Dearest: My guest tonight, DR. MARIANNE BRANDON, is a Clinical Psychologist, licensed in Maryland, and a Diplomat in Sex Therapy through AASECT. She is the co-author with Andrew Goldstein, M.D. of the new book, "Reclaiming Desire: 4 Keys to Finding Your Lost Libido." This is the first book to not just talk about the existence of low desire, not just offer "quick fixes" like the long-overused "schedule time for sex" solution, but to really explain to women how complex their libido is (being affected by their intellectual, emotional, spiritual, and physical selves). For the vast majority (of women)...a decline in sex drive takes a tremendous physical and emotional toll. These women speak of feeling deficient, ashamed, sad, angry, anxious, or unfulfilled. Drs. Brandon and Goldstein are co-founders of the Sexual Wellness Center in Annapolis, MD. where they specialize in treating women's sexual problems. Dr. Brandon, it's a pleasure to welcome you to Power Surge :) Dr. Marianne Brandon: Thank you very much - it's a pleasure to be here. I am very enthusiastic about getting this info out. Dearest: The title of your book, "Reclaiming Desire: 4 Keys to Finding Your Lost Libido" -- I like the "4 keys" - sounds like they'll open a magic door. What are the 4 keys? Dr. Marianne Brandon: We approach libido in women in a holistic approach. We go by both physiology and psychology. We've divided the women's experience into 4 quadrants which are the 4 keys we speak of. These are the woman's physical body, her emotional self, her intellectual self and her spiritual self. The physical body includes how well a woman cares for herself including sleep and nutrition. This quadrant also includes her ability to feel pleasure physically and her ability to relax. The emotional quadrant involves her mood, her level of stress, her self-esteem, body image and feelings about her partner. The intellectual quadrant includes her belief about sex that she learned from her family, her religion and her culture. It also includes her experience with a fantasy life and her beliefs about herself as a sexual woman. And finally, the spiritual quadrant relates to whether a woman feels meaning and purpose in her live and with her partner. This is not necessarily related to her religion, although it can be for some women. Dearest: Do you find that it's usually hormone-related and can be corrected with hormone supplementation, or couldn't it be that women going through menopause often don't feel well, are tired, irritable, anxious, depressed and just don't desire sex during this time? And isn't that okay? Dr. Marianne Brandon: Yes. Absolutely many factors play a role in a woman's loss of libido at the time of menopause. Hormonal changes, particularly decreases in estrogen, lead to vaginal dryness and for some women, decreases in testosterone production lead to decreased sexual responsiveness. Physical discomfort can also make it less likely for a woman to feel pleasure in her body. In addition, the cultural expectation that women lose their attractiveness and sensuality with age also plays a role here. Dearest: Do you mean the expectation of society or the self-expectation of the woman herself? Dr. Marianne Brandon: Well, both the expectation of society influences what a woman learns to expect about herself. GlendaS: Is having trouble reaching orgasm a common problem with perimenopause? I am not having dryness or anything, just have trouble reaching orgasm for the first time ever! Dr. Marianne Brandon: Yes, that's a common problem and there are solutions. Any activity or substance that can help facilitate blood flow to your genitals will likely have a positive impact for you. Try practicing Kegel exercises on a regular basis. Dearest: By the way, there are Kegel exercise descriptions in an article on Power Surge at: www.power-surge.com/educate/sexuality.htm Dr. Marianne Brandon: Also, do some aerobic exercises before sex. There is also an amino acid supplement and several herbs that have been shown to increase blood flow to genitals in men. Although we don't have research yet on women, for these substances, we have reason to believe that they can be helpful. These include ginseng, ginkgo, Yohimbe and the amino acid L-arginine. Please use caution, however, as some of these substances can cause such side effects as increased blood pressure or jitteriness, for example. One other alternative to try is using a vibrator to gently massage your genitals before making love. For women who require increased stimulation to climax, this option may be used while making love, as well. Dearest: Thank you, Dr. Brandon. May I call you Marianne? Dr. Marianne Brandon: Sure, that's fine :) Mary Anne: I had a total hysterectomy plus a bladder tuck. It'll be 2 years in February. Sometimes I feel very detached from my husband is that normal. Also, my libido is so up and