Viagra for women: Prescribe 50 Shades of Grey to your female patients

Could “mommy porn” have value in the doctor’s office? Unless you live in a cave (and we physicians sometimes do), you have heard of British author E.L. James’ modern erotic 50 Shades of Grey trilogy, 30-plus million copies sold, overwhelmingly to women. The trilogy is an erotic love story about a naïve college graduate who rescues an abused billionaire – a blend of the Story of O, Pretty Woman and a Danielle Steele novel. Not great literature, but clearly having some effect on the libido of millions of women. Do we finally have a safe and affordable clinical tool for women with blunted libidos and hypoactive sexual desire?

The prevalence of decreased female sexual desire and responsiveness has been estimated from 15 – 53%, higher in menopause and perimenopause. In one study, half of women with these symptoms spoke to their doctors about the problem, yet doctors have very few tools for women with hypoactive sexual desire. The phosphodiesterase inhibitors (nitric oxide agonists) such as Viagra increase genital circulation and can effectively treat erectile dysfunction in men, but have shown no benefit in women. Testosterone patches may increase sexual desire and satisfaction in both surgically and naturally menopausal women, but side effects can be uncomfortable, and long-term safety has not yet been established. The jury is still out on the effectiveness of adrenal hormone DHEA replacement, and herbal remedies such as gingko biloba.

So into your office walks a middle-aged female with a normal amount of stress, in a relationship that is comfortable but not passionate, and she wants her mojo back. Where do you start and what can you offer?

First, the differential diagnosis for diminished sexual desire and responsiveness in women: stress, relationship problems, depression, diabetes, endocrine (thyroid, prolactin, sex hormones), medication side effects (particularly antidepressants and blood pressure medication), vascular disease, nutritional deficiencies (and side effects of too much junk food), substance abuse, past history of trauma for starters. Eventually you’ve corrected everything correctable, made a joint decision with the patient about the pros and cons of hormone replacement therapy … and still … no fire. Now what?

Think the missing hormone … oxytocin. Yes, that old induce-labor bag of pitocin you used to hang on all those moms-to-be who weren’t progressing. Oxytocin, a major player in female sexual desire and responsiveness, released during any kind of cuddling – romantic, parental, puppies, and released during orgasm. And most importantly, released while reading romantic, erotic literature. But oxytocin blood tests are largely experimental and oxytocin replacement is not easily available at the pharmacy. How do you know if your patient has an oxytocin deficiency, and if can be behaviorally corrected?

You ask them to read the entire Fifty Shades trilogy (yes all 3 books) in one week’s time, and see how they feel.

One middle-aged woman reported her animals sat next to her while she was reading, and she felt more connected and cuddly, but it didn’t save her relationship. She realized her lack of sexual desire was not physiological, but a result of relationship issues.

A younger woman reported more intense bonding with her young children and husband, and the “biggest orgasm” of her life.

A post-menopausal woman reported that she started to feel desire for her husband again, and had an increase in frequency of intercourse “like 20 years ago,” without hormone replacement, and with no change in their marriage. (He was delighted).

No meds, just books.

The key to the success of these books in women is not the abundant sex scenes, but the romance, and the massive release of oxytocin women experience as a result of immersing themselves in the “love” part of the book. Hearts and flowers increase desire in women; thus the success of the “chick flick” for dates.

Let’s face it. Pornography, written and visual, has existed forever, but remains a greater male stimulant than female. That difference is driven by physiology – women are not aroused by visual pornography to the degree that men are aroused. Male libido is stimulated more by visual and tactile erotic images and sensations – leading to a massive release of norepinephrine (energy/aggression) and dopamine (pleasure/reward). For men, increases in dopamine and norepinephrine appear to play a greater role in arousal than in women, whose arousal seems to be largely oxytocin driven.

What about men? Is there a diagnostic and treatment role for Fifty Shades and the like genre? As a sex manual, Fifty Shades has merit as a “touch here, kiss there, try this” benefit. As a male turn-on … maybe, but don’t count on it.  Cuddle? Pleasant, but not erection-inducing.

