Gender Blogs | Brighton and Hove Psychotherapy

April 22, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

The medical definition of sexual dysfunction in women is hypoactive sexual desire disorder (HSDD) that is low or no libido. Like men, women’s desire for sex is effected by all sorts of factors such as relationship issues, bereavement, physical illness and the side effects of medication, job loss or work stress, depression and anxiety, recreational drugs, hormonal changes through aging and pregnancy, child birth, miscarriage.

There are conditions such as vaginismus where penetration is too painful for women to have sex but for the moment I want to look at chemical attempts to address women’s loss of sexual desire.

Unlike Viagra which treats the mechanics of erectile dysfunction, new pharmaceutical treatments in the US that aim to improve women’s sexual problems act on the brain rather than the genitals because blood flow has nothing to do with sexual function in women. At the moment there are no licensed treatments for women’s sexual dysfunction in the UK, but two in US are available for pre-menopausal women, these are Flibanserin (Addyi) and Bremelanotide (Vyleesi). They work by enhancing the neurotransmitters in the brain that support sexual arousal, reducing inhibition and encouraging sexual excitement.

These medications demand some commitment from users. Filbanserin is taken orally every evening whether you plan to have sex or not and Bremelanotide is injected into the thigh or stomach about 45 minutes before sex, no more than once every 24 hours or 8 times in a month. There are side effects such as tiredness, nausea, headache, dizziness dry mouth and these medications should not be taken with alcohol or grapefruit juice, as this may lower blood pressure to a risky level.

HSDD treatments do not claim to make sex any better rather they claim to promote an increase in women’s desire to have sex. The research determines a positive result as a limited increase in sexual activity measured as one more sexually significant event per month.

I have looked at the anecdotal experience of US women posting online. HSDD medication is extremely expensive costing several hundreds of dollars and the jury is out on its efficacy. Many women commented on the side effects, for some there was no improvement and/or the side effects were intolerable but others were extremely grateful for the difference it had made to their sex lives.

In the UK Prelox, a herbal supplement, is marketed as improving sexual function for late reproductive and post-menopausal women. There were no adverse effects during the trials but there it was noted that any improvements maybe due to a placebo effect.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

Further reading by Angela Rogers –

New Year’s Resolutions – why change might be so difficult

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

March 16, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Popping a bluey – young men and Viagra

Following on from my earlier blog about the physiological effects of Viagra, in this blog I am going to discuss some of the psychological and social issues that make young men pop a blue pill.

There is common notion that young men are constantly getting erections and always up for having sex. Various sources indicate the reality is different. Peggy Orensteins’s recent book ‘Boys and Sex’ cites a General Social Survey study showing young men between 18 and 29 are having less sex. This is indicated by the increase in the number of men who declare themselves abstinent, which rose from 10% in 2008 to 28% in 2019.

Orensteins’s conversations with young men reveal the extent of their performance anxiety. They fear that girls would be more knowledgeable and experienced and in contrast they will be unsatisfactory sexual partners. They are anxious that any inadequacy, such as not being able to undo a bra strap or coming too quickly will be broadcast to their peer group on social media and result in humiliation. They are also concerned that girls will take it personally if they can’t get an erection. Young men seem to feel that they are responsible for the success of a sexual encounter.

At the same time online pornography has set up unrealistic expectations about opportunity, performance and satisfaction. The Reward Foundation is an educational charity that focuses on the internet, love, sex and relationships; they have found a correlation between erectile dysfunction in young men and an increase in access to internet porn. Whether or not young men actually believe that the sexual relationships and encounters they view on screen are ‘real’, these representations have an impact. As a young presenter on VICE online magazine said, “In my head I’m thinking that girls will be expecting me to fuck them like a porn star.”

First dates or sexual encounters can be extremely anxious events. Dating apps like Tinder and Grinder make it easy to move on to a new sexual partner if the sex does not meet expectations the first time. This may increase pressure on men to have a prolonged erection or several erections and Viagra can be an ‘insurance policy’ or a ‘booster shot’ to ensure a good performance the first time they have sex with a new partner. If the relationship continues they may continue to take Viagra to maintain their performance and hide the fact that they took it in the first place.

