Your partner will lie on his back as you do a front caress and genital caress to arouse him. When he becomes erect, climb on top of him and begin peaking and/or plateauing, using his penis to pleasure yourself. As you reach the higher peaks or plateaus (levels 7 and 8), stimulate your clitoris with your fingers. Masturbate to orgasm by stimulating your clitoris as your partner strokes the inside of your vagina with his penis. Notice the added sensations you feel with simultaneous masturbation and intercourse. With some practice, you will need less and less direct clitoral stimulation with your fingers, and your ability to have an orgasm will transfer to the stimulation of intercourse. Because you receive stimulation both on your clitoris and deep inside your vagina, this exercise may allow you to experience one of those “blended” orgasms I mentioned in Chapter 2.
There are a few variations on this exercise. Both work best if you are on top. Ask your partner to stimulate your clitoris with his fingers instead of doing it yourself. Or either one of you can use a vibrator or dildo to stimulate your clitoris during intercourse. You can also practice alternating peaks with a dildo, your fingers, your partner’s fingers, and your partner’s penis.
Using Fantasy to Trigger Orgasm
Many women are able to have orgasms through their fantasies alone, or during periods of REM sleep. Here are a few suggestions to make that more likely to happen for you:• Fantasize while you are doing any exercise that involves self-touch.
• Read or look at erotic visual material while you do any self-touch exercise.
• Fantasize before you go to sleep, but don’t finish the fantasy. Go up to the point right before you have an orgasm. Then go to sleep. You may wake up having an orgasm.
• Read erotic materials or look at sexually explicit materials right before you go to sleep. You may wake up in the middle of the night having an orgasm.
All of the above activities can help you reconnect with your ability to have an orgasm with very little genital contact. Many of us had that ability when we were children and have simply forgotten how to do it.
chapter 28
Healing Low Sexual Desire
Unlike most of the previous chapters in Part IV, this chapter does not contain specific exercises to treat the condition listed in the chapter title. Instead, I’ll point out how and when some of the exercises from other chapters can be helpful for increasing sexual desire. Much of the material contained in this chapter is more theoretical in nature, although toward the end of the chapter I make many very specific suggestions for increasing sexual desire.
This chapter is largely geared toward women. That’s not to imply that men can’t experience low desire, too. And, of course, men can follow the suggestions offered here. But in my experience, low sexual desire in men is usually caused by one of about six things: low testosterone, anxiety, depression, use of prescription drugs, work-related stress, or the prior existence of other sexual problems such as premature ejaculation or erection problems. Women’s desire problems tend to be more complicated.
Understanding and Dealing with Low Sexual Desire
If you are experiencing low sexual desire, you should begin your healing process by doing the relaxation and breathing exercises in Chapter 16. Try doing them on a daily basis. You should also do the sexual fitness exercises in Chapter 17. It’s especially important to make sure your PC muscle is in good shape. In addition, do the self-touch exercises in Chapter 18. The exercises in those three chapters can often jump-start a person’s sexual desire. Other than that, no specific progression of sensual and sexual exercises exists to help heal low sexual desire, as it does for erection problems, female arousal problems, and most of the other sexual dysfunctions. Low sexual desire is not a dysfunction as such. By this I mean it’s not that the genitals aren’t working right. Low sexual desire is more of a psychological issue.
Having said that, absolutely the first thing you should do if you are experiencing low sexual desire is to have your testosterone level checked. This applies whether you are a man or a woman, and it applies no matter how old you are. It is especially true if you have experienced desire in the past and are not experiencing it now, and it is also especially true if you noticed that your level of sexual desire seemed to decrease abruptly for no reason that was obvious to you.
If you are a man and you are found to have low testosterone, the hormone can be administered to you in various ways. It used to be given in the form of a shot, but that method made it difficult to regulate the level of hormone in the person’s system throughout the day. The goal is to have a steady level of testosterone throughout a twenty-four-hour period. Now testosterone is mostly administered in the form of a skin patch that is attached to the scrotum and that continually releases the hormone.
If you are a woman with low testosterone, the situation is a little more complicated. Women don’t need as much testosterone as men, but they need some. I know that some forms of hormone replacement therapy combine estrogen and testosterone, but hormone therapy is usually used only for women during or after menopause. Unfortunately, we now know that administering estrogen after menopause may have some serious side effects. A new herbal preparation called Avlimil is available that supposedly enhances sexual desire in postmenopausal women. I don’t have any experience with it, but it might be worth asking your health-care practitioner about it.
Another solution may be to use the testosterone skin patch that men use, applying it on an area of the lower body such as the buttocks. For many women, however, the patch may prove to be too strong and may cause masculinizing side effects such as hair growth and acne. A number of testosterone-based creams have recently come on the market. Designed to be rubbed onto the thigh area, they are formulated by compounding pharmacies based on the needs of the individual woman. Effects will kick in after about two weeks of use. If I were a woman experiencing low sexual desire due to a testosterone deficiency, I would definitely consult an endocrinologist about the possibility of having a custom-made hormone mixture designed for me.
