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Men's libidos remain strong no matter how pressured they feel. Not so for women, whose sexual response is much more nuanced and complicated, it turns out. But skipping sex is not a healthy solution, warn social scientists, who have ideas about how to help.
Carolyn, 44, a married education professor at a university in Northern California, likes the idea of sex. She says it makes her feel attractive and she appreciates how it brings her closer to her husband, Jeffrey. But when it's 10:30 at night and he gives her those bedroom eyes, "I cringe inside," she says. "I feel bad, but having sex is often the last thing I want to do."
The problem, she says, is that the competing demands of her life -- a fast-paced career, an hour-long commute, two school-age kids with packed schedules of their own, hours of volunteer work in their classrooms -- take a steep toll on both her energy and her libido. Last year Carolyn started getting up at 4 a.m. to grade her students' papers, but she admits it's not a happy solution. "Now I'm tired and cranky as well as stressed -- especially at night. My brain must be going a million miles an hour, worrying about all the things I haven't gotten done, and I just can't shut it off," she says ruefully. "That's not exactly an aphrodisiac."
Jeffrey, 51, is sympathetic -- up to a point. He, too, has a stressful job (as a psychologist at a state mental hospital, where he often puts in 10-hour days), a long commute of his own, and never-ending projects on their fixer-upper house. None of that, however, puts a damper on his sex drive. "When I'm stressed, sex is what I want most, because it's completely relaxing," he says. "I could be outside in a snowstorm surrounded by a pack of hungry wolves and I'd still be in the mood. So it's hard for me to understand why she can't just let it go."
Carolyn and Jeffrey are a contemporary version of the Jack Sprats. They have incompatible appetites -- for sex. It's a problem that, by many accounts, has reached epidemic proportions across the country.
Low desire affects at least one partner in one of every three marriages, according to marriage therapist Michele Weiner Davis, author of The Sex-Starved Marriage: A Couple's Guide to Boosting Their Marriage Libido (Simon & Schuster, 2003). "Research seems to suggest that about 20 percent of married couples have sex fewer than 10 times a year," she says. "There's no prescription for a healthy sex life, but I think it's safe to say that at that rate there's probably one unhappy spouse who wishes for more."
Unfortunately, most studies show it's women who are likely to lose that loving feeling. In a national survey of more than 3,000 people between the ages of 18 and 59, researchers at the University of Chicago found that 22 percent of women have low sexual desire compared with just 5 percent of men. Since then, thanks in part to the success of Viagra and similar drugs among men, doctors and researchers have set about uncovering the physical causes of women's sexual lows.
But the problem has proved stubbornly resistant to quick fixes, leading a growing number of experts to believe that the cause may lie not in our bodies but in our overextended, overstimulated and overscheduled lives. When Carol Rinkleib Ellison, a clinical psychologist in Oakland, California, surveyed more than 2,600 women for a recent book, Women's Sexualities (New Harbinger, 2000), she found that, of the 1,600-plus participants who said they had a major sexual concern, 34 percent named lack of desire as the No. 1 issue -- a problem that many blamed on fatigue and emotional overload. "Clearly, there's not a pill, cream, or spray that's going to cure that," Ellison says.
Men's sex drives seem to be less affected by outside pressures. Researchers at The Kinsey Institute for Research in Sex, Gender, and Reproduction, in Bloomington, Indiana, recently found that stress and anxiety lessened desire for 28 percent of the 919 men they surveyed, but they also found that nearly as many -- 21 percent -- said it actually increased their interest in sex.
"Men are more likely to see sex as a stress reliever, whereas for many busy women, their husband's desire is just another demand on their time and energy," says Alice Domar, PhD, director of the Mind/Body Center for Women's Health at Boston IVF.
When one partner back-burners sex, experts say, it almost always creates marital tension. "Sexual rejection feels personal," says Weiner Davis. "You know you still love him, but he may not be so sure."
Such couples are also missing out on a primary method of bonding. "Jeffrey and I are nicer and more tuned in to each other the day after we make love," says Carolyn. "Maybe it's because we've shared something that we don't share with anyone else."
Experts agree that physical intimacy breeds emotional intimacy. "When it's scarce, couples stop kissing hello, sitting next to each other on the couch and laughing at each other's jokes," says Weiner Davis. "You can't afford to be complacent about a ho-hum sex life."
Researchers trying to tease out the complex interaction between stress and desire have found that everyday hassles and upsets can wreak havoc with hormones. Cortisol, a hormone secreted during stressful situations, is essentially a chemical messenger that tells your brain you're under siege. As it goes up, levels of testosterone, which fuels libido in both men and women, may go down, according to Robert Sapolsky, a professor of biological sciences and neuroscience at Stanford University and author of Why Zebras Don't Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases, and Coping (W.H. Freeman, 1998).
Men's libidos may be less affected by stress than women's because they have about 20 times more testosterone than women do to start with -- way more than they need to feel amorous, especially when they're young. So even if your spouse's sex drive takes a big hit from stress, chances are he's hardly running on empty. Men's testosterone levels do drop about 10 percent each decade after 50, causing about one in 10 between the ages of 50 and 60 to suffer from low testosterone levels, which can cause diminished interest in sex.
