Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with hypoactive sexual desire disorder (HSDD)?

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What's the deal with hypoactive sexual desire disorder (HSDD)? · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:00
  Speaker 1: Perry.
• 0:01
  Speaker 2: You know, I'm not sure if people know this, but
• 0:04
  Speaker 2: you and I we went to college together and we
• 0:06
  Speaker 2: were like, like we knew each other, we were acquaintances.
• 0:09
  Speaker 2: We dated each other's roommates in various Yeah, yeah, correct.
• 0:15
  Speaker 2: Guess if you had told me at that time, like
• 0:19
  Speaker 2: one day you and Francis Perry Wilson the Third will
• 0:23
  Speaker 2: do a podcast about sexual dessert like I would have
• 0:27
  Speaker 2: told you you were crazy person. I do not have
• 0:30
  Speaker 2: this on my Bango card.
• 0:31
  Speaker 3: That's that's funny because I, you know, for the past
• 0:34
  Speaker 3: twenty five years, have been thinking to myself, you know,
• 0:37
  Speaker 3: someday Emily and I are going to sit down talk
• 0:40
  Speaker 3: about sexual dysfunction together. So you know, but that's whatever.
• 0:44
  Speaker 3: Different strokes for different folks.
• 0:45
  Speaker 2: No strokes, It's totally right. So I'm excited and somewhat
• 0:52
  Speaker 2: apprehensive to discuss this complicated and nuanced topic.
• 0:56
  Speaker 3: Do we need to say that, although this is an
• 1:00
  Speaker 3: explicit podcast, it is going to acknowledge the existence of
• 1:04
  Speaker 3: sex and sexual function, and if you're listening with your kids,
• 1:07
  Speaker 3: be aware of that.
• 1:08
  Speaker 1: Absolutely, this is probably not the episode for the.
• 1:11
  Speaker 3: Car Let's do it, Let's fall in love?
• 1:13
  Speaker 2: Okay, I'm Emily Oster. I'm an economist and a data expert.
• 1:19
  Speaker 3: And I'm Perry Wilson. I'm a medical doctor.
• 1:22
  Speaker 2: It's Thursday, June eleventh, twenty twenty six. And this is
• 1:25
  Speaker 2: wellness actually.
• 1:27
  Speaker 3: Because you're getting a staggering amount of health and wellness
• 1:30
  Speaker 3: information nowadays from every source imaginable, and some of it
• 1:34
  Speaker 3: is awesome and some.
• 1:35
  Speaker 2: Of it is well actually both Fortunately we are both
• 1:41
  Speaker 2: people who know how to read studies, how to parse
• 1:43
  Speaker 2: the data, and can tell you what's worth thinking about
• 1:46
  Speaker 2: and what you can safely ignore.
• 1:48
  Speaker 3: But before we dig in, a note that this podcast
• 1:50
  Speaker 3: is for educational purposes and should not be construed as
• 1:53
  Speaker 3: medical advice. We don't know your unique situation, so talk
• 1:56
  Speaker 3: to your doctor for personal health decisions.
• 2:00
  Speaker 2: This week, we're asking what's the deal with hypoactive sexual
• 2:03
  Speaker 2: desired disorder? Perry and I will give the official smasher pass,
• 2:07
  Speaker 2: and then we'll get to your question of the week.
• 2:09
  Speaker 1: I like the idea that we're going to smasher pass
• 2:12
  Speaker 1: a disorder about sex.
• 2:14
  Speaker 2: That's fine, Okay, we're good, but first let's do the
• 2:17
  Speaker 2: health news roundup after the break. Now for the health
• 2:31
  Speaker 2: news of the week, Perry, there was an American Diabetes
• 2:36
  Speaker 2: Association conference this week and police removed people for handing
• 2:41
  Speaker 2: out an editorial. This is not something that typically happens
• 2:44
  Speaker 2: at our conferences. Can you please enlighten me.
• 2:47
  Speaker 3: Yeah. Traditionally at medical conferences, people only get escorted out
• 2:51
  Speaker 3: for being just too drunk or hungover from the night before.
• 2:55
  Speaker 3: So this is definitely outside the box. The American Diabetes Association,
• 3:00
  Speaker 3: the largest diabetes conference in the world. What was happening.
• 3:04
  Speaker 3: Was scheduled to speak was our friend, doctor j. Badicharia,
• 3:09
  Speaker 3: the head of the NIH. Now the backstory actually is
• 3:14
  Speaker 3: that he had canceled. I don't think the people who
• 3:16
  Speaker 3: were handing out the editorial knew that, and he he
• 3:18
  Speaker 3: was going to send a deputy from the NIH. But
• 3:20
  Speaker 3: the plan was doctor J was going to speak, and
• 3:23
  Speaker 3: so several members of the ADA were handing out a
• 3:26
  Speaker 3: recent editorial which criticized NIH policies and the Trump administration
• 3:31
  Speaker 3: in terms of their medical science. So this editorial was
• 3:37
  Speaker 3: I mean, this wasn't just like some random editorial. This
• 3:40
  Speaker 3: was an editorial in Diabetes Care, which is the flagship
• 3:44
  Speaker 3: journal of the American Diabetes Association, and it criticized drastic
• 3:49
  Speaker 3: cuts in funding opportunities from the NIH, this thing where
• 3:53
  Speaker 3: they're doing multi year grant forwarding, which is limiting the
• 3:56
  Speaker 3: amounts of grants that can be funded at any given time,
• 3:59
  Speaker 3: decimation of the NIH workforce, promotion of pseudoscience conspiracy theories,
• 4:03
  Speaker 3: and I think maybe most importantly, the politicization of funding decisions,
• 4:07
  Speaker 3: taking funding decisions out of the hands of scientific peer review. Now,
• 4:12
  Speaker 3: these people who were escorted out by the police were
• 4:14
  Speaker 3: not Rando's. One of them was Stephen Kahn. He's a
• 4:19
  Speaker 3: professor of medicine at the University of Washington and the
• 4:22
  Speaker 3: editor in chief of Diabetes Care as well as a
• 4:25
  Speaker 3: co author of that editorial, So he's handing out his
• 4:29
  Speaker 3: own work. He's the editor in chief of the most
• 4:31
  Speaker 3: important diabetes journal in America. The ADA did come out
• 4:37
  Speaker 3: with a statement saying, look, this isn't political, but people
• 4:41
  Speaker 3: are not allowed to hand out materials like you can't
• 4:44
  Speaker 3: disseminate materials at our conference, which I like look somewhat
• 4:49
  Speaker 3: askance at because people kind of are handing out materials
• 4:53
  Speaker 3: all the time, like handing on editorials.
• 4:55
  Speaker 2: Come on, yeah, I mean, it feels to me like
• 4:57
  Speaker 2: there's there's a letter of the law, which perhaps says
• 5:00
  Speaker 2: you can't hand out materials. But my guess is that
• 5:02
  Speaker 2: frequently people are handing out a variety of random materials
• 5:06
  Speaker 2: and there are no consequences for doing that. So it's
• 5:10
  Speaker 2: sort of obviously a political obviously a political decision.
• 5:17
  Speaker 1: Yeah, I'm really sure what is accomplish What is a
• 5:20
  Speaker 1: I always wondering these things. What is accomplished by this?
• 5:22
  Speaker 2: Surely there's more attention to this editorial now that this
• 5:25
  Speaker 2: news has been covering than Oh, I mean if you
• 5:27
  Speaker 2: just let them give out this editorial to a bunch
• 5:29
  Speaker 2: of people who probably already saw it.
• 5:31
  Speaker 3: Yeah, yeah, yeah, exactly. It's always sort of like it's
• 5:35
  Speaker 3: the stressand effect, where you know, you draw attention to
• 5:37
  Speaker 3: something now can never be lost. But actually this was
• 5:40
  Speaker 3: somewhat brilliant on the part of these editorialists. I think
• 5:44
  Speaker 3: the conferences, particularly scientific conferences, need to think a little
• 5:48
  Speaker 3: bit more carefully about who they're inviting, particularly if they
• 5:52
  Speaker 3: don't want to engender any kind of backlash. You know,
• 5:55
  Speaker 3: scientific conferences like to have famous people giving you addresses
• 6:00
  Speaker 3: and having leaders of scientific organizations like the NIH is
• 6:04
  Speaker 3: a long and storied part of that. But in an
• 6:08
  Speaker 3: era where the NIH has become somewhat hostile to the
• 6:13
  Speaker 3: people in the room who are, you know, trying to
• 6:15
  Speaker 3: get funding and get grants in advanced science. The committees
• 6:19
  Speaker 3: that are deciding on these speakers might want to think
• 6:21
  Speaker 3: just reasonably about that. Not that they shouldn't have leaders
• 6:25
  Speaker 3: of the NIH, but they should be prepared that there's
• 6:26
  Speaker 3: going to be some tough questions and pushback from the audience.
• 6:29
  Speaker 2: Yeah, and I mean, I think for me it's that
• 6:31
  Speaker 2: it's I would definitely say you should be open to
• 6:35
  Speaker 2: having J. Bodicheria come and talk at your conference. He's
• 6:37
  Speaker 2: ahead of the NIH. Whether you agree with that or not,
• 6:40
  Speaker 2: that's his job. This is an important organization. But you
• 6:43
  Speaker 2: have to understand some people are not going to like
• 6:44
  Speaker 2: that and be prepared for whatever is the consequence of
• 6:47
  Speaker 2: that activity. And I guess here they prepared by having
• 6:50
  Speaker 2: the police, which is perhaps not the take I would have,
• 6:53
  Speaker 2: you know, used not the right move.
