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Birth Control

want to dedicate this month’s column to the abundance of new and improved contraceptive choices now available to women. Such was not always the case. Reliable contraception (the Pill) did not arrive until 1960. Before then, women relied on nothing more than bulky and fragile condoms, the unreliable rhythm method, and good luck to avoid unwanted pregnancies. Hasty and unhappy marriages resulted when those methods failed and many young women’s dreams of education and career terminated because their pregnancies could not—Roe v Wade did not grant women sovereignty over their bodies until 1973!

How different is our personal landscape today. The new millennium rang in scientifically sound methods of birth control our mothers could not even imagine. We have pharmaceutical choices as well as barrier methods, and better understanding of our bodies’ subtleties resulted in us even more reliable natural methods of conception control. Though this column outlines the newest and brightest stars on the pharmaceutical scene, I encourage you to explore all your options and make your decision in concert with your partner(s) and your health care provider(s).

So what’s new? There’s a lot of buzz about the new low-dose pill named Seasonale that allows us freedom not only from worry about unintended pregnancy but also from more than four periods a year. Another option is Lybrel, a low-dose estrogen and progesterone pill taken every single day, eliminating periods altogether and therefore the attendant fluctuations of our hormonal cycles, a boon to those who suffer PMS, migraines, acne, etc. It will be available to us here in Canada next year.

Don’t want to bother with taking pills at all? Or worried that you may forget to take them every single day? A smoker over thirty-five? Not to fret. Perhaps you’d be interested in trying the NuvaRing, a slim, flexible circle you insert into your vagina once a month. It releases a low dose hormone that mimics the effect of the oral contraceptive. What could be easier?

Actually, I have an answer to that. If you have already given birth to a child, you may want to consider an IUD. I can hear you now, complaining of the cramping and the long bloody periods. But, wait. IUDs aren’t what they used to be. The Mirena is an easy-to-insert model that releases just enough progesterone to keep you from becoming pregnant while keeping your periods cramp-free and light in volume. Gone are the days of the Dalkon Shield, recalled like a bad Buick. Women now have real choices about how to regulate their fertility and their menstrual cycles, and they can do so with a high degree of confidence about their physical safety. Hallelujah!

But, you say, you’re not in a steady relationship and you require birth control protection only irregularly? Yes, we have answers for you, too. You might want to investigate the spermicidal sponge. Wasn’t that around years ago, you ask? Yes, it was. Seems water at the plant that manufactured the Today Sponge was contaminated and, rather than invest in the necessary cleanup, the company closed the plant. Consumer demand being what it is, the competition began marketing knockoffs and now even the original Today brand sponges are available, but only in Canada. Note well: the effectiveness of the sponge is severely compromised in the presence of yeast-fighting medications, and it works far better in women who have not borne a child.

Add to these recent additions the pharmaceutical storeroom of condoms, diaphragms, cervical caps, contraceptive jellies and foams, natural family planning methods, ‘traditional’ birth control pills (makes me smile), IUDs, and sterilization methods for men and women (some reversible), and we can appreciate how vast are our options for choosing conception. If given proper information, each of us can be responsible for our body and treat parenting as the privilege it should be. Could it be that those who carried placards in the ‘60s bearing the Utopian ideal “Every child a wanted child” might see their dream realized? Science and education could make it so.

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Fluid Bonding

This month’s Hot Topic is wed to our case study because a therapy session prompted the theme for this column. I spoke with a woman, Pam, who came to see me about two years after her divorce. She felt she had completed her grieving process and had recently begun to date again. She was moving cautiously and trying to make good decisions.

She was concerned about how to broach the topic of safe sex with new partners. She knew not to have unprotected sex “in the beginning”. But “When,” Pam wailed, “does the beginning end? And then what? Help!”

