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Larry King Live

What Can Be Done About Women Losing Their Sex Drives?

Aired May 25, 2000 - 9:00 p.m. ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

DEBORAH NORVILLE, GUEST HOST: Tonight, join me, Deborah Norville, sitting in for Larry King. Our subject: women losing their sex drives and what can be done about it.

In Los Angeles, actress Mariette Hartley: frank, funny and over 50; Cristina Ferrare, who fessed up to libido problems on live TV; plus Dr. Judith Reichman, bestselling author and "Today Show" medical correspondent. With me here in New York, the co-directors of the Women's Sexual Health Clinic, sex therapists Dr. Laura Berman, and her sister, Dr. Jennifer Berman, a urologist. It's all next on LARRY KING LIVE.

Hi, everybody. Thanks for joining us. I'm Deborah Norville, sitting in tonight for Larry King, who is off this evening enjoying being a new daddy.

Tonight, our topic is one for mature audiences: unlocking the secrets of women's sexuality.

Take a look at this week's "Newsweek"; it is the cover story of the magazine. And it's been estimated that about 40 percent of American women have some form of sexual dissatisfaction or sexual dysfunction. But does it have to be that way?

Our guests tonight say no, which will come as welcome news to millions of women and their partners.

OK, let's start things off with our experts here. We've got two doctors here in New York, one doctor in Los Angeles. What is the problem: Women just aren't having fun or they just don't want to have sex? -- Dr. Berman.

DR. JENNIFER BERMAN, WOMEN'S SEXUAL HEALTH CLINIC: Well, sexual dysfunction is an array of problems. It can arrange from libido problems to arousal problems to orgasm problems. So it's really not just one definition. It's a conglomerate of disorders.

NORVILLE: And when you look at these problems, is there one that presents more often than others?

J. BERMAN: Probably the most frequent complaint of women is low sexual desire, but what really needs to be determined, is it low desire because of hormones, for instance, or is it low desire because of a relational, emotional, psychological factor? That's one of the things that we really aim to tease out: the desire versus arousal problems versus orgasm versus a combination of all three, which really happens quite frequently also.

DR. LAURA BERMAN, WOMEN'S SEXUAL HEALTH CLINIC: They all interact. So for instance, a woman may have difficulty becoming aroused or reaching orgasm and so -- because sex feels like work, then lose interest. So it's a really important part of the evaluation is deciding what the source of the problem is.

NORVILLE: Dr. Reichman, you're a gynecologist. You see women day in, day out in your practice. When did you first start recognizing that there was an issue here in terms of satisfaction with women's sexual lives?

DR. JUDITH REICHMAN, AUTHOR, "RELAX, THIS WON'T HURT": Probably from the get-go. I treat a lot of women who are going through the perimenopause and menopause, and often their complaint is that even if hormonally they're feeling OK, there's a loss of libido. And women who are not taking hormone replacement in the menopause often complain of what we call dyspareunia, which is pain with intercourse, because of dryness and lack of lubrication. And once that occurs, they also don't have libido, because frankly, if something hurts, you don't want to do it.

So I've been dealing with this for many years, and there is -- are hormones that are related to both desire and response, and I've tried to deal with those. But you can't separate them out from psychological issues, other medical issues, and anything that takes care of -- anything from our brains, our neurotransmitters in the brain down to our adrenals, our ovaries, the vagina, our uterus. And there's a whole component that you have to look at that is multifactorial, and you can't just say, oh, it's hormonal or it's all in your head.

NORVILLE: But is -- is this just a menopausal thing? Are these only menopausal women we're talking about, or does it precede menopause?

REICHMAN: Absolutely not. Many women, even from the age of 18 on, will have problems. If you look at the psychological issues, often it's because they've had sexual abuse: 23 percent of women in this country have had some form of sexual abuse. It can also be due to medical issues. It can be due to medications.

For example, 50 million women take birth control pills, and birth control pills can lower libido. It can cause some vaginal dryness.

So there are other issues that we have to look at that really encompass every age group from 20s through our 70s.

NORVILLE: This was not something that anybody was talking about in the public forum like this until very recently, and Cristina, you kind of dropped a bombshell a couple of years ago when you were talking on your TV show, "Home and family," and you said, folks, I don't like to go to bed with my husband, this is not the thing I look forward to. CRISTINA FERRARE, AUTHOR, "OKAY SO I DON'T HAVE A HEADACHE": No, no. No, no.

NORVILLE: You like to go to bed...

FERRARE: I...

NORVILLE: OK, tell us what you said...

FERRARE: I didn't say I didn't like to go to bed with my husband.

NORVILLE: ... because when you said this, you just blew people away. Because, like, "Sex isn't interesting for this glamorous woman." What's going on here?

FERRARE: We had Dr. Andrew Weil on the show, and he was talking about women who are going through the menopausal stage, and at that time they lose their desire for sex. And when I heard that, I reached out to him and I said, you know, that's me, I'm having this problem. And I was so relieved to actually hear this, because it was something I had suffered with since the birth of my last child over 10 years ago. And I just had no desire for sex.

