June 28th, 2011
02:41 PM ET
Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.
Asked by Sharon from Alaska
I was abused as a child. Never intercourse, but I was threatened about it, and I had to watch my sister and this man. I was always called a prude by him. Anyway, I'm married and celibate. I do not enjoy sex nor do I have any interest in it. I am on Effexor and unsure how I feel about my husband. I do not know if this is a physical issue, mental or marrying the wrong man. Obviously this causes issues for my husband, but why should I suffer so he doesn't have to?
In a few brief sentences you have masterfully painted a picture of a situation that you share with more people than you might imagine.
It is common for people who are exposed to inappropriate sexual activity as children to spend their adult lives struggling with their sexuality. Your story highlights the important fact that one doesn't have to be sexually molested to be sexually abused.
In my experience early sexual trauma tends to produce sexual extremes in adulthood.
Many people become highly promiscuous; others - such as yourself - reject sexuality altogether. It is even more common for adults with early abuse to manifest a pattern of hypersexuality in the beginning of their relationships but then lose their ability to maintain, or desire, sexual intimacy as romantic relationships deepen.
Physical, mental or the wrong man? Your list pretty much covers all possibilities.
Of course, I have no way of answering your question, but let me suggest some things for you to consider.
It is rare for people younger than middle age to have a clear physical cause for lack of sexual desire (rare but not impossible). You, however, do have the one common physical cause for loss of sexual desire early in life, and that is the fact that you are on an antidepressant (Effexor, with the generic name of venlafaxine) with serotonergic properties.
These agents markedly reduce sexual desire and performance in almost everyone, so this may well be contributing to your lack of desire for your husband.
On the other hand, many people who experience early life abuse do so much better as adults on these types of antidepressants that they and their doctors conclude the attainment of enhanced emotional/mental functioning is worth the price in terms of sexuality.
So the first question to ask is whether your lack of sexual desire existed before you started taking the antidepressant. If no, then the antidepressant is likely a significant cause. If yes, then it is unlikely to be a significant factor in the situation with your husband.
Let's say, for the sake of argument that your lack of sexual desire for your husband existed before you started the antidepressant. You can do a simple experiment to check how likely it is that the cause of your lack of desire is mental vs. being specifically related to your husband.
Is it really true that you have no interest in sex with anyone - man or woman - other than your husband? If you spend much time at all fantasizing about sexual experiences with other people, this is strong evidence that your lack of sexual desire for your husband arises from mental causes, because your physical body and brain are clearly capable of generating sexual desire.
I cannot, of course, weigh in on whether you married the wrong man.
Unfortunately, people who suffered early abuse and trauma often unconsciously select romantic partners who conspire to replay all sorts of old pains and losses.
On the other hand, many lines of evidence indicate that even in the best situations the first flush of sexual passion (and being "in love") lasts about five to seven years at the max.
As a result, if one demands this type of "fire" in a relationship, longtime partners are frequently "wrong" in this regard - which goes a long way toward explaining why people in the modern world cheat on their spouses so often, and why in tribal societies where relationship rules are frequently more relaxed, most couples stay together for five to seven years.
Let me finish with one strong recommendation. Because you have done so good a job of outlining your situation, I know that your relationship with your husband is on shaky ground.
Several recent studies suggest that people who struggle with depression as a result of early abuse respond better to cognitive behavioral therapy than to medications. If you haven't made a real commitment to therapy, let me urge you to consider it.
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