Well, here’s an amusing coincidence…

Last month, I was prescribed Bupropion 150mg a day for treating anxiety. Last week, my doctor upped the dosage to 300mg a day, split up into two 150mg doses  in the morning and evening. She picked this specific drug because it is not an SSRI, and therefore will not conflict with my migraine medication. I was looking up information about the drug on wikipedia, and discovered this:

Bupropion is one of few antidepressants that does not cause sexual dysfunction. According to a survey of psychiatrists, it is the drug of choice for the treatment of SSRI-induced sexual dysfunction, although this is not an FDA-approved indication. Thirty-six percent of psychiatrists preferred switching patients with SSRI-induced sexual dysfunction to bupropion, and 43% favored the augmentation of the current medication with bupropion. There are studies demonstrating the efficacy of both approaches; improvement of the desire and orgasm components of sexual function were the most often noted. For the augmentation approach, the addition of at least 200 mg/day of bupropion to the SSRI regimen may be necessary to achieve an improvement since the addition of 150 mg/day of bupropion did not produce a statistically significant difference from placebo.

Several studies have indicated that bupropion also relieves sexual dysfunction in people who do not have depression. In a mixed-gender double-blind study, 63% of subjects on a 12-week course of bupropion rated their condition as improved or much improved, versus 3% of subjects on placebo. Two studies, one of which was placebo-controlled, demonstrated the efficacy of bupropion for women with hypoactive sexual desire, resulting in significant improvement of arousal, orgasm and overall satisfaction. Bupropion also showed promise as a treatment for sexual dysfunction caused by chemotherapy for breast cancer and for orgasmic dysfunction. As with the treatment of SSRI-induced sexual disorder, a higher dose of bupropion (300 mg) may be necessary: a randomized study employing a lower dose (150 mg) failed to find a significant difference between bupropion, sexual therapy or combined treatment. Bupropion does not adversely affect any measures of sexual functioning in healthy men.

So basically, I am currently on a drug that is used to treat HSDD at the recommended dose for such a treatment. I doubt that it will have any effect on me, since according to this, the main effects are on arousal, orgasm, and overall enjoyment—none of which are things I have any problems with. (Why then, I wonder, is it prescribed for a desire disorder which may be renamed to Sexual Interest/Aversion disorder? The problem that this drug treats doesn’t seem to be with desire for or interest in having sex. It seems to be mainly with physiological function. Maybe someone can enlighten me?) But I’m open to seeing what the effects are, and whether they do indeed increase my general motivation to have sex or level of sexual attraction. So far, zilch. But it’s only been a week, and it takes time for this drug to take effect. I’ll report back on how it’s affecting me later.

I hypothesize that it won’t change my asexuality at all, because contrary to popular opinion, asexuality and HSDD are not the same thing. But I’m entertaining the possibility that it actually might. We’ll see.

Guest Post: Interview with K on Female Sexual Dysfunction

This past June, as some of you will remember, I posted a link to a petition to stop the FDA from approving Flibanserin, a drug the media repeatedly called a “Viagra for women.” I did so with the assumption that my readers would follow the link and read what the advocates who created this campaign had to say about it, rather than taking my short comments as a full explanation of my concerns. It seems that many misunderstood my position. Andrew Hinderliter of Asexual Explorations then made a series of posts all over the asexual communities explaining in more detail the reasons why we should be concerned, which sparked an unexpected explosion of controversy. My own view on the subject boiled down to this: given the lack of proof that the drug actually worked as advertised, and given the great potential for harm that would come from an advertising campaign not just to asexuals who would be falsely targeted by it, but also to women who might be offered this drug as a cure for their genuinely unwanted condition only to find that it doesn’t work, I felt it was appropriate to support such a petition. I had little faith in the FDA to make the correct choice without a strong case against it, as they have been known to screw up on occasion, and so I felt it would be helpful to bolster the cause by showing the FDA how many people were concerned what effect Flibanserin’s approval would have. Had the drug been proven to have a more significant effect, I would have supported it, and focused instead only on the advertising campaign and spreading asexual awareness, but all the evidence I encountered suggested otherwise.

What I did not realize at the time was that the New View Campaign, the force behind this petition, has had a history of alienating women with sexual dysfunctions. As I was shocked to discover, some of us in the asexual community (as well as the feminist community) also have tendencies not only to alienate, but to outright marginalize women with sexual dysfunctions in our attempts to advance our own goals (not that we all share the same goals; we’re too diverse for anything remotely resembling an “agenda” but the point still stands). This was never my intention, and I want this blog to be a safe space for women with sexual dysfunction as well, and so I asked K of the Feminists with FSD blog to make a guest post here to highlight these issues. Due to my unexpected hiatus, this post was long delayed. It was originally written shortly after the Flibanserin fiasco, and has subsequently been edited by K.