So what’s the problem with young men using Viagra to perform better? If young men believe that the standardised notion of good sex is a good performance as Orenstein’s study suggested, we can see that taking Viagra would be a way to avoid some of the stress about being a good performer. Unfortunately this can create a psychological dependency making it more and more difficult to stop taking Viagra and harder to open up the subject with a partner. Like any kind of emotional withholding keeping Viagra a secret is likely to be a negative factor in a sexual relationship.

Good sex can be whatever is good for each couple and is far more nuanced and complex than a good performance. In a relationship of mutual consent sex can bring physical and emotional intimacy but sex does not always go smoothly, misunderstandings and disappointments happen. Exploring sexual dissatisfaction and difficulties makes people feel extremely vulnerable. By using Viagra to focus on performance, young men are avoiding the opportunity to speak honestly about what they expect and want from sex as well as finding out what pleases their partners. Trusting each other and exploring differences and desires together can build a stronger relationship as well as a more satisfying sex life.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

Further reading by Angela Rogers –

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

March 9, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Relationships, networks and connections

How many of us are seldom more than an arms length from our mobile phone? Our bags, clothing, even our sports wear is designed with special pockets for its’ safe keeping. For most of us it has infiltrated every sphere of life, a constant companion. Staying connected has never been so easy. Mobiles are for people (like us) on the move – always contactable – but never confined. As long as we are never too far from a power source and a signal we can bridge the gap between together and apart. It is a familiar modern experience to encounter, in a public space, a café, a bus, a pedestrian walkway, others, eyes down ensconced in their device. For many of us it feels jarring, not least because we know that we are not immune to the same behaviour. We no longer seek the eyes as a point of entry into the world of another.

Virtual proximity

Ours is a time when proximity no longer requires physical closeness just as physical closeness no longer determines proximity. Virtual proximity renders human connection simultaneously more frequent and more shallow, more intense and more brief. Getting in touch is no obstacle to staying apart. Notions of community have shifted with the tides of of socio political, economic and technological time. So too has our relationship to home. We now slip into our separate houses, more often our separate room’s bypassing the shared spaces, seeking ‘our own space’. The virtual ‘network’ is now the place we gather, the new village square, the new community, residing behind each closed door. We are lonelier than ever… more connected than ever.

Reflection

This is not a a condemnation of technology or technological innovation, how ignorant and foolish that would be. Rather it is an expression of concern about a gradual erosion of social and relational skills, of face to face, up front and personal human interaction. The more our attentions are absorbed in a virtual kind of proximity do we risk losing these skills ? Might we fail to learn them in the first place or reject them all together. Are we choosing to replace intimate proximal partnerships with virtual networks – and where may it lead us?

Quantity v quality

The language of ‘connections’ subtly usurps the language of ‘relationships’. Connections are ‘virtual relations’ entered and exited at the press of a button. In a virtual network connecting and disconnecting share the same status, are made on demand and broken at will. In a virtual network we are free to roam as we please and to terminate those connections which no longer interest or satisfy us. The old fashioned networks of ‘kinship’ and ‘partnership’ and ‘committed relationship’ are far more slow moving, clunky and messy than their virtual counterparts and certainly far more difficult to exit. Turnover is the cardinal measure of success in the consumer world. Consumer life favours lightness and speed. Variety and novelty are valued over durability. Commitment and sharing in this context lose their meaning and our appetites for interpersonal risk taking (relating) decline.

There is no doubt that in infinite ways technology improves and enhances our lives as individuals and communities. It is true too that wherever there is something gained there is inevitably something lost. So let us all remember to keep the bonds of human connection alive. Look up, make eye contact, maybe smile or say hello to the next person we stand next to in a queue or a lift. Face time for real! Let’s switch off our devices from time to time and not automatically grant them space at our tables when we commune with real life friends and family. And let’s leave them outside the bedroom door at the end of the day and reclaim that space for rest, restoration and good old human connection.

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

Further reading by Gerry Gilmartin –

Paying attention to stress

Why does empathy matter?

What is Intimacy?

