The Whole Lesbian Sex Book (8 page)

Physicians can also closely monitor patients to find the precise dosage that ameliorates the symptoms of depression while minimizing adverse side effects. Landing on a treatment that works for you can take months of persistent effort—no small task for someone suffering from depression.

Health-care practitioners have come up with other creative solutions as well. Some recommend testosterone for women used in conjunction with an SSRI. Small doses of testosterone can add a bit of zip to the libido, they say. Likewise, some women who take an SSRI report an increase in libido when it is combined with Dehydroepiandrosterone (DHEA), an adrenal hormone used by bodybuilders. (DHEA use has also been linked to acne and mood swings.) There hasn’t been sufficient research on DHEA or testosterone to know whether long-term use by women will lead to other health problems.

You can try Viagra and other recent drugs developed for men. Researchers have begun studying the potential of Viagra to help women who report negative sexual side effects from SSRIs (or “iatrogenic serotonergic antidepressant medication-induced sexual dysfunction,”
¹⁷
to those in the know). Viagra will not give you back your sense of yourself as a sexually whole person. But it may help you achieve physiological arousal and orgasm. (See “Does Viagra Work for Women?” in chapter 4, Orgasm.)

Some women who suffer from depression have found it helpful to combine lower dosages of an SSRI with Saint-John’s-wort or other herbal and nutritional remedies such as yohimbine and ginkgo. Others have abandoned SSRIs altogether, favoring herbal alternatives. (See “Herbal Supplements,” below.)

You might be helped by combining standard treatments (like medication and psychotherapy) with alternative strategies, such as light treatment
¹⁸
and acupuncture.
¹⁹
In one study of acupuncture as treatment for major depression, more than half of the women in the study achieved full remission.
²⁰

Others may find nutritional counseling (for instance, aspartame has been linked to depression in those predisposed to it
²¹
), exercise, meditation, and spiritual work as helpful as transitional medical treatments:

In the past, I often found myself in the vicious cycle of getting depressed (for whatever reason, girlfriend-related or not), then losing my sex drive, then being depressed because I have no sex drive. I talked to a few doctors about it, and they told me to regulate the foods I ate, and wanted to put me on medication, but I decided to meditate my way to a better outlook (which also reflected on my sex drive), and it’s worked surprisingly well.

Of course, decisions regarding management of depression should be made with the help of a health-care practitioner who is knowledgeable about the available treatments and respectful of the needs of lesbians, bisexuals, and transsexuals. For many of us, that is easier said than done.

Finding Help

Most physicians spend less time learning about human sexuality—roughly 12 hours of classroom instruction—than you spent learning to drive a car. Homophobia may creep into the doctor/patient relationship in a variety of ways. Your physician may downplay your concerns about your sex life. She may feel uncomfortable talking to you about sex between women (or any sex at all). Your physician may view lesbians as not sexually “active”—since they presume we’re not having sex with men. More subtly, it might be assumed that if you’re not partnered, you aren’t interested in having sex.

Herbal Supplements

Herbalists can rattle off a long list of remedies for low libido and other sexual problems: Siberian ginseng, motherwort, ginkgo biloba, fenugreek, black cohosh, wild lettuce, and wild oats (as in “sow your wild oats”).

Many herbal and other plant-derived supplements (called
phytochemicals
) are marketed as sexual enhancers. Some have been studied in controlled research settings, others not. Often studies focus on erectile function in men; we have to extrapolate. Will an herbal remedy purported to help men get erect help women get erect? Get engorged? Get off? The lack of research or understanding of how these remedies work—or whether they work—doesn’t discount the fact that some women find them helpful. But it does make it harder to know what to try.

Three herbals often associated with sexual functioning in women are ginseng, yohimbine, and ginkgo biloba. Ginkgo biloba has long been known to support circulatory function; that may explain its helpfulness in promoting physiological arousal. In one recent study, ginkgo biloba extract was found to “alleviate symptoms of antidepressant-induced sexual dysfunction related to all phases of the sexual response cycle”—in both men and women.
²²
Recent research suggests that yohimbine may help with antidepressant-induced anorgasmia. Ginseng is reported to enhance sexual drive.
²³
And motherwort is said to help with lubrication.

Commercial supplements often make vague promises of “enhanced libido” or “enhanced performance.” Sometimes it’s unclear what aspect of sexual functioning they are trying to ameliorate.
²⁴
Does this product promote orgasm? Sensation? Lubrication? Overall sexual energy?

Don’t underestimate herbal and other plant-derived remedies. Humans have a long history of making use of phytochemicals to ameliorate all sorts of troubles and to support healthy functions of the body. That they are powerful also brings with it a caution. Some of these have strong side effects or may produce adverse reactions when taken in combination with antidepressants and other medication. Some may include Saint-Johns-wort; if you are already taking an antidepressant, watch it. Others may promote estrogen production or contain phytoestrogens; if you have breast cancer and have been told to avoid isoflavones, stay away from these. Consult a healer knowledgeable in herbal remedies, such as an acupuncturist.

Susun S. Weed has an encyclopedic knowledge of herbal remedies for women. Her website (
www.susunweed.com
) features articles on women’s heath and information on the Wise Woman Center, located in upstate New York, where she offers workshops.

Generally, these are supplements one takes daily for a period of time. They don’t work like Viagra—you don’t take ginseng and get wet half an hour later.

Of course, many health-care practitioners do quite well with lesbian, bisexual, and transsexual patients—especially since so many of us fill the ranks of the health-care industry. Now that sexual side effects of antidepressants have gained such notoriety, many health-care practitioners have become quite comfortable discussing libido and medication. Whether you’re seeking the help of a psychiatrist, physician, or therapist, the best strategy for reclaiming your libido is to find someone who will work with you. Here are some questions to ask yourself when choosing a health-care professional:

• Do you get a gut sense that this practitioner will treat you respectfully—regardless of your gender identity or sexual choices?