Some ground rules for comments: this should be obvious by now, but I will tolerate absolutely no disparaging, insulting, or ablist comments. I would also like this not to get derailed by arguments about Flibanserin itself—that’s old news and we don’t need to rehash it here. (If you really want to talk about it, I guess you could dig up the dead threads on some forum, but I wouldn’t recommend that either, honestly.) What I’d like to see addressed here is how our communities can become aware of and accepting of one another, so that we can work together without any nastiness coming from either side. Whether deliberate or otherwise. So please, by all means, check your privilege before posting a comment.

(By the way, I’d also like to mention that if you are a person who is both asexual and also has a sexual dysfunction, I’d like to hear from you, too!  Please contact me at grasexuality [at] gmail.com if you would be interested in making a guest post.)

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I am a feminist blogger living with female sexual dysfunction, specifically the pain category of FSD. I have vulvodynia, specifically vulvar vestibulitis, (though at the current moment it is fairly well managed,) and some residual pelvic floor dysfunction/vaginismus. I have been blogging about feminism and sexual dysfunction for two years, in part motivated by frustration with mainstream depictions of sexual dysfunction (or the complete lack thereof.) I approach these topics from the perspective of a white, cis het woman. I am not a doctor or therapist in any way shape or form, so most of what I know comes from personal experience (mine and that of others) & what I’ve read. While I feel I have made good faith efforts to do my homework, what I say should still be taken with a grain of salt, and I do not claim to speak for anyone save myself. Today I am here to try to answer some questions about sexual dysfunction that were raised on a+, regarding sexual dysfunction and flibanserin.

In my spare time, I enjoy video games and cartoons.
Some basics:
What is Female Sexual Dysfunction? What kinds of FSD are there?

Female sexual dysfunction is a broad term encompassing several types of sexual problems with a common denominator of personal distress. A good overview of sexual dysfunction can be found at harvard.edu. When discussing FSD in general terms it is important to remember there it is not limited to one specific manifestation. In addition to sexual medicine, there’s a lot to talk about with regard to female sexual dysfunction.

There are a few different ways of looking at FSD. The two ways I’m most familiar with looking at FSD are through the medical model and the social construction model.

The medical model is probably the most widely recognized way of looking at FSD. The medical model of FSD looks at sexual difficulties as problems to be addressed medically. It is derived from Masters & Johnson’s work on the Human Sexual Response Cycle. To refresh your memory, the cycle goes arousal, plateau, orgasm, resolution. Deviations from this cycle may be viewed as problems.

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Wanting It (Indifferently)

There’s a new article out that addresses hypoactive sexual desire disorder (HSDD) and the DSM-V: Women Who Want to Want.

There have been comments already about the article’s odd non-mention of asexuality and the strange mantra that Lori Brotto tells her patients to repeat (“my body is alive and sexual”) whether they believe it or not. There’s concern about the possibility of pushing people too strongly to be sexual, and I share those concerns.

Somewhat related, I was also amused at the article’s mention of something that (via my close associations with transitioning people and the trans community) is already well-known to me: the placebo effect of taking hormones. You start taking hormones, and suddenly every zit is a sign that it’s working. You get comments like, “My skin feels softer already!” and “I think my hair is growing slower!” from people who started taking hormones only a few days ago. Which is of course nonsense. Those things do happen, sure, but not THAT fast! Of course people are going to think T is giving them zits when they’re not even on it!

Brotto’s mantra seems to me to be working with that same effect. And maybe for some people it can be useful… but for others, it might seem like something that is working for a while, but then end in disappointment when they realize that there is not really all that much of a difference, and their problem is still there. And is it really a good idea to continue to conflate the concept of life with sexuality? Because even if we use the broadest possible definition of “sexual,” there are plenty of living things which are not sexual in any sense of the word. It’s stupid, of course, to say “my body is alive” if the state of aliveness is actually what is being referred to, because that’s bleeding obvious! So of course I think she should change that word. But it’s also possible to be vigorous and effervescent, if that’s what’s meant by “alive,” without being sexual at all. I realize it is aimed at helping patients harness a certain “sexual energy” or whatever, but I still think it’s an ill-conceived and inappropriate metaphor all around. Do we really need any more of a push in the direction of “nonsexual = dead”?