Love, commitment and desire in the age of choice

March 2, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Termination and endings in Psychotherapy

We have just celebrated the ending of the year, welcoming in a New Year. It provides a shared / collective opportunity to reflect on the past, think ahead to the future. Likewise, psychotherapy invites us to think about the past, how it contributes to who we are, what is important to us, how the past can provide an understanding of previously unconscious material that has been repressed in order for us to reconcile the past and choose what is taken into the future.

This segmentation of time helps to contain a complex worldview. I suggest the break or holiday from psychotherapy offers us a chance to reflect on how we manage our internal world in the absence of the secure base represented by the clinical setting. The break provides an opportunity to see how we feel without the weekly hour or hour and a half in the session or group.

How important are endings in psychotherapy?

The therapeutic alliance between the therapist and the client provides a safe, secure and consistent base for attachment to a reliable figure for working through trauma. Childhood experiences of adult caregivers, depicted most vividly in fairytales of giants and powerful forces that impact on our emotional security; in adulthood leave traces of emotional trauma that can distort our judgment of reality haunting us as adults. Trauma inhibits the development of neurological pathways that lead to self-regulation of emotional states. Attachment styles will influence how we react to stresses in the environment, the challenge of psychotherapy is to find a way of reaching our fears and understanding how these shape our lives. The biological changes in the brain required to establish new pathways takes time and can leave us feeling confused and bewildered.

Neuroscience has given us a greater understanding of the effects of child hood trauma’s and a method of working that bring about changes in how we process feelings and thoughts.

Through our interactions in the therapeutic setting, either individual or group, enables us to experience /observe our defenses at work in a safe and containing space/ in the individual session or through the group matrix of interactions. This results in a re-working of the internal working model originally created to cope with trauma to enable change to occur. We begin to integrate more adaptive responses to our emotions and feelings. To gain mastery over long held ways of relating, the internalized working model that shaped our attachment style is revised.

What part then do breaks and endings play in this process? Jeremy Holmes suggests that different attachment styles require different approaches to endings. (See paper European Psychotherapy on termination of psychotherapy /psychoanalysis)

I suggest that some knowledge of the theory is useful to clients like a comforting diagnosis helps people feel more in control. It is what mindfulness can do for all of us used in the service of our need for regulation during times of heightened arousal / stress.

Whenever we make an attachment be it to a therapist, a working environment or an intimate relationship we are faced with separation. This is why falling is love is so disorientating; the object of our love leaves us fearing loss, jealousy, envy etc. etc. If our love is reciprocated then we are both preoccupied with one another. It becomes a joke when the love struck people are in a group of friends and only have eyes for each other.

So attachment and separation are present and unavoidable; we are social beings who seek closeness and intimacy throughout our lives. (The exception is when we are preparing for the end of life.)

Ending a relationship or needing to adjust to changes in others in our lives such as our children going from being a child to an adult requires an ability to face the often painful and difficult process of change.

Breaks in therapy offer an opportunity to try out our internalized therapeutic capacity for self-regulation. Ending therapy or a good ending requires work on understanding the capacity we have to deal with life outside of the safety and security of the therapeutic alliance.

Thea Beech is a UKCP registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst. Her work in psychodynamic psychotherapy spans 20 years in the NHS and for the last 10 years overseas in South Africa. Thea is available at our Brighton and Hove Practice.

Further reading by Thea Beech

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

What is a Psychotherapy Group?

Group Psychotherapy: The Octopus and the Group – what do they have in common?

January 13, 2020 by Brighton & Hove Psychotherapy 1 Comment

Viagra: Some ups and downs of the little blue pill

The arrival of Viagra (sildenafil citrate) came on the market in 1998 as the first drug to treat impotence. Impotence is the consistent inability among men to achieve and sustain an erection sufficient for sexual intercourse and/or to achieve ejaculation. Like the contraceptive pill in the 1960s it was greeted as a life changer giving men a chance to enjoy more and better sex when they wanted it. Of course it was never going to be that easy and the complications would take a while to emerge. In this blog I will share some thoughts on impotence and Viagra mainly in physiological terms; I will explore further psychological and relational aspects in later blogs.

There are other drugs for erectile dysfunction such as Cialis and Levitra as well as generic versions for example Kamagra. For simplicity I will use the term Viagra to refer to all the different versions.

