Ask Dr. NerdLove: How Can I Fix Our Broken Sex Life?

Hey Doc,

I got myself into a little bit of a pickle. I’ve been married 4 years and about a year in, at 30 years old, was diagnosed with bipolar depression. It took us about a year to get the meds figured out but it has been life changing to finally have some relief. The only issue is a severe decrease in libido. I don’t have any interest at all. I stopped masturbating, my husband and I have mechanical sex MAYBE once a week that is a literal chore for me. Sex just kind of grosses me out these days. I’ve talked to my psychiatrist about it, and he didn’t seem concerned since I can still reach climax, plus it took us so long to get the right combination of pills I’m terrified to change anything up. From what I understand this is kind of a common side effect, so who’s to say this wouldn’t happen with any other medication we try.

I’ve talked to my husband a little about it, I asked him to turn on the charm a little more (his idea of foreplay is “wanna do it?”) to see if that would help but he didn’t really come back with anything. I offered an open relationship (something I’ve always been open to), but he says he just wants to have sex with his wife. I’m not really sure where to go from here. Do I just keep doing my weekly chore for all of eternity? I don’t want to pressure him into the open relationship but should I talk to him about how much I dislike sex and offer that avenue again? I feel like that’s just hurting his feelings and breaking a lot of wifely expectations. I just don’t know where else to go from here. Any advice you have is appreciated.

-Disinterested

You’re dealing with a really common problem Disinterested, and one that a lot of people with mental health issues face. First, there’s the fact that it took you time to find a combination of therapies that work. That is, possibly the most frustrating part about getting help; it can be stupidly difficult to find the right medication and the right dosage of that medication in order to get the results that you want. That means a lot of folks are stuck with the question of “is this actually working or do I need to wait longer?” and “do I dare risk trying something different?”  Then there’s the question of the side-effects those medications have and whether the cure ends up being worse than the disease. A lot of medications for issues like depression, for example, have “lowered libido” as a side-effect. Hell, when I was on Zoloft to help manage my depression, it killed my sex-drive deader than disco.

So I totally understand where you’re coming from. So let’s talk about what you can do about this.

My biggest concern in this case is your psychiatrist and their lack of concern with your concerns. One of the things that we don’t often talk about is how profoundly sex negative the medical and mental health field can be. While doctors get plenty of training, that doesn’t mean that they’re without their biases… including a lack of concern – or even interest – in women’s sexual health. It’s not uncommon for doctors to dismiss women’s concerns about their sex lives – especially their libido – because… well, how important could that be? I mean, when a proposed male medical contraceptive turned out to have side-effects, it was yanked from studies with a quickness.

Plot twist: those were the same side-effects women face with birth-control pills.

So I’m not terribly surprised that your psychiatrist brushed off your concerns, with a “well, you technically can still orgasm, so what do you want?” Which may be true… but that doesn’t solve your problem.

Now to be fair: your husband does sound like he could step up his game too. The fact that he’s not exactly putting in effort into your sex life certainly isn’t helping with the issues surrounding your libido. In fact, for many women, the reason why their libidos crater is, frankly, that they’re bored. I suspect that this is, at the very least, a compounding complication to your lack of a sex-drive. But seeing as your libido’s death came along with the new medicines, it’s best to start there.

The first thing I suggest is that you advocate for your needs with your psychiatrist. Those side-effects are having a detrimental impact on your quality of life and you can tell your doctor that the “cure” is causing you problems that you aren’t willing to tolerate.  Tell them that you want to try other medications and that you want to prioritize ones that won’t destroy your love life in the process. Yes, I get that it can be terrifying to try another medicine or combination of meds, especially when this one seems to be working. I get that it can be intimidating to confront your psychiatrist – someone with years of medical training – over this. But ultimately this is your life. What good is it going to do to get your bipolar depression under control if it’s going to cost you your happiness and your marriage in the process?

If they balk? Well… it may not be the worst idea to consider the possibility of a different psychiatrist. In that case, you may want to visit the American Association of Sexuality Educators,Counselors, and Therapists website; they have a referral directory that can help you find a sex-positive mental health professional in your area who can hopefully connect you with a psychiatrist who won’t dismiss your concerns about what your medications do to your sex life.

But I also think you need to sit down and have an Awkward Conversation with your husband and lay out exactly what’s going on. He deserves to know that sex for you has become a chore and one that you dread. Were I him, I’d want to know if my wife was dreading the idea of sex with me because good-god-damn, I would not want to be subjecting her to something she hates. Knowing that you’re having to lay back, grit your teeth and think of England may be the kick in the pants that he needs to actually listen when you tell him you need him to put in more of an effort to seduce you and please you.

