Web Chat on Female Sexual Arousal Disorder with Dr. Candace Brown, Pharm. D. (The following is an edited transcript of questions and answers from a web chat held on Wednesday, February 13, 2002 on News Channel 3)

Dr. Brown: Hello Everyone and thanks for joining us today. As a psychiatric family nurse practitioner, I see many women with sexual problems. I also perform research on sexual disorders in women at the same location.

Q: I am a 25 year old new mother. Isn't it natural for me to want to abstain from having sex?

Dr. Brown: It is very natural for new mothers to want to abstain from sex. If you are breastfeeding this is particularly true, as well if you are still tender from an episiotomy. Often those sexual feelings will come back if you and your partner take a little more time, and do other activities.

Reply: How long will it take?

Dr. Brown: Most mothers will start having intercourse within 6 weeks from delivery, but it is a very individual thing. The best time is when you and your partner feel it is time.

Reply: How can I explain this to my husband in a way in which he can more or less understand?

Dr. Brown: One way would be to take your husband to your family doctor or OB/GYN who can discuss how the early postpartum period is a very common time in which women lose their sexual interest, and is due to physiological changes.

Q: I can not have an orgasm unless there is oral sex involved.

Dr. Brown: Many women are unable to have an orgasm without oral sex. In fact, many women are unable to have orgasm strictly with intercourse.

Q: What if your sex drive never really comes back to the way it used to be before you had children?

Dr. Brown: Having a reduced sex drive after children is very common. Some women will never have their sex drive return to pre-birth levels- but the majority can have those feelings return. They take a combination of an understanding partner and discussions with your doctor about possible causes.

Q: I am a 37 year old woman who has never had a orgasm from penetration, what can I do to help this problem?

Dr. Brown: The majority of women do not have orgasm from penetration. Oral sex and touching by your partner are often more successful, and are good precursors to intercourse.

Reply: Thank you so much, it is good to know that there are a lot of women out there who have the same problems. I also have a low sex drive I am only 32 years old. What is wrong?

Dr. Brown: Low sex drive may be due to personal, interpersonal, medical illness, medications, or temporary periods during your life (e.g., pregnancy, menopause). The best thing is to go to your doctor and have him/her weed these issues out.

Q: I'm 34 and I have a very high sex drive, but I can't reach an orgasm. This is a bigger problem for my husband.

Dr. Brown: By a high sex drive, I guess you mean your are interested and aroused, but don't reach orgasm. What methods to you use. Does your spouse take enough time, and can you instruct him as to what turns you on?

Q: Does this effect young mothers as well?

Dr. Brown: Young mothers very often have reduced libido. It can be a combination of increased stress form having children, feeling less "sexual" as a mother, body images changes, or physiological changes, particularly if you are breastfeeding.

Q: :I start out wanting to have sex with my partner but during the process I can no longer reach orgasm with him. I am now 40 and wonder if age has anything to do with it?

Dr. Brown: Women have their highest sex drive in the thirties and early forties. Are you still attracted to your partner and is he a good lover? Perhaps you need to take longer or use different techniques.

Q: I am always so busy with our children that my husband does not understand when I am not in the mood. How can I get him to understand that I do not want it everyday like he does?

Dr. Brown: There are often differences in the amount of desire and women and her partner have. It is important for your husband to know that daily stresses can certainly reduce your interest level. Could he show his understanding and support by helping with some of the parenting needs?

Q: How do you treat sexual arousal disorder?

Dr. Brown: Sexual arousal disorder is best treating with a medication that dilates blood vessels in the vaginal region. Examples that have been used (but are not approved by the Food and Drug Administration yet) are Viagra, which is used in men for similar problems.

Q: I have extremely low libido, with no know health problems, someone told me the drug Celexa can improve libido, is this true?

Dr. Brown: The drug Celexa is NOT effective in improving libido unless your low libido is due to depression.

Q: I am now 40 and do not have the sex drive that I used to. Periods are still the same. Could it be menopause?

Dr. Brown: If probably is not menopause unless you are starting to experience other symptoms such as hot flashes, night sweats, insomnia, and irregular periods. Look at other potential causes - such as medications, illnesses, personal, or relationship issues.

Q: After surgical menopause, no libido. Have tried testosterone cream but it seems to raise my BP. Any other suggestions to increase libido?

Dr. Brown: Surgical menopause is a very common cause of reduced libido. You may ask your doctor to consider DHEA, a supplement that has been helpful in some women.

Q: Ever since I have contracted a STD, I have not had an orgasm. What is the problem?

Dr. Brown: I wonder if you are considered about contracting another STD, and have trust issues in regard to your partner. Also, do you somehow feel differently about your self (e.g., self image) since contracting an STD?

Q: I will be 50 this year and I have started Menopause. My sex drive has slowed down. I want sex with my husband but am unable to have an orgasm.

Dr. Brown: You may consider talking to your doctor about this. Often reduced estrogen from menopause can cause these symptoms and are easily treated with hormone replacement therapy.

Q: What are some successful things that have been tried to enhance the sex drive? I have very little sex drive.

