For Women With Low Libido, Sex Is First a Decision, Not a Drive

Dear Neil: Your article about a woman’s loss of libido published in October suggested that testosterone treatment is the answer for reduced libido in women. Unfortunately testosterone is not available in New Zealand, and doctors cannot prescribe it. Could you raise this in your column in an effort to reverse the situation?

Stymied in Wellington, New Zealand

Dear Wellington: Let me do better than that. I would like to invite medical professionals to email me with an explanation of why there’s such a policy in New Zealand, and to ask them what advice they give female patients who complain of low sexual desire.

There was an excellent recent article titled Women Who Want to Want published in the New York Times Magazine. The article says that almost any method that gets people to think about sex increases their interest in having it, and that at any rate sex for most women is first a decision—and second a willingness to be receptive—not a drive as it is for men. It says that desire follows arousal—meaning desire isn’t what a woman is likely to feel first.

I will publish the most helpful letters I receive in a future column.

Dear Neil: Although I do agree with you that there needs to be communication in any relationship, I disagree with the advice you offered in one of your articles, telling a man who’s wife cheated on him that he should have initiated a conversation with her. In my opinion, it is her responsibility to initiate a conversation with him. If she is lacking something in their relationship, she needs to address that issue with him. I feel that the betrayed person was blamed.

Irritated in Trinidad, Colorado

Dear Trinidad: In the ideal world, any person unhappy in a relationship would verbalize their feelings and what they would need in order to fix the problem. In the real world, regardless of who created the problem or who has the strongest feelings about it—address the issue ASAP before it grows bigger.

Dear Neil: Awhile back you wrote a column offering suggestions for people with depression. When I became ill with depression and anxiety myself, I (a social worker by profession) read all the self-help and diagnostic books I could find. What really alarmed me was with all the reading material and counseling, my illness worsened, and I became more and more desperate. At the point of near suicide, I accepted that my illness was genetically based and biochemical in nature. Medication has worked, and now the self-help books are undeniably helpful as I begin to feel better. Sometimes the problem is biochemical, and it requires a biochemical solution—such as medications—rather than a self-help solution.

Feeling Better Through Chemistry in New Zealand

Dear New Zealand: Your point is well taken. Sometimes depression can be treated simply by looking at what is causing pain, what changes need to be made, or how you may need to view a situation differently. But sometimes depression is indeed biochemical and can be greatly assisted with medications or other treatments—along with making some of those changes.

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