I asked if she understood the concept of fluid bonding and how it can guide her safely through new sexual relationships. She shook her head. She admitted the topic confused and embarrassed her. I assured her that most of us feel that way and I shared these basic guidelines with her:

When we have sex with a new partner, we use barrier protection. Sex is defined as any activity in which we exchange body fluids capable of carrying viruses and bacteria. Those fluids include blood, semen and, to a lesser extent, vaginal secretions. The roles of saliva and tears are still being debated but, in any case, they are far less risky. Barriers are materials that prevent the transmission of those fluids. They include condoms, dams, and plastic wrap.

In the beginning of a sexual relationship, we use barrier protection during sex every single time with every single partner. No exceptions!

When a casual sexual relationship becomes more committed and we wish to dispense with the barriers during sex we discuss (yes, that means using our words) beginning a fluid bonding contract.

Each of us goes to a doctor or clinic and gets a full battery of tests to screen for STIs (sexually transmitted infections). Ask your doctor or clinic which tests are advisable or go online and educate yourself. Sometimes regional considerations will affect your decision – for instance, you may be advised to test for a particular strain of hepatitis recently reported in your area.

Our fluid bonding contract begins when we both get back clean bills of health. Because many “bugs” need time to show up – including HIV – we count six months from this date, retest, and if our next set of tests are also negative, we can safely dispense with barrier protection when we have sex with each other.

It is important to note that the contract applies only to the two people who have had both sets of tests and have had only protected sex during that time. If these criteria are met, we can joyously and responsibly become fluid bonded, meaning there is no danger of transmitting or acquiring an STI from one another through the exchange of sexual fluids.

When I finished this explanation, Pam replied, “Six months after we both get tested clear? Are you nuts?” I admitted that six months feels like a very long time to be fussing with barriers when we are busy establishing a trusting relationship and falling in love. It is a time of frequent lovemaking, and the last thing we want to be thinking about is viruses.

We are adults and we must make adult decisions. On one hand, we may be protecting against nothing at all. On the other hand, we may be protecting against a lethal disease. Do we want to ask the questions that will help us determine how much risk we believe we are taking? If our new lover has been in a (probably) sexually-exclusive relationship for many years prior to being with us, our risk could be minimal. If our new lover has been with a number of partners, however – or even with only a few, but was not practicing safe sex – then our risk rises. And then there’s our own history, and how much of it we want to share – and how honest we are about it.

So, you see, the fluid bonding contract and its cautious time-line allows us to skip those dodgy conversations for the first six months while we are learning about each other. Keeping ourselves and each other pristinely safe is a respectful way of maintaining clear boundaries about how much we need to tell. Most of us have judgments about sex and most of us fear other people’s judgments about our own sexual activity, so we can’t always trust that we’re hearing the truth. With things as important as our health and our new relationship at stake, six months really doesn’t seem so long to wait.
The point is that the fluid bonding contract is a template that ensures our mutual sexual health. We each get to decide how we behave within that framework. The tragedy is in not knowing our risks and responsibilities and unwittingly putting ourselves in harm’s way. Sex is an adult game and is surely fun to play, but there are rules. When we play by the rules, we have just as much fun and fewer consequences. Here’s to both!

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Depression? Which Depression?

We’ve all been depressed. We use the term often and loosely, describing sadness or unrelenting lethargy or any point in between. Many take prescription medications to alleviate its symptoms while others self medicate with alcohol, drugs, or bad behaviour. We grudgingly exercise to lift depression’s cloud, or we pull up the covers and watch TV reruns. Some sit before mammoth lamps during the SAD (seasonally affected disorder/depression) months while others seek therapy. Depression is a stern master and regaining our composure after a long ‘down’ period may involve experimenting with all these (and more) techniques.

Why is it so difficult to treat depression?

According to Dr. Jugenburg, part of the problem is in our definition of the term. In fact, there are two distinct depressions: situational and clinical. Situational depression is temporary, appropriate, and predictable. In situational depression, we are reacting appropriately to a life event; when we experience loss, we feel sad. To recover, we navigate the stages of grief and wait for time to heal our wound. There are no pills or potions to heal a broken heart.