• 6:55
  Speaker 3: All right, let's move on. There's a paper making the
• 6:59
  Speaker 3: rounds now that is stressing me out even more about
• 7:03
  Speaker 3: my sleep than I was before. This is a paper
• 7:06
  Speaker 3: appearing in Nature which says that there is a U
• 7:10
  Speaker 3: shaped curve between the time you spend a sleep and
• 7:14
  Speaker 3: various important clinical outcomes. So like, if you sleep too little,
• 7:18
  Speaker 3: it's bad, if you sleep too much, it's bad. You
• 7:20
  Speaker 3: want to be in that sweet spot of like sixt
• 7:23
  Speaker 3: eight hours. Emily, this is keeping me up at night.
• 7:26
  Speaker 3: What do you think?
• 7:27
  Speaker 1: I hate this literature?
• 7:30
  Speaker 2: Okay, so first of all, I want to say sleep
• 7:32
  Speaker 2: is super important, and if you want to know some
• 7:35
  Speaker 2: science about sleep, you can listen to next week's episode
• 7:37
  Speaker 2: where we discuss sleep. Yeah, however, this particular kind of
• 7:42
  Speaker 2: finding which is not new, like these guys have a
• 7:45
  Speaker 2: different set of outcomes they're measuring. It's things about how
• 7:49
  Speaker 2: well you're functioning, your organs are or whatever. But there
• 7:52
  Speaker 2: are many parts of this, many pieces of literature that
• 7:56
  Speaker 2: will show this you shaped relationship, and people take from
• 8:00
  Speaker 2: that like, Okay, there's an optimal amount of the sleep,
• 8:03
  Speaker 2: which is in their case, like between six point five
• 8:06
  Speaker 2: and like seven point eight four.
• 8:08
  Speaker 1: Hours or something like that.
• 8:09
  Speaker 2: The problem is people who sleep a lot are generally sick.
• 8:14
  Speaker 2: So if you if there's somebody who's sleeping for eleven
• 8:16
  Speaker 2: hours a day, there's something else that's wrong.
• 8:19
  Speaker 3: For the most part, or my teenager can one hundred
• 8:22
  Speaker 3: percent of this, but that's not what you're talking about, right.
• 8:24
  Speaker 2: But like, for if you take an adult who is
• 8:26
  Speaker 2: sleeping for eleven hours a day on average, that person
• 8:29
  Speaker 2: has something else going on. It could be mental health,
• 8:31
  Speaker 2: it could be physical health, you know, so to say
• 8:35
  Speaker 2: like it's unhealth.
• 8:37
  Speaker 1: That's different from saying if you you a person.
• 8:39
  Speaker 2: Who typically sleeps seven hours, if you decided to sleep
• 8:43
  Speaker 2: eleven hours, would that be bad for you? That is
• 8:46
  Speaker 2: not what this data says. You probably couldn't sleep eleven hours.
• 8:50
  Speaker 3: Yeah, But the.
• 8:52
  Speaker 2: Fact is the people who sleep eleven hours or something
• 8:54
  Speaker 2: else going on. And similarly, people who are sleeping three
• 8:56
  Speaker 2: or four hours a night generally have a lot of
• 8:58
  Speaker 2: other things that are going on. That's more likely to
• 9:01
  Speaker 2: be shift workers. People are you know, generally have fewer resources.
• 9:04
  Speaker 2: There's like other things that are happening that made people
• 9:07
  Speaker 2: sleep less. So it's like this complicated thing where the
• 9:11
  Speaker 2: paper sort of wants you to think that this is
• 9:13
  Speaker 2: causal and it wants people to think, you know, you
• 9:16
  Speaker 2: have to get exactly this amount and if you go
• 9:18
  Speaker 2: outside of it, then you're going to die.
• 9:21
  Speaker 1: But that's really not what the data says.
• 9:23
  Speaker 2: It's much more that we're identifying different groups of people
• 9:26
  Speaker 2: with other different different things.
• 9:28
  Speaker 1: Now, having said that, I think sleep is.
• 9:29
  Speaker 2: Very important, so I think people should should prioritize sleep.
• 9:32
  Speaker 2: But like, my brother sent me this article and it
• 9:34
  Speaker 2: was like the headline is like, is like you don't
• 9:36
  Speaker 2: really need eight hours of sleep, And he was like,
• 9:38
  Speaker 2: oh my god, I'm getting eight hours of sleep, Like
• 9:41
  Speaker 2: is that bad?
• 9:43
  Speaker 4: Yeah?
• 9:43
  Speaker 3: Yeah, get the sleep. You've got to give your body
• 9:46
  Speaker 3: the opportunity to sleep the amount that your body wants
• 9:49
  Speaker 3: to sleep, basically, like, that's that's great for you actually.
• 9:52
  Speaker 2: And for most healthy adults, if you give your body
• 9:55
  Speaker 2: the opportunity to sleep, you will generally sleep something up
• 9:58
  Speaker 2: like seven to seven half hours. That is what a
• 10:01
  Speaker 2: typical adult will sleep given the opportunity in a sleep lab.
• 10:04
  Speaker 2: So anyway for sleeping eleven hours a day is probably
• 10:07
  Speaker 2: because something else is wrong, that's all.
• 10:10
  Speaker 1: Okay. I hate you shaped things.
• 10:12
  Speaker 2: It's like I hate I hate so, I hate you
• 10:15
  Speaker 2: shapes in research. It just drives me nuts. It's like
• 10:18
  Speaker 2: one of my bugget boots.
• 10:20
  Speaker 1: Okay, duly noted. So don't bring me any.
• 10:23
  Speaker 3: Bringing you exclusively U shaped findings for that. What about
• 10:27
  Speaker 3: BMI and death? Okay, do that right?
• 10:30
  Speaker 4: Yeah?
• 10:30
  Speaker 2: Okay, all right, so let's talk about what's going on
• 10:35
  Speaker 2: with HIV in South Africa. There is some very promising
• 10:39
  Speaker 2: new data about PREP shots and their effects on transmission.
• 10:46
  Speaker 2: Although in the US we don't talk as much about
• 10:49
  Speaker 2: HIV as as we once did in much of Sub
• 10:51
  Speaker 2: Aheran Africa, this is still as tremendously important problems. About
• 10:54
  Speaker 2: eight million people were HIV positive in South Africa. A
• 10:58
  Speaker 2: lot of the new infections are in adult girls.
• 11:01
  Speaker 1: What is the good data here?
• 11:04
  Speaker 3: Yeah, I mean this was really encouraging news coming from NPR,
• 11:10
  Speaker 3: and it's about PREP so pre exposure profile axis for HIV.
• 11:13
  Speaker 3: So these are medications you take when you don't have
• 11:16
  Speaker 3: HIV but you're in a high risk environment and South Africa,
• 11:21
  Speaker 3: as you point out, is very high risk. There are
• 11:23
  Speaker 3: eight million people living with HIV in South Africa and
• 11:27
  Speaker 3: there's about a thousand new infections per week, almost entirely
• 11:31
  Speaker 3: unfortunately in young and adolescent girls and women. And you know,
• 11:37
  Speaker 3: pre exposure profile axis typically is an oral medication that
• 11:42
  Speaker 3: you either take daily, some can be less frequent than that.
• 11:46
  Speaker 3: But what South Africa has started using is every six
• 11:51
  Speaker 3: month injection called length of Year, and this essentially eliminates
• 11:56
  Speaker 3: the risk of transmission of HIV. So for those six months,
• 11:59
  Speaker 3: we're wardless of what's happening to people. And of course,
• 12:03
  Speaker 3: you know, I should say that a lot of these
• 12:05
  Speaker 3: adolescent women are in exploitative relationships like this is yeah,
• 12:14
  Speaker 3: and this is bad independent of the transmission of HIV,
• 12:17
  Speaker 3: but obviously transmission of HIV makes the situation even worse.
• 12:20
  Speaker 3: And for the six months that you after the injection,
• 12:23
  Speaker 3: you essentially like there's basically no transmission. This as a
• 12:27
  Speaker 3: public health intervention is just way easier, right, You have
• 12:30
  Speaker 3: to get You've got to get a hold of these
• 12:33
  Speaker 3: these people who are at risk, you know, twice a year,
• 12:36
  Speaker 3: as opposed to getting them drugs much more frequently than that.
• 12:40
  Speaker 3: The big problem now is one of funding.
• 12:43
  Speaker 2: Honestly, there's the drugs are very very expensive.
• 12:48
  Speaker 3: It's being funded right now by the Global Fund out
• 12:51
  Speaker 3: of the un like the Global Fund to Fight AIDS,
• 12:53
  Speaker 3: and you know, funding there is unfortunately limited, But there
• 12:59
  Speaker 3: are a large number of philanthropies that do have an
• 13:01
  Speaker 3: interest in this area. So to the extent that we
• 13:02
  Speaker 3: can draw attention to this like relatively successful program and
• 13:06
  Speaker 3: scale it up, I think would be ideal and of
• 13:07
  Speaker 3: course if people, if people feel like donating, you can
• 13:11
  Speaker 3: donate to the Global Funds Fight AIDS directly if that's
• 13:14
  Speaker 3: a choice.
