Low libido is a common concern for women, maybe especially those with PCOS. Why? Dr. Keesha Ewers has researched the topic extensively and developed a theory of 5 root causes. Women with PCOS will almost certainly relate to many of them including “fighting with your body” and feeling it has betrayed you, but it goes much further. As Dr. Keesha says, “What’s in your head goes to your bed.” Listen in as we discuss:
- PCOS, how it can affect our libidos, and what we can do about it
- The pill and its impact on libido
- Five root causes for low libido
- The biology of stress causing low libido
A full transcript follows.
Amy Medling: Hello and welcome to the PCOS Diva podcast. My name is Amy Medling, and I’m a certified health coach and founder of PCOS Diva. My mission is to help women with PCOS find the tools and knowledge they need to take control of their PCOS so they can regain their fertility, femininity, health and happiness. If you haven’t already, please make sure to check out pcosdiva.com because there I offer tons of great free information about PCOS, and how to develop your PCOS diet and lifestyle plan so you can begin to thrive like a Diva. Look for me on iTunes, Facebook, and Instagram as well. Today I have the honor of talking with Dr. Keesha Ewers about PCOS and how it can affect our libido, and what we can do about it, so welcome to the PCOS Diva podcast, Dr. Keesha.
Dr. Keesha E.: Thank you. I am so glad to be here. Thank you for having me on.
Amy Medling: Well, let me give our listeners just a little bit of your background. You are a board certified Functional and Ayurvedic medical practitioner, as well as a doctor of sexology, family practice ARNP, and that’s an advanced registered nurse practitioner, and a certified psychotherapist, so I think as a doctor of sexology you’re certainly qualified to talk about this subject.
Dr. Keesha E.: Yeah. It’s a fun subject because no one is talking about it, and it needs to be talked about, so I always love opening up this conversation.
Amy Medling: One of the questions I definitely want to address, and maybe we’ll just jump in with this, is the pill and its impact on libido because as you know, so many women with PCOS are given the pill as a therapy, but I think of it as really more of a Band-Aid for PCOS and their PCOS symptoms. I know when I was on the pill, it certainly affected my libido, and it really took me a long time post-pill to get it back, so maybe you can talk about that for those women listening that are on the pill or have been on the pill.
Dr. Keesha E.: This is such a great topic that you’re bringing up. Taking the hormonal birth control pill can really mess with your testosterone levels. Most of the methods that we have releases hormones that stop ovulation, so when you’re using the pill or the ring or the patch or the shot or the implant, and you’re not actually ovulating every month, that’s great because that’s the birth control that you’re looking for, but it’s also messing with your hormones that are in charge of saying, “Oh, I want to have sex,” right? So this is a problem. The other thing that can be affect are your dopamine levels in your brain. Women have to have good, adequate levels of dopamine in order to feel desire.
The birth control pill is actually starting to affect even teenagers. We’re giving to people that are younger and younger, and they’re staying on it for a lot longer than was historically the case, and so now we have a lot of really young women walking around at a time in their lives when libido is supposed to be your natural birthright and part of life on planet earth and human as we know it, and it’s messing with it. You know, I never prescribe the birth control pill. There are other ways to do birth control, so I will usually recommend that you get fitted for a diaphragm or do a non-hormonal IUD, or if you’re finished with childbearing years and you say, “Okay, my family is here and I’m done,” then to have a tubal ligation, have your partner have a vasectomy, and just stop putting that into your body.
Amy Medling: Yeah. Conceivably, women with PCOS could be on the birth control from like age 15 until her early 30s when she’s ready to now get pregnant, and may not even know she has PCOS until coming off of the pill and then might be diagnosed. For someone that has been on the pill for so long, what can be done to reclaim that sense of … even it’s femininity, I think, for a lot of women with PCOS, and that certainly plays a role into feeling desirable. What do you coach your patients, or maybe you can give us some tips?