Clinical depression, on the other hand, has quite different features. Its onset may not correspond with life events, its affect varies from person to person, and it is often unrelieved by time. Clinical depression finds its roots in our complex soup of brain chemistry. Serotinin, our ‘feel good’ hormone, becomes disrupted, causing us to feel depressed. This depression is alleviated with pharmaceutical enhancers (SSRIs and the older tricyclic medications) to address the physiological symptoms and with talk therapy to tackle the emotional lows associated with the condition. It’s a working combination, and we now know that antidepressants and talk therapy in combination is the treatment of choice for clinical depression, the two together working better than either does alone.

Neither depression grants immunity.

When assessing depression, we must remember that both situational and clinical varieties can occur in tandem. Folks suffering clinical depression face losses of course, and grieve in response. By the same token, those in the throes of grief can develop the clinical form (in fact we may be more vulnerable during those periods). The combination of situational and clinical depression is a real double whammy and requires sensitive attention from both the therapist and the health care professionals to tease out effective solutions and support systems.

It would be so much easier if we called the two depressions by different names, for then we could explain better how we feel and know better what might help. We can distinguish between sunburn and birthmarks, for instance, even though we understand they are both skin conditions, treated differently. Sadness is evident in both situational and clinical depression, but its roots, treatments, and outcomes vary. Unrelenting discouragement and paralyzing grief benefit from professional help, regardless the cause. If you are stuck in a grief pattern, or if you just can’t shake that ol’ blue feeling, invest in an assessment. Suffering may not be optional, but it can certainly be minimized. Ask for help.

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Assumptions, Resistance and Responsibility

Both as a sexologist and as a therapist I am trained to avoid making assumptions about the attitudes and behaviours of any person or people. I’ve learned to ask questions so that clients feel safe revealing their truths early, and I gather as much pertinent information as necessary with as few questions as possible. It’s one of the reasons that sex therapy is brief and often brings relief quickly.

This speed, though efficient, relies on an absence of assumptions, and sometimes those can sneak through even the most fortified filters. This happened recently, and proved to be a valuable “a-ha” for me. Let me share the lesson I learned (again).

A couple came to see me to improve their sexual communication and negotiation. They defined themselves as being in love, being happy, and being swingers. They did not identify swinging as a problem, for had both been ‘in the scene’ for some time and were informed and honourable. I made an assumption. I assumed that because they were savvy about swinging that they practiced safe sex, a major tenet of the group. It was several visits before I learned that was not the case. When I asked “Why not?”, the clients responded that they believed STDs didn’t affect their ‘class’ of people. I offered accurate information about who can catch sexually transmitted diseases, which is everyone, and given this knowledge, they chose to change their behaviour.

I was troubled by my assumption, which caused me not to ask the question about safe sex early. I wondered how it was that they’d missed that vital piece of information.

I began to ask others about safe sex and found that many of us want so badly to believe we are invincible that we deny the risk. I heard from a sex educator that she, herself, had briefly practiced unprotected sex following a painful separation. She knew full well how crazy her behaviour was, yet felt compelled to dare chance. Besides, it was so unfair that sex, perhaps our most passionate activity, should be so consequence-ridden!

I understand that. No one would argue that dental dams and condoms enhance sexual pleasure. We think “we’d rather not, thank you”, but we must. Before the advent of the pill in 1960, sex was so fraught with consequences that our whole social dance formed around harm prevention rather than damage control. If we had sex before 1960, our chances were good that we’d get pregnant. It effectively kept women from enjoying our sexuality, at least until menopause, by which time our sex-negative messages were firmly entrenched anyway. We were robbed! And no less for men, forced by unintended pregnancies to wed unwitting and unwilling. Many abandoned their posts. Many lived lives of quiet desperation. Now we have AIDS, which is cruel and fatal. Who wouldn’t rebel if they could!?