Is there anyone for whom you should NOT prescribe the Fifty Shades series? Yes – it may be too intense for younger women, even if sexually active, and it may be a trigger for women with sexual trauma or abuse histories, or it may simply be offensive. That said it’s certainly worth having a conversation with your patient, and maybe writing a prescription for the bookstore or the library (if the waiting list isn’t too long!). They’ll love you in the end.

Sara Stein is an integrative and bariatric psychiatrist and functional medicine physician at Stein Wellness Center and can be reached on Twitter and Facebook.  She is the author of Obese from the Heart.

email

Comments are moderated before they are published. Please read the comment policy.

  • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

    I’m a physician from Toronto. Although I’m sure this physician is well versed in the science of medicine, I think that recommending our patients read porn is generally a bad idea. Porn generally shows dysfunctional sexual situations, which is not usually helpful in the long run. Also porn usually stimulates a need for more porn in the user. Quite a number of porn users end up exhibiting addictive-like behavior.

    Yes, I support using less drugs and more psychosocial approaches but porn is the worst of theses options. I hope this author was just mentioning this option tongue-in-cheek or at very least was saying that the best way to increase sexual desire was through non-drug means.

    • http://twitter.com/sarasteinmd Sara Stein MD

      @facebook-793435623:disqus I take it from your reply that you haven’t read them – they are not porn, they are just sexy romance novels…that’s the point. Romance breeds sexual desire in women, NOT porn. Also I am not in the least “tongue-in-cheek” about this – I have approximately 8 women of varying ages for whom this reading challenge has either been transformative or provided great differential diagnosis. Are you talking with your female patients about their sex drives? If you are, then this is a conversation point that you should make. If you’re avoiding it… I assure you, they are not.
      Best,
      Sara Stein MD

      • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

        @twitter-18452605:disqus I’m quite comfortable talking about all aspects of sex with my patients, including sex drive. I do it frequently. I also have some training in psychotherapy. I’m also not a socially conservative person at all. I’m a liberal and if I lived in the US would probably be a Democrat.

        I realize that this book is not ‘porn’. However it does provide the story of a highly dysfunctional sexual relationship. And it is tantalizing to millions of women. The author seems to have either engineered or stumbled upon the ‘crack cocaine’ of this genre. The question is this.. is it harmful? Probably not for the majority who read this. In the same way pop tarts are probably not harmful for the majority of those who have one here and there. However food like pop tarts gets a significant number of people habituated to eating very unhealthy sweets in large amounts.

        Clearly some ‘porn’ is engineered to lead to addictive responses. Fifty shades of grey is probably not in this realm but is clearly is resonating like crazy. I think the usual sort of mommy porn, the romance novel (and anything with similar type of content) is probably pretty healthy and I would be comfortable recommending that. By this I mean the strong, funny, socially popular rebel, etc. type guys who sweep women off their feet. That’s the kind of character that women have been ‘wired’ to mate with and be attracted to. Dysfunctional relationship involving S & M are a slippery slope for a significant minority of women.

        That’s my two cents.

        Peace,
        Jonathan Marcus MD

        • http://twitter.com/sarasteinmd Sara Stein MD

          @facebook-793435623:disqus It always amazes me when a man presumes to know what a woman needs and what’s best for her, even worse when it’s a doctor. Not good.

          • penguin50

            I am a woman. I have read as much of Fifty Shades as I could stand (several pages). It definitely qualifies as porn, commonly defined as material (pictorial, textual, or otherwise) that has as its primary purpose the sexual arousal of the viewer or reader. it is SO badly written that it makes one cringe. (Have you read the one-star reviews of Fifty Shades by women readers on Amazon? They are hilarious.) I would seriously question the judgment of any medical professional who thought reading this would improve my sex life. At the very least, please do not recommend it to any patient who has a modicum of intelligence. And don’t be so persuaded by the common belief that women are aroused by sweetie-pie, tender-lovin’ “romance” and men are aroused by more hard-core material. That’s just sugar coating. Women are sexual beings too, every bit as much as men. I agree with and support everything that Dr. Jonathan Marcus wrote about the nature and potential dangers of this book.

