Sexuality in Women

Edward Laumann, George Herbert Mead Distinguished Service Professor of Sociology and the College at the University of Chicago, was online Tuesday, Sept. 20 at 11:15 a.m. ET to discuss the prevalence of sexual dysfunction in women and the factors that can cause it.

From Tuesday's Health Section:

Meeting Women's Desire for Desire (Post, Sept. 20)

Since joining the University in 1973, Laumann has acted as the editor of the American Journal of Sociology, chair of the Department of Sociology, dean of the Division of the Social Sciences, provost of the University of Chicago, and is currently the director of the Ogburn Stouffer Center for Population and Social Organization and chair of the Board of Trustees of the NORC, one of the principal national academic survey organizations that conduct social surveys for various government agencies, including the National Institutes of Health. He has been a faculty member of the RWJ Clinical Scholars from its inception and has served on its University advisory board.

Laumann's research interests include organizational and economic sociology, the sociology of health and social behavior, human sexuality, political sociology, and social stratification. He directed the National Health and Social Life Survey, one of the largest surveys of sexual attitudes and behaviors in the U.S. since the publication of the Kinsey Reports in the 1950s. He is currently co-principal investigator on three N.I.H. funded studies, including a study examining the relationship between sexual behaviors, social institutions, and health status in Chicago, the National Survey of Chinese Sexual Practices (which examined sexually transmitted diseases in a probability-based population sample using biomarkers to assess respondents' STI-infection status), and a study of physical and sexual health status, social intimacy, social network embeddedness, and quality of life among middle-aged and elderly Americans, using an extensive array of lay-administered biomarkers to assess physical status. He has also been a principal in the analysis of the Pfizer-funded 29-country survey of sexual health and dysfunction among men and women 40 to 80 years old. Author of 15 books, he has published extensively in JAMA, Sexually Transmitted Diseases, Science, Journal of Health and Social Behavior, International Journal of Impotence Research, and the American Journal of Public Health.

A transcript follows.

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Pittsburgh, Pa.: I am glad to see this subject being discussed. I am currently 46 years old, happily married, but have suffered with a lack of sex drive for the past 3 years. At that time, I had one of my ovaries removed, two weeks after adopting my now 3 year old daughter. At the time, I attributed the drop in sex drive with the increased demands of a newborn, but even now, my interest is non-existent. The doctor who performed my surgery had reassured me that since I still had one ovary, that the hormonal balance would not be affected significantly, although now, I think he was wrong. I have spoken with my new gyn about it (I moved to a new state about 2 years ago), and his solution was to suggest I start low-dose HT, which I do not want to do. (I am, however, still taking the pill to control symptoms of endometriosis and fibroids.)

What can I do? This is so frustrating for me. It seems so unfair that there are several drugs on the market for male ED, but NOTHING (at least nothing FDA approved) for women.

Edward Laumann: I am an epidemiologist who studies the prevalence of sexual dysfunction in the population at large. I am not a physician or clinician so I won't have any specific suggestions about remedies to address particular problems. You will really need to rely on your physician for guidance on the use of medications or not.

Your description of your situation is very interesting because it would be offered by many women in your situation. We have found that about 33 percent of women between the ages of 40 and 80 living in the U.S., Canada, New Zealand, and Australia report a lack of sexual interest for several months or more at least occasionally (13.4%), periodically (12.8%), or frequently (7 %). Source: International Journal of Impotence Research (2004). What data such as these have shown are the great difficulty in teasing out what are the effective or causal factors responsible for this self-report. Reports of lack of interest seem to be associated with a variety of situations, ranging from social and personal stressors in one's life, the quality of the relationship with the partner, and various health conditions. What is really remarkable is that complaints about lack of sexual interest don't seem to be related at all with one's age. That is, young women in their twenties are as likely to say they lack interest in sex as women in their forties, fifties, and sixties.

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Gaithersburg, Md.: I feel that my source of sexual frustration stems from my lack of body confidence. I am too worried about my rolls or thighs. The most prevalent side effect of our thin obsessed society is a plethora of women too afraid that we don't meet these standards. I can't get it out of my head that he'd rather be with any other woman but me! Doesn't help that no one shows good sexual role models of women of a healthier weight.

