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11. Sex After Children with Dr. Sheryl Kingsberg
87 Plays2 years ago
Amidst the beauty of parenthood, it's common for women to encounter challenges in their intimate lives. The emotional and physical changes that occur after childbirth can affect a woman's perception of herself and her sexuality.
We received the question: “Can women become basically asexual after having one or more children?”
In the episode, Dr. Rachel Pope is joined by expert Dr. Sheryl Kingsberg to answer it. Dr. Kingsberg is the chief of behavioral medicine at MacDonald Women’s Hospital/University Hospitals Cleveland Medical Center and a Professor in Reproductive Biology, Psychiatry, and Urology at Case Western Reserve University. They discuss desire, sex drive, and the definition of Hypoactive Sexual Desire Disorder (HSDD).
Featured in this episode:
- Shifts in desire throughout a person's life
- The distinction between Asexuality and HSDD
- Postpartum depression and Psychotherapy
- Other causes of low desire (This Is Your Brain On Birth Control by Sarah E. Hill)
Take the Decreased Sexual Desire Screener (DSDS) Screener here.
If you find that the challenges in your sex life persist or are causing significant distress, consider seeking professional help. Sex therapists and counselors specialized in sex can provide valuable guidance and support tailored to your unique situation.
Submit your questions on anything and everything women's health-related and we will answer them in one of our episodes.
Want more from Our Womanity?
Take the Vulva Quiz to see how well you know women's bodies.
Looking for practical advice for women in their 60’s who want to become sexually active or want to improve their current sex life? Check out Sex in Your Sixties: Who says the fun has to stop? Written by a multidisciplinary group of health professionals who address issues such as pain with sex, low desire for sex, orgasm difficulties, your bladder and sex, same sex partners, vulvar skin conditions, trauma and more.
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Transcript
Introduction to Dr. Cheryl Kingsburg and Her Work
00:00:00
Speaker
All right, we are here on Arbo Manatee with Dr. Cheryl Kingsburg. She's a world expert in female sexual health and she's been working in the field of female sexual health and menopause for over 30 years. She's past president of the International Society for the Study of Women's Sexual Health, Ishwish, and also the Menopause Society.
00:00:20
Speaker
I am so lucky to have her here in Cleveland. I benefited from her teaching and her sharing of her knowledge when I was a resident and I continue to benefit now that I'm back here in Cleveland. And I'm so lucky to have her here to answer this question that was submitted to our website. So
Building a Sexual Medicine Program in Cleveland
00:00:36
Speaker
welcome Cheryl.
00:00:37
Speaker
Thank you and can I say we are thrilled to have you back in Cleveland. You had to travel the world before you decided Cleveland was the place you wanted to land. So the fact that you have come back and we have been really able to create a sexual medicine program that is truly multidisciplinary, we owe to you really taking on sexual health. So I'm happy to answer your questions and welcome back to Cleveland.
00:01:06
Speaker
Thank you. All right. So here's
Q&A: The Origins of Asexuality Post-Childbirth
00:01:08
Speaker
the question that someone submitted. I don't know if this is a woman or man. It's not gendered here, so we'll see. It says, hi, Dr. Pope. I'm interested to hear if you've heard of other women who have become basically asexual. Okay. So I'm assuming this is a woman submitting this. After having one or more children, no interest in normal intercourse or masturbation, just totally uninterested and no pain either.
00:01:32
Speaker
Could this be caused by something medical, i.e. hormonal imbalance, or is it more likely to be psychological? Thanks for the great blog. Well, this is why I brought on our expert, Dr. Kingsburg, to help me tackle this one. What are some of your initial thoughts? Well, thank goodness we are a team, because really, her question is a fair one.
Understanding Sexual Desire and Its Changes
00:01:55
Speaker
And unfortunately, I do see it
00:01:57
Speaker
happen and it is really unnerving to many women who used to have good desire. They have a baby. They're like, well, I don't really think that there's anything that should be going on to cause my problem. Why don't I have my desire back?
00:02:14
Speaker
So first, let's look at desire. Let's just define desire. Desire really is the appetite for sexual activity. It is having thoughts, fantasies, interest, sort of the anticipation positively of having a sexual encounter, whether or not you actually act on it. It is more about appetite.