Key findings from a 2018 survey of 2000 men, carried out by Atomik Research and sponsored by Co-Op Pharmacy, showed 43% of men between 18-60 were suffering from impotence and only 28% of those surveyed had discussed it with a GP. These are worrying figures and we can see why Viagra has been such a success story. Millions of men have taken Viagra apparently without any major incident or serious drawbacks. Although given the reluctance of men to talk to their GPs about sexual problems there may significant numbers who are suffering side effects that impair their sex lives.

Impotence is caused by reduced blood flow to the penis and Viagra works by increasing blood flow. A study of 23,000 men, cited by Pfizer the pharmaceutical company that manufactures Viagra in 2019, claims that 72% – 85% of men taking Viagra (the differences relate to the dosage 25 mg, 50mg and 100 mg) achieved erections hard enough for sex compared to 50% of those men on a placebo. This looks encouraging.

It can take around 15 minutes to one hour for Viagra to bring about an erection suitable for intercourse. On average these effects last 2-3 hours, may be up to 4-5 hours depending on your body’s metabolism. Viagra can help maintain an erection after ejaculation and can reduce the time it takes to achieve another erection following ejaculation. Some men say it can be more difficult to orgasm with Viagra, which may or may not be an advantage for their partners. Pfizer advise Viagra only works when you are sexually aroused, it does not make you feel aroused or cause instant hard-ons. In theory you will not be left with an unwanted erection if you are no longer horny.

A higher dose does not necessarily mean a better hard-on but it is likely to produce more side effects. These can include headaches, flushes, indigestion, abnormal vision, stuffy or runny nose, muscle pain, nausea and dizziness. There are also negative interactions with prescription drugs, over the counter medications and natural supplements. Viagra does not work well following a fatty meal or alcohol, which is tough for those who like to wine and dine as a prelude to sex.

There are men who do not have erectile problems who use Viagra to improve their sexual performance. However the recreational use of Viagra can be dangerous, especially if combined with other recreational drugs as in chem sex; this is an issue because chems can make it difficult to achieve and sustain an erection. Taking Viagra at the same time as recreational drugs such as chems, ecstasy, cocaine, crystal meth, poppers, and speed can produce a range of side effects including serious risks of a fatal drop in blood pressure and/or additional pressure on the heart. There are instances of men taking large doses of Viagra and enduring erections that last many hours. These are often painful and if not treated can damage the penis. In 2013 a Columbian man took a large dose and ended up with an inflamed and gangrenous penis that had to be amputated.

We have to recognise the benefits for men who can buy Viagra without a prescription, however apart from the recreational risks outlined above there are concerns about self-mediation and missing the signs of serious illness. High blood pressure and diabetes are two conditions that diminish the blood flow and therefore impotence can be a symptom. In the US diabetes is the most common cause of erectile dysfunction and impotence can be the first sign of heart disease especially in young men. If left unchecked these conditions can have long term and tragic results.

Viagra has undoubtedly helped many men and couples regain a sex life or find sex more satisfying, however this little blue pill is not always an effective treatment for erectile difficulties. Men who cannot tolerate side effects or for whom Viagra is not medically advised may want to explore other ways of enjoying sex if they are and their partners are able to talk about it. Viagra often reduces spontaneity and mean partners have to plan when to have sex, which again requires talking about it. Openly discussing the impact of impotence on a relationship is not easy; sometimes the conversation never happens. This is where counselling and psychotherapy can help by offering a safe space to have these conversations as individual or as a couple.

References-

https://www.atomikresearch.co.uk/case-studies-archive/co-op-pharmacy-erectile-dysfunction-pr-survey/

http://www.tradesexualhealth.com/sexual-health/sex-drugs/viagra.html

TRADE – Free, confidential health advice, information, services and support for the lesbian, gay, bisexual and trans communities of Leicester, Leicestershire and Rutland.

https://www.viagra.com/learning/is-it-right-for-me

Pfizer, 2019

https://www.usrf.org/index.shtml

Urological Science Research Foundation

https://www.independent.co.uk/news/world/americas/man-s-penis-amputated-after-viagra-overdose-8835146.html

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

Further Reading by Angela Rogers –

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

The Contemporary Consulting Room