Edward Laumann: I think women worry far more than they should about their weight, often getting these ideas from the mass media and general conversation. William Parish and I conducted a study in China where women have a much lower BMI (body mass index) than is observed in the United States. We were surprised to learn that many Chinese women with a very low BMI's by any standard were obsessing about their weight and were seeking to "lose weight in order to be more physically attractive." There is great variability in BMI among both men and women and there are much greater variation in people's attitudes about what looks attractive than you seem to be assuming.

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Ann Arbor, Mich.: Dr. Laumann,

I'm in my late 20's and I only seem to desire sex every few months. This is frustrating to both my husband and I. I'm not on any medications (including birth control) and my doctor checked my hormone levels and they all appear to be "normal." Yet, I feel as though my sex drive should be higher. I have also been diagnosed with Polycystic ovarian disorder. Could this be part of the reason?

Edward Laumann: You might want to take a look at one of my first answers that describe how common it is for women, even in your age range, to report a lack of sexual interest. I have really been stunned to see how invariant across age these feelings are among women. We can show that there are a variety of personal and social stressors (such as worries about money and making ends meet, the loss of a loved one, etc.) that can be shown to be associated with a reduced level of sexual interest in women. I am not a physician so I can't comment on the possible role of Polycystic ovarian disorder on your situation. I think it is worth stressing, however, that since one in three women complain about this problem in any given year of age, you need to be "more forgiving" about your problem, especially if it arises only occasionally or infrequently. Our state of knowledge is really very limited in our understanding of what promotes or alleviates this condition--we do know it is very complicated, with many complex interactions among psychological, physical(biological), and social variables. As a result, it is unlikely that there will be any simple solution for a given episode of lack of desire.

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Alexandria, Va.: I've never had an orgasm through sexual intercourse. Does this fall under the umbrella of "sexual dysfunction"? How common is this issue for women?

Edward Laumann: Based on a survey of women in the US, Canada, Australia, and New Zealand collected in 2000, we report in the International journal of Impotence Research (2004) that about 25% of women aged 40 to 80 report an inability to reach orgasm for several months or more in the past year, with 9.5% reporting the problem infrequently, 10.4 % reporting periodic problems of achieving orgasm, and 5.3% reporting frequent problems in achieving orgasm. This level of problem (about 25%) was also reported in the US survey for women between the ages of 18 and 59--so it doesn't seem to be especially related to age itself. Factors associated with higher levels of inability to reach orgasm include being relatively inactive physically, thinking about sex infrequently (less than once a month), a reported diagnosis of depression, being worried about the future of the current sexual partnership, and having sex relatively infrequently (less than once a week).

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Washington, D.C.: Does anyone ever question the role that these women's husbands/partners might be playing in their lack of interest in sex? Having a bad lover tends to decrease one's interest in sex. It seems to be married women who are having the most trouble, not single women, which reinforces the notion that the married women might be stuck in long-term relationships with bad lovers.

Edward Laumann: There is clear evidence that the quality of the relationship with a sexual partner is an important factor in determining the lack of sexual interest. For a survey of women aged 40 to 80 in the US, Canada, Australia, and New Zealand, you had 2.8 times higher level of a lack of sexual interest if you described your current partnership as having no future and 2.3 times as high if you were worried about the future of the relationship. Having sex less than once a month increased the risk of reporting a lack of interest by a factor of 2.3.

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Portland, Ore.: I'm a 45 year old divorced man and my experience when I was married was that after the kids arrived, sex stopped.

Needless to say my interest did not and I'm sure it contributed to the break-up of my marriage. So I find this an interesting topic.

Is there a difference between single and married women in this loss of sexual interest? Do women with young children have a sharper loss of sexual interest? Without medication, will that interest return when the children get older?

Edward Laumann: There is fairly clear evidence that women with children under six years of age are substantially at greater risk of lacking interest in sex than women without children. It doesn't require one to be a rocket scientist to figure this relationship out--women with young children are often physically and emotionally exhausted by the demands of caring for the children. It could almost be seen to be a protective or adaptive response to lose interest in sex since this might lead to even a greater physical challenge for the women to cope. One needs to address this problem by providing suitable support for women to handle the demands of the situation.

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St Brieuc, France: Dr Laumann,

Following on from your first answer : I've heard specialists (concerning other medical 'problems') that when these affect a large percentage of the population, they should often be considered more properly as within natural variations. Surely one third of women should make us wonder who is defining 'dysfunction'?

Thank you.