It didn't mean I wasn't having it or I wasn't enjoying it once I got going, but the idea of having sex was painful to me. I love my husband. We have a wonderful marriage. And I had to think -- it's three days, four days, I better, you know, come to the party here, because there's going to be trouble here in paradise if I don't, you know, have sex.

So it was something I suffered in silence with, and it started to tear away at the very core of my relationship with my husband, because he started to think perhaps it was him. I wasn't in love with him anymore. It had something to do with our relationship. And it wasn't. And it was hard for me to explain to him, you know: It's not you, it's me. I don't know what's wrong with me.

So I wanted to...

NORVILLE: Was this something that you and your husband talked about before you had acknowledged this on television or an interview?

FERRARE: Tony and I have always communicated well with one another. And I said, you know: Honey, it has nothing to do with you; it is me. I have no sexual desire. There's something wrong with me; I don't know what it is.

And yes, I talked to him about it, but he didn't understand. He didn't want to hear it. He's a man. He loves me and wanted to have relations, and it was hard to comprehend what was happening to me, because we've been married for 16 years. And when we were -- when we first got married and for many, many years we enjoyed each other tremendously. So this -- this was a shock for both him and for me.

But... NORVILLE: Well...

FERRARE: I'm sorry, go ahead.

NORVILLE: You know, I was just going to say for you to talk about it and for us to be talking about it on television is probably sparking some conversations and during the commercial break that we're going to take right here. So we're going to take a break. When we come back, we're going to talk about something Cristina said, which was a lot of this started after the baby was born.

So we'll be back with more of LARRY KING LIVE right after this. Don't go away.

(COMMERCIAL BREAK)

NORVILLE: We're back on LARRY KING LIVE with our experts here, talking about women's sexual dysfunction.

Mariette Hartley, you're out there in Los Angeles. You are now a single women. And where does all of this come into play for you? How easy is it to find men even with whom you might have a potential relationship?

MARIETTE HARTLEY, ACTRESS: Well, first of all, at my age and if I'm dating anybody older than I am, and in the day and age of AIDS, you know, and you know, we have to use protection, they generally can't keep it up long enough to put protection on for very long. So I am so very grateful for, you know, Viagra.

I -- you know, and I -- it's like I have a list now of things that I ask people on the first date. And it's difficult.

And it's funny, I loved listening to Cristina, because I don't think my ex-husband and I ever really got through that and I was never quite clear. I think it was not clear to me as to whether or not we weren't having sex toward the end because there was a sense of resentment about what was going on in our lives. And I think resentment can be one of the first things that can stop us from having sex.

But also, as a young child -- and I realized this only later -- there were -- there was definite molestation in my life. And I kept trying to tell him that it wasn't him, that it was me. And we never, ever did get through it.

So I urge people to please talk, work on ourselves to really try to get to the core issues.

And I also think that it is physical. I think it's so wonderful that this is what's busting out. I actually have used Viagra and have been very successful with it, and it wasn't a placebo. And...

(LAUGHTER)

But I think also that some people who are using, you know, anti- depress -- you know, antidepressants need something like that to cut -- and I don't know how quite how it works chemically. It seems to work...

NORVILLE: Well, let's -- let's get into this, because there are a lot of different areas to get into. And you mentioned Viagra, Mariette. I know, Dr. Berman, you were a part of a preliminary study on Viagra. Your study had some results, but in a wider study that was just reported this week there was a 70 percent placebo effect. So everybody was out there going, yes, Viagra for women. We're disappointed kind of disappointed.

J. BERMAN: Well, in our -- in our pilot study we found that Viagra definitely in the select population of women does help to enhance arousal, lubrication, sexual satisfaction as well as orgasm. The study that you're referring to, which was a larger group of women in a European study, had some issues associated with it.

NORVILLE: But we should note these studies were also funded by Pfizer.

J. BERMAN: The one in Europe was. The one that we did, the pilot study was not. That was departmental funds from the University of Maryland actually. And I have no vested interest in Viagra. Our goal is to, whatever drug, whatever hormone, is to help women. But...

NORVILLE: Does Viagra work?

J. BERMAN: Viagra works, we believe, in a population of women that have arousal problems, that at one point were functional and for whatever reason now are not. Whether it be due to menopause, hormones, birth control pills or even antidepressants.

NORVILLE: Now, when you say "arousal," are we talking about arousal here or arousal down there?

J. BERMAN: Well, they're both connected, here and down there.

L. BERMAN: Right, it's all connected. But it's really important to take into account the emotions, and that's what I think a lot of people don't understand, is that it's not -- you can't -- no medication is going to work in a woman who has self-esteem issues, body image issues, relationship issues, emotional history issues that impeding her sexual function.

What Viagra does is it increases blood flow to the genital area. It only enhances what would otherwise happen naturally.

J. BERMAN: And it requires -- I'm sorry to interrupt -- requires sexual stimulation. You can't just take the pill and wait for -- for -- you know, to be swinging from the chandeliers.

(LAUGHTER)

It does require intimacy, you know, stimulation.

