Sheryl A. Kingsberg, PhD

With Dr. Sheryl A. Kingsberg
Clinical Psychologist and Renowned Sexology Expert
Wednesday, August 31, 2005; 8:00pm ET

Let's Talk About Sex! With health care provider visits becoming shorter and shorter, sometimes it is difficult to make the time to ask an expert about sensitive, sexual issues you may be experiencing. A live Web chat with renowned sexual health specialist Sheryl A. Kingsberg, clinical psychologist and associate professor in both the Departments of Reproductive Biology and Psychiatry at Case Western Reserve University School of Medicine, was held August 31, 2005 at 8pm ET on www.healthywomen.org. Dr. Kingsberg's main research interests are in female sexual function and the psychological aspects of infertility and menopause. She is well represented in the current scientific journals on topics including, perimenopause and sexuality, infertility and aging, sexual aversion disorder, and the treatment of psychogenic erectile dysfunction.

The transcript follows.

Editor's Note: NWHRC moderators retain editorial control over live Web chats and choose the most relevant questions for speakers. Speakers decide which questions to answer.

NWHRC Moderator: Good evening, everyone. It is our great pleasure to welcome Dr. Sheryl A. Kingsberg to this live chat. Dr. Kingsberg is a clinical psychologist and a renowned sexology expert. She is an associate professor in both the Departments of Reproductive Biology and Psychiatry at Case Western Reserve University School of Medicine, Cleveland, OH. Her main research interests are in female sexual function and the psychological aspects of infertility and menopause.

Dr. Kingsberg also serves as co-chair of Nurture Your Nature, a collaborative program between the National Women's Health Resource Center and the Association of Reproductive Health Professionals.

Before we begin, I'd like to remind everyone that this chat is moderated. To type a question, please use the box at the bottom of your screen, to the left of the SEND button. When you type a question for Dr. Kingsberg, it will not be displayed to the chat room participants. It will go directly to the moderator, who will review your question before presenting it to Dr. Kingsberg. Because of time constraints, Dr. Kingsberg will be unable to answer all questions. When she does answer a question, the question and answer will be visible to all chat participants. Let us begin with our first question.

Dr. Kingsberg: I would like to welcome all of you to this evening's chat. I am thrilled to be able to participate in this educational venture. It is certainly about time that women claim their sexual identities and enhance their sexual satisfaction. Knowledge and freedom to discuss sexuality are the first and most important steps. I hope tonight's discussion is helpful in this goal.

Stella: I am a lesbian and have been involved in two long-term relationships. Do you think there is validity to the term "lesbian bed death?" So often, there has been low sexual desire in both of my relationship experiences.

Dr. Kingsberg: Yes, Stella, unfortunately there is some validity to the term "lesbian bed death." There is a number of factors that can contribute to this problem, which reflects low desire in both women. For example, both women can have low desire or other relationship factors can inhibit passion.

Deborah: Are most sexual slumps just that, sexual slumps? Is it possible to be in a loving relationship without sex playing a significant role? I've heard of married couples that consciously decide not to include sex in their marriage. Is this healthy? Is this a set-up for adultery?

Dr. Kingsberg: Most long-term couples do experience sexual slumps and, yes, they are--by definition--slumps. They are not permanent. They can become permanent if the couple is ill prepared or not informed about the ebb and flow of relationships in general, and passion/sexual desire, in particular. The important point is that couples who do not panic or misinterpret this slump as a sign that the relationship is dead or should end can work through it and re-establish a comfortable sexual equilibrium. Non-sexual relationships are not uncommon. Barry McCarthy, a world expert in sex therapy for non-sexual couples and prolific author has estimated that 20 percent of American couples married more than 2 years are non-sexual ("non-sexual" is arbitrarily defined as sex less than 10 times per year). He also states that a good clinical adage is that bad or non-existent sex plays a greater role in undermining a relationship than good sex does in promoting it. Non-sexual relationships can work if both partners are comfortable with this, but it is often problematic and can be a set up for lack of intimacy and, perhaps, adultery in married couples.

Deborah: I'm 33 and I've been in a relationship for 4 years with a man that I plan to spend the rest of my life with. Our sex life was fulfilling in the past, but never the focus of our relationship. For a few months now we've only had sex once a week, if that. I would like to be more interested in it. Is it too early to talk to a doctor? What could a doctor do for me?

Dr. Kingsberg: It is never too early to talk to your health care provider. Having sex once a week for some time may be reflective of many things and not necessarily a problem, but your doctor may help you understand the issues that are of concern to you. Your doctor may also refer you to a counselor or couple's therapist if you are concerned that the lowered sexual frequency is related to relationship problems.

Liz: Can you tell me if a hysterectomy can impact desire and/or orgasmic function after surgery?

Dr. Kingsberg: Hysterectomy, which is the removal of the uterus, does not necessarily impact desire or orgasm, but it varies from woman to woman. For example, some women enjoyed or were used to the contractions of the uterus during intercourse and, thus, feel something is missing once the uterus is removed. In addition, after hysterectomy, the ovaries and some testosterone related to drive may be, at least, temporarily disturbed and impact desire. On the other hand, desire may increase if the hysterectomy has removed pain, heavy bleeding or fear of pregnancy.

Shirl: How can perimenopause affect fertility?

Dr. Kingsberg: Perimenopause can greatly impact infertility. It is actually a sign that your fertility is waning. It still may be possible to be fertile, but the unpredictability is not great for conception and the age of eggs is also a problem. You should speak to your gynecologist or reproductive endocrinologist

Yvette: What are some factors women should retain regarding a healthy, active sex life during our 50s?