Dr. Brown:. Some of the things that have been used are self-stimulation (masturbation) - so that you are aware of what excites you so you can tell you partner. Also, there are medications available for treating decreased sex drive, but should be discussed with your doctor.

Q: What can you do to get your sex drive back?

Dr. Brown: It is helpful if you can identify when you sex drive decreased - is their a trigger that caused this? (e.g., change in relationship, change in medication, etc.) Identifying the source can be helpful in determining the treatment.

Q: I have the same problem but am 19.

Dr. Brown: A low sex drive in a young woman is often doe to interpersonal and relationship issues. How do you feel about your self? (body image), did you have appropriate sexual education?, any child abuse? Is your partner understanding, do you trust him, does he take time. Are you taking any medications that could be responsible, or is stress an issue?

Q: I am 45 years old, I have been diagnosed with fibroids in my uterus and a large one behind my left ovary. For the last 6 months, I have had a very low sex drive, with difficulty becoming lubricated and am very dry. What can I use, without using the K-Y jelly, that takes away from the sex act itself?

Dr. Brown: Endometriosis is a very common cause of low libido, low arousal, and decreased lubrication. Are the fibroids removable? You should treat the underlying condition first (fibroids), then consider other alternatives.

Q: I am post menopausal, and I was wondering if there is any vitamin regimen that could be utilized in place of hormone therapy? I have difficulty with HRT.

Dr. Brown: Talk to your doctor about DHEA, a vitamin supplement that is a precursor to testosterone, and has been found to be successful in some women.

Q: What is DHEA?

Dr. Brown: DHEA is a supplement that you can get at the drug store - make sure that the ingredients are standardized. Most women do well on 50 mg a day, but it may take a month or two to get a response.

Q: Where can someone in Memphis go to have low libido issues treated?

Dr. Brown: You may come to the UT Medical Group Germantown Office. Call 901-347-8320.

Q: I enjoy having sex with my husband but can never reach orgasm while he is inside me. This problem both frustrates me and upsets him. What can I do to reach orgasm at this point?

Dr. Brown: Many women have this difficulty. Often women cannot have an orgasm during intercourse. The best way to try to do this is with you on top, allowing your clitoris to be stimulated. Otherwise try oral sex or manual stimulation prior to intercourse.

Q: Can cigarette smoking affect sex drive?

Dr. Brown: This is a great question. I have not seen any studies on this, but possibly the constriction of vessels that occur when you spoke in your body, could also affect those in your vagina and decrease blood flow, therefore decrease arousal.

Q: I am a 27 year old mother of a new baby and 4 year old. I have never had an orgasm with my husband. So many other women I know seem to have great sex lives. What can I do different. I have a very high sex drive and I have told my husband what I like. And still nothing.

Dr. Brown: Is your husband attractive to you? Do you know what to tell him to be turned on? Do you know what turns you on? Have you have orgasms with other partners in the past?

Q: I’m 46 and I have no sexual appetite at all I never seem to want sex and my hubby wants it everyday. It is affecting our marriage. What could be causing me to feel this way?

Dr. Brown: Is the pressure from your hubby causing you to associate sex with negative things? In other words are you wanting to avoid it? Perhaps you could take a month off, where you simply pleasure each other but with no sex allowed. This is a common technique.

Q: Does oral sex help?

Dr. Brown: Oral sex is very effective in reaching orgasm for women. This is because the clitoris needs to be stimulated, and this often does not occur during intercourse. Also, the foreplay is particularly important to women.

Q: My gynecologist doesn’t seem to be aware of any medications to treat low sex drive, other than testosterone and that was not effective in my case, what other drugs are available? What types of medication are available? What doctors are good in this field?

Dr. Brown: It is best to talk to a doctor - perhaps another one. Many doctors are unaware of other alternatives. Sometimes testosterone does not work in a particular form (e.g., tablets) but may work in a cream or patch. Also, sometimes other medications work, perhaps and antidepressant if you are depressed, which is causing the decreased sex drive. In other words there are a number of options. Some prescription medications on the markets have been very helpful in various types of sexual

Q: I have had two miscarriages; my doctor feels it has to do with hormone levels. Can this also be the cause of a nonexistent sex drive?

Dr. Brown: It would be best to have your doctor measure hormone levels for you. Most women that are young do not have a hormonal problems, but if it is an infertility issue, this is possible. Sometimes in women with infertility, depression may be an issue, where an antidepressant may increase sex drive.

Q: I'm 46 partial hysterectomy, post menopause & on Estra tab HC. The doctor just changed me over for this problem ( low libido). Should I call her back? My husband's concerned! What about this new liquid drops for women like Viagra?

Dr. Brown: Estratest is very helpful in women that are postmenopausal. You need to give it time - at least a month to see if you respond. Viagra can be helpful, but it is second line to the estratest.

Q: I am a 32 year old diabetic woman who loves her husband terribly. I find him attractive and sexy, and he is an awesome lover. I almost always enjoy sex when we have it, but I never really care if we do or not. What does diabetes have to do with that?