NORVILLE: So all of the other things that are part of a normal relationship have to be there, too.

Dr. Reichman, I know in your books you are very, very clear about patients whose doctors don't ask them about their sex life are going to a doctor whose not giving them a complete examination.

REICHMAN: The issue is that many doctors don't feel comfortable about -- talking about sexuality. We didn't take sexuality 101 in medical school.

NORVILLE: Right.

REICHMAN: And unless you bring it up, generally the doctor is not going to ask you are you eating well, are you sleeping well, and are you achieving sexual satisfaction. It's not part of the history.

So really a woman has to go in and tell the doctor: Look, I'm having a problem. Can you help me?

And part of it has to be that she has to come in with her history -- sex was great, and now it's less so; I may be on new medications; I'm feeling some discomfort; I never really felt aroused -- and get some sort of indication to her doctor so that the doctor can determine, is it hormonal, is it emotional, is it psychological, and go on to do the appropriate testing. But unless we raise the issue, we're not going to get the answers.

NORVILLE: Can I throw this out here? I mean, you're talking to a mother of three kids here now. And Cristina mentioned after her baby, her last child was born 10 years ago the interest started to diminish. There are a lot of exhausted women out there. Maybe some people are just too tired?

FERRARE: Well, I'd like to address that. And you know, I am not a doctor, but I do play one on TV. I've done a lot...

(LAUGHTER)

I've done a lot of research for the book that I wrote: "Okay So I Don't Have a Headache." And the title tells you -- it's exactly what the title says. I made up all these excuses not to have sex with my husband. I agree with the doctors here that, you know, if you're on any kind of medication, also if you are having chemotherapy, antidepressants, birth control pills, all those things play an important part in lowering libido.

However, I found through -- and I did the experiment on myself for a year and a half. I find that we as women, as we try to be everything to everybody -- the best mothers, the best wives, the best career people, the best friend, daughters, whatever -- we try to be everything to everybody. And what happens in our life -- what I call the big "S" -- and it's not sex: It's called stress.

And because we are hormonal and we are "cycular," the hormones go up and down depending on what time of the month you are. And if your hormones are playing havoc with you, you're body is playing havoc as well. So what I had to do is I had to learn how, along with Dr. Reichman's help -- and I'm very grateful for her -- she put me on the testosterone.

But that is not the end-all to my problem. She put me on the testosterone, but I also had to change what I was eating. I'm not on any kind of medication at all for anything other than the testosterone. I had to change what I ate and I had to start exercising. It's as simple as that.

But people want to have that magic pill or that magic cream to make it all go away, and it's --- it's as simple as I say, but then again it's not that simple. You do have to work at it.

(CROSSTALK)

NORVILLE: Well, there's not a magic pill -- let me just interdict. But there's not a magic pill, but there are certainly things that can be done. When we come back after this break, we're going to talk specifics. If you've seen a lowering of libido in your sex life, ladies, there are things you can do. We'll tell you what they are when we get back.

(COMMERCIAL BREAK)

NORVILLE: As many as four in 10 women in this country are dissatisfied with their sex lives, but our panel of experts here say there are things that you can do to address that.

We've got Mariette Hartley out in Los Angeles who a moment ago was talking about leaving a marriage that had not been as fulfilling sexually. I'm projecting here, but Mariette, I'm assuming that things have improved in that department of your life.

(LAUGHTER)

HARTLEY: Well, I have to...

(CROSSTALK)

NORVILLE: If I put you on the spot on national television, I sincerely apologize.

HARTLEY: No, I -- actually, my sex life with my husband was really quite wonderful for about 15 years. He was a wonderful lover. He was French, and I was -- learned actually for the first time what sexuality was all about and what it meant.

My feeling is that for a women anyway, certainly for me, sexuality isn't all that there is in a marriage. I think that it's a very complicated thing for women. I think respect for men is key, and I think that that was one of the things that I probably did lose in my marriage.

But one of the things that I noticed particularly was when I had my children there was such extraordinary sublimation that almost as if my sexuality went into my children as I nursed. And I nursed for a long time. I nursed for two to three years. Actually, I stopped nursing my son when he was 16 and he got his driver's test.

(LAUGHTER)

Not that I was trying to overcompensate for anything. But...

(LAUGHTER)

And I found that it was a wonderfully kind of sensual thing, and my husband was wonderful about that. I remember, he just kind of stayed away for about six months, and finally one day he said, hello, I'm here. And I -- and we, again, you know, continued a quite wonderful, quite satisfying sex relationship.

Now things are -- I think it's very hard to be single at this age. I love being alone. I spend downtime. I've found wonderful hobbies. I sound like an old person now. And I've also found out, you know, like, you know, Beatrice Wood, this wonderful potter, said that her best work happened after 60. So I'm really look forward to that.

And I am much more careful about who I choose. I used to be much more impetuous as a child, as a young person. And now it's much more -- I'm discovering what dating is all about, which is an interesting thing.

I -- and I hope that, you know, that things will change. I would love to find a partner. But right now my children are very much a part of my life. And...

REICHMAN: Deborah, can I just say something about...

