Part 3: Breast-Feeding

This is the third in a series of "Ten Reasons Why Women May Lack Sexual Desire."

In my private practice I frequently will get phone calls from a woman telling me that she has lost her sexual desire and that she thinks she should make an appointment for sex therapy. I can tell from her voice that both she and her mate are eager to solve this concern. But before we even finish setting a time for her appointment, I'll sometimes hear gurgle sounds or crying in the background that tell me there is a baby in her house.

That's when I stop and ask, "Did you recently have a baby?" The answer is usually, "Yes." I will follow up with, "So, while you were pregnant, did your interest in sex vary from what it was before you got pregnant?" She'll often reply, "Oh, yes!"

Some will say that they wanted more and some will say that they wanted less, but very rarely will a recently pregnant woman report that there was no change. That's when I am thinking to myself, "That's the effect that babies have on sex. It will be a while before your sexual interest will be back to whatever was normal before the pregnancy."

I'll also ask if there were any sexual problems before the pregnancy. If the woman indicates that there were some, I usually encourage her to make an appointment to come in with her mate. It's really helpful to both new parents to have a place to vent about all the aspects of their relationship that may contribute to how sex is going for them.

For some women, however, it's really not necessary to set an appointment -- at least, not right away. That's because women with no report of sexual troubles before the birth may simply be at the effect of prolactin. Sometimes a little information is all that’s needed -- that and some patience.

So, here's that information: Prolactin is the hormone that causes breast feeding to happen. It is also a hormone that decreases sexual interest. It is nature's way of trying to put some space between the birth of one child and the arrival of the next. This allows the first child to get some needed nurturing before another one vies for that same kind of attention. Since many women try to breastfeed for two years, it's not uncommon to find children spaced about two years apart (though some child psychology experts with whom I've consulted have recommended three years for the benefit of the eldest child and for the mom who then gets a bit of a break).

So, women who are breast feeding have a natural impediment to having sexual interest. It does not mean that all women will feel this way. But, most do find the thought of sexual contact tough to manage, particularly when they couple the effect of prolactin with getting only four hours of sleep in a row day after day.

Prolactin does not drop back to pre-pregnancy rates the day that breast feeding stops. It may take some time. If, after a few months of no breast feeding (and decent amounts of sleep) a woman does not have an increase in her sexual desire, she can have a prolactin blood test to see what her level is. A physician may recommend treatement with Dostinex (cabergoline) if the level is abnormally high. Of course, it's always wise to see how the couple is doing in their overall relationship since that can have an effect of sexual desire as well.

Don't short-circuit breast feeding. Pediatric experts agree that breast feeding is a pathway to strengthening infant health. I do recommend that couples understand that for the sake of their child, they should adjust their sexual expectations and widen the playing field to allow many sexual options as part of their sexual relationship.

Related Topics: Sex and the Breastfeeding Woman, Sex Drive May Be Swayed by Genetics

Technorati Tags: sexuality, libido, pregnancy, relationships

Part 2: SSRI Antidepressants

This is the second in a series of "Ten Reasons Why Women May Lack Sexual Desire."

The topic of this entry is truly one of the most common causes of lack of sexual desire for women. I encounter it with great frequency in the questions posted on the message board and in my therapy practice as well. It pits some women against some very tough questions: Lose my depression and possibly my sexuality? Or, keep my depression and maintain my sexual desire and function?

Of course, there are some women who have little interest in sex because they are depressed. That is an entirely different situation for them to unravel. It often can require the help of a mental health professional (preferably a sex therapist) to evaluate her situation and create the best path for her to take.

Women who use an antidepressant in the SSRI category (selective serotonin reuptake inhibitor) may sometimes find that their interest in sex (solitary or partnered) has decreased. In addition, there may also be negative impact upon their ability to get aroused or to reach orgasm. Not everyone experiences these difficulties, but enough do that whenever a women presents to me in my therapy practice with lowered sexual desire, I always ask about their use of antidepressant medication.

Sexual researchers are working on this very common problem. There is no ideal solution that works for most people (male or female).

Some women have had some success with using Viagra at the time they intend to be sexual in addition to their other medications. It works for some -- for reasons that we do not yet fully comprehend -- and not for others. Cialis and Levitra have not been explored as often in this manner, but my hunch is that they might offer a similar level of assistance.

If Wellbutrin (bupropion) has not been tried, it might be good to consider it either as a replacement to the SSRI or addition to it. It is a dopamine agonist and that has been found to be somewhat successful in treating women with sexual side effects due to antidepressants. Typically about 100 mg per day is used if it is added on. The woman's prescribing physician would have to be consulted in order to do this. There is good evidence based, scientifically reviewed research on Wellbutrin use for this purpose.

Dostinex (cabergoline), also a dopamine agonist, has also been used, but I have less anecdotal evidence upon which to rely and no scientific research as yet.

In addition to those approaches, a woman with this difficulty (lowered sexual interest and the need to stay on the antidepressant) could speak to her prescribing physician. Robert Taylor Segraves and Richard Balon offer a number of SSRI "antidotes" that have some anecdotal support in "Sexual Pharmacology Fast Facts." Among their suggestions are: Symmetrel (amantadine), Urecholine (bethanechol), bromocriptine, Periactin, (cyproheptadine), Kytril (granisetron), Claritin (loratadine), Prostigmin (neostigmine), phentolamine, Aphrodyne (yohimbine), and Ritalin (methylphenidate).

These antidepressants have a reportedly lower frequency of sexual dysfunction: Bupropion, Mirtazapine, Nefazodone, and Reboxetine. The SSRI antidepressants include: Celexa (citalopram), Lexapro (escitalopram), Prozac and Serafem (fluoxetine), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline).

There are several management strategies that can be tried, but each of these approaches has its limitations.

1. Waiting for spontaneous remission of symptoms or accommodation of symptoms.
2. Reducing the dose to the minimal that is effective.
3. Scheduling sexual activity around the dose.
4. Switching to another antidepressant with a lower frequency of sexual dysfunction.
5. Using other medications such as Viagra (sildenafil).
6. Take drug holidays with a doctor's permission.
7. Addition of the mentioned "antidotes."

As you can see, we are still very much in the try-and-see world with this problem. Pharmaceutical companies are well aware of these issues and will likely be tackling their own type of "solution," so -- stay tuned.


Related Topics: Human Pheromones: Our Love Scents, Married with Kids: Is Libido Lower for Women?

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