Would An Apple Every Eight Hours Keeps Three Doctors Away?
Photo "Stoicism" by Flickr user Pulpolux !!!. Used under a Creative Commons license.
You've probably noticed one of my mini-crusades is getting men to notice their partner's interest in sex tends to go *beyond* satisfying them. And that I've also posted a fair amount about how for the last 150 years, at least, doctors have done a lot to promote that idea (even though for nearly 2000 prior more than half their work, and income, came from treating women for "hysteria," which was cured by massaging the "pelvis" until she "achieved hysterical paroxysm.")
Oh, and worse, for the last few months I've been talking offline with a number of women who's partners have survived prostate damage (which often destroys the nerves and/or tissue involved with erection and orgasm) and they're all pretty bitter about the attitudes they're getting from doctors, family members, and even partners when they ask if their partners will ever be able to have sex with them again. Because a lot of people evidently think they're being, oh, selfish and uncaring, or that "as women" (and usually by the time someone's husband has prostate surgery they mean "as *older* women") they ought to be relieved to be done with sex.
I haven't posted as much about it but some years ago I took medication for situational depression and like you and a *lot* of other people it threw a wrench in my libido. Or not so much that (I was still interested and it still felt nice) as being able to have an orgasm. That had consequences for me, sure, but the ramifications affected my partner as well.
So anyway, when Anastasia of Sexualité talked about her healthcare provider's discomfort with a medication he's giving her it made me want to break out in hives.
He then asked me if I was having any side effects from the current dosage. I told him that I yawned a lot during the day. He said that was a normal side effect….
“And then there’s my libido. That practically doesn’t exist. Lucky I don’t have a sex life.”
...his face reddened, “Apart from that…”
"Apart from that?" WTF?!?!? For all the reasons I've listed above it's really troubling when caregivers aren't comfortable dealing with it when they've put else's libido in the cupboard.
Just to be clear it's not that I think everyone should have some pre-determined libido, it's that I don't think *anyone* should be able to determine that for someone else. And it's not that I think everyone should have some baseline sex life, it's that for a lot of men and women and any partners they might have a suppressed libido or extinction of capability is not a trivial side-effect.
Caregivers who can't get over their squeamishness really ought to find work in garden shops or real-estate instead. They'll be happier and their former patients will almost certainly be *much* happier.
And by the way, anyone else find themselves in the same situation where they've been stonewalled (maybe "blush-walled" is a better term?) over their own, or their partner's, post-care libidos?
[Please note: I'm *not* saying doctors or other healthcare providers are bad. I know other doctors who take libido-hampering side-effects very seriously in both their male and female patients. So it's the "modesty" factor, not the medical factor that continues to bug me. --fl]
Have you read any of what Ducky Doolittle says about doctors and sex? She does sexuality education at a medical school, and what she has to say about how doctors are trained is fascinating.
[Yes! She's great about that. I seem to have lost the link (I can Google it back up I'm sure) to a project she's collaborating on to help doctors better vet the significance of new research reports. It's obviously good all around but *especially* helpful if extended to journalists and any research related to sex. Thanks, Rosa. --fl]
I have to say, that a reduced libido is a strange thing. There are some days I don't even think about it, but there are other days where I do stop and think, albeit jokingly, 'I have to add 'orgasm' in my organizer just so I remember.' The effect of some meds may be like a chemical/sexual lobotomy some days, and although they do help in other areas, like anxiety or any sort of stress, there are always side effects, so I do wonder why companies don't work on alternative medications, but then again that would mean more clinical trials that take more time.
My therapist is a senior citizen, and I do take that into consideration, but Rosa's comment also points toward the possibility of sexuality being a low priority, during my therapist's time at medical school. He's probably 65? I remember when I was at uni studying a science/biomed degree, and sexuality was the last thing of any importance. Sexuality only came up during my biological psychology elective, when we had to endure an associate professor's lectures on the sexual response, and the professor was so damned uncomfortable with the subject, it was hilarious. She'd blush, stutter, and couldn't talk about the penis without some sort of behavioral tic.
How does it prepare medical personnel for their patients? Not that well, I'm afraid.
[Actually if he's 65 he'd have been in med school in roughly the mid 1960s so... yeah, the sexual revolution was underway then but except maybe for the dawning recognition that cunnilingus is fun to do everything was still awfully male-centric and, um, "potency"-centric where if you were a woman and couldn't have an orgasm it wasn't a big deal, unless maybe you were "frigid" too so you wouldn't have sex anyway. And if you were a man and couldn't perform in top form then they believed it was mental, not biological, chemical, or medical, and usually meant you were, like, a "latent homosexual" or attracted to your mother or something. So yeah, if I grew up in that context I'd be deeply embarrassed talking about it too. :-) But seriously, that was a *very* long time ago now and there is such a thing as continuing education. Thanks, Ana. --fl]
Figleaf, I'm glad you're writing about both these issues. There *is* a common denominator in that many medical practitioners are uncomfortable discussing sexual side effects, whether due to cancer surgery or antidepressants. In this, they reflect the rest of American society (and I'm not sure that other developed countries do all *that* much better). It's just that when doctors and nurses can't be frank about this, they're in a position to do much more mischief than your average prudish schmuck.
