I’ve learned much in 27 years of taking care of women.
Lately, I’ve been working to understand what it is about relationships that is healthy and positive.
My job as a physician is to support my patients’ wellness and help them achieve the health and life they want.
I have seen women ranging in age from 13 to 103, all with questions and concerns about a vast range of situations—from unplanned pregnancies to planned pregnancies, from giving birth to losing a child, from great health to chronic health conditions.
Their lives do not occur in a vacuum, but surrounded by people—families that include significant others, children, siblings, parents, extended relatives, friends and co-workers.
The relationships that seem to have the most power are the ones that are closest, with those who we let into our most vulnerable and important moments.
I think of the newly dating couple: excited, nervous and so hopeful for the future. They have wishes and desires for what they want to happen. They envision how they want their life to go.
As couples start to get entwined, they might start to give up something to gain something else.
From all my years caring for women, it seems the couples who stay most connected and continue to be intimate are those who really like each other.
I don’t mean love—that’s typically a given and it’s defined differently by each couple.
I mean couples who genuinely like each other. They get their partner’s sense of humor, they have the same values, they respect each other and their actions, they brag the other up—“He’s so cool!”—and they do things for each other without being asked.
When women might say to me, “I have low desire, I have lost it!” I first ask, “Do you like each other?”
The answers seem to relate to the level of sexual desire.
The next question is, “Did you at some point have a really good thing?”
Most know what I mean. Is it something you want to get back to?
Low desire is an issue for about 30% of women older than 40. It’s also associated with a high level of distress.
Women don’t want to have low desire, but for reasons they don’t always know, they might think their desire is gone, never to return.
For a majority of women over 40, the reasons are commonly related to poor self-image or reduced emotional connectedness.
If these issues are restored and there is no insurmountable hurt that occurred in the meantime, desire improves.
Relationship issues are key to good sexual health.
Why would anyone want to be in the most vulnerable situation possible if they do not feel good about their body, or if they’re worried the other person doesn’t like their body, or they don’t like or respect or feel close to the other person?
People want to be seen, heard, liked, wanted and respected, especially in the closest relationship in their lives. When this goes both ways, it’s magic.
A patient I’ll call Lori came to me after hearing me talk on TV about sexual health. She grew worried she and her husband had lost their spark.
Their kids were busy teenagers. She and her husband had demanding jobs.
He came from a dysfunctional family and she only had her mom, who helped with the kids and whatever needed to be done.
She and her husband had grown apart, not just with schedules.
They seemed to have different interests, too.
He was more active at church, including committees and the softball team, she with her book club and kid activities.
He said it was because she was too busy for him. She felt obligated to put the kids first, as she worked full time.
Things were coming to a head because on the last date night, which had become fewer and fewer over the years, they had talked about sex.
Because she did not want the conversation to go anywhere, it left them in awkward silence at dinner and in silence the rest of the night.
She felt sad because they used to have so much fun and had a really good sex life.
She thought he was a great dad and she respected how he worked so hard to provide, but she did not feel like he respected her work outside the home and he did not understand her desire to be fully present for her kids.
She knew she had gained weight and she did not have great self-image about her body or shape, but she thought she could deal with that later when the kids had grown.
Lori had grown really worried about what was happening in her marriage. She wondered why she had low desire.
For the sake of full disclosure: I am not a marriage counselor, nor a psychotherapist.
In taking care of my patients, I have seen the concepts of “Getting the Love you Want” ring true over and over.
In this book, the author, Harville Hendrix, describes a long-term healthy relationship as having the following key components: understanding why you picked who you picked; giving the other what they never got as a child or from other key relationships; each person asking for what they need; and having the spark of sexual chemistry.
In Lori’s relationship with her husband, they had a good foundation from past years of healthy respect, mutual support and sexual chemistry.
As life happened and responsibilities pulled them apart, however, they didn’t stay connected. They didn’t ask for what they needed of one another.
Lori put everyone and everything else before her own health and before her husband.
He dealt with her changing priorities by taking care of himself as he always had since childhood—by reaching out to others, such as feeling needed at church and having the camaraderie at softball.
He dealt with stress by exercising. She dealt with stress by staying busy in the home and with parent-teacher organizations and other kid-related activities.
As we discussed, sex is about safety, intimacy and pleasure. They had little of any of this together. They were therefore not in a place to enjoy this together.
What was the solution for Lori and her husband?
She initiated a discussion about her desire to reconnect and she said that he and their marriage are important to her.
He easily agreed to a weekend of Imago Therapy to sort out the root cause of why they drifted apart.
They reconnected by asking each other what they needed and made sure they each felt heard.
Lori also decided she wanted to recommit to her health with regular exercise, especially if they could exercise together.
Her husband pulled back from his outside activities and she delegated home duties to her mom and the teenagers.
They started to remember why they got together in the first place. He loved how she wanted a family and connection. She loved his confidence and work ethic.
They decided to recommit to each other and their family. Her sexual health concerns became a thing of the past.