Edward Laumann: I think this is quite an appropriate question to raise--when something becomes that prevalent how can it be regarded as atypical or abnormal? I think you are putting your finger on what is a challenging problem of interpretation. In an important sense, dysfunction in sexual capacity may be seen as a regulative or control device that is adaptive or protective for the individual organism. Historically there was a direct connection between sex and fertility. And since women who became pregnant, if not in good health and supportive circumstances, faced a real threat to their very survival or that of the unborn child, it would seem adaptive if sexual interest closed down when circumstances were not favorable to a successful outcome. This is how I see the role of personal and social stressors in a person's life, which elevate a lack of sexual interest, as a protective response.

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Dallas, Tex.: How much more likely are women who are victims of sexual abuse to lose interest in consensual sex?

Edward Laumann: Our data indicate that women who have been victims of childhood sexual experiences or unwanted sex as adults do show elevated levels of sexual dysfunction--but this is a very complex question to tease out which factors play the critical causal role. We simply don't have very good data in hand with sufficient numbers of cases to have a definitive answer to this question although the indications are that such experiences do have these adverse outcomes. Christopher Browning and I have an article on childhood sex and subsequent life outcomes in an article that appeared in the American Sociological Review in 1997.

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McLean, Va.: Dr., what do you think of the current leanings toward abstinence-only teachings of sexual education in schools today? In my own educational experience (which includes post-graduate classes in human sexuality), these do not help adolescents make intelligent choices, but I was wondering what your findings may have led you to believe.

Edward Laumann: This has not been a focus of my own research to evaluate systematically and carefully the efficacy of "abstinence-only" teachings of sexual education in the schools. It turns out that this is a very challenging research question and I have not seen any very convincing studies on the topic.

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Washington, D.C.: Is there a norm or standard for sexual desire for women? That is, how often 'should' a woman desire sexual intercourse and what should she 'expect' from it? My own view is that lack of desire is not abnormal. Sometimes it's a matter of choice of activity. There are a lot of things that are just as much fun as sex.

Edward Laumann: There is really no norm or standard for sexual desire for women. How would one go about establishing such a standard? One would have to establish or define what one means by sexual desire in women and my reading of the literature is that things are really quite confused and contested. For example, it has been recently that there has been an effort to measure sexual arousal in women and the results have been conflicting and disappointing in the sense that there doesn't seem to be much of a correlation between physical states of arousal and subjective self-reports. I certainly agree with you that lack of desire is not abnormal, but very much to be expected. The issue is constructing a theory of sexual interest and expression that is rooted in empirical reality. Research in this area is just beginning.

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Virginia: Have you noticed any prevalence of sexual dysfunction in 20-somethings, completely happy in their relationships, about to be married and in love with their partner? I have no interest in sex, which pretty much started when I started having sex. I do not enjoy it, it is sometimes painful. My partner is frustrated with this aspect of our relationship, though patient and loving about it. I'm not sure if it's stress, something physical (my gyno assures me I'm "normal"), or something psychological. Have you seen this behavior in other young, otherwise healthy women?

Edward Laumann: According to my article in JAMA (1999) based on the US national sex survey, women between the ages of 18 and 29 32% lacked interest in sex, 26% were unable to achieve orgasm, 21% experienced pain during sex, 27% reported sex was not pleasurable, 16% were anxious about performance, 19% had trouble lubricating. It is not uncommon for young women to report pain during sex (which declines with age as women become more sexually experienced, as one hypothesis would have it). You can see that the problems you report are fairly frequently reported. There are sex therapists who might be able to help on this problem.

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Atlanta, Ga.: You mentioned that young women in their 20s can also experience a lack of sexual interest. Can you explain further as to why this happens, causes, etc? And what are some treatments available today?

Edward Laumann: There are a number of risk factors that are associated with low sexual desire. According to the JAMA 1999 article based on the US national sex survey, with respect to health conditions, having ever had an Sexually Transmitted Diseases (44% more likely), being in poor or fair health (2.2 times more likely), having emotional problems or stress (2.7 times more likely). If your household income has fallen more twenty percent over the past three years, 66% increase in low desire. Regarding sexual experiences, having partnered sex no more than once a month increases low desire 2.3 times; if you think about sex less than once weekly, 2.37 times more likely; having been sexually forced by a man ever increases low desire by 45%.

Various proposed treatments are in the pipeline awaiting FDA review and approval. There have been controversial because long-term effects have been difficult to evaluate. You need to consult a physician you trust to review possible options.

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washingtonpost.com: This concludes today's discussion with Edward Laumann. Thank you for your questions.

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Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.