Dr. Keesha E.: Sure. I’d like to sort of circle back to the beginning of what libido even represents and why it’s so important. The word “desire” is a Latin word that actually means “from the stars” and so the way that I think about desire is, your desire for your whole life from the stars. It’s what’s your life purpose here on the planet. What is it that, I’m going to say use the word God, but your God given birthright and purpose for being here? That passion infuses you to do that. You know, your life work, your life path, whether it’s mothering, coaching, writing, marathon running. What is it? What’s the thing that inspires you? If you don’t have desire for that, then you’re not filled with the amount of vitality that you need to be living your life in the most juicy way that you can.
To me, libido becomes more of kind of a gage, like the gas gage on the dashboard of your car. If it’s low, it’s the same as having nothing left in your tank. If you’re driving a car and there’s nothing left in your tank, you know you have to stop pretty quickly, pull over and go to a filling station and fill up, or you’re going to be broken down on the side of the road. What we do instead of filling up, pulling over and taking care of ourselves with some self-care, we will grab dark chocolate if we’re super attuned and on the healthier track, or a pastry or a Red Bull or a coffee, and try and get our energy levels that way.
What happens is, you do break down on the side of the road, and eventually, because you’re not taking care of your tank, so for me, when I’m taking to a woman, it’s not going to just be about, obviously, the birth control pill when we start talking about level of desire. I’m saying, “If you used to have a good sex drive with your partner and liked having sex with your partner, and you know that this is an intimate connection that has brought your relationship a lot of health and joy … There are so many healthy, amazing aspects that come from having sex. If you know that you’ve been there before and it’s now gone, then we address it from one direction.” If I ask a woman, “When was the last time that you did have a sex drive that you were satisfied with?” This is usually a woman that’s coming in asking me for a bioidentical hormone replacement.
I’ll say, “When was the last time that you did have a sex drive that you wanted,” and if she says, “I never have had one” and starts crying, then I start asking questions like, “Is there a history of abuse? Did you have a fairly stressful childhood, adolescence? Was college tough for you?” Stories will come out as a result of that question that are just heartbreaking. Or, “I’ve been fighting with my weight.” A lot of times people with PCOS have been, and they use that word “fighting,” fighting with their weight, and have been somewhat at odds with their bodies from at least adolescence forward.
When I’m coaching somebody in my office around this, I’m looking at five root causes for low libido. They’re going to be anywhere from physical, like you’re on a medication that’s affecting it because another thing that’ll happen is a lot of women are put on antidepressants. Of course, the number one side effect for that is low libido. Surgeries, birth control pills, illnesses like Hashimoto’s thyroiditis or any other autoimmune disease, or hypothyroidism, all of these will affect libido level because they’re impacting your gas tank. You’re looking under physical, you’re looking in mental places. Is there a body image issue? Are you at war with your body or you’re in a collaborative relationship with your body? Do you feel safe with the opposite sex? Do you feel safe with same sex? What’s going on mentally for you with your beliefs about your sexuality? Those were created in childhood and adolescence, and so those can impact your level of desire. They can be in the emotional arena. Maybe there’s some trauma in the past.
You know, Amy, I say that every single person comes out of childhood with trauma. It’s not necessarily sexual abuse. That’s my history. When I was 10, I was sexually abused by the vice principal of my elementary school, but that’s not everybody … People will hear that and go, “Oh.” You know, that’s a huge trauma. If you had a group of friends on the playground one day and the next day they reject you, that’s trauma too, so it’s part of the process of growing up, is to go through these experiences of rejection that feel terrible, and failing. Failing a test or not being good at something, and taking on this message that “I’m not good enough.” All of these things actually impact your desire for your life.