          • http://twitter.com/sarasteinmd Sara Stein MD

            @penguin50:disqus and as I said, not great literature, and may be offensive to some, or unhealthy for others. The data on female arousal due to oxytocin is science, not opinion…what gets any individual woman secreting oxytocin is obviously variable and individual. I disagree with you that the book is “dangerous” any moreso than bad movies, bad talk shows, and bad television.
            Cheers,
            Sara Stein MD

          • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

            Oxytocin release in and of itself is neither good nor bad. It does feel good though. Dopamine also feels good and it is released by sugary meals (among other things). Does that make eating sugary food a good thing? I would imagine robbing a bank (if one is into that sort of thing) also releases feel-good hormones. Point is, I think the mode of the release of the feel-good hormones matters and I think as physicians we need to take this into account when we recommend ‘interventions’ for patients.

          • http://www.facebook.com/bariatricgirl Yvonne Burns McCarthy

            I think the books were a great read. Sometimes I feel like some people have to be critical of something that is very popular. If you don’t like it don’t read it but please read the whole thing before you trash it. Millions of books have been sold for a reason and every woman I’ve spoken to said their husbands thanked the author (and so did they). I’ve read great literature that I like and I liked this too. Art is in the mind of the beholder. It is a love story. The male character had some horrible things happen to him when he was a young boy. He begins to love someone for the first time and leaves the alternative sexual practices behind.

            It’s the same story on You Tube when you look at the comments on the classical pieces of music from the book. Many people are just appalled they listened to and liked the classical music just because of 50 Shades. As a classical Cellist I’m pleased they ended up appreciating the music and I don’t care how they got there. It was a great article and I’m sorry you got beaten up. I couldn’t agree with you more. If this book was dangerous we need to start getting rid of a great deal of books including some classic literature.

          • http://twitter.com/sarasteinmd Sara Stein MD

            @facebook-1207203554:disqus Thank you! I tried to make it clear that this was not a fly-by-night treatment, but a carefully thought out challenge test for a hormone that is almost impossible to test for and replace, to be used after every other cause of sexual dysfunction was ruled out or corrected. I get that it is offensive to some, and that they could experience the same effect from You’ve Got Mail or Pretty Woman – it’s not how you get there that matters, it’s that you have something to try that might finally work, (and is essentially harmless and inexpensive).
            I’m very purposeful in having women read all 3 books in a short time, because the first book is rough, and the romance really comes in the last two books. That said, there are an awful lot of smiley women and men around lately!
            Best,
            Sara Stein MD

          • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

            @twitter-18452605:disqus I’m not sure what the fact that I am a man has to do with this conversation. I have no problem when people point out what certain male tendencies are… even if those people are female healthcare professionals.

            Also note that I pointed out that regular porn use has a significant side effect of decreasing the sexual chemistry in intimate relationships for women AND men…. not my opinion, based on measurable data.

          • Kelly

            This seems a rude and inappropriate response to Jonathan Marcus. As a woman – I find nothing he says offensive or out of line. He does not come off as “presuming to know what a woman needs, or, what’s best for her” – this misrepresents his remarks. His points are valid too; your response an attack.

        • Lara M.

          @Jonathon Marcus, If we’re all wired to want “a strong, funny, socially popular rebel, etc. type guys who sweep women off their feet”, why has Fifty Shades of Gray been such a hit with women?

          Personally, I think the romance novels you favor and Fifty Shades are on the same continuum of depicting unrealistic, unhealthy relationships. I’m sorry, but expecting someone to swoop in and rescue you in the real world is also unhealthy. Most people are just more comfortable with that social construct.

          I flipped through Fifty Shades and laughed, which is also my response to the romance novels you recommend. Unlike you, I trust that women are smart enough to differentiate between fantasy and reality. If a woman enjoys reading a romance novel, go for it. If she enjoys the kink of S&M-erotica, then good on her. We’re not feeble creatures who need to be protected from books (or maybe you’ve been reading too many romance novels).

          And please don’t tell me what I’m “wired” to want. You don’t know me.

          • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

            @disqus_4jXEfBqy9O:disqus I didn’t recommend regular romance novels/ ‘chick flicks’ etc. I only pointed out what is attractive to women about the men in them. It’s not my opinion that some combination of the archetypal male qualities I suggested are what attract women. It’s thousands of years of evolution social conditioning. Of course not all women are attracted to all or even some of these characteristics…. but more are than aren’t.