NORVILLE: Yes, please.

REICHMAN: Post-partum is a time when our hormone levels really drop, and when we continue to breast feed, often there is very low estrogen levels. And so women can have very thin vaginas, there can be atrophy there. It can almost like being menopausal.

And many women find that sex is uncomfortable, they don't have the sensation they had before. And so this is partially hormonal and partially the chance of bonding with your child. It's almost as if nature made it so you spend your time with your child, and you didn't go and have sex and have another baby, because you have to spend the time with that child.

The same thing happens...

NORVILLE: But when you've gone into menopause, the same thing happens?

REICHMAN: Yes, exactly, and that can be taken care of. We do have medications and ways. First of all, you can use lubricants if indeed there is an issue of discomfort. But if there is no engorgement, if there's no arousal, Viagra may be one of the drugs, but also estrogen, and you don't always have to take the estrogen systemically. You don't have to take a pill or a patch. You can use a local estrogen.

And we have creams that you can put in intravaginally. And there is a ring that's come out. It's called an Estring, and it's sort of like a hollow diaphragm ring. And you can just insert it. It stays there for up to three months, and it very slowly secretes small amounts of estrogen, enough to keep the vaginal mucosa...

NORVILLE: Hold that up so we can see it while you're talking.

REICHMAN: It's enough keeps to keep the vaginal mucosa healthy, but it's not enough to cause high systemic levels or blood levels of estrogen. So do use it in women who've even had breast cancer.

And this will help...

NORVILLE: And does this interfere with sexual intercourse in any way?

REICHMAN: No, you can leave it in. Most couples don't even feel it. Sometimes I tell my patients take it out and then put it in after. And it is good for three months.

And then what we're doing with some patients who have low libido -- and I test their testosterone levels and I test something called free testosterone. And if indeed it's low, we can supplement, and we can supplement with gels that you can put on the labia. And...

NORVILLE: Of testosterone.

REICHMAN: Yes, this is testosterone. There are lozenges that a women can put under her tongue, and that will release the testosterone without it going through the liver, because it's absorbed under the tongue.

There's a new one out, which is actually -- we have this compounded, and it's a drop that you can put under the tongue.

And if a woman needs to take estrogen, it's clinically mandated, and she wants to take it, you can take an estrogen that has testosterone in it. And this is called Estratest, and works quite well in both helping libido. Also, it helps control hot flashes, menopausal symptoms, and it also seems to help with osteoporosis and sense of well-being.

So there's a myriad of things...

NORVILLE: But there are side effects with some of these.

REICHMAN: Everything, yes.

NORVILLE: And we're going to have to talk about what some of those side effects are right after this. Back in a moment on LARRY KING LIVE.

(COMMERCIAL BREAK)

NORVILLE: Back talking about women's sexual dysfunction and possible solutions to this.

Dr. Berman, you were saying during the break that there are side effects to a lot of these treatments that we just heard Dr. Reichman talk about.

J. BERMAN: Well, one -- I mean, there are negative side effects, and there are also potential good side effects, being enhancement of libido, sensation, arousal, and so forth.

One thing that I did want to point out, though, that in the menopause, when we replace estrogen and give women estrogen replacement it actually can lower testosterone levels. What it does it increases a protein in the blood that binds to testosterone, making it less available to the tissues.

So beside from enhancing the vaginal mucosa and the lubrication, it can function to decrease libido.

NORVILLE: But there are also possible side effects such as risk of breast cancer, risk of heart disease with estrogen?

J. BERMAN: Right. Estrogen or testosterone should not be given to any woman that has a history of breast cancer or endometrial cancer, meaning cancer of the lining of the uterus.

Another thing that I did want to point with regard to the Estring is that it's not FDA-approved for use in women with breast cancer, although it is an alternative under strict guidance of your oncologist and gynecologist if that's approved.

NORVILLE: Cristina, I know testosterone made a major difference in your life. Tell us how it impacted your libido when you began taking the testosterone.

FERRARE: It impacted my libido in a very positive way. However, I knew that -- and I want to make this perfectly clear to everyone, and I know that the doctors will agree with me -- that this is not the end-all, be-all to the woman's problem. It's part of the solution.

I used the cream that Dr. Reichman prescribed for me three times a week, but I also eat right and I exercise. And I really believe that if you learn to you to feed your stress and to manage your stress in your life that plays an important part as well, as well as having a loving, understanding partner.

This is a bigger picture than just using the lozenges, these creams and all of the...

HARTLEY: Come on, you don't always eat right.

(LAUGHTER)

FERRARE: No, I -- no, I don't always eat right. HARTLEY: She eats cookies...

FERRARE: Right.

HARTLEY: ... and Tony will not touch her for two days.

(LAUGHTER)

FERRARE: Only because I know how certain foods affect me. If I -- I can't assimilate sugar. I know if I drink red wine, I get hot flashes. If I eat sugar or anything with cookies, I am in a bad mood, foul mood. Don't come near me, don't touch me.

NORVILLE: But that underscores what Dr. Laura Berman, our sex therapist here, has been saying, which is there are two components to this issue: the physical as well as the psychological.

