What do women want?
I've been an internist for 14 years, most of my patients are women, and a lot of them have the same wish: to recapture the desire they once felt for their husbands.
I've been married even longer than I've been in practice, and so I know what it's like to watch a once-strong libido mysteriously dwindle. This is not something they taught us about in medical school, so I embarked on my search for answers.
I started by setting aside the emotions and looking at basic biology. Nature does not like to waste energy on anything, reproduction included. You can easily see this in the wild. Females respond to males only when ovulating, only if there's a chance to expand the gene pool. Also, female animals aren't receptive to males until their young are ready to be on their own.
Now, back to us.
Women (prior to menopause) ovulate once a month, yet males produce sperm daily. They are equipped to donate to the gene pool any time, while women have just a few days out of the month. Plus, our young are dependent on their parents — particularly their mothers — for a very long time.
There is a definite drop in libido in women who have children, perhaps a built-in shut-down mechanism to prevent another pregnancy too quickly.
But it's not all about kids. Consider why it is that once the courtship is over, so many men wonder what happened to that passionate woman they dated. And so many women wonder if they only imagined the nice guy who opened doors and showered her with flowers.
During courtship, women experience a boost of testosterone, making them more sexually aggressive and attractive. And men have an increase in estrogenlike hormones, making them more gentle and romantic.
Once a relationship is solidified, the hormones go back to normal, and you know the rest. No wonder single women so often have more of a libido than their married sisters.
Add the hormonal changes of menopause into the mix, and it should be no mystery that women's sex drive drops over time.
Seven years ago, I decided to interview same-sex couples who had been together more than five years, hoping to get more insight into libido.
Not surprisingly, sex turned out to be important to the female couples, but it was far more essential to the male couples. Many of the women even had separate bedrooms. They wanted a partner, someone to feel close to, build a history with, to count on in times of need. Men wanted all that, too — but they also wanted a lot more sex.
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So, what do heterosexual couples do when there's a libido gap?
First I think we have to understand we are different, and accept that. Blame should never be assigned either to a man who needs more sex or to a woman who needs much less.
As with so much of life, we as partners need to find a compromise. If your man wants to have sex every day, and you would be fine with it once a month, what about trying once a week?
Both partners need to understand that most women do not have on/off switches. We need time (and sometimes creativity) to get in the mood. But women also should understand that sex is like exercise — you may not think you want to do it, but once you get going, it can feel really good.
Women need to understand that sex is healthy. It stimulates hormones that keep us feeling younger, happier and less moody. It improves our mental function, increases our immune system and lets us sleep better. Women who have a healthy sex life often have a much easier transition into menopause.
And it can do wonders for your relationship.
But I would never suggest to a woman that she fake desire — just that she be open to the possibility that with effort and patience, she can rediscover it.
Don't feel like a session between the sheets has been a failure if you haven't had an orgasm. Concentrate on your partner's pleasure, knowing your time will come. Faking orgasms will only make you more jaded to the experience.
Above all, do your best to communicate what you need. Men (at least the good ones) really do want to please their partners, but they are not mind-readers.
It has been observed that desire depends more on the brain than the body, and I believe that's true. Whatever the state of your relationship, it's bound to get better the more you communicate.
Katarzyna "Kasia'' Ostrzenska, M.D., is medical director of Bay Medical Center in St. Petersburg and is board certified in internal medicine. She is hosting a free "Let's Talk About Sex" seminar for women only on Feb. 24. Contact her at (727) 343-6606 or www.baymedical.com.