Today the Journal of the American Medical Association (JAMA) published research that suggests women who experience sexual side effects from the use of antidepressants may obtain relief by taking sildenafil (Viagra).

For the thousands of women who take antidepressants, decreased sexual desire is a huge problem. The Women’s Sexual Health Foundation, of which I am editor of the organization’s Women’s Sexual Health Journal, has been surveying the problem through an on-going internet poll.

All of this information is sure to cause a huge buzz among those of us who treat women with sexual problems. On one side will be feminists like Dr. Leonore Tiefer, who argue that women’s sexual problems cannot be treated with a pill. On the other, physicians who genuinely want to help their female patients with, well, a pill.

Having worked in medical settings and in my private practice with women (and men) who experience sexual side effects from antidepressants, I don’t think the answer lies in entire answer lies in the use of a pill, either. I think it lies in the way in which we treat depression, and the way in which we understand women.

This is a big, complicated topic, too big, perhaps, for a blog. But doctors tend to hand out antidepressants like Pez, medicating situations that need and deserve to be explored in therapy. So that’s the first problem right there. Some people absolutely need medication. But all people in that group also need psychotherapy. And then there are those who do get tripped up by life–perhaps a job loss, or the traumatic death of a loved one. If they have trouble climbing out of a dark mood after a few months, then they may also benefit from medication–and psychotherapy.

The largest group by far, those with mild depression clouded by longstanding automatic negative thoughts (”ANTS”) can be helped with psychotherapy alone. This group, however, often receives Pez instead, with the belief that it’s just easier. Given the potential sexual and other side effects, it’s quite clear that it’s not that easy at all.

The fact is, too often it is physicians–GP’s–who are prescribing medication. Psychological issues are often much deeper than lay people–including, dare I say it, physicians–realize. In my ideal world (never gonna happen, but you can view it anyway), all folks who visit the physician for an antidepressant would get a recommendation to have an evaluation by a mental health professional. Going further, they would all be required (definitely never gonna happen) to have 6-12 sessions of cognitive behavioral therapy.

But remember I said that it’s complicated? Well, of the women who go on antidepressants and have sexual side effects, how many of them do you suppose had pre-existing sexual concerns? You don’t know, do you? Well, neither do I. But I’m guessing it’s a large number. And who knows, maybe some number of women are going on antidepressants because they cannot have an orgasm, or are inhibited, or were sexually abused and cannot enjoy sex. I know I recently treated a woman who had been treated for deep depression who realized that part of the reason she was so depressed is because she couldn’t have an orgasm. Think about that–never experiencing something that comes naturally, like being able to laugh or cry. I wonder if anyone–physician or psychologist–had ever asked her about sexual function.

So we could go in all kinds of directions with the thoughts generated by this one small study. I’d love to hear what you think–I invite you to comment, and I’ll write more on this topic, based on my own ponderings as well as any comments I receive.

By now you’ve surely read about the 16 (possibly more) girls in Gloucester, MA who made a pact to become pregnant. This is so strange and so wrong on so many levels. Becoming pregnant to create comraderie isn’t unusual; growing up, I was friends with the sons and daughters of my mother’s friends, because they had been pregnant around the same time.

It’s the age and context that are so troubling. Jamie Lynn Spears just gave birth; how could she not have influenced the girls in their choices? Don’t we hear over and over again how influential the media is?

But do we really heed the message? I don’t recall hearing anyone talking about how Spears’ life would change. We saw how it changed her sister Britney–from rock idol to shattered young mother. Magazine articles make celebrity motherhood sound all too easy, and very unlike reality.

Working actresses have choices that the Gloucester girls most likely do not. They can take time off from work; they can hire help. Whether they marry or not seems to be of little consequence.

Statistics about teen pregnancy tell a very different story. Teen girls tend to have premature and underweight infants. They struggle to finish school or earn a living. Children raised by single mothers are more likely to end up in poverty.

All of these issues have become embroiled in conservative ideas about abstinence. Obviously, these girls didn’t hear that message, making them no different than the scores of other girls who become sexually active, on average around age 15.

It’s all pretty sad, isn’t it?

If you have a teenager, this is a great time to talk about your views on premarital sex and pregnancy. Truthfully, it’s a conversation that should have begun in childhood, but better late than never. And if you can’t bring yourself to do it, enlist the help of a physician, nurse, or even a sex therapist.