Really, though, I wasn’t all that bothered by or interested in that part of it. I was too distracted by the ideas presented by Basson to pay much attention to Brotto:

A different manifestation of desire — not initial hunger—– appears about two-thirds of the way around Basson’s circle. There, in the diagrams she began publishing in obstetrics and sexuality journals 10 years ago, come the words “responsive/triggered desire.” For Basson, this is necessary to satisfaction. But it comes after arousal starts. So a typical successful experience might proceed something like this: first a decision, rather than a drive, to have sex; next, as Basson puts it, a “willingness to be receptive”; then, say, the sensations of a partner’s touch; next, the awareness of being aroused; then the “responsive desire” along with increasingly intense arousal; and at last the range of physical and emotional payoffs that sex can provide and that offer positive reinforcement leading back to the top of the diagram, to the reasons for setting off on the circle to begin with.

I have sometimes wondered if I might consider myself sexual if I had been presented with a different model of sexuality than the one that society adopts. And under this model, I might be considered so.

This describes pretty much exactly the way that I myself navigate sexual activity. It was never about desire to begin with; it has always been a conscious decision to go ahead with it, for me. Of course, it isn’t true that I decide I’m going to have sex before I find myself in the middle of foreplay every time. But it is true that I made the decision to have sex with my partner, and gave her my implicit consent to initiate if she wants to, told her that it is generally okay for her to touch me in ways meant to arouse me, and I’ll stop her if I don’t want her to do it right then. Almost always, I end up aroused and able to enthusiastically consent. Of course, it helps that C is good at reading my signals (which are subtle and probably difficult for most people to read), and that she knows what I will respond to. She doesn’t push beyond my limits, is careful to stop whenever I say it’s getting painful, and also checks in with me whenever my facial expression is so ambivalent that she is not sure how I am doing. Over time, we’ve built up a safety net that allows me to be receptive to her as a general rule. And because that safety net is in place, I’m able to relax and follow my body’s cues to experience this sort of arousal-desire that Basson is talking about.

And so I think she is onto something, here. Society’s model of sexuality really is very attraction-focused, but the truth of it is that attraction often has very little if anything to do with enjoyable sex. Lots of people, probably women more so than men, find it pretty easy to have sex with people they are not attracted to. Of course there are people who say that they can’t imagine having a sexual relationship with someone they don’t find sexually attractive, but a lot of them settle anyway. Sometimes it takes a bottle of alcohol and a sense of desperation to get them to do so, but other times? I know a guy who met a girl a while back that he kept saying he wasn’t attracted to because according to him she is a “hambeast,” and now they’ve been together for six months or so, and live together as well. And I wonder how many married couples there are who don’t find each other sexually attractive anymore, but are still perfectly able to enjoy having sex with one another? Maybe some of them stop having sex for that very reason, but I suspect a lot of them keep on going at it–a little less like bunny rabbits, maybe, but still!

However, as much value as I see in Basson’s approach as described here, I don’t think it covers everything. There’s still the idea of lust–a concept I feel greatly removed from. I don’t really get it. At all. I never find guys hot in a “check the oil” sort of way. Or girls, for that matter. The attraction part of it is just missing for me, and even if it is an overblown cultural ideal more often than it is a reality, I still feel pretty alienated when I’m the only one in the room who doesn’t get it, which happens pretty frequently.

So I call myself asexual. And although my moniker hints at me being in the gray area between sexual and asexual, and I guess since I find sex enjoyable then according to some people I would be considered sexual, I’m really not feeling particularly “gray” lately. I don’t think that having sexual desire pretty much only when it is sparked by physical arousal is very strong evidence of being sexually attracted to people, and that missing attraction is (for me) what asexuality is all about. That’s the only definition that makes sense to me, and during the years that I have identified as asexual, despite my frequent reevaluations and openness to new experiences, my own asexuality has only become increasingly clear to me.

Causality

I always wonder why it seems to matter so much (to other people) what asexuality is “caused by.”

Of course, there are a lot of people out there who would say that asexuality doesn’t really exist, and that it’s just repressed sexuality caused by trauma, or “latent” sexuality caused by a lack of appropriate hormones or whatever pseudo-scientific bullshit theory is being spouted these days without any evidence to support it whatsoever.

But my question is not whether or not asexuality is, or can be caused by either of those things (because of course, sexuality in humans is highly complicated and possibly a little bit like HTML—in that if there is even one component missing, it might not work; so there are probably many different potential causes for asexuality), but whether it matters.
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