Some thoughts and information from the Boston University20 years, 3 months ago
Posted on Nov 10, 2003, 8 a.m.
By Bill Freeman
[Editor: The following article was not written by A4M/WHN staff]Lis and I went to a lecture on "Women without orgasm: now or not ever" presented by the Institute for Sexual Medicine at the Boston University Medical Center last night. As usual, the general topic was sort of explored, but the basic point of, at least, Dr.
[Editor: The following article was not written by A4M/WHN staff]
Lis and I went to a lecture on "Women without orgasm: now or not ever" presented by the Institute for Sexual Medicine at the Boston University Medical Center last night. As usual, the general topic was sort of explored, but the basic point of, at least, Dr. Goldstein's part of the lecture was to inform people of the findings and new discoveries that the ISM was making.
Which is fascinating stuff. The ISM has two parts, a basic research department, which is doing clinical research, animal trials, and so forth, and a treatment clinic. These two sections are closely tied together, and each benefits from the experiences of the other.
The lecture consisted of four parts -- one of the psychiatrists did a presentation on the psychological factors, a patient spoke about her experiences, Dr. Goldstein did a lecture on some of the most recent findings they'd uncovered, and then questions-and-answers.
The psychological part was nothing new. I mean, in all honesty, there's been no real progress in the psychological treatment of sexual dysfunction in years. Obviously, it's important, and there are a couple things they're doing a little better than they used to -- an improved Sexual Distress Scale questionaire, stuff like that. But nothing really exciting.
But the physiological side. . . that's just amazing what they're doing. It's a completely new field. They're discovering things about how hormones work, what they are, what they do, what affects what . . . stuff that's never been studied before.
As people who know Lis and me know, we've been in treatment for Lis's sexual dysfunction for years. We started out with psychological treatment, and, after years of this, discovered that Lis has no emotional or psychological traumas, has a perfectly fine body image, no sexual hangups, and no sex drive.
The entire field of actually studying what can go wrong PHYSICALLY with women's sexual responses only started five years ago.
Almost everything can be traced back to hormone levels. But it's amazing just how many things those hormone levels impact, and in how many ways.
Okay, obviously, low testosterone leads to low desire. Fine. We knew that. But it goes on from there. . .
Screwed-up hormone levels lead to the inside lining of the vagina all but going away. That's the part that lubricates. So, if you don't have the right hormones, you lack most of the part of the body that causes lubrication. And the amount of lubrication it secretes has a higher water percentage and lower mucus percentage than if the hormone levels are working -- so it's a lousy lubricant anyway.
The hymenal opening has vestigial musk glands around it -- they also produce some lubrication, but basically, once upon a time, they were musk glands. With proper hormones, they produce mucus and clean themselves out. With low androgens, they don't produce mucus, and become a haven for bacteria, which settle in and cause infections. Imagine how painful intercourse would be if you had swolen infected glands surrounding your vaginal area. . . Lis doesn't have to imagine this. . .
Those were things we'd heard about previously (the actual animal studies on rats on the inside of the vaginal lining were new, but that was suspected last time we'd heard this). And they'd discovered the vaginal glands the last time we saw them.
But they found out a number of new things about neuron activity and androgens.
The nerves in the genital area require testosterone to function.
So, if you have no, or very low, testosterone, you have less feeling in your genitals.
Basically, Lis might have as much feeling in her clitoris as most people have in their forehead.
You know how difficult it is to give someone an orgasm by licking their forehead?
No wonder she's never had an orgasm.
It's not my fault.
Anyway -- why does this happen? Well, that's not known yet. But they're starting to come up with hypotheses. . .
(Just a quick reminder of how steroidal hormones work -- the body takes cholesterol, then whaps it around a bit, and it turns into DHEA, and then the body takes the DHEA and whaps it around and turns it into testosterone. It goes through other pathways, too, turns into various things in between, and estrogens are made and stuff like that. I'd need a chart to follow exactly what turns into what how, but that's the basic idea. Stuff turns from cholesterol into other stuff, and that other stuff turns into Stuff You Need.)
Apparently, testosterone is produced in like two different places in a woman's body -- I don't remember exactly where, and I wasn't taking notes, but I think they were like the adrenal gland and the pituitary gland. Birth control pills completely shut of testosterone production from one of these. Not only that, but they also produce a secondary something-or-other which bonds to free testosterone and neutralizes it.
So -- they cut off like half your production of testosterone, and neutralize a good chunk of the rest of it.
If you manage to make so much testosterone that, even after losing over half of it, you still have enough testosterone to maintain neural pathways to your genitals, and maintain the vaginal wall thickness, and maintain the health of those glands, and all those other things, then you're fine. But if you don't, you're fucked. Or, more to the point, you're NOT fucked.
Oh, and once that gland has been told not to produce testosterone for long enough, it won't. Even if you go off of birth control pills. That function of it is just plain dead. It's been destroyed.
Again, if you manage to produce enough testosterone anyway, this isn't really that bad. But, if you don't, Everything Dies. Desire, ability, lubrication, the triggering chemicals in the brain that tell you to have an orgasm, the sensation in the genitals, the bits of the hymenal glands that keep it from becoming painfully infected -- it ALL GOES AWAY.
Now, it seems that there are other things out there that can cause a lack of testosterone in women, besides birth control pills. But I can't help but wonder if the sharp increase in the reported incidence of sexual dysfunction in women comes, at least partially, from the point when birth control pills became so prevalent that women could be given them very shortly after the onset of menses. Lis was on birth control pills by her third period or so -- her body CAN'T have finished figuring out how to manufacure all the hormones it would need as an adult by that point. And now it never will.
Obviously, you'd need to do a large-scale study to find out if there is any correlation between the age at which women went on the Pill and sexual dysfunction. But it seems like it would be a reasonable hypothesis.
So, anyway -- what can you do about it? You can take DHEA suppliments. Those are not only over-the-counter, they're not even counted as DRUGS by the FDA. Which is bad. Because if a bottle says "25 mg of DHEA", there's no way to be sure that there is ANY DHEA in it, let alone 25 mg. There's no oversight authority. So the BUMC does tests. They buy various brands, and test for the presence of the hormones in the amounts they claim.
That helps some women. If the problem is that their bodies can't turn cholesterol into DHEA, but they can turn DHEA into other stuff, then that's all they really need.
But if the problem is farther down the line, adding DHEA isn't enough. You have to directly add testosterone, too.
Topical testosterone is manufactured. It's for men who don't produce enough testosterone. It's in a gel form. And the amount of testosterone each dose has is appropriate for a man for a day.
It's ten times what a woman needs. A woman needs to divide this gel up into ten little bits and use it over ten days.
And the FDA hasn't approved ANY topical testosterone for women. So pharmacists have refused to fill ther perscriptions. . .
I'm still furious at Congressman Jeff Flake.