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The Biggest Sex Issue No One Is Talking About

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When it comes to sex, you probably read and hear a lot about new positions to try, the latest sex toy tech, and how to have a better orgasm. One thing you *don't* hear a lot about? Women—especially younger women—who aren't really all that interested in having sex. Most people know that it's quite common for hormonal changes to mess with sex drive during menopause, but did you know that low sex drive is actually super common in premenopausal women, too? In a recent survey conducted by the American Sexual Health Association (ASHA) with support from Valeant, a pharmaceutical company, 48 percent of premenopausal women (ages 21 to 49) said their sex drive was lower now than in the past. Crazy, right? These aren't women who never had a sex drive. They're people who have somehow lost it. And if almost half of women in this age group are experiencing this phenomenon, why aren't we talking about it more? Let's start the convo now.

What's Female Sexual Dysfunction?

Unlike erectile dysfunction, which pretty much everyone knows about (thank you, Viagra commercials), female sexual dysfunction (FSD) is definitely not as widely discussed. Yet 40 percent of women will suffer from it in some form during their lives, according to a study published in the American Journal of Obstetrics and Gynecology. There are several types of FSD, including issues with desire, arousal, orgasms, and pain, according to intimacy and sexuality expert Pepper Schwartz, Ph.D., author and professor of sociology at the University of Washington. While all of these issues are important to deal with when they arise, lack of sexual desire, also called hypoactive sexual desire disorder (HSDD), is the most common, affecting almost 4 million women in America.

The Telltale Signs

If you're wondering what makes HSDD different from just not being "in the mood," there's a pretty clear way to tell. "The biggest clue is that it's persistent," explains Schwartz. While everyone has ups and downs and bouts of feeling frisky and not so much—even for a period of a couple months—going for months and months at a time without wanting to have sex is a pretty clear indication that something's up, she says. Of course, things like stress, relationship troubles, work issues, illness, and medications can have an impact on your sex drive, so ruling out those factors is a big part of getting to a diagnosis. But Schwartz explains that "if you notice that the arousal and desire you used to feel is just gone and it keeps happening and you're getting more and more distressed about it, then it's time to go talk to a health provider and have them do a clinical checklist to see what's wrong."

The Fallout from HSDD

Obviously, HSDD affects your sex life, but it can also seep into other parts of women's lives, which is why it's so important to raise awareness about it, says Schwartz. "Our sexuality doesn't fit in some little black box that you put in a drawer and take in and out. It's part of who we are and it's part of how we feel about ourselves," she says. There are two main things that happen when a woman has HSDD, according to Schwartz. First, her self-esteem can drop because she may think there is something wrong with her and that what she's experiencing is totally abnormal, or worse, her fault. Second, it can affect a woman's relationship (if she's in one), and even make her partner question his or her own desirability. When your self-esteem and your relationship aren't secure, it can affect everything from work to friends, causing way more than just infrequent sex. (FYI, generally, women feel horny at a totally different hour than men.)

Why It's So Taboo

The ASHA survey found that 82 percent of women who meet the criteria for FSD believe they should see a healthcare provider, but only 4 percent have actually gone out and spoken to a professional about it. If women believe they need help, why aren't they getting it?

Well, it *might* have something to do with how sex is portrayed and regarded in today's society. "Sex is sometimes more complicated than we give it credit for, particularly now that we have the permission to be sexual," says Schwartz. It's awesome that people are more open about their sexuality than ever before, but this can leave women with sexual dysfunction feeling alienated. "We tell people that sex is wonderful and make it look easy. We have these examples like 50 Shades of Grey, where someone is intensely successful with their sexual pleasure and of course, this just makes women dealing with this issue feel worse when that's not what's happening for them," she says. This makes people way less likely to talk about it.

What's more, for women in serious relationships, talking about their sex lives can be different from talking about sex lives while dating. "They don't talk to their girlfriends about sex as much as they used to because they're worried they won't be seen as 'normal' and they're also protective of their partner," says Schwartz. "They don't want their emotional and sexual business to be known because they see it as disloyal."  That's part of why Schwartz together with ASHA created FindMySpark, a site that allows women to not only learn about the signs, symptoms, and treatments for FSD but also to connect with and read stories from others who are going through the same thing. "The more we talk about it, the better," she says. "There is a stigma, and we have to work against it."

But What If You're Cool with Not Having Sex?

So you might be wondering, "What about women who just don't want to have sex and are totally fine with it?" To be clear, being asexual or consciously taking a break from sexual activity is *not* the same thing as HSDD. The two hallmarks of the disorder are having less sexual desire than before (meaning you definitely used to have a sex drive) and being upset or distressed about it. So if you're not having sex and you're totally happy about it, there's no reason to get freaked out that something is wrong.

What's more, it needs to be acknowledged that it's not really that weird if you don't want to have as much sex as your partner, especially if your partner is male. There are many important ways in which female and male sexualities are different. It's often assumed that women and men should want to have sex with the same frequency, but due to a variety of psychological and physiological factors, that's not always the case. Science shows that while female and male sex drives can be more or less powerful depending on the individual, in most cases, men think about sex more, women are more sexually flexible, and the psychological process women go through to become aroused is different from the process men go through. These differences inherently create discrepancies in the sex drives of women and men, so while comparing them might be tempting, it's not exactly helpful.

That's part of why Schwartz emphasizes that when it comes to frequency of sex, "There is no number that's normal for everybody. People look at these averages of how many times others are having sex for either some reassurance or some gauge about their sex life and I don't think that's particularly helpful," she says. But seeing that you fall at the extremely low end of the spectrum and feeling bummed out about it can be a clue that something is going on.

How to Deal If You Think You Might Have HSDD

More than anything, talking to a doctor or another medical professional you're comfortable with is a great first step to getting your sex drive back. There are a range of treatment options from switching up your current medications, to taking new ones, to trying out sex therapy. At the end of the day, what's most important is normalizing FSD to the point that women actually feel comfortable bringing it up with their health care providers. After all, your sexual health impacts all areas of your life, not unlike your mental health and overall physical health. Don't be afraid to pay attention to it.

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