reading this and are experiencing similar changes in your relationship wiht your partner, I want you to know it doesn't have to feel like you've lost something special. Try a few sessions of sex therapy where you share your feelings of loss with your partner.

I suspect that with some creativity and some willingness to communicate very directly, you can revive some aspects of what once was. It won't be like it was, but it can be much better than it is now.

Related Topics: WebMD Video: A Solution to Sleep Apnea?, 10 Tips to Get Better Sleep

Technorati Tags: sleep apnea, CPAP, intimacy, relationships