The last time anyone was inside me, it was to take a swab.
We've received feedback, and have come to understand, that the following author's note presents a reductive and cissexist view of women's bodies and sexual health. The author's note, which attempted to justify conflating "female" with "owning a vagina" for the purpose of consistency with medical language and for search engine accessibility, was the compromise between the writer and myself, the Editor, who is a trans woman.
I take full responsibility for signing off on the content, and want any feedback to be sent directly to me, not the author. HARLOT Magazine has a sincere endeavor to be intersectional and inclusive.
I genuinely regret publishing anything that felt dismissive or exclusive of anyone's identities and experiences. I will work post-haste to appropriately amend the article and produce an article speaking on these issues from a non-cis perspective.
I totally hear all of this. Thank you for saying something. I will work to do better.
Author's Note “Female sexual dysfunction” is a standard medical term used throughout the literature to refer to what is essentially a cisgendered women’s issue. I have maintained the use of this term and of “female and “woman” to denote cisgendered women in order not to complicate Google searches, but only because of that.
I used to think of myself as having a sex drive. That’s not strictly accurate; when I was fifteen through seventeen, at least, I thought of myself more or less as a sex drive, a sort of sentient vagina on legs. I grew into sex early, accepted it as a natural, glorious benefit of being young and having a nerdy boyfriend whose parents let me sleep over at his house. I was never promiscuous—that is to say,
I was never nearly as promiscuous as I would’ve liked—but I was healthy, active, and I was getting it awwn. And then, very suddenly, I wasn’t.
If my sex drive was a rock pool filled with minnows and scuttling things, comfortable and contained under the sun, then chronic illness was the tide that bashed into it and washed the crabs away. (Metaphorically speaking. To the best of my knowledge.)
It began with a roaring beast of a thing, the anxiety that invaded me in 2005 and never really left. The doctor put me on Dothiepin, which didn’t seem to affect my ability to boogie-down but did gain me a hefty fifty pounds. A year or two later they swapped me to Luvox in an attempt to reverse the weight gain; it didn’t work, but at least the boogies were preserved.
It wasn’t until 2009, when I was diagnosed with bipolar disorder and BPD, that the drugs began to come thick and fast and I—well, you get the idea.
I was prescribed Prozac for the anxiety and depression, lithium for the mania, Xanax for the panic, and Seroquel to help me sleep. And they worked. I stopped screaming in fear when something fell off the fridge, stopped plotting to kill myself in ludicrous ways, stopped lying awake for nights on end thinking in terrible clichés. But slowly, inexorably, they stopped me doing other things too. Stopped me wanting. Stopped me desiring. Stopped me thinking of my vagina as anything else other than a vehicle for pee and yeast infections.
In many ways, stopped me being me.
Prozac, like most antidepressants and selective serotonin re-uptake inhibitors (SSRIs) in particular, is noted for causing sexual dysfunction. Lexapro, the drug I was shunted onto in 2011, has an even nastier reputation. These side effects are generally played down by the medical establishment: the little leaflets that come with my pills describe decreased sex drive, impotence and difficulty having an orgasm as “less serious side effects”.
I suppose from the point of view of someone hanging off the side of a bridge, the ability to rub one out is more or less by the by. But for the vast majority of people who are prescribed these medications long-term to manage anxiety, depression, OCD—just about any condition you care to name—a bit of rumpy-pumpy from time to time seems very little to ask.
Sex is one of the most fabulous, messy, squirty things to make us human. Our sexuality informs our identity; it has been an integral part of our personal and social lives since before we were human. I struggle to describe its value now, having gone without it so long. How can being wholly deprived of it be described as a “less serious side effect”?
To be fair, it’s hard to say whether or not SSRIs were the sole cause of my sexual woes. Depression is also known to cause sexual dysfunction, and it can often be hard to tell whether things come down to the illness or the medication. 2009 was also the year I began showing symptoms of fibromyalgia, a fantastically marginalised illness which affects as many as 2% of people in the US, most of whom are women. The irony that so many of the conditions stigmatised in today’s society are those perceived as women’s illnesses is not lost on me.
Living as a fibromyalgia sufferer is an exercise in gaslighting: very few doctors accept it as a real condition, and those that do are woefully unequipped to help. The stigma around invisible illnesses such as fibromyalgia has created an army of women (and to a lesser extent, men) who by necessity are more educated about their symptoms and the relevant medical literature than their doctors are.
All too often, however, they are accused of lying or of faking their symptoms when they attempt to share this knowledge; regarded as problem patients by their doctors, and malingerers by everyone else. When you add sexual dysfunction into this mix, another highly-stigmatised condition doctors regularly refuse to acknowledge, you create a perfect storm of seriously, fuck you.
Of course, fibromyalgia has had its own impact on my sex life..When you are racked with pain, so fogged with it that you can barely remember your own name, when your colon is throwing paint like Jackson Pollock every half hour and there’s a migraine physically climbing out of your head—these are not ideal moments for sexytimes. Sex is about loving your body, and after just a few months living with fibromyalgia I had very little love left for mine. This, combined with the SSRIs, left me about as aroused by flesh-and-blood humans as I was by carrots shaped like cocks.
