Humble women are stuck

Why so many women are listless

annabelle: Eliane Sarasin Ricklin, you are a gynecologist and also offer a sex medicine consultation. How many of your patients report a lack of sexual desire?
Eliane Sarasin Ricklin: It will be forty to fifty percent.

So many?
Yes, female pleasure disorder is the most common sexual problem of all. But that does not mean that every woman who does not feel pleasure also suffers from it. Having no desire and no partner or having no desire while the partner also has no desire is not a problem.

How big is the proportion of those who feel stress?
About ten to fifteen percent. Some say: I miss my lust. I don't feel so alive anymore, not so feminine anymore. These women are easier to treat because they are motivated to change something. Much more often, however, I hear: If my husband didn't put pressure on me all the time, I wouldn't lack pleasure. The only thing that bothers me is the conflict that weighs on the partnership.

So these women are looking for your help because their partner said it couldn't go on like this?
Yes, it happens a lot. Some men believe the problem lies with their partner and urge her to seek a consultation. In such a case, I first try to find out what the woman herself wants. Is she just not in the mood for sex with her husband? Or does she not feel like having sex in general? Would she like a different kind of sex? Would she like to have sex with someone else?

Have not your patients already asked themselves these questions?
Mostly not. Some even react quite helplessly to it. Many women with pleasure problems feel so cornered that they can no longer think about their own wishes. They feel they are deficient, which blocks them completely, while at the same time they are harassed by their partner. In some partnerships, these positions have been cemented over the years.

What is it that spoils women's lust?
It's not always easy to find out. Some people say with full conviction: I love my husband and we are actually fine together. I'm really sorry for him that I don't feel like it. During the conversation it becomes clear that, for example, they feel that they are not supported enough in the household or with the children or that they are completely exhausted. Often old grievances ferment in the background without the problems coming on the table. However, the reason for the listlessness does not necessarily have to be in the partnership. Job overload, financial worries or stressful events in the personal biography can also have a negative effect on pleasure. Every stressful situation is a pleasure killer per se.

Are there also organic causes?
Of course, health and sexuality are closely related. In addition to illnesses, certain drugs such as antidepressants can also impair pleasure. One of my patients was unable to orgasm because of such a drug. When she told her partner about it, he said: Then it's no longer worth having sex. He believed that sex was worthless without her orgasm, even though the woman didn't feel that way. Men are much more goal-oriented.

How does menopause affect libido?
The effect of hormonal changes caused by menopause is overestimated. Estrogen is just one piece of the mosaic of female pleasure. A patient recently registered with me that she has to undergo anti-hormonal therapy because of her breast cancer diagnosis, which drastically reduces her estrogen level. The reason for the consultation was her sexual listlessness, which she attributed to her treatment. But when she finally came to my practice after a few weeks of waiting, her listlessness was blown away, despite the low hormone level. Because two weeks earlier she had fallen in love again. We all know that: a new relationship, a flirtation, an affair - and we feel alive and lustful again.

So it's a myth that postmenopausal women lose interest in sex?
Yes. Often, however, the mucous membranes in the genital area become drier due to the drop in estrogen. This can be painful during sex. I recommend that my patients regularly care for this sensitive area. If there is nothing medically against it, I also prescribe locally acting estrogens in the form of vaginal suppositories or creams, the risks and side effects of which are much smaller than those of systemic hormone therapy.

Why do so many women experience climacteric as an unotic phase?
Lust killers are thoughts like: I'm no longer attractive now. No man turns to me anymore. If my children move out, I will no longer have a job. Those who only associate menopause with goodbye suffer more. In addition, at this age, most of them have been in long-term relationships, and to desire someone you think you are sure to have is only exciting to a limited extent. A patient once put it this way: The same yogurt every day - that is not tingly, even if it is the favorite variety.

How is it that most couples only have a more or less short phase of grandiose love-infatuation sex before they fall into boring routine?
Sexuality in a relationship usually takes place on the lowest common denominator. You get to know each other and try out each other, in this phase the sex is still extremely exciting. Then you find out what the other likes and what you like yourself, and agree on an individual process that you repeat over years or decades - without discussing whether the scenario is still right for both of them. Despite all the harmony, such a routine is not particularly erotic. The American sexologist Jack Morin came up with the formula: arousal = attraction + obstacle. Having to overcome something increases the desire. That is why long-distance relationships usually work quite well. The obstacle there is the geographical distance.

What can you do against boredom - if you don't want to move to two different cities?
It often helps to change the usual scenario a little. You could reveal to the other what other sexual desires you have. Of course, this takes courage and trust, because you have to expect that your partner will not like them. At the same time, it is the only way to build up new sexual tension in a long-term partnership.

How do you get couples who have fallen asleep to erotically approach each other again?
There is no one-size-fits-all answer; every couple has its own dynamic. The basic requirement is that both partners must be motivated for a change. If that is the case, I usually recommend that you meet up regularly and take turns directing these evenings. Even the preparation of such a rendezvous can be exciting. One specific suggestion is “The Indiscreet Question Book” by Ulrich Clement (see box, editor's note): Which wishes of your partner do you like to fulfill, which ones less? Are there things that you accept for your partner's sake without really wanting them? What are you grateful to your partner for because you would not have achieved it without him? What do you resent him today and do you not forgive him? - Discussing such intimate questions with one another can create erotic tension. When it comes to pleasure, a lot runs through conversation. A secret in functioning long-term relationships is the constant interest in each other, the joy of rediscovering each other again and again and remaining curious about each other. This also applies to sexuality.