I believe that rebelling against safe sex guidelines is one way we fool ourselves into believing we can outwit fate. Many of us refuse to take responsibility for our sexuality, pretending that we’re not planning to have sex, or that we were swept away on a wave of romance. It’s the myth responsible for our soaring teen pregnancy rate and epidemic STDs. Couple this with inadequate and incomplete public sex education and sexual and relational messages we get from media (I can’t remember a couple mentioning safe sex on TV or in the movies), and we’ve got a recipe for fear and ignorance, not great components for managing our sex lives well.

Of course we’d rather not have to bother with latex and chemicals, but if we want to claim the privileges of sex (wonder, power, desire, arousal, connection) then we must pay the cost, which is that we protect our bodies and those with whom we share them. We must question our assumptions, resist our fear of claiming our sexuality, and take responsibility for this most wonderful of expressive gifts, sex.

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Masturbation and Sexual Health

A well known piece of advice from urologists for men with recurring or chronic prostatitis and/or who might be at increased risk of developing prostate cancer is to have more ejaculations by masturbating.

From the New Scientist Print Edition (16 July 03):

“It will make you go blind. It will make your palms grow hairy. Such myths about masturbation and stronger erections are largely a thing of the past. But the latest research has even better news for young men: frequent self-pleasuring could protect against the most common kind of cancer.

A team in Australia led by Graham Giles of The Cancer Council Victoria in Melbourne asked 1079 men with prostate cancer to fill in a questionnaire detailing their sexual habits, and compared their responses with those of 1259 healthy men of the same age. The team concludes that the more men ejaculate between the ages of 20 and 50, the less likely they are to develop prostate cancer….”

Masturbation is perhaps the singular sexual activity in which almost all of us participate and about which almost none of us speak. It wears a shroud of shame and silence. Many believe it is an infantile activity, to be replaced with the more ‘mature’ intercourse as soon as adulthood is reached. Masturbation guru Dr Betty Dodson has this to say about masturbation:

“Sex will change throughout your life. After hot, romantic sex, there will be the sweetness of early married sex, the mystical quality of procreative sex, and the comfort—or boredom—of long-term monogamous sex. Most of you will get divorced and have another phase of hot romantic sex, and run the cycle again. Those of you who are lesbian or gay will follow a similar pattern. A few of you might go on to explore sex in depth, getting beyond conventional sex roles and labels, and experiencing bisexual threesomes and group sex. But take note! The most consistent sex will be your love affair with yourself. Masturbation will get you through childhood, puberty, romance, marriage, and divorce, and it will see you through old age.”

How fortuitous that the Giles study now reinforces the value of masturbation. Regardless of our societal attitudes, we must now admit that regular self-pleasuring ensures good prostate health. We’ve known since the 1940s, when Dr. Alfred Kegel developed pubococcygeal (PC) muscle exercises to counteract incontinence in middle-aged women. That PC muscle strength also enhances women’s orgasmic response (yoni eggs provide similar result, here’s more about it: yonieggs.co). In other words, masturbation is good for all humans, at all stages of life. Research now confirms that our genitor-urinary health depends upon it.

Perhaps we shrink from embracing masturbation because we believe we are not entitled to sexual pleasure unless someone else gives it to us, thus relieving us of personal responsibility. This excuse explains not using safer sex techniques, poor judgment in our sexual behaviour, and a host of interpersonal miscommunications. Many unnecessarily forego the gratification of vibrators and other sex toys to protect their partners’ egos. Such unnecessary inhibitions!

Masturbation is natural, normal, and (now we know) healthy. Almost all of us do it. We need, as responsible sexually-aware people, to stifle our shyness and talk with our partners about this most basic and universal of sexual behaviours. Urinary continence, prostate health, and lifelong pleasure…it really should be an easy sell, don’t you think?

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Masturbation Protects Against Prostate Cancer

For the past few centuries, masturbation has had a bad reputation, first as sin and later as sickness. Even since the sexual revolution of the 1960s, solo sex has been viewed as somehow ‘less’ than partnered sex. It is the butt of bad jokes and rarely discussed as a serious subject.