I found myself settling gently, grudgingly, into a routine built around cuddles instead of cunnilingus, warm fuzzies instead of fellatio. My attitude to sex was a peculiar mix of boredom and distaste: even if I was able to rouse myself into arousal, it often petered out halfway through, leaving me more guilty and frustrated than ever. And so the years went on, and the gaps between times I was down to boogie grew further and further apart. When something that was once easy becomes impossibly hard, sometimes it’s easier not to try at all.
Trying to explain this to doctors was tough. I’ve lost count of the number of doctors, male and female, who told me that this was just how SSRIs worked, and that there was nothing they could do. The ever-present implication was that my sex drive was an acceptable casualty of my treatment, that it wasn’t really essential for a woman to be sexually functional, especially if they weren’t popping out babies. The drugs were working; I didn’t really have the right to complain.
If pushed—and I always pushed—most would come up with the same suggestion: cut down my dosage or go off the pills altogether. I was never really comfortable with this. Antidepressants fuck with your sex life, but not half as much as anxiety attacks or suicide attempts. And nothing makes you feel quite so dogshit as coming off a drug on doctor's orders, experiencing a dangerous relapse of symptoms, and then being shamed for thinking you could cope without it.
Several attempts to cut back made it painfully clear: I needed my drugs. And so I was stuck between a rock and a hard-on. It took six years and three countries before I found a doctor who actually believed my sex life was important, who was willing to confront these issues and try to help me. A sex positive doctor is a rare and wonderful thing, like a unicorn without all those hang-ups around virgins. I thought my search had finally turned a corner. But with the lack of any solid research or any treatment bar reducing my dosage, even his hands are largely tied.
The advent of flibanserin (Addyi), the first drug approved by the FDA to treat female sexual dysfunction, might be seen to offer some hope. However, a little research reveals a sinister side to the “little pink pill”. For starters, flibanserin is not officially approved for use for women whose sexual dysfunction stems from SSRIs— this will probably not stop doctors prescribing it for them.
And it's not without its own host of dangerous side effects: extreme low blood pressure and fainting, especially when combined with alcohol; dizziness; nausea; fatigue; insomnia and somnolence, presumably not simultaneously; the list streams on and on. The drug was only approved by the FDA on its third attempt, after a concerted campaign known as Even the Score drew attention to the gender bias in sexual dysfunction treatment; I was impressed by this, until I discovered it was backed by the pharmaceutical company producing the drug.
It would be wrong to pretend that dudes taking these medications do not suffer from these issues: in fact, research suggests that on average, more men than women experience SSRI-associated sexual dysfunction. I asked my therapist what it was like for them, and he described it almost hauntingly:“you can get it up, but it’s like being accustomed to fireworks and finding yourself with a sad little sparkler in your hand.” There are treatments for some symptoms of male sexual dysfunction, but by no means all: Viagra and Cialis can assist with erectile dysfunction, but men experiencing decreased libido or anorgasmia are as on their own as the rest of us.
That said, women who suffer from SSRI-associated sexual dysfunction do tend to experience it with greater severity. Women are also far more likely to be prescribed SSRIs in the first place: a report released in 2011 suggests 25% of women in the US now take antidepressants, as opposed to 15% of men. And inevitably, women are also far more likely to experience discrimination or see their concerns dismissed by medical professionals.
Research into female sexual dysfunction lags well behind the equivalent for men: PubMed lists 4500 more articles on male sexual dysfunction than on female sexual dysfunction, even though rates of sexual dysfunction in women are estimated to be as high as double that in men.
The takeaway is clear: female sexual dysfunction, from SSRIs as well as other causes, is still seen as unworthy of serious attention from doctors or the research community.
I don’t know if there is an answer to my sexual dilemma. I have to be realistic: 60% of people who take SSRIs experience some form of sexual dysfunction, and I am one of the unlucky many. I knew it was a risk going in, and I accept that on the whole it’s a risk I was better off taking. I know that even if I could be safely weaned off these drugs, I still have eight chronic illnesses and eighteen other pills a day to contend with, any of which could be interfering with my lady parts in new and fascinating ways. I know that my doctor’s hands are tied as long as the healthcare and pharmaceutical industries continue to see female sexual dysfunction as low priority or worse, not a problem at all.
But what I never knew until I started writing this article was just how little we talk about this. I can count dozens of people I know who have taken SSRIs, and I’ve never had this conversation with any of them. It’s never come up in my online support groups. I’ve never read an article coming out as dead downstairs before. And I think it’s because we are ashamed. Ashamed that our bodies have stopped working in one of the best and joyous ways they can work. Feeling guilty that we “caused” this by needing to take the medications we do. Feeling certain that the fault lies, somehow, in ourselves. But it doesn’t. And it is our right to stand up as humans and say: Hey, I like sex. It’s a pretty big part of life. And while being denied it sucks, hearing people deny your right to it sucks harder still.
We can’t stop SSRIs knocking out our sex drives. But we can stop being okay with doctors telling us it doesn’t matter. We can stop being okay with the lack of research into such an important issue.
We can start standing up—even if not all of us can manage it—to be heard.