Sounds like exhausting relationship work.
Yes, unfortunately, if you want to change something, there is no other way. There is no convenient solution. I remember a middle-aged patient who came to my practice at her husband's insistence. He demanded that she had to get more pleasure again, otherwise the relationship would be in question. The two have not had sex for many years, apart from that, the woman described their marriage as unencumbered. At first she wasn't very interested in change. But after a while she warmed up to the idea of ​​letting more eroticism into her life again and began to change outwardly as well. Her clothes, her movements, yes, her whole demeanor became more feminine. When she wanted to discuss with her husband what kind of sex she might like, he was suddenly no longer so interested and said: Oh, you know what, honey, okay, let's leave it.

Did her sudden insolence frighten him?
Yes. Talking about your own sexual desires means leaving your usual comfort zone and venturing into new terrain where you feel naked and vulnerable. This can also unsettle the partner who originally wanted the change.

How did the two of them continue?
At some point they hesitantly began to approach again, when he got erectile problems and withdrew. The woman reacted very hurt and wanted to stop the therapy. Three quarters of a year later, the two of them came to my office hours again, this time together. They had noticed that the topic of sexuality is important to them and that they can only bring about change together.

Did you manage to find each other again?
Yes. I also asked this couple to take turns seducing each other. The woman found out that a certain setting is important to her when it comes to sex: candles, fragrant massage oil, cozy warmth, romantic mood. Accordingly, she designed her own evenings lovingly. The man's needs hadn't been clear before. Now he could adjust his seduction strategy. This brought movement into the deadlocked love life of the couple.

Is female pleasure more prone to failure than male?
In any case. It seems to me like a butterfly that can be scared away very quickly. We all hit the gas during sex and we hit the brakes. Most women tend to be more on the brakes than men. However, we can also learn to give a little more gas.

How come?
By asking ourselves: what turns me on? How do I turn myself on? Some women don't even know which eroticism suits them. For example, you could experiment with the choice of clothes, with makeup and perfume, erotic literature, dancing or yoga. Anything that helps you become more aware of your body can make your sexuality more satisfying. The pleasure starts with you, it doesn't just have to do with your partner.

There is Viagra for men. What does the pharmaceutical industry offer women?
The lust-increasing drug Flibanserin, also known as Pink Viagra, has been on the market since August 2015 - but so far only in the USA. The American feminists pushed it pretty hard, so the authorities allowed it in a kind of fast-track process. Flibanserin is originally an antidepressant. The first studies showed, however, that the antidepressant effect is modest; instead, the test subjects unexpectedly reported more sexual pleasure. Flibanserin has to be taken daily, it has significant side effects such as dizziness, nausea, and drowsiness, and alcohol should be avoided altogether while taking it.

Is it any use?
Study participants who took Flibanserin had at most one more positive sexual experience per month. So the effectiveness is modest. And Flibanserin will not make me George Clooney if I have a partner whom I do not find sexually attractive.

Which tools can you recommend with a clear conscience?
I find lubricating gel useful, especially for older women after menopause, for whom dryness of the mucous membranes is an issue. The new silicone-based products are particularly recommended.

Can a vibrator give a listless woman a helping hand?
Maybe so. Vibration in the genital area is experienced by many as arousing. A visit to the erotic shop can therefore be worthwhile. These shops no longer have the filthy image they used to. There are boutiques specially designed for women with competent advice. If you like sex toys, you should experiment with them.

What kind of experiments do you mean?
We have all developed our individual masturbation techniques with which we can reliably reach orgasm. I advise my patients to expand their erogenous zones by finding out what else could feel pleasant and arousing beyond the usual. Slowly, consciously tensing and relaxing the pelvic floor can be helpful when exploring - as can a vibrator or other sex toys. The better you know your own body, the more satisfying you experience your sexuality.

Some doctors offer to inject collagen under the G-spot. Do you actually feel more then?
I doubt it. There is indeed an area with more nerve endings on the anterior vaginal wall, but whether this corresponds to the G-spot and whether it even exists is still highly controversial.

It is said that the most important motor for female pleasure lies between the ears.
Yes, sexual fantasies can be very stimulating. However, they are not always compatible with our modern image of women. A lot of sex has to do with taking and being taken, which contradicts political correctness, which aims at gender equality. For example, many women find overwhelming fantasies in which one or more men dominate them arousing. Younger, gender-conscious patients in particular, who experience themselves as emancipated women, are sometimes very alienated by themselves when they admit such overwhelming fantasies to themselves.

Can't you reconcile the fantasies with your self-image?
Exactly. In most cases it is not a question of putting the scenario into practice. They should remain a fantasy. Overwhelming fantasies are fed by the need to be desired. Behind this is the idea: I'm so irresistible that the men can't help but attack me. This narcissistic idea is what creates the arousal.

Does lust disappear completely in old age?
That depends on the individual life situation. Recently a patient over 80 was in my office hour. She told me that her husband had unfortunately become impotent as a result of his adult diabetes and had completely withdrawn sexually. She regretted this very much because sex has always been a source of strength for her and she lacks tenderness and intimacy. Even if you are over eighty! In general, the desire for sex decreases with age, and so does the level of suffering. For many, however, the interest in sexuality never completely disappears. •