And if that doesn’t work, if his putting more effort in doesn’t help ease the way sex squicks you out right now? Then knowing how it makes you feel may mean that he’ll be willing to discuss alternatives for the two of you while you adjust your medication.

Good luck.

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Hey Doc,

I’ll get right to the problem, I’m a 22 year old guy dating a 20 year old woman, and it’s going well. We really admire and respect each other, have great physical chemistry, and have healthy communication and boundaries. I just have one problem: she smokes, and I want her to quit.

Now this may seem like a pretty normal, bog-standard problem, but there’s a bit of wrinkle in the context of our relationship specifically. See, I have a kink that involves seeing women I’m attracted to smoke, and because we’re pretty open about that kind of thing with each other, she is aware of this. She likes the fact that I have this kink, because she assumes (semi-correctly) that this makes her more attractive to me. The thing is, as we’ve grown closer, I’m realizing more and more that I don’t actually want to indulge this kink, because I am much more worried about her health, and I ultimately feel that it’s inappropriate for me to make such a request.

Moreover, I’m getting a bit anxious over the whole thing, I’ve had a few nightmares over the thought of having to bury her in 20 years or so, and the thought of having to see her waste away.

The problem with my asking is I think she’d take it very poorly. As mentioned before, she specifically said that she was glad that I have this kink, and I don’t know how she’d feel about me suddenly not wanting to do anything with it, not to mention that she’s mentioned being a bit resistant to the idea of quitting.

In turn, I’m not sure if I want to break up over this or not. Everything else is fine, and I’d further be worried that she’d try to dig in and find some “other” reason besides that for the breakup, and that I’d put more self doubt than she already has on her shoulders.

I guess my questions are the following: Should I ask her to quit? Should I consider breaking up? and finally, if I do decide to end things, how should I explain why?

-Scared To See Her Leave

Y’know, my dude, I think you may have jumped several steps here. There’s a world of space between “talk to her about quitting” and “now she’s going to leave me” but you seem to have decided that this is the inevitable end result. Without, y’know. Actually talking to her. Yeah, you have your kink – it’s actually a surprisingly common one – and she gets spun up by how hot it gets you… but presumably you’re into her even when she’s not smoking. And honestly, there’re ways you can indulge that kink without nicotine. I mean, vaping is a thing. So, for that matter, is weed. Hell you could combine the two…

But the issue here isn’t the smoking or the alternatives to smoking. Not really. The issue here is that you have a concern and you’re afraid to bring things up to her. That is your bigger problem and the one that you need to work on.

You don’t say how long you two have been together, but it sounds like it hasn’t been for that long. If the two of you have only been together for a couple of months… yeah, it’s gonna be a pretty big ask. It’s a little presumptive to say “hey, I know when we got together I was really into this thing that you do, but now I feel weird about it and I want you stop doing that thing for me right now.” While you may have the best of intentions at heart – hey, not wanting to see your lover die from a horrible disease is pretty understandable – it’s kind of presumptive to make demands of somebody you haven’t known for that long.

Not to mention “yes, we’ve only been together for a little while, but I’m getting anxious about something that may happen 20 years down the line, at a time when we may or may not still be together” is… well, that’s kind of an example of what I mean when I talk about people investing too much, too quickly in a relationship.

But even if we allow that you’ve been together for long enough that this isn’t a big ask or that it’s reasonable to make plans for 20 years down the line, you have more options than “ask her to quit smoking” and “leave her right now”.

What you should do instead is – as I just told Disinterested – is sit down and have an Awkward Conversation. In this case, you want to bring up that you’ve been hesitant to indulge your kink because of the potential health effects and it feels weird to be getting a boner when you also keep thinking about cancer and tumors. While you don’t necessarily want to tell her to quit, you do want to at least let her know that this is a concern for you and the dissonance between your kink and the side effects it could have on her are causing you anxiety.

(I would leave out the part about getting worried that you’ll be burying her in 20 years.)

Now I stress: the point of this conversation isn’t to get her to quit. It’s to simply lay the groundwork for you to be able to actually talk with her about your concerns instead of assuming that you only have two, mutually exclusive possibilities. Because I can guarantee you: there will be other, more immediately pressing concerns in your relationship. And if you can’t talk to her about how you feel? Well, your relationship’s going to fall apart sooner, rather than later.

And seriously: it’s admirable that you’re thinking 20 years down the line, but focus on your immediate future for now… like, maybe 3 months down the line instead. Take some time to make sure this relationship’s got legs before you start borrowing trouble from a potential future.

Good luck.