The myth of must-have penetration

I recently went to a very interesting talk about libido. The female specialist who gave the talk was excellent, with an up-to-date view of the literature and evidence on how to improve libido, mainly the female kind.

We were reminded that there is a huge natural variation in libido, and it is reduced by all sorts of things, like a non-nourishing relationship, medication, menopause, previous sexual trauma, physical fatigue, mental stress and sometimes just simple boredom.

She reminded us that, if a couple have an equally matched libido all will be well at home, but, problems will arise when one partner’s libido is higher or “better” than the other’s.

We learned about the perils of being a postmenopausal woman, who might need oestrogen or even testosterone to keep up with her partner’s ongoing sexual needs.

I was struck by how the narrative around libido is heter­onormative, assuming that successful intercourse involves the penetration of the vagina by the penis.

Treatments focus on this one sexual act, so we have an industry of oestrogen creams to make the vagina more stretchy and inviting, and less subject to pain, as well as a variety of lubricants to improve the passage of the said organ into its receptacle. We know the characters in this story, a male husband and a female wife.

About now we might notice that the discourse around libido starts from the assumption that the partner with the “reduced” or “poor” libido is the person with the problem. They need treatment and as these poor-libido partners are mostly the women, we can offer hormonal treatments, oestrogen and testosterone.

We might also advise couples therapy or individual sex therapy for the “poor libido” partner to understand all their sexual hang-ups and how to improve their performance.

It has all made me wonder, what if we tipped the whole thing on its head and said the partner with the increased libido is the one with the problem?

We could recommend all sort of treatments for their inappropriate levels of arousal.

We could send them to therapy, where they could learn how to deal with their feelings of rejection, such as cognitive behavioural therapy techniques to prevent feelings of hurt or righteousness. We could create apps with a special form of mindfulness known as “organ calming” to quell their sexual urges to an appropriate level more respectful of their partner’s needs.

The partner with “hyper libido” could also go to individual sex therapy to learn how to have physical intimacy without an erection appearing. They could be introduced to simple ways of showing physical affection without the suggestion these are foreplay, for example, non-genital massage, the simple nude embrace and advanced caress techniques.

Of course, these new skills could well result in a change in their partner’s libido but that would not be the purpose of the therapy, just a side effect.

We could research libido-reducing medications with some urgency in order to save the marriages of men living with postmenopausal women, who are frankly sick of their sexual demands.

There might be all sorts of things these chaps could take daily to save their relationship, medications like old-fashioned beta-blockers or methyldopa or antipsychotics.

While waiting for the evidence, we could recommend they take fluoxetine, a selective serotonin reuptake inhibitor well known to reduce an over-inflated libido quite nicely and having added effect that, if intercourse does occur, the person with hyper libido will also orgasm more slowly. This may have the bonus effect of improving the enjoyment of the wife whose sexual response is more normal and prolonged.

The other advantage of an SSRI is that it may improve the mood of the hyper-libido partner, making him less grumpy, more relaxed and easier to pack the car with. In the new narrative, an SSRI could become the standard treatment for the over-aroused older man, and we might expect decent men from all quarters would be demanding to take it, to save their marriages.

Just as in the current narrative, “poor-libido problem women” are lining up in their thousands to take daily testosterone in order to achieve, on average, one or two more vaguely enjoyable, penetrative sexual encounters with their partner in a month. As my now-grown children might say, WTF?

Lucy O’Hagan is a medical educator and specialist GP working in the Wellington region