Dr. Brown: Diabetes can decrease blood flow to many organs in the body, including the vagina. It would be best to talk to your doctor, but a medication that dilates these blood levels may work. An example that is not approved by the FDA is Viagra.

Q: Does any insurance companies pay for this type of treatment?

Dr. Brown: Insurance will cover treatment if it is due to an underlying cause - e.g., hormonal imbalance, pre-menopausal symptoms, diabetes, etc. Generally, insurance will cover this condition if coded in this manner.

Q: I guess my problem is desire. I have a great marriage and a very understanding man. We have three children and I am fortunate I can reach multiple orgasm. But I never want to have sex. I find my husband extremely attractive but I feel horrible that I just don't want to have sex. I do, for him which makes him feel bad. No one has addressed lack of desire with the ability to have orgasm. We have been married 15 years and otherwise have a great relationship. And he has been wonderful.

Dr. Brown: You are addressing a libido issue. Do you find your husband attractive? Do you thing about sex? Do you fantasize about sex? Do you every use self-stimulation. That would help define if you have a libido problem.

Q: My first marriage was to a abuser. Ever since then I just don’t enjoy sex anymore. I feel dirty having it

Dr. Brown: A prior history of being abused can have long-term effects in women, but it is very treatable with individual therapy.

Q: I have endometriosis and want to know if this could have anything to do with lack of having orgasms?

Dr. Brown: Most certainly. Endometriosis can cause pain during intercourse and can cause reduced lubrication. Does the endometriosis need surgical attention? Otherwise, you may consider a lubricant such as Astroglide.

Q: I don't ever remember really enjoying sex, yet I love my husband dearly. Fortunately, he's put up with me for nearly 40 years. I had a total hysterectomy at age 30 and have tried hormones with bad side effects. I really think it's probably psychological rather than physical, but I'm not sure what to do.

Dr. Brown: If you have never enjoyed sex, I wonder if you had any childhood sexual experiences that were traumatic, did not have sexual education, or have a disorder with medication that may be interfering with your response.

Q: My endometriosis has been removed internally, but I have unusual tissue on the entrance of my vagina. Could this be endometriosis also?

Dr. Brown: That tissue that you are discussing may be endometriosis. At any rate, it needs to be examined by your OB/GYN to identify what it is and see if may relate to your reduced sex drive.

Q: If Viagra isn't approved, how could I get it? Also, is it the lack of blood flow to the vagina that leaves me unaroused? I don't fantasize or self stimulate. I just have no desire. I never would have linked it to the diabetes at all if I hadn't heard you mention it on TV. Is there any herbal or vitamin supplements that might help if I can't get any Viagra?

Dr. Brown: I would recommend you ask your doctor. Some of the supplements are as well studied. Medications that aren't approved for sexual disorder are still often prescribed by doctors if monitored closely.

Reply: Yes I know it is a libido problem. As I said I do find him very attractive. But no to all the other questions. I used to be able to say Yes to all those things now I am not interested and would rather go to bed or snuggle.

Dr. Brown: Do you and your husband have time to be intimate, and to you have to privacy to do so. What has changed in life from when you used be sexual and are not currently?

Q: I had a hysterectomy and the docs found cancer of the cervix in July 2000. Ever since my surgery I have not a sex drive and it really is getting to me and I believe my husband also even though he understands. I went through the chemotherapy and radiation. I have always enjoyed sex with him. What can I do?

Dr. Brown: It is possible that you feel differently about your body since the surgery - this is common is women who have cancer in the past. If would be best to talk to your doctor about this.

Q: My friend and I are wondering why we are 22 years old and have no desire to have any type of sexual relations or sex with our long term boyfriends?

Dr. Brown: If these are "long term" boyfriends, has the romance gone out of the relationship? Are these partners taking time with you, making you feel "womanly" like perhaps they did earlier?

Q: I have fibrous tissue in my breast. Is this some thing that is found in the vagina also?

Dr. Brown: Fibrous tissue in the breast is not related to the same tissue in your vagina. However, fibrous breast tissue can cause tenderness when touched. Does this somehow have an effect on your foreplay?

Reply: Yes, everything is great....I just never feel like being affectionate and obviously this is having a negative affect on the relationship.

Dr. Brown: What is going about not feeling affectionate? Is this a change for you, or has this always been the case? Are you afraid that by being affectionate it will lead into sex - which you are not wanting?

Q: I have never talked to a doctor about my sex drive, and I am finding the thought of it very intimidating. Any tips on how I might feel more comfortable doing so?

Dr. Brown: You may feel better with a female doctor. Also, practice ahead of time.

Q: It just seems like I completely lack a sex drive at all....but this has not always been the case, I love my boyfriend and I wish I was not acting this way.

Dr. Brown: Is your boyfriend pressuring you into being intimate when you are not ready? Many women need time, and you may not feel that this is the right time yet. Communication is my recommendation.

Moderator: Thanks to everyone for joining us today. You have had a lot of good questions, and we appreciate your patience. Candace Brown, Pharm.D. has been our guest and we hope to have her back with us again soon. If you would like more information on clinical treatment log onto http://www.utmedicalgroup.com.