Sex Questions from the Twittersphere: Sex Drive and SSRI
By Dr. Carol Queen • Jul 1st, 2009 • Category: Blog, Carol QueenStaff Sexologist Dr. Carol Queen answers your questions…
Question: my wife takes paxil + is also survivor of sexual abuse as a teenager = she has like 0 drive or enjoyment, sex is a 1 a mo duty – what 2 do?
You’re right that your wife’s low libido/enjoyment could be due both to the meds she’s on and her history; let’s take these things one at a time (though they could well have some connection, and it’s valuable to acknowledge this, addressing them separately is also important).
First, the meds. Paxil (paroxetine), like many other common anti-depressants, is an SSRI: a specific seratonin reuptake inhibitor. Its side effects definitely include sexual problems, which in some people tend to manifest in the desire phase, and in others with an inability to get too aroused or to reach orgasm. Ironic, isn’t it, that so many people’s anti-depressant has a truly depressing side effect like this? But I digress. It’s possible that your partner will have better luck with a different SSRI — Welbutrin is one I’ve heard some people recommend — but this is, of course, a question for her to discuss with her doctor, as is the question of whether her dose could be lowered. About.com has a brief, good overview of ways to cope with SSRI-related sexual side effects at http://depression.about.com/od/sexualdysfunction/a/sexdysfunction.htm
Your wife should also take care not to become pregnant while using Paxil; it’s associated with a heightened chance of birth defects, and it carries a black box warning; if her prescribing physician has not carefully discussed this with her, she should make sure to get all relevant information. Whether or not she wants to remain on Paxil or switch to something else, she should definitely NOT just stop taking it; this drug is associated with a high incidence of withdrawal syndrome, which can have very unpleasant side effects. Even more depressing news: for some people, sexual dysfunction associated with SSRI use may continue past the time the drugs are being taken.
It’s worth knowing, finally, whether her libido and enjoyment of sex were always zero, or whether the Paxil has seemed to make these matters worse. But now let’s consider the other element of your wife’s known sexual issues: her abusive past. As you and she likely know, unpleasant or damaging sexual experiences can have a lifelong effect. One element of this is the way being used or exploited sexually can leave a person with no sense of her (or his) own sexual agency and pleasure potential, and also little or no connection to the notion that sex CAN be (and in fact I’d almost say is *supposed* to be) about pleasure and that engaging is sex without desire isn’t what most people want to do and isn’t want most partners want us to do either. Obvious in your letter is not just concern that the two of you have little sex, but also that it is duty-bound and not desired.
Last week, in a fairly different context, I mentioned Staci Haines’s important book The Survivor’s Guide to Sex (Healing Sex). I would strongly recommend that your partner check out this resource and see whether there’s something there for her — not just for her relationship with you, but for herself. It may be that even with her Paxil-influenced arousal issues, she can still achieve sexual pleasure through masturbation, and many sexologists have noticed that women who masturbate are often *more*, not less, interested in partner sex. If relatively mild stimulation isn’t rocking her boat, maybe a powerful vibrator like the Hitachi Magic Wand will — and if that proves to be true, welcome it into bed with the two of you, because the more she gets in touch with her own body and sexual feelings, the better it will be for both of you. YOU should also make sure you masturbate, not just as if it’s your only resort until that special night rolls around next month, but to truly explore pleasure. Do it lavishly. And make sure the two of you have as much opportunity to be loving and sensual and caring together as you can. Let her know you are her ally in healing — among other things, that means you can’t push her, only support her.
One last thing about the drug/sexual abuse connection. I cannot, of course, tell whether what I’m about to say is specifically relevant to your partner, but it’s worth considering this: If someone has not begun the healing journey from a difficult, painful, or abusive past, they may well have the sorts of issues that anti-depressants are typically prescribed to address. Put another way, if life has been depressing, a doc may well think an anti-depressant is called for. But SSRIs are powerful brain meds designed to correct a chemical imbalance, and it is my personal sentiment that many people are prescribed them who’d be better served by different healing modalities.
Best of luck to you both.
–CQ
Dr. Carol Queen >> Carol Queen is a writer, speaker, educator and activist with a doctorate in sexology. First as an organizer in the lesbian/gay community, where she helped found one of the first gay youth groups in the United States, and later in the emerging international bisexual community, as a sex worker and a practitioner of alternative sexualities, she typically teaches and writes from her own experience and that of her communities even as she references academic thought on these subjects. See her website: www.carolqueen.com.
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Hey this was great and unexpected answer – thanks !! Some follow ups that may give you insight, because this still I think leaves me stuck. I think finally being stuck is starting to wear on me after several years.
#1) I’ve been told by her she has no interest in changing medication + or reading books + or using sex toys. I have told her this needed change is for her, but she sees this 100% my interest area.
#2) I never push her, I’ve just almost given up on ever asking. I get an invitation once and a while, it’s likely drunk and in the dark.
#3) Regarding the abuse, it has led to her cheating in the past as sex is a form of control / game for her. You asked about a sex drive – yes she has it + she even has taken drug holidays – which seem to be more about her having a chance to enjoy herself. Ironically in our younger years I was fat and lazy so I missed out. Now I’m in shape, and its the opposite way. I also think from the past affairs sometimes that I may just not be her cup of tea sexually then.
#4) I have completely given up on self pleasuring. I mean I do it to get by, but I have no interest in it anymore at all. I just don’t find it pleasurable, only frustrating.
#5) There is also a big disconnect here re: your mention of Paxil + pregnancy. We know this already. I have no interest in kids too. So this disconnect in our interests (she wants to adopt, I said I’m open to listen but not really interested) – is leading to an even worse situation re: intimacy – not that it was any better though before this disagreement.
I’m at the point now that I’m not sure what I would do in a situation where I received even the slightest form of physical affection from another person.
I cannot speak to the abuse issue, but I affirm Dr. Queen’s assertions in the final paragraph.
I have a history of depression, including three hospitalizations. I spent several years on SSRIs. In retrospect, they were useful and even necessary for a time. I have used Paxil, Zoloft, Wellbutrin, Prozac, and Serzone. For me, there was no SSRI that did not inhibit or eliminate my ability to climax — that is the primary reason I tried so many different drugs. Life without climax is a bummer.
Eventually I wanted my sex life back, and I became determined to find other options. I consulted a nutritionist. Who knows which change made the most difference, but I started regular exercise (spinning — a huge endorphin rush), eating at least 25 grams of protein three times a day, taking fish oil three times a day, and B vitamins with breakfast and lunch. Within three months I suspected I might have found a way to live without SSRIs. Within a year, I was certain of it.
I no longer need the endorphin blast to feel okay, but when I was trying to break free of SSRIs, I do think vigorous exercise was especially helpful. I now practice yoga every day and am mostly vegan, so I don’t take fish oil. I am less concerned about the protein, but I am years away from the person who had to have a pill every day just to get off the sofa. There is life after SSRIs.
I should say I did all this with the support of counseling, so not in a nutritionist-only vacuum.
There is a time for pharmaceutical intervention, but for me, that time was not the rest of my life. The more I take responsibility for my own health, the healthier I am. Discipline and a program of recovery are essential. My program is yoga — which, incidentally, has proven efficacy for helping practitioners reconnect the emotional and physical bodies. Yoga is all about learning to listen to the body. Can’t hurt; might help. Good luck.