    • Dave Roberts

      I thought that Dr. Stein pointed out in good manner the difference
      between the porn. and the other content in the book(s) and the
      respective effects of both and how they translate to the different
      genders. . so of all the things to take out of context this might be it.
      Sorry Jonathan. But I must differ, I know it did my wife some good.
      If it was the romance in the story line, or the explicit writings,
      doubtful I will ever find out.

      • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

        I’m not saying the book is evil. I’m sure it could do some people good. However if a person habituates themselves to need this sort of content to become sexual, that could be a problem. ‘Regular’ romance novel where a big strong, slightly bad ass many sweeps a woman off her feet I think are healthier than this particular book.

  • http://www.facebook.com/pamela.wible Pamela Wible

    Sometimes sharing a story or recommending a book can be far more transformative that writing a prescription. I’ve even taken a patient to a writing workshop. People are bottled up. They often need self-expression and emotional connection, not another bottle of pills!

    • http://twitter.com/sarasteinmd Sara Stein MD

      @facebook-1125157294:disqus I totally agree! (a writing workshop – what a great idea!) thanks!

    • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

      I could’t agree more Dr. Wible!

  • http://twitter.com/DrSherryPagoto Sherry Pagoto

    As a licensed clinical psychologist I strongly disagree with this recommendation. I have read the entirety of the 50 Shades series and I would never recommend these books to patients. The leading male character is emotionally abusive (e.g., shouting in anger, stalking behaviors, controlling behaviors, emotional bullying, highly manipulative) thus a major concern I have about recommending to female patients for sexual excitement is that portraying such a character as romantic and/or sexy reinforces the notion that it is OK for a man to be emotionally abusive if he makes up for it with romantic gestures and sexiness. The leading character’s behaviors (as those of all emotionally abusive men) are never OK. This is precisely how emotional abuse is carried out. I was shocked (and hugely disappointed) at the “happily ever after” ending of the book, as it is rarely the case in real life that someone would just snap out of emotional abuse and be the “knight in shining armor.” This reinforces the idea that if a man loves you enough, he will be a better man and won’t abuse you anymore. That notion is very destructive, especially when sent to women who live every day of their lives with an emotionally abusive man. While the leading character was in psychotherapy, the therapeutic relationship was highly dysfunctional, lacking in professional boundaries (invite your therapist to your house parties?!) and did not seem to address his abusive tendencies head on. Please be cautious about promoting this book, especially because patients may not have shared with you the realities of their domestic situations (even when you ask) and the messages in the book have the potential to be very destructive.

    • http://twitter.com/sarasteinmd Sara Stein MD

      @twitter-264356595:disqus
      Thank you for that caution, and please note I made the exact same recommendation – that it may be a trigger for patients with abuse histories of any sort. I have recommended this treatment to 8 women thus far, all of whom met criteria for hypoactive sexual desire and wanted treatment for that specific issue. They complete an oxytocin deficiency questionnaire (a poor diagnostic, but less expensive than an unproven blood test) and discuss with them IN DEPTH what the reading challenge is. I tell them to skip the unpleasant parts (some do).

      That said, you may be doing women a disservice by assuming they are not capable of distinguishing between fantasy and reality. Middle-aged women want their sex drive back without having to take hormones, and this is a useful tool for that specific purpose.
      I would be remiss not to share an easy success with providers.
      Best,
      Sara Stein MD

  • http://twitter.com/sarasteinmd Sara Stein MD

    @kategould:disqus That’s a great site, thank you. This blog is not about erotica as much as it is about romance – different neurotransmitters, different effects. Erotica has always been out there, and is read more often by younger women than older women – even the best Lonnie Barbach is not about romance as much as sex. I would ask those of you who take offense at the relationship in this trilogy to recognize that it is not offensive to many others, thereby explaining the success. Again, this is NOT a blanket endorsement for this trilogy to any XX chromosome that walks in your office. It is a challenge test for women who enjoy romance (and are not offended by the content) to see if they can endogenously produce their own oxytocin and treat their own hypoactive sexual desire without medications. If you don’t like the book, don’t recommend or read it. but don’t presume that a 65 yr old grandmother will feel the same way. Best, Sara Stein MD