• 13:15
  Speaker 2: Yet another reason why it was very unfortunate that they
• 13:17
  Speaker 2: cut all the funding for PEPFAR, which has been one
• 13:19
  Speaker 2: of our most successful global health interventions over the past
• 13:23
  Speaker 2: twenty years. It is on that note, that's it for
• 13:28
  Speaker 2: the health news of the week, and after the break,
• 13:30
  Speaker 2: we'll ask what's the deal with hypoactive sexual desire disorder?
• 13:40
  Speaker 3: All right, we are back. We're asking what's the deal
• 13:43
  Speaker 3: with hypoactive sexual desire disorder? Okay, I'm lee this is
• 13:50
  Speaker 3: one of the topics, maybe not HSDD per se, but
• 13:54
  Speaker 3: like sexual activity, sexual function in my age group, in
• 13:58
  Speaker 3: my cohort, presumably in your cohort as well, is something
• 14:02
  Speaker 3: a lot of people sort of allude to without really
• 14:06
  Speaker 3: digging down on. There's a lot of like there's a
• 14:08
  Speaker 3: lot of sly comments, like sort of the boomer humor
• 14:11
  Speaker 3: stuff that I hear about, you know, like, uh, you know,
• 14:14
  Speaker 3: my wife's got a headache, like that kind of thing,
• 14:17
  Speaker 3: but no one ever really sits down and compares notes.
• 14:20
  Speaker 3: I mean, I think fortunately, but but that's sort of
• 14:24
  Speaker 3: what we're here to do, because if something is a
• 14:27
  Speaker 3: disorder and it's out there, people might naturally wonder like
• 14:30
  Speaker 3: do I have it? What do I have it? And
• 14:33
  Speaker 3: I think maybe the place to start before we talk
• 14:37
  Speaker 3: about like a disorder of sexual function is what is
• 14:42
  Speaker 3: normal here? Like when we think about this, especially you
• 14:46
  Speaker 3: know for people our aged, you know, forties kids, that
• 14:49
  Speaker 3: kind of thing. You actually have some really interesting data
• 14:53
  Speaker 3: on this.
• 14:53
  Speaker 2: Yes, I want to start by by I once did
• 14:56
  Speaker 2: a really great podcast with Emily Nigoski, who is a
• 15:00
  Speaker 2: writer who writes about sex, and I asked the question,
• 15:03
  Speaker 2: you know, what's a normal amount of sex?
• 15:05
  Speaker 1: And she was like, that is the worst possible question.
• 15:10
  Speaker 2: And I came to think that she was right because
• 15:12
  Speaker 2: of course, like there is no, no, there's average. I
• 15:16
  Speaker 2: can tell you in the data what is the average,
• 15:18
  Speaker 2: But the word normal has this like connotation about what
• 15:22
  Speaker 2: is appropriate or what you should do, and I think
• 15:25
  Speaker 2: that's actually not very helpful in a place where people
• 15:29
  Speaker 2: are going to vary in like what makes them happy.
• 15:32
  Speaker 2: So I'm going to tell you the average, but I'm
• 15:34
  Speaker 2: not going to tell you what's normal.
• 15:36
  Speaker 3: I think that is very well said. It doesn't imply
• 15:40
  Speaker 3: that if you're less than the average or more than
• 15:41
  Speaker 3: the average, that you are per se abnormal or pathological,
• 15:45
  Speaker 3: but please go okay.
• 15:46
  Speaker 2: So we I get very interested in this question a
• 15:49
  Speaker 2: couple of years ago because I talked to a lot
• 15:51
  Speaker 2: of parents of young kids and it comes up all
• 15:54
  Speaker 2: the time, the question of are people having sex and
• 15:57
  Speaker 2: how much are they having And it's a place where
• 16:00
  Speaker 2: people just like to have data. So we did this
• 16:02
  Speaker 2: big survey of parents. People were very I do a
• 16:06
  Speaker 2: lot of surveys actually on my website, and.
• 16:11
  Speaker 1: This was by far the most popular.
• 16:13
  Speaker 2: So I got twenty six thousand people to report their sexual.
• 16:18
  Speaker 3: It's pretty amazing data. It's pretty amazing. It's one of
• 16:20
  Speaker 3: the largest studies of its type. Like as I was
• 16:23
  Speaker 3: looking at the literature too.
• 16:25
  Speaker 2: So you know, the answer is that for parents at least,
• 16:30
  Speaker 2: sex varies quite a lot with the age of the
• 16:32
  Speaker 2: youngest kid. So in the data, for people with kids
• 16:36
  Speaker 2: under a year, the like modal frequency was once to
• 16:40
  Speaker 2: twice a month. For people with kids over five years,
• 16:44
  Speaker 2: the mode was more like.
• 16:45
  Speaker 1: One two times a week.
• 16:47
  Speaker 2: There's a reasonable share of people who say that they
• 16:50
  Speaker 2: never have sex or less than once a year. It's
• 16:54
  Speaker 2: not very high, but it's it's certainly, you know, for
• 16:57
  Speaker 2: almost ten percent basically for people with very small children,
• 17:01
  Speaker 2: and there are a very small number of people, like
• 17:04
  Speaker 2: less than one percent even with older kids, who say
• 17:06
  Speaker 2: they have sex every day, So you know, like we're
• 17:10
  Speaker 2: kind of if you ask what's the average, it's something
• 17:12
  Speaker 2: in the range of.
• 17:15
  Speaker 1: Twice a week too, uh, once a month.
• 17:18
  Speaker 3: I think one of the really interesting things that was
• 17:20
  Speaker 3: in your data was this relationship with age of parents
• 17:25
  Speaker 3: and age of kids. So what you found is that
• 17:28
  Speaker 3: if you holding the age of kids steady, like, statistically,
• 17:32
  Speaker 3: the older the parents were sort of the less frequently
• 17:36
  Speaker 3: they would have sex, which kind of makes sense, right
• 17:38
  Speaker 3: you get older, like things happen. But then the older
• 17:41
  Speaker 3: the kids are, the more often the parents would have sex,
• 17:46
  Speaker 3: And of course those are correlated because older parents tend
• 17:48
  Speaker 3: to have older children everything. So it's this really complex
• 17:51
  Speaker 3: interplay between biology, which is as we get older, like
• 17:55
  Speaker 3: the hormones that drive our sex drive decrease, and then
• 17:59
  Speaker 3: like logistics, which is like, as our kids get older,
• 18:03
  Speaker 3: there's just more opportunity.
• 18:06
  Speaker 1: Do you think that's true? This is a different topic.
• 18:08
  Speaker 2: I feel like there are some ways in which having
• 18:11
  Speaker 2: older children presents less opportunity. Okay, I mean because then
• 18:17
  Speaker 2: they could catch like it well anyway.
• 18:19
  Speaker 3: Okay, oh no, I think this is a critical thing
• 18:23
  Speaker 3: to discuss. And if any of my children are listening
• 18:26
  Speaker 3: to this, please turn it off. Turn it off, go
• 18:30
  Speaker 3: to bed, Go to bed, stay in your room.
• 18:37
  Speaker 2: So one of the things I thought was was interesting,
• 18:39
  Speaker 2: which maybe sort of leads into the question of how
• 18:43
  Speaker 2: we sort of pathologize this is actually a pretty large
• 18:46
  Speaker 2: share of people said that they were not having enough sex,
• 18:51
  Speaker 2: not as much as they would want to, right. And
• 18:55
  Speaker 2: so even the people who are having sex one to
• 18:58
  Speaker 2: two times a week, a little bit forty percent of
• 19:00
  Speaker 2: them said they were having somewhat too little or way
• 19:03
  Speaker 2: too little sex. As you get to people who are
• 19:05
  Speaker 2: having sex a few times a year, almost one hundred
• 19:07
  Speaker 2: percent of them say that's not enough. And this for
• 19:11
  Speaker 2: me was actually a much more telling piece of the
• 19:13
  Speaker 2: of the data than the frequency, because I think if
• 19:16
  Speaker 2: you say, you know, we're having sex twice a year
• 19:18
  Speaker 2: and that works for us, like that's that feels like enough,
• 19:21
  Speaker 2: then it's great. It is more concerning when you have
• 19:25
  Speaker 2: almost everyone saying, well, actually i'd love to have more.
• 19:29
  Speaker 2: But something else is happening, that's getting in the way. Yeah,
• 19:33
  Speaker 2: I and obviously are more likely to say they don't
• 19:38
  Speaker 2: they're not having Men would like to have more sex
• 19:40
  Speaker 2: than women.
• 19:40
  Speaker 3: Oh yeah, when you stratified, when you stratified by sex.
• 19:43
  Speaker 3: But many women in your survey, in fact, the majority,
• 19:47
  Speaker 3: are also saying, yes, I'd like to have more. So,
• 19:49
  Speaker 3: you know, in theory, you've got these couples, right, both
• 19:53
  Speaker 3: members of the couple are like, you know, I really
• 19:54
  Speaker 3: wish we would have more sex, and yet we don't.
• 19:57
  Speaker 2: Yeah, And I mean it was it saying Okay, I'll
• 20:01
  Speaker 2: just say one more thing about this, which is that
• 20:02
  Speaker 2: people left a lot of comments, like thousands and thousands
• 20:05
  Speaker 2: of people left comments, and some of this is just
• 20:10
  Speaker 2: I'll just read this because I think it summarizes a
• 20:12
  Speaker 2: little bit of how people often feel with little kids.