A recent article in MSNBC addresses the issue of intimacy for returning veterans. Being injured neurologically and physically can have major impact on adjusting back to civilian life, and one of the areas not spoken about is how those will regain the intimate emotional and physical functioning they had before being deployed. One couple who experienced this first hand has started to speak publicly about this issue since it’s an important topic that veterans may be embarrassed to talk about or their doctors feel bringing it up would cross the line, but whatever the case it’s there and not only effects sex, but also, relationships in general. Due to having to adjust to their changes, the injured encounter new insecurities that may hinder their previous and future relationships, but with the right information and tools this can be helped.

According to DailyMail, pelvic floor exercises are a drug-free alternative that involves contracting of the pelvic muscles and brings the same results as Viagra, but without the side effects. This muscle, known as the pelvic floor, goes from the tailbone all the way to the pelvic bone having an important role when it comes to, not only having sex, but also controlling other daily functions that use that area of the body. According to one urologist, those who can have an erection, but are unable to keep it will be successful at this exercise, which we teach at The Buehler Institute. Check out the article to read about one mans successful experience with this.

This is a tough topic, but it’s been on my mind for weeks so I’ve decided to go ahead and tackle it.

It’s the subject of weight. Specifically, overweight. Now, anyone who knows me knows that I am, well, plump. There. Now you know. That being said, I have some endocrine problems chasing my number up the scale.

Last month I started using a medication that is supposed to bring that number down. Twice a day I have been injecting myself with Byetta so that I can be at a healthier weight. It’s pretty radical and I wouldn’t do it unless my metabolism wasn’t so slow. So believe me, I understand weight and have empathy for those who have that struggle.

It is heartbreaking to me when a married or partnered client comes, usually alone, to tell me that the real, secret reason they are no longer sexually attracted to their partner is because of weight gain. Usually, it isn’t just a matter of 10 or 20 lbs; most people seem to understand that as we age, weight may go up a bit.

No, what they complain about is a gain of 50 lbs. or more. They will show me the “pot” that their partner now has, modeling with their hands. And they all say the same thing: I love my partner, but they just got too darn fat. (more…)

I’m so excited! Next spring I will be speaking at “Reclaiming Healthy Intimacy, Passion, and Pleasure” in New York at a function sponsored by The Women’s Sexual Health Foundation and Columbia University. I edit the foundation’s newsletter, which is run by Lisa Martinez, a nurse and attorney. Lisa is one of the most energetic people I know when it comes to promoting sexual health. Visit the foundation’s website and read some of the past newsletters.

Want to learn more? Then check out this story in Best Life Magazine, where I am quoted along with my colleague, Dr. Michael Krychman, on low libido.

Last week I received a mailing from a company that manufactures a supplement that they claimed helped women with their sex drive and men with their erectile function. Their research? None! In fact, nearly every member of one organization to which I belonged received the same mailing. We all get upset when we find out that someone is selling a product that has no research to back it up. In fact, two people from the organization contacted the company to discover that not even the CEO could say why their product worked.

Buyer beware. Pills from China, herbs from India, etc. are probably not going to fix what ails you. See a physician, see a sex therapist, but please get real help.

In an article from the New York Times a human papillomavirus vaccination for boys may come by 2009. Although recent media has advertised this vaccination for girls, human papillomavirus, or H.P.V. for short, is a sexually transmitted disease that can cause cervical cancer and genital warts in both sexes. The ethical debate over this brings about the same questions parents had for the vaccination for girls, such as parents explaining to their child why they should get this shot whether or not they’re sexually active. Another factor contributing to this is the threat of oral and anal cancers from H.P.V. Keep in mind that this STD can affect gay, straight, young, and old people. So it’s not surprising that three other countries are a step ahead of us having this already approved for boys.

In an article from USA Today over two dozen colleges have put the opposite sex as a preference for incoming students filling out their student housing application, and more are adding themselves to the list. According to some students it’s not about sex, but parents don’t see how sexual tension wouldn’t arise from this living situation. College housing rules have changed over the decades, which may account for this difference in opinion. Step further is an option practiced by some colleges, one being nearby UC Riverside, are couples living together. What do you think?