L. BERMAN: Absolutely, and that's so important. And I think one of the themes that we've been hearing is how -- that sex is really a couples issue. If you're in a relationship, it's a couples issue. And that means that there needs to be communication, trust, a level of connection, a level of intimacy.

Women are multitaskers, which is a gift, but it also can be a curse sexually, because if you're feeling very stressed, if you're not feeling great about your body, if you're not feeling great about the person you're with, it's very hard to turn those things off and focus on your arousal and let go and allow yourself to experience the sexual arousal and sexual process.

NORVILLE: But there are some, I'm guessing, ways that you can get your partner involved and to buy into some of these issues that ladies need to work with.

L. BERMAN: Right, and it's a really big thing for the men -- and I think we've heard this as well, that it's very common -- men and women experience sexual dysfunction in different ways, both when they have it themselves and when their partner is suffering with it. And it's very common for men to feel rejected, to feel like it's their fault, and for the woman to want to protect him and pretend to become aroused when she is not really, or feel guilty or feel remorse.

And it's very important for women to educate their partners as well as themselves, and for men and women to understand that not only is sexuality a very integral part of our quality of life and something every woman is entitled to, but there are very real issues that can impact on a women's sexual health.

NORVILLE: We are going to let members of our viewing audience get educated in just a moment. We're going to take a commercial break. When we come back, we'll open up the phones. A lot of people have questions for all of our panelists, and we'll hearing from them in just a moment.

You're watching LARRY KING LIVE. I'm Deborah Norville. Back after this. (COMMERCIAL BREAK)

NORVILLE: Welcome back. I'm Deborah Norville, guest hosting this evening for Larry King.

This evening we're talking about female desire and sexual dysfunction. What women don't know can definitely leave them unsatisfied. With us tonight in Los Angeles is award-winning actress Mariette Hartley; Cristina Ferrare, who got a lot of people talking when she admitted she suffered a lot of libido and talked about it in her book called "Okay, So I Don't Have a Headache;" also Dr. Judith Reichman, gynecologists and "Today" medical correspondent and a best- selling author as well, of "Relax, This Won't Hurt." With us here in New York, the co-directors of the Women's Sexual Health Clinic at Boston University medical center, Dr. Laura Berman, a sex therapist, and Dr. Jennifer Berman, a urologist.

You know, one thing, ladies, we haven't mentioned is that women and men come at sex from different points of view. For, dare I say most men, it's a physical thing; and for ladies, it's what goes along with the roses and the chocolate and the flowers, and that's got to figure in her somewhere. Anybody want to jump in on that one?

FERRARE: Well, you know, I believe that men, after they've had their full day, how they release their stress is to have sex. They have a lot of testosterone. We hardly have any. And when I'm finished with my day, I want to go to bed, and I want my husband to hold me and to cuddle with me and I want talk to him. But does he want to do that? No. He wants to have sex. I'm not complaining now. It's fine. I believe men and women do come from a different point of view on this subject.

NORVILLE: Dr. Berman.

J. BERMAN: For men, the goal is to have an erection that's satisfactory for intercourse. For women, there's so many more issues at play -- the romance, the intimacy, the safety that she feels, feeling touched, feeling loved, her body image. All of those things need to be in place for her to feel sexually aroused.

L. BERMAN: She also has to have a context in which to experience her sexuality, and as many options as these medications give us, which are tremendous, wonderful options, one of the risks is that we're going to become really goal-oriented toward sexuality, to see orgasm as ultimate goal of any sexual encounter, to see intercourse as the ultimate expression of sexuality. The ultimate expression in sex is about much more than that. It's about intimacy, and connection and self-expression and the way we feel about ourselves and our bodies, and I think that's really important to remember.

J. BERMAN: Especially for women.

NORVILLE: What if you're watching this show, and you're saying, you know, I don't have a lot of sex, and that's OK with me. Is there something wrong with you then? J. BERMAN: Then you do not have a problem. I mean, that -- these definitions must cause the woman personal distress. So if her husband says that she has a arousal problem or her husband is upset because her vagina isn't lubricated, then -- and she could care a less, then by definition, at least in the consensus that we've established, she does not have sexual dysfunction.

L. BERMAN: One woman's dream orgasm is another woman's inadequate orgasm. It has to be personally defined.

(LAUGHTER)

NORVILLE: Who's laughing in Los Angeles? All of you.

REICHMAN: The other thing is that everyone things everybody else is having better sex and more frequently, and we're made to feel very inadequate. So what a women has to know is that what's good for her, what's enough for her, it means that she doesn't have a dysfunction. The problem is when there's a tremendous discrepancy between what her husband or her partner wants and what she wants, and that discrepancy doesn't mean that there's something the matter with her. He may be using sex as a way to get attention, or because he's bored or its his Valium, and it's his problem, it's not her problem.

So among other things they have to discuss it, there has to be communication, and even though I talk about medications and what we can do, I want to re-emphasize that these medications are not magic bullets, and you don't give it to a woman in a vacuum. You have to understand the entire situation, her entire history, both psychological and medical, before you can give a prescription for any of these medications.