• 20:15
  Speaker 2: It's not that the sex is bad or that I
• 20:17
  Speaker 2: don't love my spouse as much. It's just that we're
• 20:19
  Speaker 2: both so tired all the time that the sex is
• 20:21
  Speaker 2: very bland and feels like something we do quickly just
• 20:24
  Speaker 2: for basic maintenance while the kids are temporarily asleep. The
• 20:27
  Speaker 2: best analogy I can think of is forcing yourself to
• 20:29
  Speaker 2: eat because you know, you should even though you're not
• 20:31
  Speaker 2: actually very hungry.
• 20:33
  Speaker 3: Okay, that's a little bleak.
• 20:35
  Speaker 2: It's bleak, But I think we should come back to
• 20:37
  Speaker 2: it later because actually there is some stuff in the
• 20:39
  Speaker 2: data suggesting that that actually may not be a terrible
• 20:43
  Speaker 2: approach to sex in some cases. So that's probably a
• 20:48
  Speaker 2: good place to move into what we actually mean when
• 20:53
  Speaker 2: we say hypoactive sexual desire disorder.
• 20:57
  Speaker 3: Right, so let me start by saying, we don't mean
• 21:01
  Speaker 3: like everyone like sometimes isn't in the mood, right, Like
• 21:05
  Speaker 3: that's normal, that's natural. It's not you're you know, you're
• 21:08
  Speaker 3: not going to be there all the time. This is
• 21:12
  Speaker 3: Hypoactive sexual desire disorder is a clinical disorder, and because
• 21:18
  Speaker 3: it's clinical disorder, it now appears in the d s
• 21:21
  Speaker 3: M five. So the Diagnostic and Statistical Manual is the
• 21:23
  Speaker 3: big book of psychological diagnoses. It's where you find like, oh,
• 21:27
  Speaker 3: what do I you know, what criteria do you need
• 21:29
  Speaker 3: to fulfill to have major depressive disorder, bipoloy disorder or
• 21:32
  Speaker 3: schizophrenia or anything. And as of the fifth edition, which
• 21:35
  Speaker 3: is the most recent, HSDD was put in here, although
• 21:39
  Speaker 3: in the DSM five they call it female sexual interest
• 21:42
  Speaker 3: slash arousal disorder. This actually engendered some controversy, which I'll
• 21:47
  Speaker 3: get to in a second, but just to say it,
• 21:50
  Speaker 3: in order to be diagnosed with this, you need to
• 21:52
  Speaker 3: have decreased or absent three of the following things. Interest
• 21:57
  Speaker 3: in sexual activity, sexual erotic thoughts are fantasies, initiation of
• 22:01
  Speaker 3: sexual activity or unreceptive to partner's attempts to initiate sexual
• 22:05
  Speaker 3: excitement or pleasure. And almost all encounters sexual interest slash
• 22:08
  Speaker 3: arousal to erotic cues, genital or non genital sensations during
• 22:12
  Speaker 3: sexual activity. It needs to be going on at least
• 22:14
  Speaker 3: five months. It needs to not be better explained by
• 22:17
  Speaker 3: something else like a medical condition or medications you're taking,
• 22:20
  Speaker 3: or stress or the million other things that obviously can
• 22:23
  Speaker 3: cause all these things. And here's the kicker for all
• 22:26
  Speaker 3: psychological disorders. It has to be causing you significant distress.
• 22:31
  Speaker 3: You have to be upset about it.
• 22:33
  Speaker 2: So the piece of this that I find a little
• 22:36
  Speaker 2: hard in diagnosis is all of these things are kind
• 22:40
  Speaker 2: of in the abstract, but most of the time we're
• 22:42
  Speaker 2: thinking about sexual behavior in the context of a relationship,
• 22:46
  Speaker 2: and so there's actually maybe an important distinction between like
• 22:50
  Speaker 2: am I interested in sexual activity or initiation from the
• 22:54
  Speaker 2: person who I am have available?
• 22:57
  Speaker 1: Or am I interested at all?
• 22:59
  Speaker 2: Right, there is an important distinction here, which is would
• 23:02
  Speaker 2: you like to have sex with someone or would you
• 23:05
  Speaker 2: like to have sex with the person that you can
• 23:07
  Speaker 2: have sex with? And those things may not be the same.
• 23:09
  Speaker 2: And in principle that seems like quite important distinction, because
• 23:14
  Speaker 2: a sexual interest arousal disorder is not a it's not
• 23:18
  Speaker 2: a marriage problem. It's not like there's a partnership problem.
• 23:20
  Speaker 2: It's supposed to be a thing about your sexual function,
• 23:24
  Speaker 2: not about the other person. But it feels almost impossible
• 23:27
  Speaker 2: to separate those.
• 23:28
  Speaker 3: Yeah, And as I said, there was some controversy about this.
• 23:32
  Speaker 3: In two parts number one, the d s M five
• 23:35
  Speaker 3: links sexual interest and sexual arousal in the same disorder,
• 23:40
  Speaker 3: which is really not the same thing. One is a
• 23:42
  Speaker 3: physiologic thing, you know, like arousal is a little clearer
• 23:46
  Speaker 3: to document in a man because of penises and direction
• 23:50
  Speaker 3: penises and so men have an arousal disorder. Men can
• 23:54
  Speaker 3: have impotence, and there's like a drug to there are
• 23:56
  Speaker 3: many now drugs to treat that. That's different then interest,
• 24:01
  Speaker 3: And it's the same with women. And so the DSM
• 24:05
  Speaker 3: did get some criticism for that because those things are separable.
• 24:07
  Speaker 3: There are women who are very interested in sex but
• 24:11
  Speaker 3: just physically don't become aroused in that way. Lumping these
• 24:14
  Speaker 3: together doesn't seem necessarily appropriate. The other controversy is that
• 24:18
  Speaker 3: you'll see some people arguing that hyperactive sexual desire disorder
• 24:23
  Speaker 3: basically was created to sell drugs, you know, by the
• 24:26
  Speaker 3: pharmaceutical industry. And we'll get to what those drugs are
• 24:29
  Speaker 3: and their FDA approved and whether or not they work.
• 24:32
  Speaker 3: But this is kind of a new thing, and I
• 24:34
  Speaker 3: think it's important to tease out, as you say, like
• 24:38
  Speaker 3: whether this is truly something inside the woman with hyperactive
• 24:43
  Speaker 3: sexual desire disorder, or if it is a result of
• 24:46
  Speaker 3: external things, whether that's the relationship, whether that's the result
• 24:49
  Speaker 3: of life stress, et cetera.
• 24:51
  Speaker 2: Yeah, I mean this feels to me, like, you know,
• 24:53
  Speaker 2: if you think about some of the symptoms we associate,
• 24:55
  Speaker 2: say with perimenopause or menopause, like baginal dryness, it's like
• 24:58
  Speaker 2: a very specific reas in that you might not be
• 25:01
  Speaker 2: like that, you might have trouble having sex or not
• 25:05
  Speaker 2: find it as pleasurable because of this particular symptom, and
• 25:09
  Speaker 2: that is something that deserves treatment. It has various kinds
• 25:12
  Speaker 2: of treatment. Is totally different from interest, but is going
• 25:15
  Speaker 2: to show up in some sense in the same way like.
• 25:17
  Speaker 1: If you are not.
• 25:20
  Speaker 2: If you're not going to enjoy this, you're not going
• 25:22
  Speaker 2: to want to do it again. Those things are not
• 25:25
  Speaker 2: the same, and so you almost want to diagnosi as like, well,
• 25:27
  Speaker 2: do you like watching porn?
• 25:29
  Speaker 1: Like if you.
• 25:30
  Speaker 2: Watch the po like, how do you react to that?
• 25:32
  Speaker 2: And that's separate from do you want to do it yourself?
• 25:35
  Speaker 1: Or would you enjoy doing this?
• 25:36
  Speaker 3: Yeah? Absolutely, I mean that's what one of the criteria
• 25:40
  Speaker 3: of in the DSM five is like a difficulty or
• 25:44
  Speaker 3: decreased or absence aroused her to erotic cues. So it
• 25:48
  Speaker 3: is clear that like, you know, this is supposed to
• 25:50
  Speaker 3: be something, right, regardless of what you're watching, regardless of
• 25:53
  Speaker 3: whether you're reading you know, fifty Shades of Gray or
• 25:57
  Speaker 3: you're with the partner that you love or you with
• 26:00
  Speaker 3: the partner that you hate, Like, it's all the same, right. Yeah,
• 26:04
  Speaker 3: let's talk about distress though, so.
• 26:06
  Speaker 2: Can I ask another thing about the diagnosis also, which
• 26:08
  Speaker 2: is are they looking for changes over time? So I
• 26:10
  Speaker 2: think you know, we can. There's so much variation of
• 26:14
  Speaker 2: in just general interest in sex. I think across across
• 26:17
  Speaker 2: the pod really sho some people have a higher taste
• 26:19
  Speaker 2: for sex than others.
• 26:21
  Speaker 1: Just yeah, in general, I would have.
• 26:23
  Speaker 2: Thought that we'd be looking here for things that are
• 26:26
  Speaker 2: changes from your norm.
• 26:28
  Speaker 1: Is that part of the diagnosis or not?
• 26:32
  Speaker 3: No, it's not. That's not in any of the criteria.