A new Australian study is putting this traditionalist stance on its head. Now we know that masturbation is not only universally practiced, but it is scientifically linked with improved health for men throughout their lives. No longer can informed mothers chastise their sons for playing with themselves, threatening consequences of bodily ruination. Masturbation actually seems to help prevent one of the most serious threats to male health, prostate cancer.

Boys and men have always masturbated, and will continue to do so. What is newsworthy about this research is that we now can validate that the practice promotes physiological as well as psychological health. Surely in all but the most conservative pockets this news will free males to enjoy the pleasure they find in masturbation as well as in partnered sex.

A snippet from the headlines states that:

“The Cancer Council Victoria in Australia has just announced the results of a study into the relationship between prostate cancer and ejaculation in men. Published in the British Journal of Urology International, the results of the study show there is evidence that the more frequently men ejaculate between the ages of 20 and 50, the less likely they are to develop prostate cancer. The research suggests that the protective effect of ejaculation is greatest when men in their twenties ejaculated on average seven or more times a week. This group were one-third less likely to develop aggressive prostate cancer when compared with men who ejaculated less than three times a week at this age.”

No longer must masturbation be seen as a second class activity. And with the lifting of censorship around self pleasuring will hopefully arrive the acceptance of physical pleasure in many realms. Regular readers will not be surprised to hear me lament our culture’s fear of pleasure. How often do we see people (mostly women) cover their mouths when they laugh, as if to hide from view the ‘slip’ of humour? We shy away from ‘too much’ fun, fearful we will ‘lose control,’ regardless the source of the pleasure. Add our nervousness about things sexual and the stakes get outrageously high.

It is not coincidental that the treatment for premature ejaculation, a major sexual concern for many men, is based upon masturbatory exercises that focus not on the denial of pleasure (if that method worked, there would be no premature ejaculators, for they all try that before seeking the help of sex therapists), but on the recognition of and sensitivity to that very pleasure path. If this study (more will surely follow) helps to encourage parents to educate their sons about the nature and benefits of regular masturbation, adult men will suffer far less with the consequences of rushed self-pleasuring. Of course, their future partners will benefit as well.

This study reinforces what many of us have long suspected: that pleasure, even (or perhaps even especially) sexual pleasure, is good for us, not bad for us.

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Humans and Touch

Many of you will be familiar with Desmond Morris, a zoologist with a penchant and talent for viewing the world with the eyes of an anthropologist and sociologist. He has written scores of books, perhaps most notably The Naked Ape. He has also penned a series of works with self-explanatory titles such as Cat Watching, Dog Watching, and (the unfortunately titled) Man Watching, each informative and captivating looks into animal behaviour and its interpretations. Dr Morris also wrote a much less popular book, Intimate Behaviour, which examines the touching behaviours of humans. I read this many years ago, and forget much of what it contained, but I remember clearly Dr Morris’s look at the ingenious and creative methods we use to acquire touch when it is lacking in our lives.

Obvious techniques include visits to massage therapists, who calm and comfort us with their laying on of hands. Morris suggests other less apparent avenues are estheticians (who hold our hands during manicures and caress our faces during facial treatments), chiropractors, and physicians. This need for human touch, Morris explains, drives lonely people to appointments with their family doctors for complaints that in happier times would not require an office visit. Surely stress and depression are correlated with physical complaints. It makes sense to me that our unconscious would steer us to venues where someone would touch us and ask us how we are feeling.

I was surprised with Morris’s observation that we seek our hairdressers in times of deprived touch. True enough, getting a haircut (or in ‘olden’ times, a shampoo and a set) requires our heads being touched, and few would argue about the delight of having our hair shampooed and fussed over. When women were expected to have long hair, doting husbands and loving children could sometimes be found giving Mum’s hair its daily one hundred strokes. It was often the subject of magazine illustrations focusing on the happy homemaker. When those same women were sad or depressed, they went shopping for a new hat (days were that women did not leave the house with their heads uncovered, a tradition still observed in some conservative cultures). Though hair length has changed, we still spend daily time and attention on doing our hair. Our choice of style, colour, and texture signals the world about our personality, age, and heritage.