00:02:35
Speaker
We all have a certain level of drive, if you will. Some of us would like to have sex if we could every single day. Some of us once a week would be fine, some of us once a month, and some of us every leap year. And that's a range. So in this case, we would look to see what her prior appetite was. You know, was it once a month? Was it once a week? And whether it's changed.
HSDD vs. Asexuality in Postpartum Women
00:03:02
Speaker
Now, she uses the term asexual, and I really want to differentiate that because asexual means not having any sexual interest and not being distressed by it. In contrast, what she is concerned that she may have is hypoactive sexual desire disorder, which is the absence of or loss of
00:03:25
Speaker
the interest in being sexual that causes distress. So there are women who have no interest and are distressed by it and we would not diagnose them with the sexual dysfunction. So it is really, really don't want to do that. But if somebody had desire, they've lost it and they want it back. That is kind of the key to hypoactive sexual desire disorder. Women want to want, whether it's lifetime loss,
00:03:54
Speaker
lifetime absence of desire or having it and then losing it. And unfortunately, again, with pregnancy,
Hormonal Changes and Sexual Desire After Childbirth
00:04:01
Speaker
postpartum, many women will develop HSDD. The good news is the vast majority it will resolve. But if it goes on beyond six months or beyond the time somebody stops breastfeeding and gets their normal hormonal balance back, now we've got a problem and we really need to treat it.
00:04:22
Speaker
So please don't assume it's HSDD until you are, like I said, done breastfeeding or at least six months postpartum because we do know that hormones absolutely can impact sexual desire. And I'm not talking about no time, no energy, no privacy that every new mother will experience. And I'm not talking about the fact that breastfeeding can lead to
00:04:47
Speaker
vaginal changes that would mimic menopause and genitourinary syndrome of menopause, painful. I'm not talking about that or lack of arousal. I am talking about lack of appetite. And so if it goes beyond six months when their body is healed and returned to a sort of their baseline state, now we need to treat it as hypoactive sexual desire disorder.
Breastfeeding and Affectionate Desires
00:05:12
Speaker
It's really interesting that you mentioned that timing, because I have read and actually heard women talk about this themselves in clinic too, that sometimes in those early months or that first year, they're breastfeeding, they have a baby on them frequently, and they have this skin contact and this sort of
00:05:32
Speaker
you know, you get you get all those great chemical endorphins from that as well. And then these women say, you know, I'm not really I'm not feeling like I need to be affectionate with my partner. I'm not getting that sort of longing because you're getting it elsewhere. And not not to say that it's romantic with their children, but it's just that skin to skin. And sure. Well, two things. One is the you would hope that the oxytocin would sort of pay off for the partner and that that sort of hormone of affiliation would
00:06:02
Speaker
lead to more sexual interests. But for many women, they're touched out. That they are completely inundated with the physical sensation of connecting to their baby or maybe even other children. And they have almost nothing left in terms of a desire for physical touch, which, you know, certainly could be problematic. And there's also for some women a difficulty in switching gears.
00:06:31
Speaker
from the touch and sensation and the pleasure of, you know, holding their baby and then switching gears and having their body feel erotic. So, you know, if they're breastfeeding and their, their breasts are being used to feed their baby, it's very hard for them to switch that and become erotic and have the breasts as an erogenous zone. And just their whole identity can shift.
00:06:56
Speaker
I don't think that's what the woman in the question was asking about. I really don't.
Addressing Long-term Lack of Desire and Menopause
00:07:01
Speaker
I just want to validate that for many women who early on as they're dealing with children have difficulty sort of switching gears. A hundred percent. And not to mention the exhaustion, right? I had a patient last week who told me, yeah, I'm not thinking about sex because if I have any free time, I want to sleep. Absolutely. Absolutely. And then to kind of answer this question where we think she's coming from,
00:07:25
Speaker
Few years later, maybe even children are grown and then just not having interest. You see patients in those scenarios. Now, if they are 20 years later, for example, I see women who will come in and they'll say, I think I have postpartum depression. And when I ask them how old their child is, they say 21. That is not postpartum depression.
