The Oprah Winfrey Show
Advice for Wives Who Don't Want Sex


The Doctors Answer Your Questions

The response we received from last week's show was overwhelming. Now, Laura Berman, Ph.D. and Jennifer Berman, M.D., are here to answer your questions from your discussions on the message boards.

Question 1: I will be 23 in March and sometimes feel as if I could do without sex. The other night my partner asked me if we could have sex, and in the back of mind I was trying to come up with a master plan to avoid sex that night. So, I picked an argument. My partner puts so much pressure on me to make sure I have an orgasm that I have been faking them so he could have an orgasm, and we'd be done. I am so afraid to tell him that I just don't have the drive for sex. I don't know what to do. Can someone please help me?

The Bermans' Answer: It sounds like you are really struggling with this problem, and believe us you are not alone! Many women feel the pressure to fake orgasms in order to protect their partners' feelings. However, this leaves them feeling isolated and alone, and often leads to anger and resentment. It is important to separate the issues of desire and sexual response. The fact that you are not interested in sex in general may very likely be the basis of your lack of response (or vise versa). If you want to bring this issue out in the open with your partner, but are not sure how to do so without hurting him or causing an argument, here are some tips:

1) Bring the subject up when you are in a peaceful moment together. Don't wait until he is trying to be sexual with you or when you are arguing about this or anything else.
2) Tell him how you feel. That means focusing on you, not him. Explain to him that while you love him and find him attractive, you feel: (a) cut off from yourself sexually in a general sense (b) a lack of sexual drive overall (c) a lack of genital sensation (d) or whatever scenario applies.
3) Tell him how important it is for you that he understands that the feelings you are struggling with are not related to him.
Share with him your fears about losing him, explain to him your desire to please him, and make him feel appreciated. Let him know how much pressure you feel to reach orgasm and how that may actually make it harder for you to respond. If you are finding that the conversation isn't going anywhere or he is having trouble hearing you, you may want to consider sex therapy, ideally as a couple. You should also consider a medical evaluation just to make sure that there is not a physiological basis for your complaints, such as low genital blood flow, low testosterone, or nerve/vascular injury.

Best of luck and keep us posted.

Question 2: I have the same problem that everyone else is talking about! I noticed that after had my last baby, which was 10 lbs. and 16 years ago, that I no longer was able to have an orgasm. I have told many doctors but they don't seem to really care. The last doctor that I told did run a testosterone test on me and it was a little low, but I am on blood thinners and he said that if I take testosterone it can mess up my blood thinners. Just wondering if there's anything else I can do.

The Bermans' Answer: Thank you for your question. Unfortunately, many doctors are still under the opinion that if women are able to have sex, they are considered functional — it doesn't matter if they enjoy it! We can not offer you any personalized advice about testosterone replacement without evaluating you in person. However, there are many different forms of testosterone replacement (creams, gels, patches, lozengers, pills, etc). There certainly are numerous potential side effects that women and their doctors should consider (such as weight gain, acne, hair growth, voice deepening, clitoral enlargement, high cholesterol and potential liver damage). The main thing is to not take 'no' for an answer from your doctor. It may help to seek a second opinion from a well-respected physician in your community who may have another perspective. The main thing is not to give up and keep the lines of communication open, not only with your doctor, but your partner as well. Best of luck!

Question 3: I have been with my husband for 19 years and have two great children. I have found that my desire has decreased as the years have gone by. I feel that our relationship would be fantastic if there wasn't sex hanging over my head, but I really don't know if I have lost my desire completely or if I've just lost my desire for him. And if so, what that means?! And how do you find that out without committing adultery and wrecking a good marriage? Believe me this is not said lightly, as I really am confused.

The Bermans' Answer: It is clear you are struggling with this and that it is causing you significant confusion and distress. Your comments are not taken lightly and we are so glad you brought that important point up. You are not alone. Many women suffering with both low desire and sexual response difficulties consider infidelity in order to determine if the blame lies in their partner or in themselves. More often than not they are devastated when the problem persists with another partner, or when their partner finds out, or when they disclose it to their partner, just to name a few possibilities.

It is unlikely that this will help you find the answers you are looking for. If it is your relationship or your partner, on some level you know it. You may not be clear on all the pieces of the puzzle, but you do already have some sense in your heart... you just have to look there. It is important, however, that you get some help — both medically and emotionally. You should think about being evaluated for testosterone levels as well as other medical causes (Remember:Testosterone declines slowly throughout the lifecycle).

It would also be useful to talk to a therapist (either alone, but even better with your partner) to determine what relationship or emotional factors are at play. For instance, where should your desire really be after 19 years of marriage? Is the issue that you are having trouble adjusting to the "attachment" you feel toward your husband instead of the "infatuation" you felt so long ago? Is there a way to readjust your perspective on him and the relationship, which would open you up more sexually? Are there things he could be doing to help? These are just some of the important questions you should be addressing with him in a safe environment with a trained therapist.

In any case, these are just some places to start. We wish you the best of luck, and if there is anything else we can do to help, don't hesitate to let us know.

Sincerely,
Laura and Jennifer Berman
Co-Directors, Network for Excellence in Women's Sexual Health
Co-Directors, Female Sexual Medicine Center, UCLA Medical Ce:wqnter, Los Angeles, CA


If you are considering any kind of treatment, remember to always consult with your doctor to come up with the best plan for you.

Check back next week when the doctors answer more of your questions from your discussions on the message boards.

Find out more about Doctors Laura and Jennifer Berman at their Web site www.newshe.com.