If you are a woman, it will help to recognize a few really important things about low sexual desire so that your expectations are in line with reality. First of all, women regularly undergo many hormonal events throughout their lives that can have profound effects on their sexual desire. One is pregnancy, which the majority of women in the world go through at least once. Pregnancy and its aftermath (childbirth and breastfeeding) can affect a woman’s sex drive in a number of ways. Many women report that they experience increased sexual desire during some phases of pregnancy, but many women report a sharp decrease in sex drive right after childbirth, especially if they breast-feed. There are a number of reasons for this. Pregnancy and childbirth greatly affect the body’s hormone levels. And if you breast-feed, you secrete more than the usual amount of oxytocin, the so-called bonding hormone. Oxytocin can temporarily suppress testosterone. Many new mothers experience a sharp decline in sex drive due to a combination of lack of sleep, feeling out of shape physically, and the change in self-image from “hot babe” to “mother.” Many women become extremely upset after childbirth when their sex drive fails to return right away. The reality is that it can take as long as two years for it to return to normal. The good news is that, like postpartum depression, hormone-based loss of sex drive is temporary. It will come back; it just takes time.
Another hormonal event that women undergo that can affect their sex drive is menopause. Unlike men, women do not maintain their fertility throughout their lifetime. Somewhere in her forties, a woman’s estrogen levels start to drop, and by her early fifties she has usually stopped ovulating and stopped having menstrual periods. Some women report a decrease in sex drive during this process, which is not a one-time event but lasts for several years. Again, this decrease in sex drive is usually temporary.
Men also appear to undergo hormonal changes starting in their late forties. The major differences between the so-called change of life for men and for women is that women can no longer conceive, but
men are more likely to experience behavioral sexual changes such as erection difficulties, less urgency to ejaculate, or decreased desire. Surprisingly, most research shows that menopause does not usually affect a woman’s ability to become aroused or have orgasms.
Women who take birth control pills (oral contraceptives) may also notice a decline in sex drive after several years of use. This is unfortunate because oral contraceptives are so effective at preventing pregnancy. The drop in sex drive related to oral contraceptives can be a serious problem, and many women have opted for a different form of contraceptive in order to restore their sexual desire to its former level.
If you are a woman, there is another important thing you need to recognize about low sexual desire. This one has to do with societal expectations about women’s sexual behavior. Our definition and diagnosis of low sexual desire is highly influenced by a woman’s relationship status. We tend to think that women are only likely to consider low sexual desire a problem if they are in a relationship. In this case, of course, the symptom would be that a woman lacks interest in having sex with her partner. Our stereotypical view of the woman with low sexual desire is usually a woman in her fifties who has gone through menopause and has been with the same partner for over twenty years. But single women can also experience low sexual desire. If you are a single woman, it’s really important for you to recognize the difference between sex drive (the physiological component) and sexual desire (the psychological component). If you don’t have a current sexual partner or love interest, you could still feel “horny” due to your testosterone level. You might experience this feeling as an urge to fantasize, masturbate, or look at erotic materials. It’s also normal when you’re single to feel a high level of sex drive but at the same time to have a low level of sexual desire, and that’s not a clinically significant problem. In fact, if you don’t currently have a partner, a strong libido can be a curse, because it’s really frustrating to be horny and have no one to have sex with. So you need to ask yourself, “Do I really want to increase my sexual desire?” It might be better to just put it on hold for a while. I believe that women who are between partners should maintain a basic level of sexual functioning by using self-touch and some combination of daily sensual activities like massage and PC muscle exercises. You want to be ready when the right man comes along. But there is nothing wrong with you if you experience a drop in sexual desire when you are between men. That’s completely normal.
Are there drugs that have been shown to increase sexual desire? Not really, in any reliable sense. Health food stores sell herbal preparations that purport to increase desire. If they have any effect at all it’s probably due to the placebo effect: expectations. None of these substances have been scientifically tested and found superior to a placebo.
In terms of the effects of drugs on sexual desire, what you’re not taking is more important than what you are taking. We have already seen that oral contraceptives can lower sexual desire. Commonly prescribed antianxiety agents, such as Prozac, Paxil, Zoloft, and other, similar drugs, are also notorious for decreasing sexual desire. This class of drugs is called the selective serotonin reuptake inhibitors (SSRIs). If you have problems with sexual desire, you should never take any of the SSRIs.
There are no specific sensate-focus exercises that are designed to treat low sexual desire. However, you can still use this book, because many of the exercises that work well for other sexual problems also work especially well for low sexual desire. If you are having a problem with low sexual desire, after you have started practicing the relaxation, sexual fitness, and self-touch exercises, begin to work with your partner on the basic partner exercises (the face caress, the back caress, the front caress, the genital caress, and oral sex).
