I am 26, have been married for one-and-a-half years. I suffered from depression from ages 6 to 22 and was treated with antidepressants from 17 to 23. I have not been clinically depressed since. I have no sex drive — never did. My husband is frustrated, but the thought of sex disgusts me and makes me feel dirty. If we have sex, I am 100 percent passive. I avoid it at all costs. What can I do to overcome this?
It sounds like you are not currently taking any antidepressant medication, but you do not mention whether or not you have any other medical problems or are taking any other medications. When considering a lack of sex drive, one must first rule out any medical causes (various medical problems, such as hypothyroidism or other metabolic problems can decrease your libido), or any side effects from medications. Antidepressants, especially the serotonin selective reuptake inhibitors (SSRIs) are notorious for decreasing a person’s libido and affecting sexual functioning. But medications used for the treatment of blood pressure, headaches, and seizures, just to name a few, can also have this effect.
If a person is in good general health, one of the second causes to consider is a clinical depression, whether a major depression or a dysthymia. You mention that you are not clinically depressed anymore, but you do not give any specific details about how you are feeling and functioning overall. Certainly, chronic lack of interest in sex is one of the findings in mood disorders.
Another consideration that is always in the back of my mind when I hear about a woman who has difficulties with sex (especially when there is a long history of chronic depression dating back to childhood) is the consideration of childhood sexual abuse. When a young child is abused sexually, she commonly develops a lifelong confusion about her sexual desires and needs, or a feeling of complete repugnance for sex. She often will also experience deep-seeded feelings of shame, self-loathing and depression that can go on for many years. Although this is an extremely difficult and complex issue, it will be important for you to examine it and see if it applies in any way to your childhood (by the way, not all sexual abuse involves physical contact; it can happen in the purely psychological domain as well). Do not do this kind of internal exploration all on your own — make sure you have a strong support system (husband, best friend, clergy, family member, counselor).
It is important for you to seek consultation and treatment with a highly experienced mental health professional, either a psychiatrist or a psychologist, who specializes in working with women with sexual dysfunction. Either your ob/gyn or a nearby university medical center should be able to give you some names.
First, you will need to work with this person and your internist or ob/gyn to make sure that you are well medically. Then you will need to go into the question of possible hidden depression. You will also need to begin the complicated and sensitive exploration of how your sexuality has developed from childhood to adulthood, including any possible issues of sexual abuse. Finally, you and your husband will need to be involved in some couples’ therapy so that he can understand what you are going through and also discuss his concerns. The two of you will need to discover mutually satisfying ways that you can explore your sexuality and also understand your husband’s sexual needs.
After all of these aspects have been explored, you and your doctor may determine that you could benefit from testosterone, which increases a person’s libido, or DHEA, another hormone that may help women with low sex drive. These treatments should be undertaken with the help of a physician who is an expert in sexual problems in women and should also be done in conjunction with psychological treatments so that you can become more comfortable with your sexuality and sensuality.