down. Dr. Marianne Brandon: Certainly such emotion reactions are not uncommon after an hysterectomy. There are things you can do to turn those feelings around, if you choose. We address some of these issues in our book Reclaiming Desire. I would encourage you to begin reclaiming your desire by gently gently massaging your own body including genitals and don't be embarrassed about getting to know your own body better. Through this process of gentle massage, you can reconnect with your body and then teach your husband how to please you. It is typical for women to need to relearn what feels pleasurable to them after surgery. SusanMaj: I sometimes feel very sexual and then I have this drying point going on, no libido. It's either a lot of intercourse or none. Dr. Marianne Brandon: It's natural for a woman's sex drive to vary over time. BeachGirl: I have no libido at all and have tried everything. I am 62 and menopausal for years and unhappy about it. Dr. Marianne Brandon: What have you tried? BeachGirl: I have tried testosterone, creams, self massage etc. Any other suggestions? I have a severe reaction to the testosterone. My mind is willing, my body is not. Dr. Marianne Brandon: I would imagine that there are multiple variables playing into your lack of desire for sex. Our book has a quiz you can take which may help you sort through the 4 quadrants mentioned earlier and may be playing a role in your problems. Maybe you're too anxious and thinking about it too much. We can also try focusing on your sensual pleasure first, before sexual pleasure. Meaning experiment with sensual experiences via each of your senses (sight, sound, touch, taste, smell). For example, take yourself to the grocery store and create a sensual meal for yourself. Many women find chocolate, ripe fruit, and wine to be a sensual meal. Jolie59: I have NO libido whatsoever. I am 40. I was given testosterone cream compounded 2% to rub on. It is excellent for libido, but all testosterone always gives me a wicked side effect of raging madness, like I want to kill. What else can I use? I tried all forms. Dr. Marianne Brandon: I would refer you back to your doctor for that question and remind you that there are likely to be other solutions such as facilitating a spiritual connection with your partner. Dearest: Or you might want to get in touch with Power Surge's natural hormone specialist, Pete Hueseman, R.Ph, PD. You can ask him anything at www.power-surge.com/asktheexperts.htm Jolie59: Are there other preparations for low libido that are alternative to prescription? Dr. Marianne Brandon: Jolie, no. The herbs I spoke of earlier address physiological arousal rather than libido. Stella0324: Dr. Brandon, I'm 52 and dealing with Chronic pain, depression, meno and a husband who's 10 years younger. Also my DHEA is on the low side. I feel nothing lately. How do I get my libido back with all these problems before my marriage suffers? Dr. Marianne Brandon: Stella, are you taking medication for pain or depression? Stella0324: yes, I'm on Ultram, Bextra and Lexapro. They help a little. Dr. Marianne Brandon: Pain medicine and antidepressants often interfere with sex drive. You may want to try timing your pain medication after sex, as opposed to before. The antidepressant Wellbutrin can actually increase sex drive for many women so you may want to speak to your doctor about adding Wellbutrin or changing to that. LynnieB: Right at the time I hit menopause, my husband told me that nothing I could do or wear except thong underwear would make him happy. I cannot wear that without wanting to strangle him within 15 minutes, it is so uncomfortable. Then he got a subscription to Playboy. What had been what I thought a good relationship deteriorated, as I felt unsafe, undesirable, and unable to be myself. All my life I have been very sexual, and have enjoyed sex. Since then, I have had an awful time feeling free and spontaneous, etc. Also, I have had some physical changes such as vaginal dryness. I am unable to tell if the problems in decreased sex drive are due to menopause or to the demands of my husband. We have since been to counseling and things are better (he's been doing his own counseling and has taken responsibility for his behavior), but it is a slow comeback for me and I really miss my old self. How much do relationship issues affect sex drive, and how much does menopause itself? Dr. Marianne Brandon: Both can affect the woman's sexual experience and the degree varies with each woman. I'm very glad to hear that the 2 of you are in therapy. I hope that you are talking specifically about these sexual concerns. LynnieB: Yes, we are. Dr. Marianne Brandon: That's good! Julie: I had a TAH (Total Abdominal Hysterectomy) 3 years ago at the age of 31. The desire has not returned and my relationship is in a sexual rut. My fiance says it's all in my head, Is he right? And