HARTLEY: I think, too, that sex, on some levels, can be threatening to women, and I really speak for myself.

NORVILLE: Oh sure, you're taking your clothes off, they see you naked -- I mean, there's a lot of pressure here.

HARTLEY: There is a feeling sometimes of intrusion, I think, and I think there's something wonderful when you are intimately involved with somebody when there's a sense of safety, when there's a sense of trust.

And there was a test about how people sleep that came out a couple days ago, I was listening to the radio, and they said that people that have good relationships, good intimate relationships are people that spoon together, that intertwine their legs, and I can really -- it took me a long time to learn, because of the way I was raised also, to learn how to touch, learn to you to hold, to learn how to hug, and I sometimes find hugs better than sex, because there's no sense of pressure, there's no sense of performing. I don't know, it's an odd thing, and I think people -- women need to know that it's not about comparing, it can't be about comparing, it's about how we feel, and sometimes when we want to. I think it's OK to say no once in a while. I just need a hug, you know. NORVILLE: We're going to give you a hug right now, and we're going to give Huntsville, Texas a chance to get into the conversation with us.

Caller, are you there?

CALLER: Yes.

NORVILLE: What's your question, please?

CALLER: I'm only 33 years old, and my libido is very low. I felt very sexual until the birth of my second child -- who weighed over 11 pounds, by the way. But I have normal blood tests, so doctors will offer to treat me for depression, but I want to want to have sex.

REICHMAN: One of the problems is if you take a medication for depression, especially what we call the SSRIs -- the Prozac, the Paxil, the Zoloft -- that will actually cause diminished libido, so on the one hand, you might feel better and calmer, but you're libido may go down. And whenever I talk a history on a patient who comes in with lowered libido, the first thing I'll ask is, "Are you taking an antidepressant?"

So in your case, I'm not sure if they tested all the hormonal issues. Perhaps there was some change vaginally. Perhaps innervation is different. You have to know, is certain positions better for you? Are you able to become aroused? You have to have a physical exam. Perhaps there were tears that could have affected your sexual response. And again, libido is not just wanting it, libido is knowing that you're going to enjoy sex when you have it, and if somehow you feel inadequate and you're not enjoying it, then you put it off. And these are all the issues that have to be looked at.

J. BERMAN: She's absolutely right, Dr. Reichman, and I agree with her wholeheartedly. One thing, though, to point out as far as child birth goes, there is nothing natural about natural child birth, I mean, particularly an 11-pound baby coming out of a small channel, and there is an extreme amount of changes and damage that can occur, not only tears.

NORVILLE: So what should this caller do?

J. BERMAN: I would have her attend to the hormonal levels. If she had testosterone checked, have free testosterone, total testosterone, DHEA levels. I mean, those a whole array of tests. And she can go to her gynecologist or call us, or call a specialist that has experience in this.

L. BERMAN: And also check out her arousal, too, and see if that's...

J. BERMAN: The sensation in her genital area, arousal, libido, testosterone.

REICHMAN: And then if I may say.

NORVILLE: We're going to take a break and be back just real quick, OK?

(COMMERCIAL BREAK)

NORVILLE: If you need any proof that this is a big problem, it's been estimated by the year 2008 as much as $1.7 billion worth of treatments to treat women's sexual dysfunction issues will be available on the market. This is a big problem, and it's growing as Baby Boomers approach menopause and enter into menopause; it's only going to get more impactful for more people.

How difficult is it for a women to get relief, Dr. Reichman, when she presents for these the problems? And we've already heard there are so many possible areas that need to be addressed. What are we talking about timewise before a woman feels from doctor visit to "I'm satisfied with the way my life is going?"

REICHMAN: It depends what the issues are. Certainly getting a blood test to check hormone levels, you'll get the results within a week. Talking to your doctor about psychological issues may take several sessions. Then if you are referred to a psychologist or even a sex therapist to discuss underlying issues, we may be talking week, months, but there are issues that have to be dealt with, especially if there has been sexual abuse. So this isn't a one-visit cure-all, this is an ongoing relationship with your doctor, perhaps psychologist, and you have to be patient.

And the funny thing is that we're told as women that we should know nothing about sex and be virginal when we enter into a relationship. Then all of a sudden, we're supposed to know everything, and we're supposed to cure ourselves if there's a problem, and there's no other medical condition in which we feel this way. So what I like to tell women is this is a learned response, it requires emotional attachment, it requires communication, it requires a healthy psychological basis. You have to be in good health, you have to take care of yourself, and at some point, if any of these things are off- kilter, you have to get the help to get on track.

(CROSSTALK)

J. BERMAN: ... I'm sorry to interrupt, is that just having those initial discussions is so validating for the women, to hear perhaps it's not all in their heads, which they've been told for so long. That begins the process, and that alone sometimes gives them a feeling of happiness, self-worth, fulfillment, and then they're more invested in the process, more invested in the clinic, and...

NORVILLE: And likely to have a successful outcome.

J. BERMAN: Right.

NORVILLE: Mariette, you started to say something.