The fourth root cause will be in the spiritual area. Sometimes people are raised in a religion where desire is a sin from the pulpit, and they hear that over and over and over again. They’re expected to repress all of that, and then get married and all of a sudden be able to turn the faucet on. That’s not really reasonable, right? There’s this kind of angel-whore complex that can happen inside of religions that say sex is bad, sex is a sin unless you do it in these certain paradigms. There’s that piece. There’s also just the cultural story that can occur too. Did you get raised in a sex positive household or a sex negative household? In other words, were you able to talk freely at the dining room table with your family about age appropriate aspects of your sexuality as you were developing? Was that just part of the family conversation or was it hush-hush?
The fifth cause will be in what I call your libido story. That’s, as you were going through your human growth and developmental stages in childhood, what were the meanings that you made up around different sensual, sexual body experiences that you then created beliefs around that you carry forward into adulthood, and get an opportunity reframe if you do it with intention? So it’s a really complex subject for women. Men, we have this whole arousal paradigm that happens.
Masters and Johnson identified it in the 1950s and ’60s in their groundbreaking research. They applied it to men and women, but it’s mostly men that run this way, where there’s desire, then there’s arousal, then there’s an orgasm, and then there’s a refractory rest period. You can see that on a man, right? The penis shows the whole thing, while with a woman it’s really different and we have all kinds of different motivations for engaging intimately with somebody. That could be emotional connection. It could be kind of like cuddles and that closeness. It could be wanting to be ravaged, and that will be one day of the month that you feel that way, and then you’ll feel all cuddle, snuggle the next day of the month. It’s very different for women because our hormonal levels, our context of our lives are so different. Our brains are wired differently than men’s are. That’s why I do this whole program for this because you can see there’s so much here, right?
Amy Medling: Oh, yeah. You hit upon several topics — I was writing them down — that parallel what I’m hearing from women with PCOS. I find this common thread. Certainly fighting with your body, that really resonates. You’re growing hair where you shouldn’t be growing it and you can’t lose … like you said, fighting to lose the weight. The-
Dr. Keesha E.: Acne.
Amy Medling: The hair loss.
Dr. Keesha E.: Yeah.
Amy Medling: All of it. It’s like, “Okay. I have this body that has sort of betrayed me.” Having to shift through a place. It takes a lot of work to do that, to sort of embracing your body and beginning to love it so it will love you back, so to speak. I also find that women who are really struggling with PCOS have lost their connection with creativity, and I think you described it with things that make them feel vital, and trying to rediscover that so you can experience that flow state when you’re doing something that you really love to do. There’s a real disconnection from that for a lot of women, and I can see now how that could really affect your libido, so it was great that you’ve described your five pillars.
Dr. Keesha E.: There’s another component to this and it’s our brains. This was a fascinating thing that came out of my research when I was going through my doctoral work. I did a research study. I called it the HURT Study, which is Healing Unresolved Trauma Study. I asked women, because I was seeing this in my office and there was nothing in the medical literature to reflect what I was seeing in my office. I asked women, “Do hurt’s emotional wounds that somebody comes along and presses on in current day, these things that happened a long time ago, impact your willingness to have sex?” As woman it seemed like, “No, duh. Yeah, of course.” If my partner forgets my birthday, I’m not going to really be in the mood to have sex with him that night, right?
There was nothing in the medical literature that actually talked about this phenomenon, and it’s all focused around hormones or this idea that there’s a pill, the pink Viagra, something that’s going to solve women’s libido by taking it every morning. I was, in my clinical work, saying, “No. Women are so complex. There’s just no way.” As I started delving through the research and looking at PET scans, PET images of brains and different studies that had been done in this arena, I found, as I mapped the brain, that the same parts of the brain that are required for women to have libido are the exact same parts of the brain that are co-opted or lit up when there’s chronic daily stress or PTSD, post-traumatic stress disorder. Same brain injury.
If you feel that you’re overwhelmed day in and day out as if you’ve had a big trauma, like in the Adverse Childhood Experiences Study that was done between 1995 and 1997, 17,000, over 17,000 people were looked at and over two thirds of them reported some form of neglect or abuse that then the researchers tied into, “Oh, this is actually causing some of the chronic illnesses that we see in adulthood.” These are linked. People with more perception of trauma get sicker in adulthood.