But!!! The differences between the two topics are immense, and I'm really, really uncomfortable with conflating them. If you're on antidepressants, for instance, you can try Wellbutrin (which may or may not work); you can try therapy instead or as an adjunct; you can slowly try weaning off the meds. By contrast, there is *no* treatment for prostate cancer that leaves sexuality untouched. And it can take two years or longer post-surgery before a man can gauge how much recovery he can expect.
Most antidepressants in the U.S. are prescribed by primary care physicians, who ought to know their side effects but admittedly aren't psychiatrists (often not a great idea, IMO). Prostate cancer patients are under the care of specialists, however, and unlikely primary care providers, urologists have *no excuse* whatsoever to be clueless about this.
Final factual point: The vast majority of men who've had a prostatectomy can have an orgasm even if they can't get erect at all. It won't feel the same as before (obviously) but it illustrates how narrowly we tend to think about these things. It's the erections that are a much dicier matter.
I used to work in a nursing home where there was a rule that resident's room doors must be open at all times. As a safety precaution it's understandable--you don't want someone to be on the floor and no one noticing. But, and I couldn't express this to my coworkers without sounding like a weirdo, it always bothered me that the residents had no time or place to masturbate.
We also had an incident where a married couple, rooming together, were "caught" doing what a husband and wife, even at ninety, have every right to do. Some staff members wanted to separate them for "safety" reasons. Fortunately they were overruled, but it goes to show--and this facility was a resident-centered and caring place, in general--the kind of attitudes people have toward sexuality in the elderly and in healthcare settings. It's supposed to not be a concern, and when it comes up, even professionals giggle and blush and try to avoid it.
There was an interesting discussion on the Blowfish podcast about Viagra--and how it couldn't exist before "ED" was a disease, because taking a pill for sexual pleasure is frivolous, so it's only okay to take a pill if you have a disease. Otherwise it would be a recreational drug, and that would be--even for a legal non-addictive substance with few adverse affects--Very Bad. Strange thinking.
[Wow, incredible point about medicalization and viagra, Holly. As for geriatrics and sex, yeah, it squicks some people out. Great. So what we're saying is when it's our turn for the nursing homes we want to be strapped into the beds to keep us from squicking anyone else. Like we're going to enjoy *that* kind of "bdsm?" :-) Thank you, Holly. --fl]
I've always had rather the opposite problem. It's not that my psychiatrists haven't wanted to talk about it. I've always been too embarrassed to bring it up.
Every time I've had a doctor ask me whether I'm having problems or side effects with an anti-depressant, I can never bring myself to tell him or her that I'm sexually crippled. With the one I'm on now, I not only can't have an orgasm, I can't even get close. I can't even get aroused. I used to get excited just thinking about masturbating, now...nothing.
It took me about six months to tell the last doctor I was seeing that I couldn't have an orgasm on Wellbutrin, but before he could even open his mouth to respond, I cut him off with some variation of "I know that's not important..." I did it again a couple of weeks ago with the doctor I'm seeing now (Cymbalta, same story) I told her about the problem, but then, in the same breath told her that I know it's not that important.
But it IS important. I'm the only person I've had sex with in very nearly five years now, so it's not as if I can even get the secondary satisfaction of pleasing someone else or the being-held-and-kissed-and-stroked satisfaction from sex. I really miss my orgasms.
But......if I bring it up, I'm just afraid that the doctor will think, if not say, something along the lines of "Well, you came to me to get medication because you're sooo depressed, and I give you something to address that and here you come complaining about this...trivia. What do you want me to do? Do you want to feel better or not?"
Then I think "All the people in the world who don't have clean water or a safe place to sleep or food for their children would love to have your 'problem'. Suck it up, you big baby."
And I go around and around and around like that. Gets to be very time-consuming.
[Ok, TLT. First, this is why I don't automatically hold caregivers responsible -- they're most likely to communicate to us the way most of their patients do. I might wish they'd pry a little deeper but I totally get why they might not. On the other hand, he or she can't read your mind. As for the "suck it up" thing? Look, if the medication you need could be used instead to help all the other people with problems in the world then yeah, it would be selfish of you to want a normal, healthy, happy sex life instead. But it's *not* that way, which means you don't need to be so stoic. I promise. Thanks. --fl]
"If you're on antidepressants, for instance, you can try Wellbutrin (which may or may not work); you can try therapy instead or as an adjunct; you can slowly try weaning off the meds."