HARTLEY: Well, something that was occurring to me. I find this such an interesting show and hopefully helpful to a lot of people out there. But one of the things that we haven't discussed yet is how many people are in bed with us, and I certainly was aware in my marriage that often my father, my mother -- my mother, particularly, was in bed with me, and my kids. Of course, it's you're nursing also, there was that whole "let's get them into bed," I mean, literally, while we do that. The big bed was very popular in my day. But I mean, is the baby crying? I mean, do I dare? Can i? Are the doors locked?

NORVILLE: Let's do it quick before the kids wake up.

HARTLEY: Yes. And, you know, all of that stuff adds an enormous amount of pressure and stress to the actual act of intercourse, which is what's so much fun about going away, I think. And we used to go away in the same town...

(LAUGHTER)

NORVILLE: Hiding.

HARTLEY: ... so that we always knew that if the kids -- if there was a real emergency, we could always go there. But it was like a hideaway, and it was like a little honeymoon, and I think that "motelitis" is something that, you know -- the minute you get into a hotel or motel room, there is something that goes, whoa, I'm not home, I'm not the mother, I don't have that pressure.

NORVILLE: We're going to go to Orlando, Florida. Speaking of hotels, there's many of them there. You've probably been to Disney World. I don't know that our caller is calling from the land of Mickey Mouse. But we have somebody on the phone from Orlando with a question.

Go ahead please.

CALLER: Hi.

What should someone in their early 20s who has no children or testosterone deficiency do to treat this kind of a problem?

J. BERMAN: One thing that actually should be determined is, if she's taking birth control pills. Are you taking birth control pills at this time, contraceptive pills?

CALLER: I've been put on the lowest one. I'm on Ortho Novum 777 right now.

J. BERMAN: Because even the lowest doses of testosterone can affect libido and lower testosterone levels as well as your estrogen levels, so that's something that should be checked and could be impacting on sexual desire.

NORVILLE: So would say this young lady should have her blood levels checked, as you advised for the previous caller?

J. BERMAN: In our clinical practice, that's what we do, and we have found that these women do have low testosterone levels.

L. BERMAN: And also question -- take a look at your arousal process, how satisfied you are with sexual response, how you feel about your sexuality. Does sex feel like work? Is it frustrating? Is it ever painful? Is it hard to reach orgasms? Those things can all affect your motivation as well as emotional and relational things and historical things that might be playing a role. That's not to say it's all in your head, but that there is a component that might need to be attended to.

NORVILLE: What about masturbation?

UNIDENTIFIED FEMALE: Who said masturbation.

(LAUGHTER)

FERRARE: No, but also, I would say for her to also check what she is eating, what does she put in her body. I believe firmly that if you take the proper vitamins -- herbs have helped me, the vitamins have helped me, and what I eat, along with exercise, plays a very important role in getting my libido back. I mean, we're talking about psychologists and creams and stuff. You have to -- that adage you are what you eat is so true, so you have to be careful on the type of things that you put in your body as well to help you get...

NORVILLE: And it really underscores the whole part of personal sense of self-esteem, which is something we haven't talked about yet, but we will touch on after this break.

Back on LARRY KING LIVE, talking about women's sexual dysfunction, after this.

(COMMERCIAL BREAK)

NORVILLE: Cristina Ferrare made an excellent point about you are what you eat. If you don't take care of the body, you can't expect it to perform. You are who you feel you are. If you don't like yourself, it's kind of hard to like yourself being in such an intimate position with another man.

J. BERMAN: That's absolutely true. I mean, your self-esteem impacts on how you're able to express yourself sexually.

I want to go back masturbation.

L. BERMAN: That is a very important part of woman getting to know her body, knowing what to do to arouse herself, knowing what needs to be done to stimulate herself.

J. BERMAN: She can teach the partner what needs to be done, what arouses her, what satisfies her, unless she knows herself and feels comfortable herself doing that. So that point you brought up really is extremely important and it's something that we...

L. BERMAN: Because she can't expect the partner to just know what to do. He can be with a gazillion women and still not know how to satisfy a woman or how to satisfy her, unless she advocates.

J. BERMAN: A lot of women come to us and say, I have sexual dysfunction, I can't have orgasms, I've tried every position, and then we give her a vibrator, and 10 minutes later, you know, she's got a smile from here to here. One of the problems.

HARTLEY: You cannot travel with a vibrator in your purse, because they get...

(CROSSTALK)

L. BERMAN: Put in the suitcase.

REICHMAN: Many women come to me and say, I'm having some sexual dysfunction and arousal is a problem, and what they do is they expect to become orgasmic and to really enjoy sex only with intercourse, and we know that for most women they won't achieve orgasm just with intercourse. They need clitoral stimulation, they need fondling, they need other things.

So it is a question of again, learning what causes a response. And when Cristina was talking about general lifestyles, I might add that studies have shown that exercise, not only raises the neurotransmitters in our brains that make us feel good and make us feel good about ourselves, but it increases blood flow to the vagina, and it is healthy thing to do for the vagina because, again, arousal is dependent on that blood flow. So there are some studies that if women have sex after they have had 20 minutes worth of exercise, or if they see an erotic movie, there will be better arousal and better blood flow. So I always say, the couple that exercises together might enjoy having sex together a little better.