• 26:35
  Speaker 3: It does have to be persistent for five months, but
• 26:37
  Speaker 3: of course if that has been your norm forever, that's
• 26:40
  Speaker 3: your norm, and it has been persistent for more than
• 26:42
  Speaker 3: five months. But again it has to be causing distress.
• 26:45
  Speaker 3: So they actually call out in the DSM five they
• 26:49
  Speaker 3: call out a sexual orientation and as like, this is
• 26:54
  Speaker 3: not hyperactive sexual desire disorder. So if you, you know,
• 26:57
  Speaker 3: are asexual, if that's your sexual or and it's not
• 27:01
  Speaker 3: causing you distress, and you've been that way, you know
• 27:03
  Speaker 3: you've been that way, then that's it. You don't have
• 27:05
  Speaker 3: a disorder, that's just who you are. I think this
• 27:09
  Speaker 3: distress thing, though, is the one I keep getting hung
• 27:11
  Speaker 3: up on. And by the way, this appears in every
• 27:13
  Speaker 3: like DSM five, It's almost like for every diagnosis you
• 27:16
  Speaker 3: can have psychologically there's always like and it's harming your
• 27:20
  Speaker 3: everyday life or it's causing you distress or something the
• 27:22
  Speaker 3: same with like alcoholic disorder and everything. But when it
• 27:25
  Speaker 3: comes to sex, there's other people involved often and so
• 27:33
  Speaker 3: you know, I do wonder how you tease out like
• 27:35
  Speaker 3: this is causing me distress because gosh, I wish I
• 27:39
  Speaker 3: could get more interested and it's just a fun zesty
• 27:41
  Speaker 3: part of life that I'm not engaging in and I
• 27:43
  Speaker 3: want that to change, versus it's causing me distress because
• 27:47
  Speaker 3: my partner is upset with me, And like, how do
• 27:52
  Speaker 3: you know the difference?
• 27:54
  Speaker 2: Yeah, I mean there's a thing in the DSM about
• 27:57
  Speaker 2: you know, this is not explained by relationships stress. Yeah,
• 28:00
  Speaker 2: but it seems awfully difficult in the context, particularly of
• 28:04
  Speaker 2: you know, long term marriage and so on, for this
• 28:07
  Speaker 2: to not be wrapped up in you know, disconnects between
• 28:11
  Speaker 2: people and in relationship stress. I mean, this is a
• 28:14
  Speaker 2: huge source of stress in many marriages. So I guess
• 28:17
  Speaker 2: I worry with this diagnosis in general, that we are
• 28:22
  Speaker 2: pathologizing a set of issues which are really not at
• 28:25
  Speaker 2: all about something physical and are just things we should
• 28:30
  Speaker 2: be trying to address to make people happier and we've
• 28:35
  Speaker 2: gotten to well, well we're going to give you some
• 28:36
  Speaker 2: drug for it.
• 28:38
  Speaker 3: Yeah yeah, yeah, well that's much more profitable totally just
• 28:41
  Speaker 3: trying to make people happy.
• 28:43
  Speaker 1: Yeah. So true.
• 28:44
  Speaker 3: You know, you've alluded to the fact that there are
• 28:47
  Speaker 3: baseline the bido differences in people, and I think that's
• 28:50
  Speaker 3: true and relatively well established that, like there's some kind
• 28:54
  Speaker 3: of the beatinal set point that people have, and yes,
• 28:57
  Speaker 3: it changes over time and generally as you get older,
• 29:00
  Speaker 3: and well at least post puberty, as you get older,
• 29:02
  Speaker 3: that sort of wanes kind of difference between men and women.
• 29:06
  Speaker 3: What that means, of course, is that in partnered relationships
• 29:10
  Speaker 3: there is the potential to have a discrepancy. And this
• 29:13
  Speaker 3: is again where I kind of keep coming back to
• 29:15
  Speaker 3: with HSDD, is like is it the discrepancy that's causing
• 29:19
  Speaker 3: the problem or not. And so I was looking into
• 29:23
  Speaker 3: this a little bit into the data, and there's actually
• 29:25
  Speaker 3: like a really rich body of literature about assessing lbidinal
• 29:30
  Speaker 3: discrepancies and married couples of all genders and sexual orientations,
• 29:35
  Speaker 3: and it's fairly robust. So I'll let me tell you.
• 29:37
  Speaker 3: I'll go through one of these from the archives of
• 29:39
  Speaker 3: sexual behavior in twenty fourteen. And I'm curious what you
• 29:41
  Speaker 3: think here. So this is a study that looked at
• 29:44
  Speaker 3: over a thousand married couples. They assessed the desire like
• 29:49
  Speaker 3: they asked each member of the couple how often they
• 29:53
  Speaker 3: would like to have sex, how often they were having sex,
• 29:57
  Speaker 3: And I wonder if any of these findings are surprising.
• 30:00
  Speaker 3: So fifty two percent of females indicated the desired frequency
• 30:04
  Speaker 3: was equal to the observed frequency, so they were like,
• 30:06
  Speaker 3: this is we're at the right spot. Thirty seven percent
• 30:09
  Speaker 3: of males said that forty eight percent of husbands reported
• 30:14
  Speaker 3: a higher desire reality score, So that's like they want
• 30:18
  Speaker 3: more than what is happening than the wives did. Eighteen
• 30:21
  Speaker 3: percent of wives reported higher than their husbands. Greater discrepancies
• 30:25
  Speaker 3: between this were associated with lower relationship satisfaction, greater conflict,
• 30:32
  Speaker 3: lower positive communication, all with sort of modest effect sizes.
• 30:36
  Speaker 3: So how do you take this literature? I mean, you know,
• 30:40
  Speaker 3: this is both men and women actually saying that they
• 30:43
  Speaker 3: could do more. But men again, men are men wanted
• 30:48
  Speaker 3: more and more than women.
• 30:50
  Speaker 2: I don't find either of these sort of any of
• 30:53
  Speaker 2: this thing in this space surprising. I think exactly what
• 30:57
  Speaker 2: they mean is again a little hard to tease out.
• 31:02
  Speaker 2: So one issue that comes up all the time is
• 31:06
  Speaker 2: the question of what direction is the causality. So is
• 31:10
  Speaker 2: it that people have a discrepancy in their desire and
• 31:14
  Speaker 2: that's leading to relationship dissatisfaction, which is leading to more
• 31:18
  Speaker 2: desiral discrepancies. Is it that they have relationship dissatisfaction that's
• 31:22
  Speaker 2: leading to the discrepancy, you know, And then when we
• 31:26
  Speaker 2: think about the amounts the sort of desire for more,
• 31:30
  Speaker 2: there's a glass half full, glass af empty, which kind
• 31:33
  Speaker 2: of comes back to some of this discussion of you know,
• 31:35
  Speaker 2: what happens with kids, Like a lot of what happens
• 31:37
  Speaker 2: when people have children, I should say, which is that
• 31:40
  Speaker 2: a lot of what people are saying when they talk
• 31:45
  Speaker 2: about wanting to have more sex is almost like it's
• 31:48
  Speaker 2: almost a positive frame. It's like I wish I had
• 31:51
  Speaker 2: more time for this, yeah, as opposed to like I
• 31:54
  Speaker 2: wish I were involved with someone else that I was
• 31:56
  Speaker 2: more interested in having sex with, the sort of like
• 31:58
  Speaker 2: I want to do this. When we do it, it's great.
• 32:01
  Speaker 2: It's like just hard to find the time. But I'm like,
• 32:04
  Speaker 2: but it's it's a it's a positive statement. And yeah,
• 32:08
  Speaker 2: that feels different than you know, I'm frustrated that my
• 32:11
  Speaker 2: partner doesn't want to have sex with me as much
• 32:12
  Speaker 2: as I want.
• 32:13
  Speaker 3: Yeah, I like, I like thinking of it that way,
• 32:15
  Speaker 3: and I think to some extent even being able to
• 32:19
  Speaker 3: communicate that between partners can be helpful. Right, There's like
• 32:23
  Speaker 3: just like, hey, by the way, we're on the same
• 32:25
  Speaker 3: page here. It's not always going to work, but you
• 32:29
  Speaker 3: know it's still the desire is still there, right, because
• 32:32
  Speaker 3: there's there's You mentioned that one of the comments that
• 32:35
  Speaker 3: you got with someone talking about sex is just kind
• 32:38
  Speaker 3: of like maintenance on a car, right, just like something
• 32:41
  Speaker 3: that you know you got to do periodically to kind
• 32:44
  Speaker 3: of keep things together. And yeah, I said that feels bleak.
• 32:48
  Speaker 3: But but the truth is some of the data and
• 32:51
  Speaker 3: maybe you can walk us through this like suggests before
• 32:54
  Speaker 3: we get to drugs and stuff like that, that this
• 32:57
  Speaker 3: is a strategy.
• 32:58
  Speaker 1: Yeah.
• 32:58
  Speaker 2: So I before I talk about the date, I want
• 33:00
  Speaker 2: to read you this quote, which I love so much
• 33:02
  Speaker 2: from someone we're both so tired, but when we do it,
• 33:05
  Speaker 2: we're always like, man, that's great.
• 33:07
  Speaker 1: We should do that more.
• 33:10
  Speaker 2: That may be very happy because I think that is
• 33:12
  Speaker 2: you know, for some set of people that this is
• 33:16
  Speaker 2: is really about, Like, you know, we're just it's not
• 33:19
  Speaker 2: a phase of life in which this is the thing
• 33:20
  Speaker 2: we're doing as much as we would as much as
• 33:23
  Speaker 2: you would like. Of course, there are many other people
• 33:25
  Speaker 2: who will say, you know, I just don't want to
• 33:27
  Speaker 2: do this anymore.
