Let's Talk About Sex*
*Sex troubles, that is. And while we’re at it, let’s break the silence on mental illness and drug abuse. Incontinence? Now there’s another taboo topic women are only beginning to discuss with their doctors. Open up. Don’t be embarrassed. Honest, you’ll feel better if you’re frank with your physician—and with other women—about such verboten subjects.
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Taboo Topic No. 2
Last year, a new—and pink-covered—edition of the feminist health classic Our Bodies, Ourselves was published. The public’s reaction was ho-hum—not anything like the excitement that greeted the first edition of the book in 1970.
But back then—when Mary Richards never appeared in bed with a boyfriend and long before Sex and the City became a gleam in some producer’s eye—female sexuality was a highly taboo topic.
That meant talking about sexual problems was also off-limits.
Our Bodies, Ourselves (and other sexually explicit feminist books of the early ’70s, such as Erica Jong’s Fear of Flying) transformed many women’s sex lives. Barb, now a 62-year-old Twin Cities dental hygienist, recalls, “I had been married several years, but I wasn’t having orgasms, or only infrequently. I would just fake it.” Then she picked up a copy of Our Bodies, Ourselves and learned—for the first time—precisely how female orgasms occur.
“For me, the problem was lack of knowledge,” she says. She had never thought to talk with her mother or any of her four sisters (“too embarrassing”) or with her doctor. “I didn’t think of it as sexual dysfunction,” she says.
Today, sex is no longer a taboo topic. Turn on the television, particularly in prime time, and you’re likely to hear some kind of sexual reference. According to a 2005 Kaiser Family Foundation report, 7 of 10 television shows (excluding news, live sports, and children’s programming) include sexual content, with an average of five sexual scenes per hour. That’s nearly double the sexual content on TV since 1998.
But talking about sex and talking about your own sex life are two different things. Many women are still uncomfortable doing the latter, partly because, ironically, of how sex is portrayed in the media.
“In movies, on television, people talk about how great sex is,” says Beatrice “Bean” Robinson, PhD, a licensed psychologist and associate director of the University of Minnesota’s Program in Human Sexuality. “You don’t really get a sense that it can be a struggle. So people with problems think they’re the only one. They don’t know that there are other women who struggle with the same things.”
And women do struggle—usually silently—with sexual difficulties. In a much-cited 1999 study published in the Journal of the American Medical Association, 43 percent of women (compared to 31 percent of men) ages 18 to 59 reported that they had experienced some sort of sexual problem—mostly low desire, difficulty with arousal, or pain during intercourse—during the previous year. Interestingly, problems were most common among younger women.
“Low desire is an epidemic right now,” says Robinson. “Everyone is trying to figure out why that is. Some of it is we’re just too damn busy, and we don’t get enough sleep. Sex is like dancing, you need to be relaxed and have time for it.”
The 1999 study has its critics. Some researchers say the study was flawed because it didn’t ask women if they were distressed by the symptoms they reported. Others denounce sexual dysfunction studies in general, calling the term highly misleading because it implies the existence of a medical condition—and thus the need for medical (drug) solutions. Low libido, these critics point out, can be a natural and healthy response for women who are stressed, tired, or in a troubled relationship.
For women struggling with a sexual problem, however, it doesn’t matter how many other women are affected or what it’s called. They just want help. Asking for that help can be very difficult. Robinson recalls one woman in her forties who was too embarrassed to answer “yes” when her ob-gyn asked at her annual checkup if she had any sexual concerns. The woman didn’t want to talk about her sex life in front of a young resident doctor who was shadowing her ob-gyn that day.
“The woman waited until the next year, when she was scheduled for another Pap test,” Robinson says. Only then, when the doctor asked the woman the same question without anyone else in the room, did she open up about her worries and concerns.
A wide variety of physical and psychological factors cause or contribute to sexual dysfunction in women, including diseases such as diabetes that reduce genital sensitivity; medications that diminish libido; lack of vaginal lubrication, particularly after menopause; yeast and other infections that can make intercourse painful; and depression.