• Do you feel comfortable talking to this practitioner? Does he listen to you?

• Does this practitioner have other lesbian, bisexual, or transsexual patients or clients? Who’s recommending this individual?

• Is the practitioner qualified to answer your questions regarding the best course of treatment for your depression?

• How many hours of formal training in human sexuality has this practitioner received?

• Does the practitioner support you in prioritizing sexual satisfaction in your sex life?

Resources such as Kink Aware Professionals (
www.bannon.com/kap
) provide referrals to health-care professionals who are sensitive to the needs of lesbians, gays, transsexuals, sex workers, and S/M and fetish devotees. The Gay and Lesbian Medical Association (
www.glma.org
) offers referrals to queer-friendly physicians in the U.S. Local announcements lists, like San Francisco Bay Area’s BA-Sappho, are also sources of referrals. The resources section of this book lists many helpful contacts for those seeking support and care. Your local women’s, transgender, or queer community center may also provide referrals to health-care professionals.

Illness and Disability

Any disability, medical condition, or medical treatment that affects blood pressure, blood flow, muscles, or nerves can affect one’s ability to orgasm. These may include diabetes, multiple sclerosis, spinal injuries, and high blood pressure. Nerve damage can affect the sensitivity of the clitoris, making it either numb or too painful to touch. Some women suffer from oversensitivity. For seemingly no reason, their clit or nipples are too sensitive to be touched at all. Conditions like attention deficit disorder (ADD) that interfere with one’s ability to concentrate can make orgasm difficult.

Surviving cancer and the treatments for it can affect sexuality. Many women who undergo chemotherapy experience a chemically induced premature menopause, with all the associated symptoms, like loss of vaginal lubrication and elasticity.

Hidden disabilities like fibromyalgia, chronic fatigue, and crohn’s disease can have a particularly frustrating impact on sexuality. Feeling fine one day but experiencing genital touching as painful the next can make it very difficult to sustain interest in a sex life.

Often the first sign of arousal many of us notice is lubrication. So, if we don’t lubricate, we may not “feel” aroused. Lubrication, of course, is affected by our menstrual cycle, aging (with the loss of estrogen in menopause, many women lubricate less), and medications—even antihistamines can dry you up.

If you aren’t lubricating, you may think you’re not turned on. What to do? Well, for starters, invest in your sexual pleasure by purchasing some lube. (More on lube in chapter 17, Sex Toys and Accoutrements.) Second, start noticing your other signs of arousal. Do your nipples harden and become more sensitive? Do you feel a fluttering in your belly? Can you feel your PC muscles contract?

Finally, ask yourself how
you
feel about your capacity for pleasure. Want to come faster? Want to take longer? Want to have deeper, more satisfying orgasms? Want to come even one time in a night? What’s important is that
you
develop your sexuality in directions that bring you the most pleasure—regardless of what others may think or what you’ve been told is possible for you.

Perimenopause and Menopause

I’m finally admitting that my sexuality (or at least how I express it) is changing as I get older. That my desires are getting more interesting as my physical sensations are changing. I’ve become more diffuse. I find more aspects of women—and myself—erotic. It’s less about this act or that act, more about nerves and skin…it’s just more.

How do our sexualities evolve as we get older? What is the relationship between fluctuating hormone levels in midlife and sexual energy? How do hormonal changes affect blood flow and genital engorgement? Nipple sensitivity? Clitoral sensitivity? Overall skin sensitivity?

Some women experience reduced sensitivity to stimulation and difficulty reaching orgasm:

Yes, the older I get, the harder it is for me to have orgasms. I also don’t think they are as strong or satisfying as they used to be.

Others report just the opposite—intensified sensitivity and stronger orgasms:

My breasts are very sensitive, more so now that I’m going through menopause. I like fingers, but gently, and it can’t go on for too long or it starts to irritate me.

How much of libido is hormonal, anyway? Many women
do
experience a drop in libido during menopause—though many do not. One study followed 326 women aged 35 to 47 for four years. Less than a third reported decreased libido.
²⁵

Hormones aren’t alone in influencing sexual energy during perimenopause and menopause. The editors of Power Surge (
www.Power-Surge.com
) report: “A drop in libido at this time in a woman’s life may be due in part to physical changes that can occur at menopause, including hormone changes, changes in vaginal tissue and lubrication, fatigue, sleep disturbances, hot flashes, night sweats, and increasing general health concerns. Mental and emotional contributors include stress, changes in body image, relationship issues, and changes in sexual expectations.”
²⁶

When the challenges to libido are so complex—and interconnected with such complexity—what can you do? There are some factors you can suss out: You can have your thyroid tested (unrelated to menopause, but an easy problem to rule out). You can get a blood workup and check your hormone levels. You may discover a hormonal deficiency.

But it’s unlikely you’ll be able to trace your lowered libido, difficulty reaching orgasm, or other sexual concern to a single cause. Instead, focus your attention on ways to sustain and support your sexual well-being. And there are many:

• Masturbate—often, daily if possible. Frequent sexual stimulation will help keep your libido going. Susun S. Weed writes, “My Rx for low libido is 7 orgasms a week, whether you feel like it or not. You can do one a day or all in one day. Continue for at least 3 months.”
²⁷

• Keep a sexuality journal. Track your erotic highs and lows. How often do you masturbate? Have you noticed changes in sensation? Orgasm? In your fantasies?

• Talk to your partner. One woman wrote, “I had a hot flash during sex about a week ago and I was embarrassed (not sure why), but I still had a wonderful time. I think being with a woman who’s close to me in age helps. Just talking about it helps.”