A funny thing sometimes happens in sex therapy with couples who are experiencing low sexual desire. I might ask them to do the basic partner exercises, and after either the genital caress or oral sex, the couple comes into my office looking kind of sheepish. I ask them what is wrong and they say, “Well, after the genital caress, we were feeling so good that we went ahead and had intercourse, and it was great!” Often, if your sexual desire problems are due to overwork and poor time management, the basic sensate-focus exercises are essentially your “cure.” It’s not so much that these exercises increase desire as such. It’s more that making time to spend with each other in a place free of distractions increases desire.
That’s why, for couples who are having problems with low desire due to stress, overwork, and any of the lower-level causes I described in Chapter 5, the standard advice from sex therapists is to schedule a weekend together free of distractions and plan to have sex all weekend. This will actually work if your problems aren’t too serious, especially if you start slowly, using the basic sensate-focus exercises and massage as foreplay before you proceed to intercourse.
If you and your partner have gone through the five basic sensate-focus partner exercises and still feel that your desire level could use a little more of a boost, the peaking and plateauing processes are dynamite for low sexual desire, because they boost your production of endorphins, the pain-killing and pleasure-causing brain chemicals. Endorphin production is extremely reinforcing, in that it leads you to desire sex more the next time.
Detailed descriptions of the peaking and plateauing processes appear in this book in Chapter 23 (from the male point of view) and Chapter 26 (from the female point of view). If you want to use peaking and plateauing to heal low sexual desire, do the following: 1. Do a peaking exercise with manual stimulation with the man as the focus, then do the same with the woman as the focus.
2. Do a peaking exercise with oral sex with the man as the focus, and then do the same with the woman as the focus.
3. Do peaking exercises in the different intercourse positions with each partner as the focus.
4. Do intercourse peaking exercises in which the man and the woman alternate peaks.
5. After completing these exercises, follow the same progression with plateauing exercises: Use all of the different forms of stimulation, all of the different intercourse positions, and all of the different plateauing techniques.
If you do two exercises a week, this progression of exercises will keep you busy for quite a while. I guarantee you that at some point in this process you’re going to look at each other and say, “I can’t believe this. I’m feeling sexual again.”
The guided activities and exercises in Chapters 34 through 37 will also help you. They don’t progress in a particular order, so read through them and choose whichever ones appeal to you.
More Suggestions to Jump-Start Your Sexual Desire
This section describes other factors that have been reliably shown to increase sexual desire. Many of them don’t sound overtly sexual. We could probably call this section “Things that don’t seem like they would increase your sexual desire but do.” I put the list together from many different sources. Especially helpful was the book Why We Love, by Helen Fisher (see Recommended Reading), but I’ve arranged the material according to my own take on sexual desire.
Actually having sex is probably the most important thing you can do to increase your level of desire. The problem is, most people don’t want to have sex if they don’t feel like it. But it’s okay to have sex even if you don’t feel like it, and it can boost your desire for the following reason, which has to do with attitude-behavior relations. An attitude is a positive or negative evaluation of something. Most people believe that the attitude-behavior relationship is a one-way street. We have a positive attitude about a certain behavior and then we do the behavior. And, of course, for most of us it does work that way a lot of the time. The seeds of behavior are often attitudes or intentions. But it can also work the other way around. Behavior can precede attitude. If you actually do a behavior even though you don’t feel like it, it can cause you to have a more positive attitude about the behavior in the future and to want to do it again.
An example that’s relevant to
sex is physical exercise. How many of us have vowed to start an exercise program on the morning of a certain date, and then when that morning came along, we didn’t feel like getting out of bed and going to the gym? If you actually start exercising even though you don’t feel like it, after a few sessions you will start to like it. That’s why personal training is so popular. Once you’ve been motivated to start that first behavior change, you’ll like it so much you’ll want to stick with it. And the same thing is true of sex.
This next suggestion may be a little harder to implement. Being in love usually causes an increase in sexual desire. Besides heart-pounding excitement, some of the other factors that are involved in being in love include uncertainty about the nature of the relationship and artificial barriers to being together. This one is a little tricky, because obviously you love your partner, or you wouldn’t care about jump-starting your sexual desire. But your relationship may have reached a stage where the love you feel for each other is more a companionate or friendship love than wild, sexual passion. You can help bring some of that passion back into your life by injecting a small element of uncertainty into your relationship—a bit of playing hard to get, for example. You could also create minor artificial barriers to being together and then overcome them.
Here’s one way to create a small artificial barrier to being together: If your partner asks whether you would like to go out for dinner on the weekend, instead of readily agreeing, you could hesitate a moment and then say, “Can I let you know tomorrow? There’s a possibility I have something else to do that day.” Then just agree to the date tomorrow. This creates enough uncertainty to pique your partner’s interest.
You can play hard to get sometimes when your partner asks you to have sex. You can say, “Talk me into it. Tell me everything you want us to do together and how it’s going to feel.” You fully intend to go to bed with your partner, but you put him or her off for a few minutes, during which he or she has to plan some sexy activities and talk you into them.
Sexual Healing Page 33