We would be alarmed, and would quickly react, if a stranger touched our head. On the other hand, a lover running fingers through our hair can bring a host of pleasant emotions signalled by sighs, moans, or a catch in the breath. Our heads must touch to kiss or to whisper in a friend’s ear. Cradling another’s head in our arms is an act of mercy and tenderness. Resting our heads on someone else’s shoulder is an unmistakable mark of trust.

I think we under-rate the value of touch in general, and propose that each of you pay attention to how good it feels to massage your scalp the next time you’re lathering your shampoo. Brush your hair with intent, noting the sensations and emotions that repetitive stroking can bring. Dedicate some time to luxuriating in the intimacy of brushing, stroking, scratching – whatever feels delightful. Share the treat with friends, lovers, children. I bet we’ll all feel better for it.

I’d love to talk more with you about this topic, but I’ve got to run – I have an appointment with my hairdresser!

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Prostate Cancer: Over 50? Male? Please Read This.

– Originally published on DrKoop.com

Prostate cancer is not a subject we want to talk about….or think about, for that matter. Still, as with many diseases, early detection is the key to survival, and awareness of our risk factors promotes testing before the appearance of symptoms. All men past the age of fifty should get tested annually. For those of African-American heritage, the age of first testing drops to forty. This is true also for those who have a close relative with the disease, for that factor increases risk two to five times.

The test itself is called a PSA, for Prostate Specific Antigen. Although it detects only about half of all cancer cases, it is still the best screen available. With an uncertain or elevated PSA result, most doctors will recommend a biopsy and/or ultrasound. The biopsy involves a probe equipped with a needle being inserted into the rectum (more embarrassing than painful) and a series of six to twelve samples being removed from the enlarged prostate gland. This is uncomfortable and awkward, but no more so than the annual mammograms women endure. And of course, it is just as life-saving. Other diagnostic alternatives are MRIs, a painless procedure requiring 45 to 60 minutes, and CAT scans, which use contrast dye to map the growth of the gland.

If cancer is found, the treatment options include radiation, hormone therapy, and surgery. During radiation, much like receiving an x-ray, you will be immobilized and subjected to noisy equipment. Still, it is painless, fast, and has minimal side effects. A bone scan, a twenty minute procedure, may be suggested to determine if the cancer has spread. You may also hear the term brachytherapy or seed therapy, a one-hour, out-patient treatment. Hormone treatment is particularly effective in treating prostate cancer. It reduces the size of tumors in 90% of men and is the only effective systemic treatment yet known. The side effects are lowered libido or sex drive, increased weight, hot flashes, diarrhea, and nausea. Exciting research is being done in the area of chemotherapy, and scientists hope that in another five to ten years this will be the treatment of choice.

Prostate surgery refers to prostatectomy, or removal of the prostate gland. This 2 ½ to 4 hour operation causes temporary loss of bladder control. You will need to wear a catheter (a tube inserted through your penis and into your bladder) for a couple of weeks following surgery, and you will need to relearn bladder control during the convalescent period. This is usually successful, as only 25% of men remain mildly incontinent and only 2% never regain urinary control. Maintenance of sexual functioning, the ability to attain and maintain erections, is dependent on whether nerves can be preserved during surgery. You will not know this outcome until your healing process is complete.

What will you need following treatment or surgery? It goes without saying that you locate a physician in whom you have confidence, and with whom you can discuss your situation openly, including your sexual concerns. Support groups are available for you, and men report that they are invaluable in helping to navigate the turbulent waters of such a distressing diagnosis. Do research on prostate cancer, its treatments, and its effects. Talk with other men and with the women in your life – you do not need to go through this stoic and alone. The rates of prostatic and breast cancer are comparable, making this an area where men and women can support and educate each other. Both breast and prostate cancer have the same mortality rate as well, and the key to survival is the same: early detection and prompt intervention if trouble is found. Do not wait. Book your appointment for a PSA and a physical examination today. You’ll be glad you did.