Dr. Kingsberg: Yvette, the first factor is that 50-59 is a great decade and many women are just hitting their sexual stride. To maintain health, besides the obvious need of a healthy diet and exercise, it's helpful to have good genital health--it is a case of "use it or lose it" with postmenopausal vaginas. Without adequate estrogen, the vagina can become thinner, dryer and lose elasticity.

Gwilkes2: Do all women eventually get a dry vagina after menopause?

Dr. Kingsberg: No, not all women do. However, with the loss of estrogen, decreased lubrication is quite common. Over-the-counter lubricants are very effective during sexual activity. If using systemic estrogen is not an option, you may consider talking to your physician about a local estrogen used vaginally.

Blanche: Please help me settle this discussion with my partner. Sometimes I just want to be close to him; I find it very exciting sexually. But he insists that complete sex is the only way to be satisfied. Who is right?

Dr. Kingsberg: You are right, of course!! I hope you bet something expensive. It may be frustrating for some partners to be close and not have sexual activity that results in orgasm (particularly for many men), but women tend to be focused on intimacy and pleasure, and less focused on just the orgasm.

Gwilkes2: Is vaginal elasticity loss reversible?

Dr. Kingsberg: Yes, it can be reversed. It is best to discuss the options with your doctor, but there are many options.

Deborah: My husband and I have never agreed on how much sex is enough. Sometimes this is a real issue for our marriage. What type of medical professional might be able to help us? Is there something we can do on our own to figure this out?

Dr. Kingsberg: It is an age-old heterosexual dilemma. And it is the mark of a good relationship to be able to discuss this and come to some compromise where your husband feels you are interested (how's that for an assumption that he has the higher drive--it could be you--sorry) and you are not feeling so pressured to have sex that it feels like a chore instead of an enjoyable interlude.

Bodden: How much do you feel depression factors in decreased sex drive for perimenopausal women?

Dr. Kingsberg: Depression can impact drive regardless of menopausal status and, certainly, depression should be addressed and treated. Ironically, some of the medications used to treat depression also have loss of desire as a side effect.

Deborah: I think my husband is menopausal! I'm still interested in sex, but he NEVER is. . .and the few times a month when we manage to have sex, he's pretty lame. I thought men never lost their sex drive. What's going on and what can I do about it?

Dr. Kingsberg: Loss of desire is not reserved just for women. Many factors can contribute and they must be assessed. Is the relationship stable? Is his loss of desire really a loss of drive or a pulling away from this particular relationship? Is his loss related to an underlying medical condition such as low testosterone?

Deborah: What's the truth about sex and menopause? I've read a lot of different things. Will my sex life end when I reach menopause?

Dr. Kingsberg: Your sex life does not have to end with menopause. Many women find their sexuality increases or is enhanced. However, loss of ovarian function might impact the drive in some women. About 10-15 percent of postmenopausal women experience loss of desire with menopause. This jumps to 25 percent in surgically menopausal women.

Doobie060: Why is it that after a relationship begins to become more comfortable and stable that the sex tapers off?

Dr. Kingsberg: Passion tends to be highest in the early part of a relationship when there is danger, mystery and novelty, and you put all of your time and energy into being with your partner. It can't last by definition as couples become more comfortable and settle into long-term partnerships and the passion fades. The best couples work hard to rekindle this over time and recognize that it takes effort. Only affairs and new love offer the easiest form of excitement--the rest of us work at intimacy and novelty.

Blanche: I've tried to ask my ob/gyn questions about my sex life--and my husband's sex drive and what's happening between us. I never get any answers. . .just a nod of the head. Any advice?

Dr. Kingsberg: Yes, you need a new gynecologist. I spend much of my time educating gynecologists that it is their responsibility to talk to their patients, educate them and take, at least, a first pass at some treatment for sexual dysfunction.

Gwilkes2: What can be done for men who, although they can get an erection, partially lose it? Will this get worse with age?

Dr. Kingsberg: Unfortunately, erectile dysfunction (ED) is common in aging men. According to the National Institutes of Health, by age 40, five percent of men will experience some ED and by age 65, it's up to 25 percent. However, there are great treatment options including PREVENTION, which is the best option! Great books on this topic include one by Barry McCarthy.

Blanche: Where can I find a good sex therapist and get my husband to come with me to talk?

Dr. Kingsberg: If you look on www.healthywomen.org, you will find a list of resources, and you can also check www.aasect.org for a list of therapists in your area. Also, www.sstar.org and a variety of other sexuality Web sites list practitioners in your area. Getting your husband to join you is the greater challenge. Invite him to go at least once to talk about goals and what he would like to see improve.

Yvette: Through what other "venue" can we--as laypersons--continue to receive education or training to advocate better sex health for women?

Dr. Kingsberg: Great question. There are a number of Web resources, as noted in the NWHRC and Nurture Your Nature Web sites, that will offer education and the Nurture Your Nature program has publications directed at the lay public. National speakers and books abound on this subject!

NWHRC Moderator: That's all the time that we have for tonight's chat. We would like to thank Dr. Kingsberg for her time, expertise and candor. To learn more about Dr. Kingsberg, please view her biography. We would also like to thank all of you for participating in this chat. Please visit www.healthywomen.org for more information on healthy sexuality. Good night.

Dr. Kingsberg: Thank you all for your candor and your willingness to ask such intriguing questions. I hope this discussion encourages you to continue open communication around the topic of sexuality--either with your partner and/or with your health care provider, or even with your friends! Knowledge is power and all of you are entitled to understand and maximize your own sexuality. Keep talking!