Health: Women who don't want it

More and more women today are going off sex. Is it a lack of desire - or satisfaction?

A book published this week reveals that as many as four in 10 women experience sexual dysfunction at some time in their lives. According to Catherine Kalamis's Women Without Sex, the issue of "female impotence" is largely ignored, but the impact can be devastating.

Kalamis surveyed 1,160 women in the UK and found that nearly one in five had lost all pleasure in sex, and one in three was worried about the future of her sex life.

Gillian, a 45-year-old management consultant from Kent, is one of the thousands of women in Britain who suffer from some form of female sexual dysfunction (FSD). In her twenties she had a fulfilling sex life, but when she reached her thirties, she had three children within three years by Caesarean section. She started to lose interest in sex. Now, she says: "The earth no longer moves. It is a whole different experience. I just thought it was to do with being continuously pregnant for so long, breastfeeding, being tired and so on. But when it did not return to normal after I had fully recovered from the birth of my third child, I realised it was more than that."

The Guild of Health Writers, an association of journalists and authors, is today holding a seminar on FSD at the King's Fund, London. Julia Cole, a psychosexual therapist with Relate, is one of the speakers at the seminar. "Four out of 10 women coming to Relate's psychosexual therapy service between 1992 and 1994 were diagnosed with this dysfunction," she says.

FSD may be caused by hormonal problems, blood-flow abnormalities, nerve damage, disease, childbirth and certain operations, including hysterectomy. Some illnesses, such as depression, can reduce desire, and certain drugs, most notably the antidepressants, can affect a woman's ability to climax. The condition may result in a lack of sexual drive, female sexual arousal disorder (where the woman may not have lost her sex drive, but finds sex too much of an ordeal), or lack of sexual arousal.

The Kinsey Institute New Report on Sex, published in 1991, says that half the clients going to sexual therapists in the US complain of problems with sexual desire. Julia Cole also cites loss of desire as the major problem, and suggests that many women lose interest in sex because they have never had a satisfying sex life. "If you look at a lot of studies going back to Kinsey, women have consistently said that they were dissatisfied with their sex lives. There were two studies in the late Seventies which showed that between 12 and 20 per cent of young wives were dissatisfied with their sexual experiences - much higher than the proportion of young married men who were dissatisfied.

"If this is the case, then where is the money for research into improving women's experience of sex? Britain has spent all this money on Viagra; where is the money to improve women's sexual lives?"

Although there is no magic pill for those whose main problems are psychological, sex therapy can be helpful and highly successful. Relate has run a sexual therapy service for more than 25 years, and of the 1,000 women questioned in their last survey, 70 per cent of women with a loss of interest in sex, or arousal problems, noted improvement.

"We try to help couples develop a sexual language that is right for them," says Cole. "Women still buy into the James Bond school of sexual understanding - that men ought to know instinctively what to do. Some women say: `If I have to tell him, then there is something wrong. A real man would know what to do.' What we do is encourage people to talk to each other."

The longer a relationship lasts, the more sophisticated the language of communication has to become. "I sometimes make an analogy between communicating in a relationship and communicating when abroad. If you are going abroad for a few days, you can get by with a few gestures. But if you are going to stay longer, you will need to learn the language a bit, and if you are going to stay for a couple of years, it is worth becoming fluent."

Unfortunately, many couples fail to go for therapy out of embarrassment. "They fear that they will be questioned in a way that is insensitive or uncaring," Cole explains. "It is not unusual, as a therapist, to be asked by clients whether they `will have to do something here'. It is a misunderstanding of the nature of therapy."

Some couples get more out of sex therapy than others. According to Kinsey, "factors that appear to increase the likelihood of success include a high motivation by the male partner for improving the relationship and faithfully carrying out the homework assignments".

Cole said that one of the most encouraging things shown in Relate's last analysis of its figures was that as well as couples' sex lives improving, therapy helped their relationships as a whole to improve.

"This is particularly relevant for women. Men, on the whole, are able to separate sex from their general relationships. A man might say to me: `We had an argument this morning, but why should that prevent us from making love tonight?' A woman is more likely to say that an argument in the morning put her right off making love that evening."

`Women Without Sex, the Truth about Female Impotence and Other Sexual Problems', by Catherine Kalamis, is published by Self Help Direct, price pounds 10.95 (0181-445 1262)