• 33:28
  Speaker 1: It doesn't make me happy.
• 33:29
  Speaker 3: So and of course there's other things that we don't
• 33:32
  Speaker 3: have time to do that, like like I didn't get
• 33:35
  Speaker 3: to go to the gym today like I wanted to.
• 33:37
  Speaker 3: I didn't have time, you know, I had there was
• 33:39
  Speaker 3: too much other stuff going on. So this is not
• 33:41
  Speaker 3: like exclusive to sex for people with kids.
• 33:46
  Speaker 1: And no totally. People actually also say they want to
• 33:48
  Speaker 1: talk to their spouse more. Yeah, on date to talk
• 33:51
  Speaker 1: to them or have sex with them either.
• 33:53
  Speaker 3: One got multitask people multi.
• 33:58
  Speaker 1: Task all right.
• 34:00
  Speaker 2: So there are a bunch of strategies that people have
• 34:05
  Speaker 2: tried to use to like mitigate these issues, which have
• 34:09
  Speaker 2: some at least I would say, survey based evidence that
• 34:13
  Speaker 2: they work for some people. So one is communication. Talking
• 34:20
  Speaker 2: about how you feel about things is almost always a
• 34:24
  Speaker 2: good idea, and a very large share of people more
• 34:26
  Speaker 2: or less one hundred percent of couples say that having
• 34:29
  Speaker 2: some communication about differences in sexual.
• 34:33
  Speaker 1: Desire is helpful. This is why therapy is helpful.
• 34:36
  Speaker 2: But another thing, perhaps almost as almost as helpful as communication,
• 34:42
  Speaker 2: is an activity people call have sex anyway, which is
• 34:47
  Speaker 2: actually a core part of some marital counseling advice when
• 34:52
  Speaker 2: people are struggling with this, which is just to say,
• 34:54
  Speaker 2: you know, just even though it's like eating your actually
• 35:00
  Speaker 2: the starting of it may feel like eating your your vegetables, Like,
• 35:04
  Speaker 2: just put it on the schedule, say twice a week,
• 35:06
  Speaker 2: we're going to have sex on these times, and this
• 35:08
  Speaker 2: is going to be on the schedule, and we're going
• 35:09
  Speaker 2: to do it. Partly because for many people you do,
• 35:11
  Speaker 2: you're like, oh that was pretty fun, and there's a
• 35:13
  Speaker 2: moment of connection and then you kind of get are
• 35:16
  Speaker 2: reminded that this is an enjoyable activity.
• 35:20
  Speaker 1: Have sex anyway.
• 35:21
  Speaker 3: Yeah, I mean, this is you're quoting data. The numbers
• 35:24
  Speaker 3: I'm looking at are pretty pretty impressive. So you're quoting
• 35:28
  Speaker 3: data from this study of two hundred and thirty couples
• 35:31
  Speaker 3: from the Archives of Sexual Behavior in twenty twenty, and
• 35:34
  Speaker 3: as you say, zero percent, not a single couple said
• 35:38
  Speaker 3: communication was unhelpful. Like every single couple said you should
• 35:42
  Speaker 3: talk about this. That's the number one thing, but coming
• 35:45
  Speaker 3: in hot at number two of the coping strategies, with
• 35:49
  Speaker 3: only five percent of couples saying it's not helpful. Was
• 35:52
  Speaker 3: this have sex anyway?
• 35:53
  Speaker 1: Six anyway? Six anyway?
• 35:55
  Speaker 2: There are other things which seem to work, you know
• 35:58
  Speaker 2: for some people, So engagement in another activity with the partner,
• 36:02
  Speaker 2: So doing something else to try to connect with your partner.
• 36:06
  Speaker 2: About eighty eight percent of people said that that was.
• 36:08
  Speaker 1: Date night helpful. Date night.
• 36:10
  Speaker 4: Yeah.
• 36:11
  Speaker 2: The other thing people say is you know, to do
• 36:14
  Speaker 2: it by yourself, which this that he refers to as
• 36:16
  Speaker 2: engagement and activity alone masturbate and and I will say
• 36:21
  Speaker 2: eighty percent of.
• 36:22
  Speaker 1: Couples here said that that was useful.
• 36:24
  Speaker 2: And I think part of it is, you know, if
• 36:25
  Speaker 2: really the issue is one person just wants more orgasms
• 36:29
  Speaker 2: and the other person maybe that the compromises that they
• 36:32
  Speaker 2: get to have some of them by themselves. What it
• 36:34
  Speaker 2: is a thing that people found no almost no one
• 36:37
  Speaker 2: found helpful was doing nothing disengagement.
• 36:40
  Speaker 1: Nobody likes that, so don't do nothing.
• 36:43
  Speaker 3: Don't do nothing, and it's it is this can be
• 36:45
  Speaker 3: obviously something that's difficult to talk about, you know, going
• 36:48
  Speaker 3: back to communication. In part, and it's not just because
• 36:51
  Speaker 3: it's like, ooh, it's a taboo subject and whatever, because
• 36:54
  Speaker 3: you know, most people after they've been married for a
• 36:56
  Speaker 3: while have talked about a lot of things. But in part,
• 36:58
  Speaker 3: it's because that all also takes time, which we've already
• 37:02
  Speaker 3: established we don't have a lot of and so it's like,
• 37:06
  Speaker 3: and by the way, let's cut out some extra time
• 37:09
  Speaker 3: to talk about our sex lives and stuff like that.
• 37:13
  Speaker 3: It is also something else to that fills up the schedule,
• 37:16
  Speaker 3: which I think can be you know, it's easy to
• 37:18
  Speaker 3: put off. I guess is maybe the way to say that.
• 37:21
  Speaker 2: I also think you're understating how difficult people find it
• 37:24
  Speaker 2: to discuss find to discuss this with a partner, you
• 37:27
  Speaker 2: particularly if it wasn't something that you needed to discuss
• 37:30
  Speaker 2: as much, you know, but you like in earlier parts
• 37:33
  Speaker 2: of relationships and there was more time and you know,
• 37:36
  Speaker 2: people were but we get good. Older people's bodies change,
• 37:39
  Speaker 2: they want different things, like maybe they're feeling like the
• 37:42
  Speaker 2: idea of bringing up you know, well, why aren't we
• 37:44
  Speaker 2: doing this more like is it because you aren't as
• 37:46
  Speaker 2: excited about me?
• 37:48
  Speaker 1: Or is it like I think people have. This is hard.
• 37:51
  Speaker 2: Talking about sex and talking about money are really hard,
• 37:54
  Speaker 2: even with people that you love.
• 37:56
  Speaker 3: This is fair, and I think we're all afraid of
• 37:58
  Speaker 3: opening a can of worm do right, Like, you know
• 38:01
  Speaker 3: what am I going to hear? And am I going
• 38:03
  Speaker 3: to hear something I don't want to hear? Especially hard
• 38:05
  Speaker 3: from people you love? So Emily, let me put on
• 38:08
  Speaker 3: my pharmaciel hat and say, like talking is tough and
• 38:11
  Speaker 3: takes time, how about you just pop a pill? How
• 38:15
  Speaker 3: about that you don't even have to do it. You
• 38:17
  Speaker 3: don't even have to tell your partner.
• 38:20
  Speaker 1: Sounds amazing. I mean, look it worked for me. Okay.
• 38:23
  Speaker 2: I think part of the thing here is, you know,
• 38:26
  Speaker 2: this is all coming out of again like a very
• 38:30
  Speaker 2: clear medical diagnosis. Right, Rectile dysfunction is like a real game.
• 38:35
  Speaker 2: It's like a real physical thing. You need the penis
• 38:38
  Speaker 2: to be away. It's not the way. We came up
• 38:41
  Speaker 2: with a system to make it the way that you need.
• 38:43
  Speaker 2: Like that was like a solid and they made a
• 38:46
  Speaker 2: really just an absolute ton of money on that.
• 38:49
  Speaker 3: Yeah. Yeah, banger drug.
• 38:52
  Speaker 2: That's a banger drugs. One of our best drugs. It's
• 38:55
  Speaker 2: probably one of our best drugs.
• 38:56
  Speaker 3: You know, I think most people know this, but just
• 38:58
  Speaker 3: to say that viagra was originally developed for pulmonary hypertension.
• 39:01
  Speaker 3: It's a phase of dilator And this was just a
• 39:03
  Speaker 3: very pleasant side effect that the initial trials revealed as
• 39:07
  Speaker 3: part of adverse event reporting. People were like, something's going
• 39:11
  Speaker 3: on here. So I was like, uh, pivot.
• 39:22
  Speaker 1: Lungs. Those are not important, yes.
• 39:27
  Speaker 4: So.
• 39:29
  Speaker 3: Let's talk drugs. We have two f d A approved
• 39:32
  Speaker 3: drugs for hyperactive sexual desire disorder whatever that may be.
• 39:36
  Speaker 3: One is flabanserine or ad ye ad ye addie, which
• 39:42
  Speaker 3: is taken.
• 39:44
  Speaker 1: Why do they name them these things.