It's far less clear how much damage a stress-induced testosterone drop does to women. Studies have shown that women with abnormally low levels of testosterone suffer from low sex drives. But researchers at the University of Pennsylvania, in Philadelphia, who followed 326 women between the ages of 35 to 47 for four years and measured their hormone levels every eight months found that women who reported decreased libido had testosterone levels similar to those with normal sexual desire. The researchers, who reported their findings this past March, did find there is some evidence of a testosterone-desire connection, however: Women who had the greatest variation in testosterone levels -- a condition that could be triggered by stress -- were four times more likely to report decreased libido.
If such fluctuations undermine desire, the long-awaited testosterone patch would appear to be the perfect antidote because it releases a low, controlled dose of the hormone. Indeed, Procter & Gamble recently announced remarkable results from the third phase of its study of the patch, which, if approved, could be available for prescription sometime next year. The 562 women in the study, ages 26 to 70, who had low sexual desire and low testosterone levels as a result of having both ovaries removed, experienced a 56-percent increase in sexual desire as well as a 74-percent increase in the frequency of "satisfying sexual activity."
Unfortunately, experts warn, the results may not translate to premenopausal women. "Everyone is talking about testosterone as if it makes this huge difference in sex drive, but if you look at the data carefully there's very little evidence that the average woman without a true testosterone deficiency will benefit from it," says Neil Goodman, MD, professor of medicine at the University of Miami School of Medicine, in Coral Gables, Florida.
In fact, unlike the success of Viagra among men, most attempts to find a pharmaceutical fix for low libido in women have been fruitless. After eight years of research and testing, Pfizer announced in February that it was abandoning its effort to demonstrate that Viagra might boost women's sexuality. That doesn't mean researchers are giving up on either gender, however. Some groups, for instance, have pinned their hopes -- and research dollars -- on PT-141, a new drug that purportedly helps both men and women feel randier, all with a quick whiff or two of a nasal spray.
The failure of Viagra among women, however, made sex researchers realize just how much their sex drives differ from men's. When men are physically aroused, they crave sex (and vice versa). Obvious, you say. But even when a woman is physically aroused, she may not feel desire. "You can increase all the ingredients involved in female arousal, you can even produce clitoral engagement and vaginal lubrication, but a woman still isn't going to want to have sex if she's feeling overwhelmed and thinking about the 18 things she has to do the next day," says Sandra Leiblum, PhD, director of the Center for Sexual and Relationship Health at the Robert Wood Johnson Medical School, in Piscataway, New Jersey. In other words, women's libidos exist almost solely in their heads, not their bodies.
If desire is more psychological than physical for women, it's not difficult to understand why stress would result in the body's sexual boycott. "Stress is an enormous mental distraction," says Daniel Amen, MD, coauthor of Healing Anxiety and Depression (Putnam, 2003).
Studies have found that when women are preoccupied, especially with negative thoughts, they're less interested in sex. In one intriguing study, researchers at the State University of New York at Buffalo had 48 adults listen to a scripted audiotape of a sexual encounter where the man and woman made mean, inflammatory comments to each other. Seventy-nine percent of the women participants said they would have become so angry in a similar situation that they would have ended the encounter; a similar percentage of men said they would have felt angry but that it wouldn't have interfered with their sexual activity.
"Men are better able to compartmentalize their emotions, especially when there's the prospect of sex on the horizon," says Dr. Leiblum. For that same reason, it may be that women find it more difficult to tune out distracting thoughts when it comes to making love.
"Aside from a reasonable lover, the main ingredient of good sex and orgasm is attention span," says Dr. Amen. "Fact is, you're simply not going to be able to get into sex if your mind is somewhere else." Indeed, researchers at Ball State University, in Muncie, Indiana, found that women who say they're easily distracted during sex are less satisfied by the experience in general and more likely to fake orgasms than those who are mentally engaged. And unsatisfying sex can make you less likely to seek out sex again, further depressing an already-flagging libido.
Good sex, on the other hand, will make you want more -- one reason therapists like Weiner Davis are advocates of the "just do it" school of sex therapy. She and others point to new research showing that women's sexual response cycles are different from men's and warn that if women wait until they feel lustful to have sex, they may be waiting a long time. "Many women and even some men -- particularly those who have been married awhile and are juggling work and family -- don't experience spontaneous sexual desire," says Dr. Leiblum. "But if they can relax enough to be intimate with their partner -- to start kissing or stroking -- then they get turned on." In other words, desire actually follows arousal, rather than the other way around.
As a result, the most effective strategies for rekindling the cooling embers of passion are to create a climate in which your knee-jerk "not tonight" becomes a "maybe." For most people, that means taking active steps to shed stress and make a conscious shift into a slower, sexier mind-set. Carolyn says that massage is most effective for ridding her mind of clutter and feeling more relaxed, but she doesn't ask her husband for one very often because she feels bad about never reciprocating. Jeffrey was surprised to hear that. "I don't mind, really," he told her. "If it helps you, I'm happy to do it." Several nights later, Jeffrey offered Carolyn a massage, she accepted, and voila, they segued quite naturally -- and happily, Carolyn says -- into a romantic interlude.
"You don't need to be dying to have sex every time you and your partner start to kiss," says Dr. Ellison. "Just agree to touch each other and see where it leads." You'll probably be happy you did.
Originally published in Ladies' Home Journal magazine, November 2004.