Depends on the severity of your mood disorder, though. For simple depression, maybe (though even then you may *need* meds and have trouble finding one you can respond to that doesn't have sexual side effects). Lots of people with bipolar disorder, though, need multiple meds to stabilize - perhaps a couple of mood stabilizers, an antidepressant, an atypical antipsychotic - and can't wean off the meds without disastrous destabilizing. Some people are lucky, and have a cocktail that works and still leaves them sexually functional. Others are lucky to get any mix that works well at all, even if it leaves them with hardly any libido.
[Yup. If it's a matter of saving your life, and since there's *more* to life than sex, then it can be worth it. I know a guy in his late 20s who's on liquids only since losing his stomach and most of his intestines(!!!!!) and quite a few other usually-critical organs to a runaway overnight infection. And even though he actually "eats" and "drinks" through a tube into his abdomen, and evacuates through a catheter and colostomy bag, he tires easily but can still be pretty active (hikes, biking, dancing) even if it's at a relatively simple level. So yeah, not to sound dumb or redundant but life's worth living. On the other hand even if you can't get around loss of libido there's no excuse for caregivers... let alone partners... failing to recognize, acknowledge, and sympathize, and do what they can to help. It's the squeamishness and denial that bugs me, in other words, not the necessity. Thanks, Lynn. --fl]
Yes, I probably should've clarified that. I was mostly trying to distinguish prostate cancer from depression, because even though depression routinely follows upon cancer, they're so different that discussing them together obscures more than it illuminates. I'm pretty sure the same is true for the various flavors of depression, too, so I apologize for overgeneralizing.
I do know that bipolar disorder is a different matter than other forms of depression. For that matter, "simple" depression may not always be so simple, either. Wellbutrin didn't work *at all* for my mate. Eventually he was able to go off meds but he did it on his own, cold turkey. Bad idea.
A doctor is remiss if he doesn't keep tabs on all of this. I've seen a number of people with situational depression stay on the meds longer than they'd have needed, just because that's the path of (apparent) least resistance. The problem is, most doctors are constrained by 1) embarrassment about sexual side effects and 2) insurance plans that penalize them for spending "too much" time talking with patients.
Six years ago my partner was diagnosed with early-stage prostate cancer and underwent a prostatectomy performed by a surgeon who was a specialist in the technique known as nerve-sparing. The surgery was a success for my partner who has remained cancer-free and, his nerve function was relatively unimpaired. But my partner will often say that, for him, cancer was easier to beat than depression. Why? For a man in his 50's depression is at the nexus of so many factors: genetic predisposition, andropause, dissatisfaction with a career and, all too often, the accumulation of a lifetime of self-defeating modes of thinking.
Did the surgeon discuss sex with my partner and me? Yes, but in a way that was almost comical. During my partner's first post-operative check-up, the surgeon said, "It is very important to begin stimulating the erectile tissue." He made this pronouncement about three times during the office examination and each time he looked directly at me, not at my partner. Apparently, I had been designated as the Official Stimulator of the Erectile Tissue. Holy cow!
Another observation which I mentioned to Anastasia: most psychiatrists consider the patient's ability to continue working more important than her or his ability to enjoy sex. As one doctor explained to me, some patients are so disabled by anxiety and/or depression that giving up sexual pleasure is considered a small price to pay for the ability to hold a job and be independent. And that is true, for unemployment and the constant worry about paying the rent can have a devastating effect on one's libido.
But this attitude of telling a patient to accept the loss of so important a part of their sexuality does baffle me. The sense of well-being we enjoy after achieving orgasm is exactly that: well-being. The chemistry of the brain is returned to a healthful equilibrium. I tend to think of it as a deposit in the good health account, which we need to build up as a reserve against the loss and setbacks that are part of life.
I think it is important to remember that for both men and women, our level of sexual desire does not remain constant throughout our lifetimes. How two people negotiate the change in desire that leaves one partner feeling sexually abandoned is an important topic that warrants a separate post from me. So at this point, I'll conclude my comment.
[Thanks for those insights, Kochanie. It sounds like your partner's surgeon was working in the right direction even though it also sounds like he might have been nudging the problem over towards your side of the table. I'm sympathetic with therapists and social workers who prioritize getting people upright and mobile as it were, but I agree with you that if treatment routinely suppressed the ability to desire, or even taste food the conversation would be a lot more up front. I look forward to your post, by the way. --fl]
When I was in a long distance relationship and going to a psychiatrist for medication for my anxiety I was extremely surprised that he was concerned about my libido. He chose a medication that was not known for lowering libido even though I kind of wished he had given me something to kill it. I wasn't getting laid due to said long distance and it was driving me a little insane. ;)
It is a shame when doctors do not consider that sexuality has a great impact in emotional and physical health.
[Excellent point, by the way Sakura. There are definitely times I've wished I had something to outright extinguish my libdio! But then, as you and I both know, that would be *our choices* and not side effects. Thanks! --fl]