• 39:46
  Speaker 3: I don't know. It's it's a pill that is taken
• 39:50
  Speaker 3: daily at bedtime. The mechanism, it's always like, it's really interesting,
• 39:55
  Speaker 3: Like we don't know enough about sex and arousal and
• 39:58
  Speaker 3: desire and the complexities the human mind to actually know
• 40:01
  Speaker 3: why a lot of these drugs work. So like this drug,
• 40:05
  Speaker 3: flibanserin is a partial serotonin agonist, which like, okay, serotonin
• 40:10
  Speaker 3: is important, but like we have SSRIs, which you know,
• 40:14
  Speaker 3: have a well described side effect of decreasing right sexual interest.
• 40:17
  Speaker 3: Like it's it's it's way too complicated to fully understand
• 40:21
  Speaker 3: one of the things. I'm curious what you think Emily
• 40:23
  Speaker 3: is in these trials. Right, So if you're going to
• 40:25
  Speaker 3: get a drug approved by the FDA, you have to
• 40:28
  Speaker 3: say there's a disease that it treats. Okay, So all right,
• 40:31
  Speaker 3: we've created hyperactive sexual desire to sort and there's an
• 40:35
  Speaker 3: outcome that we can show with statistical tests improves. And
• 40:39
  Speaker 3: so these researchers and from school companies had to come
• 40:43
  Speaker 3: up with that outcome, something measurable that they could send
• 40:49
  Speaker 3: back to the FDA and say, look, this thing increased.
• 40:51
  Speaker 3: And the thing that they used in all the flab
• 40:55
  Speaker 3: aanswerin trials was an outcome called satisfying sexual events. So
• 41:02
  Speaker 3: a satisfying sexual event is a sexual event that could
• 41:07
  Speaker 3: happen with or without a partner. It could happen with
• 41:11
  Speaker 3: or without an orgasm, it could, uh, you know, anything
• 41:16
  Speaker 3: that the woman taking the drug would define, but it
• 41:19
  Speaker 3: had to be satisfying in however she wanted to define that.
• 41:25
  Speaker 3: And the pivotal trial for flull banswering showed that the
• 41:29
  Speaker 3: change in satisfying sexual events per month was one point
• 41:33
  Speaker 3: two in the placebo group. So placebo effect, once again
• 41:36
  Speaker 3: rearing its beautiful heads one extra sexually satisfying event in
• 41:39
  Speaker 3: the pacibo group two extra sexually satisfying events in the
• 41:42
  Speaker 3: full banswering group. Is that the correct outcome should this
• 41:46
  Speaker 3: have been FDA approved.
• 41:49
  Speaker 2: I mean, I don't very difficult to say what would
• 41:52
  Speaker 2: be the right outcome. You know, you could say how
• 41:55
  Speaker 2: many times you know, there's a more direct thing, which
• 41:58
  Speaker 2: was just like how many times did you and gauge
• 42:00
  Speaker 2: a in asexual event, either alone or with a partner.
• 42:04
  Speaker 1: My guess is that they didn't.
• 42:07
  Speaker 2: The issue with that is that the placebo effects are
• 42:09
  Speaker 2: like too strong, particularly if you start taking this drug
• 42:12
  Speaker 2: and people are like, okay, now I'm taking this, I'm
• 42:14
  Speaker 2: going to have more sex with my partner. My guess
• 42:15
  Speaker 2: is the placinbo effect is too big and that you
• 42:17
  Speaker 2: don't get anything right.
• 42:18
  Speaker 3: It's like oysters, right, which which have no afrodisiac effect. Actually,
• 42:22
  Speaker 3: but like if you.
• 42:22
  Speaker 2: Think they do, so, I can see why they didn't
• 42:26
  Speaker 2: go with just counts and they went with something else.
• 42:28
  Speaker 2: But it's it's sort of oddly defined. I mean, it's
• 42:31
  Speaker 2: just an unfortunate aspect. Like I guess you could go
• 42:34
  Speaker 2: with something more science y, which I would have been
• 42:37
  Speaker 2: inclined towards if you really thought this worked, which was like,
• 42:40
  Speaker 2: you know, put there are ways to like probe how
• 42:43
  Speaker 2: much blood flow there is to the vagina, right, and
• 42:46
  Speaker 2: so you could say, like I'm going to put a
• 42:48
  Speaker 2: probe in the vagina.
• 42:48
  Speaker 1: I'm going to have.
• 42:49
  Speaker 2: People watch porn, and I'm going to see like whether
• 42:52
  Speaker 2: this drug gets them more aroused in those settings. Like
• 42:56
  Speaker 2: I think that would have been an interesting alternative approach
• 43:00
  Speaker 2: to this. It's a little more sciencey, a little less
• 43:02
  Speaker 2: real world. You probably also get some placebo effects, but
• 43:07
  Speaker 2: I suspect that you would get much more minimal effects.
• 43:11
  Speaker 1: So this feels like, yeah.
• 43:13
  Speaker 3: I mean these are effects. It's hard to it's hard
• 43:16
  Speaker 3: to know. Like that, I think it was right.
• 43:20
  Speaker 2: Like the meta analysis here is a half a sexual
• 43:23
  Speaker 2: half a satisfying sexual event per month. So it's like
• 43:26
  Speaker 2: I don't know, like every day I take this pill
• 43:29
  Speaker 2: every day, and then like one half of one time
• 43:33
  Speaker 2: every thirty days.
• 43:34
  Speaker 1: Like something good happens. Yeah, it feels like.
• 43:39
  Speaker 3: And I'll tell you this pill is not entirely benign.
• 43:44
  Speaker 3: It can cause significant hypotension, low blood pressure, and fainting.
• 43:48
  Speaker 3: And I think forty percent or so of women in
• 43:50
  Speaker 3: the pivotal trial. Uh complained of nausea on this pill,
• 43:55
  Speaker 3: which I don't know how that is compatible with having
• 43:58
  Speaker 3: more sexually satisfied events.
• 44:00
  Speaker 2: But here we are one half of the one day
• 44:02
  Speaker 2: when you don't feel nauseous.
• 44:03
  Speaker 3: You have I don't know, Like, Okay, I'm not nauseous.
• 44:06
  Speaker 3: Let's go.
• 44:07
  Speaker 2: Is there anything else I'm not this? The ad campaign
• 44:10
  Speaker 2: for this is uh, it's so pink. It's like the
• 44:13
  Speaker 2: pinkest ad campaign I've ever seen, the little pink till
• 44:16
  Speaker 2: that everyone's talking about.
• 44:17
  Speaker 1: It's so pink.
• 44:18
  Speaker 3: Yeah, they really leaned into this for men, female ladies.
• 44:22
  Speaker 1: Ladies love pink.
• 44:24
  Speaker 3: Let's say you don't want to take a drug every day.
• 44:26
  Speaker 3: The other FDA approved medication is called brim Lana Tide
• 44:30
  Speaker 3: or vleisi. It is emily.
• 44:32
  Speaker 1: A peptide, our favorite.
• 44:35
  Speaker 3: Yeah, so one of the.
• 44:37
  Speaker 1: Few verine stack it it's not the Wolverine stack.
• 44:42
  Speaker 3: No, it would be the we're gonna stick with the
• 44:44
  Speaker 3: X men. It would be like the rogue or Gene
• 44:46
  Speaker 3: Gray stack. I guess maybe the.
• 44:49
  Speaker 1: Geen graystack. That's solid. I like it.
• 44:51
  Speaker 3: Okay, okay, Jean Gray stack. So this is a subcutaneous
• 44:56
  Speaker 3: injection as needed so the recommendation is take it forty
• 45:00
  Speaker 3: five minutes beforehand, so maybe a more via agra.
• 45:04
  Speaker 1: Is more like viagra.
• 45:05
  Speaker 3: It works by binding another brain receptor we don't fully understand,
• 45:10
  Speaker 3: called the alpha malanta coortin receptor. They appear to modulate
• 45:14
  Speaker 3: sexual behavior and mice. It also seems to do something
• 45:18
  Speaker 3: in humans. The trials in this case looked at a
• 45:23
  Speaker 3: survey was their outcome called the female Sexual Function Index,
• 45:29
  Speaker 3: and they use the desire score subscore of that index.
• 45:33
  Speaker 3: So this is a survey asking like how much how's
• 45:36
  Speaker 3: your sexual desire doing? And there was a significant increase
• 45:41
  Speaker 3: in sexual desire by zero point three points or so,
• 45:46
  Speaker 3: and there's also less distress by a similar amount. These
• 45:52
  Speaker 3: are very modest effect sizes, but at least it's only
• 45:56
  Speaker 3: it's at least it's taken as needed.
• 45:58
  Speaker 2: I don't know, there's no difference in sexually satisfying events.
• 46:02
  Speaker 2: It makes forty percent of people nauseous, and it causes
• 46:05
  Speaker 2: you to tan.
• 46:06
  Speaker 3: It can make your little tan. Yeah, that's right. It's
• 46:08
  Speaker 3: a variant of you guys might have seen in the
• 46:11
  Speaker 3: we talked about in the peptide episode. There's a peptite
• 46:13
  Speaker 3: called milano tan which literally like causes your melanocytes to
• 46:17
  Speaker 3: make more melanin, and like you inject yourself and turn
• 46:20
  Speaker 3: yourself tan. It's kind of crazy. And this is a
• 46:22
  Speaker 3: related peptide, so it's not you don't get quite as tan,
• 46:24
  Speaker 3: but it is listed on the side effects and and
• 46:28
  Speaker 3: you know tan people have more sex for sure.
• 46:31
  Speaker 1: What they watch or whatever.