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Antidepressants and Women: The Sexual Side Effects

– Originally published on DrKoop.com

Antidepressants can bring sunshine back into a life filled with gloom. They can help us cope with the inevitable ups and downs of life. They can restore us to balance, even out our sleeping and eating patterns, and turn
desperation into calm. Few would argue their value.

No drugs, however, are without side effects, and antidepressants are no exception. A new breed of the drugs, called SSRIs (selective seratonin reuptake inhibitors), are better tolerated by most and produce fewer
troublesome side effects. Sexual function is impacted, though, even by SSRIs. If we are prescribed these drugs, we must educate ourselves about how they will affect us, both positively and negatively. The relief brought by antidepressant therapy may be tempered by unwelcome sexual changes.

For women, desire and arousal patterns may be unaffected or even enhanced. It makes sense that when we feel better, we more easily respond to erotic stimuli. As we reconnect with those around us, we welcome
sexuality once again. We glory in the feelings that have so long been subdued and gratefully embrace desire. With depression lifted, we rejoice as our bodies remember the pleasure of sexual connection and arousal. It is true that our sexual response patterns may be altered, but for most, arousal is attainable and consistent.

It’s not all good news, however. SSRIs often affect our orgasmic response. What this means in practical terms is that, although we are feeling like life is being restored, we are reconnecting with those we love, and we
are experiencing desire and arousal again, orgasm may be elusive. We get close, closer, closest…..but can’t experience release. If we make a chart of a sexual encounter, we see something that looks like a mountain. Orgasm is the peak. SSRIs tend to leave the mountain intact, but shear off the summit. At first, we may not mind, for we have recaptured, after all, the ability to make the invaluable human connection that sex is. But repeated ‘failures’ to enjoy orgasm are frustrating, and our partners may react as well. We ask ourselves, “What’s wrong with this picture?” The answer is that antidepressants may alter the response pattern so that orgasm simply doesn’t happen. What can we do about this? Different women respond to different interventions. We need to experiment to see what works for us. We can try:

– Skipping a single dose. Once our dosage requirements are established, some women find that eliminating a pill before an evening of lovemaking enables our bodies to attain orgasm. Although this sounds simple enough, we must use caution here. Antidepressants work best when our bodies receive a constant supply, and NO medication should be manipulated incautiously. Repeated skipping can, indeed, diminish the capacity of the drug’s efficiency. We must be extremely cautious with this.

– Trying another antidepressant. Each drug is specifically formulated. Dosages differ, as do side effects. There are now many options available, and new drugs are being developed and released all the time. Our doctors can work with us to find the prescription that gives us the best relief with the fewest side effects.

– Varying the time of ingestion of the drug. It may be that taking our medication in the morning, rather than in
the evening, allows our bodies to accept sexual stimulation to the point of orgasm. This option is, unfortunately, the least likely to be effective, especially with long-term use of the drugs.

Our doctors must be involved in this investigation. Antidepressants are powerful drugs (that’s why they work!) and we are patients, not pharmacists. No dosage should be manipulated without sufficient dialogue with our health care providers. That means that we must talk with our doctors about how the medications are affecting us. We must be bold in bringing up our sexual concerns. If our doctors silence us or fail to respond appropriately, we need to seek physicians who will listen and support our search for the best drug regimen available to us.

Recovering from depression is like coming back to life after a long, dark absence. Sexuality is far too important a part of our lives to ignore or dismiss. If we take the responsibility to keep informed, surround ourselves with empathetic health care providers, and insist upon the best quality of life available to us, we can be assured of full, rich sexual interactions. We may not experience the same sexual responses as before depression, but we can strive for the best possible outcome given the hand we have been dealt. The future looks brighter all the time. Seize the day!