00:07:47
Speaker
Right. But so in this case, you know, if it's if they're grown, she may now be in menopause, and we have a whole different issue. But if it's been several years, and she still has no desire, I would have hoped she would have come for treatment sooner. Unfortunately, many women don't. Right. But thanks to your podcast, maybe more women will
00:08:08
Speaker
Maybe. And we need to approach treating the hypoactive sexual desire disorder or HSDD. Yeah. Very, you know, evidence based. So we may try psychotherapy, which I do for a living and look at more mindfulness based approaches or look at
00:08:26
Speaker
helping her manifest her responsive desire, even if some of her spontaneous desire has decreased, although she still may be distressed that she has no spontaneous urgent. So I don't want to, again, invalidate that. We have two FDA-approved pharmacologic options to try to bring back some drive for women. We have Addie, or phlebans, who is the generic name, and we have Vileacy, or Bremelanatide, and
00:08:55
Speaker
when they talk to their healthcare professional, they can think about which one might be a better option for them. They are both non-hormonal. So if it is driven by a hormonal imbalance that just never got back to a baseline, it is possible to look at changing hormones or using a different oral contraceptive issues on that or an IUD.
00:09:22
Speaker
Um, but it may be that what caused the problem may not be what we used
Impact of Medications and Life Changes on Desire
00:09:27
Speaker
to treat it. Yeah. And you bring up a really good point actually, that now that this person has already had children, maybe she's taking other medications that as a side effect are going to cause low desire, right? So if she's trying to actively not become pregnant, maybe she's on an oral contraceptive and now all of her free testosterone is bound up by that. So her drive is decreasing.
00:09:50
Speaker
or maybe, you know, there was some postpartum depression that came out or some other depression or anxiety and now she's on a SSRI and her drive is decreasing. So sometimes it's not really directly related to the having children, but it's more about the life circumstances and then even
00:10:09
Speaker
new medications. Absolutely. You know, a good healthcare professional will assess all of those things. And in fact, we actually have a simple screener, the DSDS, the decreased sexual desire screener.
00:10:22
Speaker
that will help even the general clinician who may not be thinking about all those things. It kind of takes them down that path anyway. It says, did you used to have desire and now it's gone and are you distressed?
Evolutionary Biology and Sexual Drive
00:10:33
Speaker
So that gets away from asexual and HSDD. And then it has an ABCDEFG of possible modifiable factors that may be related to their decreased desire, including medication.
00:10:47
Speaker
including depression, including partner issues, including stress, like no time, no energy, no privacy. So that takes the clinician through that. So the clinician and the patient can decide themselves what seems to be the most logical sources of problems. And do we want to look at them to try to treat them? And so I think it makes it easy for almost everybody.
00:11:13
Speaker
Yeah, and I'll put that screener up on the website in case people are interested in kind of quizzing themselves. Okay, my last thought here, so I did study anthropology as an undergrad. And so part of me also wonders, is there something evolutionary about this, that we are driven in some way, and we have a higher sex drive when we want to procreate? And then maybe that wanes for people who have that sort of a drive. Is there something biologically that could be there? Or am I
00:11:43
Speaker
just thinking too theoretical about this. Well, it is theoretical, but that evolutionary biology doesn't always sort of line up because many women will lose their desire despite the fact that they actually wanted more than one child.
Conclusion and Resources for Desire Issues
00:12:01
Speaker
Maybe it happened after their first kid and they're like, now that really stuck. So that may not work. And I do think that there may be a hormonal issue
00:12:12
Speaker
But it isn't necessarily, you know, pre and post children, it may be during their menstrual cycle. And we do know that some women, not all, will experience changes in their level of drive based on where they are in their menstrual cycle. And others are like, I have no idea where I am in my cycle. I have no idea. You know, there's a wonderful book by a psychologist, This is Your Brain on Birth Control, that
00:12:41
Speaker
really point to the fact that some women are greatly affected by hormones and contraceptives and some women are not. And so that's also something important to talk to your provider about.
00:12:55
Speaker
Right, and lots of people have high drive and don't want to have any children, so yeah. Well, I think this has been very useful, and I hope that the person who submitted this question anonymously is satisfied with these answers, and I'll put that screener up for other people who are curious. Thank you so much, Dr. Kingsbury, for sharing more of your expertise with us all. Well, thanks for inviting me.