how do I get the desire back? Dr. Marianne Brandon: No, he's wrong. I would suggest you try Viagra. Research has shown it to be helpful for women after hysterectomy. Other variables may also be at play, such as your experiences of yourself as a woman since the surgery. These issues can be addressed in counseling. I am concerned that your fiance tells you it's all in your head. Dearest: What about infidelity. Once a man has cheated on his wife/partner, isn't it difficult not only to trust him again, but to share intimacy with him? Dr. Marianne Brandon: It can be, although that is not the case for everyone. Some couples do use affairs as opportunities to work through relationship problems and actually improve their marriage. However, that can take a lot of time and is certainly not the case for all couples. IndigoBuddha1: I just began a new relationship a year ago, I found out this summer that I am in perimenopause. While my partner can still excite me, I am still concerned how perimenopause might affect my libido. I am currently on a antidepressant, Paxil. I also have problems pleasuring myself, the ability to reach an orgasm, whereas this used to not be a problem. Dr., your insight is welcome. Dr. Marianne Brandon: First of all, try not to worry about a problem that has not happened. Secondly, keep in mind that as men age, they experience many more changes sexually than women do. For example, with age, most men have difficulty maintaining their erection over time. They require a longer time between ejaculation and their erections are not as strong. So stop worrying. His body will be changing too. The problems with pleasuring yourself are also normal at this time of life, unfortunately. Marlo: Hi, Dr. Brandon. How do you feel about vitamin E and libido? Also, I would like to tell everyone that Revival gave me back my libido. It really works. Soy has plant estrogens. If you take it for three months it will help. Dearest: Marlo is talking about Revival soy protein which you can read more about at www.power-surge.com/revival1.htm Dr. Marianne Brandon: We have no research to show that vitamin E increases libido. Marlo: Why do they call it the sex vitamin? Dr. Marianne Brandon: They're probably referring to the fact that E and many vitamins are required to produce sex hormones. Marlo: OK, so if you would take any lubricant in the form of a vitamin or oil will it help? Dr. Marianne Brandon: Yes, it can help with lubrication. Hop-To: I've been reading reports that say getting more sleep has become more important to women than having sex. That says a lot, doesn't it? Dr. Marianne Brandon: Certainly, if a body is sleep deprived, it will be more interested in sleep than sex. Remember, low desire can be a healthy response to an unhealthy situation such as sleep deprivation. Dearest: What other medications can have an effect on libido? Dr. Marianne Brandon: Pain meds, anxiety meds, antidepressants, blood pressure meds as well as many others. In addition, nicotine and alcohol can interfere with sex drive. Texwoman: I had a hysterectomy about 7 years ago and sex just doesn't seem the same since. They took 1 ovary and left 1. People tell me I won't even know when I will go through menopause because I have an ovary. I don't know if I am going through it or have already gone through it. I have been told that a hysterectomy automatically throws you into menopause? Anyway, I really have no desire for sex anymore. I am only 42 years old. I am not taking any meds except for BP meds. I get frustrated during sex because my husband says since the surgery it seems harder to satisfy me. He can't seem to keep an erection for just a very short time. He has tried Viagra a couple times but it didn't do anything and now I just don't even want to try anymore. He is 3 years younger than me. Dr. Marianne Brandon: Sex has to be worth wanting and it sounds like sex is no longer enjoyable for you. Are you engaged in the same patterns of making love? Most couples find that boring. Most couples do get stuck in patterns and find that boring. Texwoman: Nothing seems interesting to me. Dr. Marianne Brandon: I would suggest you buy a book on sexual techniques and read it with your husband. See if changing the way you make love makes sex more interesting and enjoyable for you. Dearest: Dr. Brandon, thank you for joining us tonight in Power Surge for a very informative chat about women's sexual issues. Those who missed any of the chat will find the transcript in the library in a few days -- see links at the bottom of the chat room. I highly recommend everyone get a copy of Drs. Marianne Brandon and Andrew Goldstein's wonderful new book, "Reclaiming Desire: 4 Keys to Finding Your Lost Libido", and visit her Web site at: www.wellminds.com/reclaiming_desire. Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994- by Power Surge. All Rights Reserved.