What I found is that they also don’t have libido and that made so much sense to me when I started thinking about what libido actually is as a measurement of your vitality. Our brains change if we think we’re stressed. Now, that was huge because you hear this all the time, the Wonder Woman Complex. Women, we have ourselves painted into a corner where we think we have to bring home the bacon, fry it up in a pan, and look hot at the same time. We’re strung out and burned out and over-scheduled, and taking our kids hither and thither and yon, and we hardly breathe.
Of course you’re not going to feel like having sex, right? You got nothing left in the tank. That was a fascinating thing to see. The great news about that is that that brain change that happens on these images, you can actually heal it. That to me is true freedom. “Oh, we have this neuroplasticity in our brains that we can actually heal this if we pull some focused intention on it.” That’s why I did this program. It’s like, “Oh, you can heal every one of these things.” That’s amazing and that’s empowering, and so then that means that just like we’re not a victim of our trauma, we’re not a victim of our genetics, we’re not a victim of our circumstances; we actually have the power if we put attention and consider ourselves important enough to heal.
Amy Medling: Yeah. That just fits in with my whole Diva philosophy that-
Dr. Keesha E.: I know.
Amy Medling: And it’s beautiful. I love this saying that you have, and what you just explained is so true. “What’s in your head goes to your bed.”
Dr. Keesha E.: Yep.
Amy Medling: I think if you think of us all on an evolutionary sort of animal level, that why would we want to procreate if we felt like we were being chased by the tiger, right?
Dr. Keesha E.: Right. It’s not only why would we want to; our bodies say, “You cannot.” If you’re a zebra being chased by a lion and you think you’re going to get eaten, it’s not even about a choice. Your body says, “I can’t keep you alive. I’m not going to reproduce” so every amount of hormone that would go towards desire, which is what’s the precursor of reproduction, goes away. It gets reallocated to your adrenal glands to keep you in survival mode, so you don’t even have a choice, and that’s the thing about running around overwhelmed all the time. Your body believes you’re getting chased by a lion.
Amy Medling: Yeah. As women with PCOS, we have elevated cortisol and adrenal issues. That’s why it’s so essential that we learn to take care of ourselves. I love that you brought that connection to libido. It’s not something that just magically comes back, like you said, with a pink pill.
Dr. Keesha E.: Right.
Amy Medling: For those women that are listening that are really struggling with feeling feminine, how would you coach them?
Dr. Keesha E.: It depends on what feelings feminine means. What do you mean by that?
Amy Medling: I think it goes back to that feeling like your body has betrayed you. You don’t feel like-
Dr. Keesha E.: Okay. Stop with that right there because that’s a huge one and I see it in my office all the time. If you have made up the meaning and have the belief that your body has betrayed you, then your behaviors that result from that belief are going to be, like I said earlier, more combative with your body and not in collaboration with, and you’ll do a lot of self-sabotaging behaviors. If you believe that, that your body has betrayed you, that’s where you heal first. That’s the part that you ask, “Is that really true? Has my body betrayed or is my body just trying to get my attention, and I haven’t been listening? And in fact, I’ve betrayed my body because I’ve tuned out from it and I’ve been doing all this self-sabotaging behavior.” Ask, “Is that really true that my body betrayed me?” Because it’s actually not possible for your body to betray you. Your body gives you feedback and it starts really early with very quiet little tugs on your skirt, like a little toddler who’s trying to get mommy’s attention.
It will be something like a coating on your tongue or constipation or dry hair or acne, it’s like these early signs. If you don’t pay attention and say, “What do you need, body?” … I always say, “Test, don’t guess.” If you don’t go get some testing done that’s actually functional medicine style testing rather than go get your TSH checked, then you won’t know what the body is trying to tell you. That’s the, I think, criminal part of our medical model, is that we’re not taught to listen to our bodies in that way. We’re actually taught to think in terms of betrayal.