Treatments are as varied as the causes. They range from learning new sexual techniques to medications to surgery. “You just have to find doctors who know something about proper diagnosis and treatment,” says Robinson.
And you have to be willing to talk. Barb makes a point of being available to her grown daughter for frank discussions about sex. “My mother and I never had those kinds of talks,” she says. “I wish we had.”
Taboo Topic No. 3
Betty Triliegi, a Minnesota real-estate agent, has always talked openly about her past. “I was a drug addict and an alcoholic,” she says. “I’ve never been in the closet about it.”
There was a time toward the end of her 12 years of addiction (to barbiturates, mostly), when she was much more circumspect. “At the end, you’re pretty much alone,” she says. “You don’t even hang with a bunch of other addicts, because you’re protecting your supply. You get pretty isolated. You’re hiding. You’re ashamed.”
Sober since the day in 1970 when her mother forced her into treatment, Triliegi worked for many years as a chemical-dependancy counselor and remains an outspoken advocate for better services and treatments for addicts. She’s discouraged about the public’s current attitude toward substance abuse—an attitude that she thinks is sweeping the problem back under the rug.
“Everybody wants it to go away,” she says. “Nobody wants to think about it.”
People particularly don’t want to think about the women in their lives—their mothers, wives, grandmothers, sisters, best friends, or themselves—as struggling with an addiction. “There still is a stigma against women having a drug or alcohol problem,” says Sheila Specker, MD, medical director of the Substance Use Disorder Treatment Programs at the University of Minnesota. Women who drink excessively tend to be viewed as promiscuous, for example, while men aren’t. (It’s a fact, though, that drinking does increase a woman’s risk of being sexually abused.)
This double standard (which goes all the way back to first-century Rome, when drinking by women was considered a crime) wreaks havoc on marriages. Men are much more likely than women to walk out on an alcoholic spouse.
Denial can’t erase the fact that substance abuse is one of the most serious—if neglected—women’s health issues in the United States today. According to the U.S. Department of Health and Human Services, about 6 percent of American women have a drinking or drug problem. Although that’s half the rate for men, the gender gap is narrowing and has actually closed with teenagers. A 2004 government survey found a statistical dead heat in substance abuse between teenage girls (9 percent) and teenage boys (8.7 percent).
The risk of developing an alcohol or drug problem diminishes for women after age 25, but it doesn’t go away. Women are at greater risk than men of developing alcoholism late in life. About half of all cases of alcohol abuse among women begin after age 59, compared with one-quarter of cases in men. In addition, older women are almost twice as likely as men to become addicted to prescription drugs.
Studies have also shown that women of all ages tend to become addicted to alcohol and drugs more quickly than men—a process called “telescoping.” This means that women also tend to develop related health problems faster—and with more devastating results. More alcoholic women die from cirrhosis of the liver than do alcoholic men.
Because of the shame associated with substance abuse, women often try to hide their addiction from families and friends, and they can be very clever at it, filling an empty vegetable-oil bottle with alcohol or stashing a prescription pill bottle in a roll of toilet paper stored on a basement shelf. Women, Specker adds, are also usually more successful than men at “doctor shopping”—going from doctor to doctor to get multiple prescriptions for the drug they abuse.
“Before I went into treatment, I was seeing 11 different doctors,” says Triliegi.
Unfortunately, women are less likely than men to get help for addiction. Shame, embarrassment, and denial are all factors. So is fear—the fear that seeking treatment may cost them their marriage or, worse, their children. And they worry about the financial impact treatment could have on their families.
But the personal cost of not getting help is huge. Fortunately, Minnesota offers addicts many treatment choices.
“Here in Minnesota we humorously say we’re the land of 10,000 treatment centers,” says Specker. Many programs focus specifically on women, with an emphasis on group therapy. “Having low self-esteem, not being assertive, and not having coping skills—these are all things that, for some women, are easier to deal with when they’re in a group of other women,” Specker says.