  • Kara Nance

    Great discussion! I also talk about sexual dysfunction regularly with my female patients. While I agree that one shouldn’t read 50 Shades as a model of what a personal relationship should look like, or as great literature, I think what the book appeals to is that base, animal, sexual nature that women have locked away, but are too repressed to express. No one wants to be “hurt” but studies by Helen Fisher in “Why We Love” indicate that women are turned on by being dominated. Domination in a safe context is sexy for most women. Women control most of the day to day decisions in traditional American households. I think when they get to the bedroom they want the man to “take over”. Willing submission in a safe loving relationship is hot. The man feels strong and the woman gets to “take a break” and enjoy herself! I’ve also found that many women DO like watching porn after they get over the social stigma associated with watching it. The media creates all sorts of fantasies every day. 50 shades and other forms of pornography are simply titillating playgrounds for the mind, which we all need from time to time to escape the drudgery of everyday life.

    • http://twitter.com/sarasteinmd Sara Stein MD

      And there you have it – 30 million copies later! thanks @google-c227533bb880113f09ead768e2f9c8a6:disqus

  • http://www.facebook.com/mimi.ekeji Mimi U

    BULLSHIT, so for a mother to get turned on she should read a book, patients need instant gratification, like viagra for men. ONly an extremely shelterd lady whose never had amazing sex would be turned on by 50 shades of grey

    • http://twitter.com/sarasteinmd Sara Stein MD

      @facebook-501075039:disqus Women’s sexual response changes drastically with menopause, even when they are in happy, fulfilling relationships. This is about the biochemical changes that occur in the body, and how to jumpstart them without taking hormone replacement.
      Best,
      Sara Stein MD

  • Molly_Rn

    These are books about abuse, not love and not sensuality. Yuck, I wouldn’t recommend them to anyone. As a woman I avoid books like this and tv shows and movies where women are abused either in a “relationship” or are the victims of perverted killers like “Criminal Minds”. Abusive men do not suddenly become loving devoted lovers/husbands.

    • http://twitter.com/sarasteinmd Sara Stein MD

      Very clearly offensive to some and traumatizing to others, not for everyone. Thank you for commenting
      Best,
      Sara Stein MD

  • http://profiles.google.com/reesie22 Reesie 22

    For years, the U.S. culture has been shaped by the perverted worldview of Hollywood elites. The TV shows have erased the father or made him out to be an incompetent boob . TV shows make it like we don’t need husbands or fathers and this is one of the reasons why our society is in a mess and now we have the government taking money away from some tax payers to be the husbands and fathers to other citizens. I’m tired of the feminist ideology of bashing men. Sara Stein and Lara M gang up on Jonathan Marcus and use the female card to do it. Why is it OK for Sara and Lara to make blanket statements telling us what all women love and want and what turns them on, but Jonathan is not allowed to give his opinion or he gets slapped down? I do not agree with what Sara and Lara say and I agree with Jonathan and Sherry Pagoto. The feminist movement is full of that kind of hypocrisy. (I’m a woman, by the way.) The feminist movement has been responsible for denigrating men and taking away from women beautiful characteristics that God put in women, such as being greatly fulfilled by being a wife who has great sex with her husband whom she loves and he loves her. Being pregnant with her husband and being fulfilled by caring for a baby and loving, nurturing babies and children with her husband. Being loved by their husband so much that he elevates her standing in society and opens doors for her and helps her and protects her and admires her. A woman can still be strong, smart, capable, and allow herself to be loved and cared for by her husband and to care for him as well without ceasing to be independent and able to take care of herself. Now to the books. They are porn. Porn has never helped anybody long-term. Porn is an insidious mind and soul pollutant that denigrates women as a piece of meat and erases the emotional loving aspect of sex that comes from people who are committed to each other. It ends up diminishing the ability for a person to have fulfulling emotional sexual pleasure. And I am not a prude so don’t put that label on me.

    • http://twitter.com/sarasteinmd Sara Stein MD

      @google-20ded7675be2e724e148664f60c1e2e3:disqus Thank you for your comments. Clearly you are quite affected by this subject matter, and feel strongly. Point of information, Dr. Marcus and I are quite capable by virtue of our extensive medical training of engaging in a civilized disagreement and do not require rescuing by anyone. Like any debate, people take sides, and I welcome (as I presume he does) input. I do not agree with you, but I respect your right to your opinion.
      Best,
      Sara Stein MD