NORVILLE: Let's go the phones, we have got Salem, Oregon holding on the line.

Salem, are you there please? Have we got our caller from Oregon? I guess they're out exercising, taking advantage of some of this good advice.

J. BERMAN: As we were saying, one really exciting thing, at least from the standpoint of exercising, is the use it or lose it phenomena. Is that studies have shown in both men and women that the more sexually active you are, both men and women, the less dysfunction you have. So it's a good message to get across. The more sex we have, the healthier we have, the less chance of sexual dysfunction.

L. BERMAN: That doesn't mean you have to be having sex with someone else, but keep those fluids going.

HARTLEY: Also, I mean as an actor, I find that if you go a moment at a time and don't work for a result, often the result occurs, which is not to say that we need to know our bodies, we need to know what works, we need to be as uninhibited as we possibly can. We need to be able to say what we want and what we need. And I have just learned on some levels how to do that because I was raised to not have my needs or wants, I shouldn't let anybody know what it was that I wanted or needed.

But I think, if we push for orgasm all the time, we're missing out on something that's very key, and that is the moment to moment foreplay and loving intimacy between two people.

NORVILLE: So focus on the end goal maybe, and not so much on the specifics. We'll be right back.

HARTLEY: No, no, the other way around.

(COMMERCIAL BREAK)

NORVILLE: If as many as 40 percent of American women are experiencing difficulty in their sex lives, there is a problem. Tonight we have tried to address that problem, and we hope we have left you with some thoughts that will be useful to you.

Mariette, anything you would like to leave our viewers with before we sign off this evening.

HARTLEY: No, it has just been a very interesting. I'm so turned on that I just don't know what the heck I'm going to do tonight. I am home, I've got my cats and I am going to cook my dinner by myself, but you know what? It's OK. No, I loved being on the show, and thanks so much for asking me, Deborah.

NORVILLE: Well, we appreciate you being here.

Cristina, you have really opened a lot of women's lives to the fact that their lives can be very, very different. They just need to speak up and start doing it.

FERRARE: That is right communicate. That is the most important.

HARTLEY: I would say that too, communicate, communicate, absolutely.

NORVILLE: Dr. Reichman.

REICHMAN: I just want women to know that they have to get help, and they don't have to be silent. And if they start with their doctor, that's a great place, open up, discuss it, discuss it with your spouse, because when all is said and done, we all deserve to be in the mood.

NORVILLE: And that's something that you deal with every day in your sex therapy clinic, Dr. Berman.

L. BERMAN: Right, that sex is an integral part of every woman's general health and wellness, and that every women, if she wants it, is entitled to sexual response and to sexual satisfaction and it is important for her to take holds of that. And to know that nice girls not only do, but they enjoy it.

NORVILLE: And should men who are listening who are thinking: You know, my wife, my woman, is not as involved as I wish she were. Should he speak up after seeing a discussion like this?

L. BERMAN: Absolutely, speak up, open the lines of communication. They say that men feel intimate as a result of having sex, and women have sex as a result of feeling intimate. And that is something really important to remember, communication is a key factor.

NORVILLE: And Dr. Jennifer Berman.

J. BERMAN: I reiterate what Laura says, women need to feel entitled to their sexual response, they need to go to their doctors and demand to be heard, and demand treatment, because it is available, and I guess my message is is that these problems aren't necessarily all in our heads, we should be listening to them, and that there is potential help, both from the hormonal spectrum, as well as the blood- flow enhancing agents.

NORVILLE: And I think one thing that we have learned too, just from our callers, I mean, contrary to what most people might think, that this is an issue that is only problem for women who are approaching menopause or women who are already in menopause, Dr. Reichman, is that there are young women, who presumably are hormonally exactly where they ought to be, who are not having satisfying sex lives.

REICHMAN: Absolutely, and that's why you can get tested. There are things that can be done. You have to play detective. But again, you have to seek the help. And don't sit back and think there is something wrong with me, I won't talk about it, I'll fake it, because you don't have to.

NORVILLE: All right, we've been talking about women's sexual dysfunction. The survey says that as many as 41 million baby boomers are approaching menopause, it will be a problem for many of them. But many people who are long before menopause are dealing with this issue.

Our thanks tonight to all of our guests for talking with us about this. It's been really, really quite interesting.

Cristina, when you talked about this on your show a couple of years ago, did you have any idea what a -- not Pandora's box because these are not bad things that have come out, but any idea what you were creating with this?

FERRARE: No, I didn't, but I'm certainly glad I did. I am glad to know that there are other women out there that were feel the way that I did. It gave me a feeling of relief to know that there were other people that felt like I did. And I think women are fabulous, we reached out to one another and we help one another. So I'm glad I did.

NORVILLE: And I'm glad you did to, too.

Thanks to all of our guests and thanks to you for watching. I am Deborah Norville, in for Larry King, Good-night.

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