Ayurvedic medicine, which is a 10,000 year old model of medicine that’s the sister science of yoga that came out of India all that long ago, actually identified that we’re not all the same way back then, which is sort of revolutionary with the science of genetics today and epigenetics or nutrigenomics. We’re saying, “Oh. We’re not all the same” but they knew this a long time ago and said, “You know, your body is giving you feedback all the time, and if you’re out of balance, all you have to do is do these small corrections, like an airplane that’s going off course. The pilot’s got to get it back on course. It’s just a tiny little correction and then you’re back in balance again.” But we don’t think that way in our model of medicine. We go by match drug to symptom, and we got so far out of balance that our plane is taking a nosedive, and is in crash and burn by the time we pay attention.
That’s part of what I teach, is how to listen to the quiet tiny voices your body is trying to do communicate with you through. Then you’re not in that, “Oh, my body has betrayed me.” You’re in that, “Oh. Body, you’re trying to get my attention. Let me listen to you. Let’s be a team. Let me figure out what you need and give that to you.” Then your body gives back this amazing strength of carrying your spirit around in your life’s path. It’s such a gift and a blessing to have a body, so when you’re in a combative relationship with it, nobody wins.
Amy Medling: Right. No, and it’s so true. Before we run out of time, I’d love for you to talk a little bit more about how we can work with you through your five steps to help us regain our vitality and our libido.
Dr. Keesha E.: Sure. I have this program called the Libido Cure. It’s seven different modules and you do it at your own pace, and you can drop into it at any time. What you get is you join this incredible vital tribe of women that are already taking it. It’s yours forever, so you can keep returning back. You’ll see in the tribe and the private group these women saying, “Okay, I’m going through it again, and this is what I learned this time.” It’s like layer upon layer because this is, you’ve heard, this is all about healing from the inside out from all these different layers of meanings and beliefs you created when you were a kid. You get that amazing support of community and then these seven modules that have videos, a bunch of tracking tools, a lot of material and lecture.
It’s just a really amazing program that goes through each of those five areas I was talking about, in addition to a lot of relationship work. I’m a psychotherapist as well as a medical provider. The number one reason for women to have low libido is actually if they have a dissatisfaction in their relationships. Women get really stressed about that, so there’s that component too, and then healing some of those old beliefs, and like we just talked about with the body betrayal piece, there are many of those, and how to rework them and reframe them and heal them, so it’s really an amazing program.
Amy Medling: It sounds wonderful, and I love that it really makes that mind-body connection, and touches upon all of those facets of being a Diva, so I really highly recommend those listening that are struggling with libido, that you work with an expert. Dr. Keesha has been doing this for a long time and is really, from a functional perspective and a root cause perspective, she’s somebody that I would work with for sure.
Dr. Keesha E.: I’m going to give your group, your tribe, Amy, just because I feel so grateful that you work with people in the way that you do … You’re doing such amazing work. I’ll give you a link that you can use with this podcast for your tribe that will give them a discount.
Amy Medling: Oh, excellent. Yeah, and we will post that right below the podcast recording for everyone that’s listening. Well, thank you so much.
Dr. Keesha E.: Sure. Thanks so much for having me on. I love talking about this and helping women become their own Diva. That’s such a great way of saying it.
Amy Medling: I’m so happy that you joined us. Thank you, everyone, for listening to our podcast today. I hope that you enjoyed it. If you liked the episode, please don’t forget to subscribe to PCOS Diva on iTunes or wherever you might be listening to this show. If you have a minute, please leave me a quick review on iTunes because I love to hear from you. If you think of someone else that might benefit from this free podcast, please take a minute to share it with a family member or a friend so she can benefit from it too. Don’t forget to sign up for my free newsletter. Just enter your email at pcosdiva.com to get instant access, and make sure you never miss a future podcast. This is Amy Medling wishing you good health, and I look forward to being with you again soon. Bye-bye.