• 46:34
  Speaker 2: My read of let's talk about before we can like
• 46:38
  Speaker 2: overview this, Like, I think the the third thing that
• 46:40
  Speaker 2: is disosterone, which we talked about in the tesosterone episode,
• 46:44
  Speaker 2: which probably does work. Actually write for this, but not
• 46:49
  Speaker 2: FDA proof for this, but in there are a bunch
• 46:52
  Speaker 2: of trials that show kind of I would say, comparable
• 46:55
  Speaker 2: effects to the little pink the.
• 46:58
  Speaker 1: Adie little pill.
• 47:01
  Speaker 2: You know about one increase, one more satisfying event per month.
• 47:06
  Speaker 3: Yeah, testosterone clearly works. You can listen to the hormone
• 47:09
  Speaker 3: replacement therapy episode to hear more about that. But those
• 47:12
  Speaker 3: are the those are the drug options. Again, if you
• 47:14
  Speaker 3: don't want to talk about.
• 47:16
  Speaker 2: It, look, I think that you should talk about Like
• 47:21
  Speaker 2: I find this space pretty hard to think about because
• 47:25
  Speaker 2: it doesn't it feels like I'm kind of with the
• 47:29
  Speaker 2: people who work complaining that the DSM has you know,
• 47:32
  Speaker 2: created a disease for a.
• 47:35
  Speaker 1: Drug, because so much of what actually seems to.
• 47:40
  Speaker 2: Be going on feels like it's just people are struggling
• 47:45
  Speaker 2: through some things in their partnerships that they could do
• 47:48
  Speaker 2: a better job communicating about. And telling them if you
• 47:51
  Speaker 2: just take this pill it will fix your relationship problems
• 47:54
  Speaker 2: is misleading and probably will leave them in a worse
• 47:57
  Speaker 2: position having not improve their marriage and having one half
• 48:02
  Speaker 2: of one additional sexually satisfying event per month, possibly alone.
• 48:06
  Speaker 3: Right, yeah, all right, let's do it then, So Emily,
• 48:11
  Speaker 3: with that said, smash. This is the This is the
• 48:14
  Speaker 3: this is the most appropriate smash or pass ever. Okay,
• 48:18
  Speaker 3: but what am I sash?
• 48:20
  Speaker 5: You got to be a little more specific, like hyperactive
• 48:24
  Speaker 5: sexual desire disorder as a I don't know as a
• 48:29
  Speaker 5: as a treatable condition, smash your pass pass.
• 48:32
  Speaker 2: I think this is something people should be talking more
• 48:35
  Speaker 2: about with their partner if they have one, they should
• 48:38
  Speaker 2: be thinking about it. I am passing on medical treatment
• 48:42
  Speaker 2: options for it. But what I am smashing, if you
• 48:45
  Speaker 2: are listening to this and you are thinking this is
• 48:46
  Speaker 2: really resonating. What I am smashing is Emily Nagoski's book
• 48:51
  Speaker 2: Come Together which is a really really good book talking
• 48:55
  Speaker 2: about some of these issues in relationships, and I would
• 48:58
  Speaker 2: really really recommend people pass on the drugs.
• 49:02
  Speaker 3: I am going to smash here. I I think that
• 49:08
  Speaker 3: we've done I think we've done a bad job like
• 49:17
  Speaker 3: exploring female sexuality, understanding female sexuality. And I am cautious
• 49:23
  Speaker 3: about too quickly attributing to like attributing everything to the
• 49:28
  Speaker 3: environment as opposed to acknowledging that there's the possibility that
• 49:31
  Speaker 3: there are underlying biological things that you know, could be
• 49:35
  Speaker 3: addressed here, Like I don't want to write that off.
• 49:37
  Speaker 3: So I'm going to smash for the research, but probably
• 49:41
  Speaker 3: I would do testosterone before some of these other agents.
• 49:46
  Speaker 1: Amazing.
• 49:47
  Speaker 2: All right, that's it for hypoactive sexual desire disorder your
• 49:50
  Speaker 2: male back. Question of the Week after the Break.
• 49:58
  Speaker 6: Hi, Emily and Perry, this is Tamar, your producer. My
• 50:03
  Speaker 6: question is, even though we all know that sticking c
• 50:07
  Speaker 6: tips in your ears is probably the greatest feeling in
• 50:11
  Speaker 6: the world, after the topic of this episode, why shouldn't
• 50:17
  Speaker 6: I do it? Even though I don't want to know
• 50:20
  Speaker 6: the answer? Thanks?
• 50:22
  Speaker 3: Does this creep you out? Emily?
• 50:23
  Speaker 2: Like?
• 50:24
  Speaker 3: Is this one like when you like think about it? Yeah,
• 50:26
  Speaker 3: I get a little bit of it.
• 50:27
  Speaker 2: Yeah, I don't love I don't I don't like it.
• 50:33
  Speaker 1: My impression was.
• 50:35
  Speaker 2: The bad thing is that it compacts all of the
• 50:37
  Speaker 2: wax all the way into your ear, where it can
• 50:40
  Speaker 2: be potentially problematic. And I will say once one of
• 50:43
  Speaker 2: my children had to have like some impacted wax removed
• 50:46
  Speaker 2: from their ear, not because of cutips, but like they'll
• 50:49
  Speaker 2: stick like tweezers into the ear and like it's horrible, Yeah, disgusting.
• 50:55
  Speaker 1: Is that is that correct? Doctor?
• 50:56
  Speaker 4: Yeah?
• 50:57
  Speaker 3: Yeah, no, so that's that's definitely part of it. Like
• 50:59
  Speaker 3: ear wax naturally like gets slowly comes out of the
• 51:04
  Speaker 3: ear and like on its own, but yes, if it
• 51:07
  Speaker 3: gets compacted, it can get stuck in there and build up.
• 51:09
  Speaker 3: There's also risk of damaging the ear drum itself if
• 51:12
  Speaker 3: you push to uh far. That's a sensitive area. And lastly,
• 51:17
  Speaker 3: the cotton on Q tips and particularly on off brand cutips,
• 51:20
  Speaker 3: but also onqtips can come off the tip and get
• 51:24
  Speaker 3: stuck in there, and then you have cotton in your
• 51:26
  Speaker 3: ear that someone needs to pull out. So there, you know,
• 51:29
  Speaker 3: I know everyone kind of does this because it's satisfying,
• 51:31
  Speaker 3: but you probably shouldn't.
• 51:32
  Speaker 2: Do it when I sometime during the pandemic, I started
• 51:35
  Speaker 2: getting fed and I do not know whether this was
• 51:37
  Speaker 2: COVID or related or else elsewhere, Instagram started feeding me
• 51:42
  Speaker 2: ads for like this product that was like it was
• 51:46
  Speaker 2: like it went in your ear and it had like
• 51:48
  Speaker 2: a little camera and then you could like watch what
• 51:50
  Speaker 2: you were doing on your phone and like and like
• 51:53
  Speaker 2: sort of clean out the ear wax with like your
• 51:56
  Speaker 2: like phone camera.
• 51:58
  Speaker 1: Is that a good idea?
• 52:02
  Speaker 3: That seems also dangerous. I think like the middle ear,
• 52:07
  Speaker 3: which you're coming up to when you get to the
• 52:09
  Speaker 3: ear drum, is a really important part that gives you
• 52:12
  Speaker 3: hearing that and.
• 52:13
  Speaker 1: Don't and balance and stuff.
• 52:15
  Speaker 3: Yeah, like well that's the interior is balance. But yeah,
• 52:18
  Speaker 3: like just don't mess with it.
• 52:20
  Speaker 2: I don't know, nothing larger than your elbow in your ear,
• 52:23
  Speaker 2: Like my mom said, this seems right.
• 52:25
  Speaker 3: Thanks Emily's mom. All Right, that's it for today. Stick
• 52:31
  Speaker 3: with us next week when we'll ask what's the deal
• 52:33
  Speaker 3: with sleep?
• 52:35
  Speaker 2: Wellness actually is produced in association with iHeartMedia. Our senior
• 52:40
  Speaker 2: producer is Tamar Avishai. Our executive producer at iHeart is
• 52:43
  Speaker 2: Jennifer Bassett. Our theme music is by Eric Deutsch. And
• 52:47
  Speaker 2: our content is for educational purposes only.
• 52:50
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• 52:52
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• 52:55
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• 52:58
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• 53:01
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• 53:05
  Speaker 3: Head over to Wellness Actually dot fm and leave us
• 53:07
  Speaker 3: a question for our mailbag or suggest a topic for
• 53:10
  Speaker 3: a future show.
• 53:11
  Speaker 1: We'll let the influencers have the last word.
• 53:14
  Speaker 4: What the heck is female viagra? Why the heck have
• 53:16
  Speaker 4: I never been offered this medication? Why have I never
• 53:19
  Speaker 4: heard of this medication?
• 53:20
  Speaker 1: What is it?
• 53:21
  Speaker 4: Tell me all the things today we're going to talk
• 53:23
  Speaker 4: about Addie. Addie does not increase blood flow to the
• 53:26
  Speaker 4: genitals like viagra or the cialisis of the world do.
• 53:30
  Speaker 4: It works on your brain, and it is less of
• 53:34
  Speaker 4: sexual dysfunction performance drug and more of an increasing your
• 53:40
  Speaker 4: libido in sexual desire so you actually want to have
• 53:43
  Speaker 4: sex drug