2
010年6月，美国食品药品监督管理局(Food and Drug Administration)的一个评审委员会否决了德国一家制药企业建议对缺少性欲(libido)的女性实施药物治疗的申请，这个事件被认为是推广 “女性伟哥”药物(female Viagra)的最新挫败。
Bernard Maisner
与一般认识相背离的是，“伟哥”(Viagra)这类治疗勃起功能障碍(ED)的药物也不能解决男性的性欲问题。通过增加阴茎血流，ED药物也许有助于激发勃起或延长勃起时间，但它们无法从根本上让人产生性欲，不能引发波士顿泌尿科临床医生摩根泰勒(Abraham Morgentaler)所谓的那种“性饥渴”。
从理论上说，性欲意味着需要性爱的冲动、本能或精神能量。从荷尔蒙分泌减少和养育孩子，到工作晋升或失业，所有的一切都可能会抑制的性欲水平。专家们正在研究“性渴望”(desire)与“性冲动”(arousal)之间的区别，无论是在男性还是女性身上。
“性爱本身以及人们对性爱的感觉，这两者之间的关系比我们想象的更为错综复杂。”印第安纳大学(Indiana University)金赛性、性别与生殖研究所(Kinsey Institute for Research in Sex, Gender and Reproduction)研究员詹森(Erick Janssen)说，“一般来说，你感觉有性欲时，身体不一定会出现冲动迹象；同样，你的身体出现冲动时，心里不一定会有性欲。”不过，专家已经建议在《精神疾病诊断与统计手册》(Diagnostic and Statistical Manual of Mental Disorders)这本精神病学指导书籍的下一个修订版中，将女性的性冷淡（医学上称之为“性欲低下失调症”）与难以被挑起性冲动的现象合并为同一种失调症。男性的这类症状也可能同样会在手册中做出类似的修订。
在性生活频率方面，很多人就想问一个问题：多少天一次算正常？但这是个很难回答的问题。研究发现，美国夫妻平均每周有一次性生活，但个体差异很大，部分原因跟年龄有关。乔治亚州立大学(Georgia State University)的社会学家多奈利(Denise Donnelly)称，有高达15%的美国夫妻在过去半年到一年内都没有过性生活。此外，同性恋夫妻的性生活频率也差异巨大。
“所谓的正常有很多种形态，关键问题在于，你自己觉得多久一次属于正常？”耶鲁医学院(Yale School of Medicine)妇产科临床教授米金(Mary Jane Minkin)提出自己的主张，“只有当你和你的另一半出现隔阂时，性生活频率才成为一个问题。如果两个人能够和谐共处，那么无论多久一次都可以。”
这是一个很虚无缥渺的“如果”。芝加哥大学(University of Chicago)从1992年就开始一项研究，并经常被广为引用。研究发现，约15%的美国男性以及30%的美国女性至少在以往一段时间内缺乏对性的兴趣。在两人相处的过程中，如果一方的性趣起初更高一些或消退得更快一些，不好的情绪就会接踵而至。
要想解决这一问题，首先要做的（往往也是最难做到的）就是开诚布公的沟通。“性欲降低会引发各种问题，从‘你太让我生气了，但我就是说不出来’到‘我整天带孩子，都累死了’等等，不一而足，” 多奈利博士说。
“如果一个女人说‘我很爱你，但真的没有想做爱的感觉，’那就应该去看医生，”米金博士说。这种情况同样适用于男性。
心脏病、高血压和其他健康问题会降低人们对性生活的渴望。抗组胺（antihistamine）药品和β受体阻滞药品（beta-blocker）会降低人体的性欲，选择性血清再吸收抑制剂（selective serotonin reuptake inhibitor）的一种常见副作用就是降低性欲，比如治疗精神抑郁的药物百忧解(Prozac)等。
年龄增长也会降低人的性欲。无论男性还是女性，荷尔蒙水平都会随着年龄增长而自然降低，而这往往伴随着对性生活需求的减少。对处于绝经期以及围绝经期（perimenopausal，指妇女从40岁左右开始至停经后12个月内的时期）的女性来说，雌性激素的减少可能导致阴道干涩，让性交过程变得痛苦，米金博士说道。在这种情况下，她推荐使用局部润滑剂。“只有疯子才会去尝试痛苦的性交。” 米金说。如果这样也不奏效，她建议服用雌性激素或睾丸素药物，或者两者同时服用。
很多女性并不清楚的是，一些口服避孕药（特别是那些通过降低睾丸素来减少粉刺痤疮的药物）也会降低人体内的性欲。
男性体内性欲降低的情况也很复杂。许多男人分不清对性生活的抽象渴望和性生活本身有什么区别。“一个男人会说：‘我很喜欢做爱，我妻子很漂亮，性生活对我来说很重要。’但这并不是性欲，”波士顿男性健康中心(Men's Health Boston)的负责人摩根塔勒尔医生(Dr. Morgentaler)说。这家机构专门解决男女性生活和不孕不育问题。
低睾丸素是男性性欲的头号杀手，摩根塔勒尔医生说，45岁以上的男性有三分之一存在因睾丸素过低导致性欲低下和勃起障碍的情况。
真正的性欲杀手可能在于双方的关系。“女性有时候会自以为已经失去吸引力，或者长得太胖了，但实际情况通常并非如此，” 摩根塔勒尔医生说，“如果我只能给来我诊所的女性一个建议，那就是：‘给自己的男人至少一点空间，别总是埋怨他这也不是那也不对。’男人需要有自信，才能更性感。”
“如果听由丈夫来做各种决定，女性的性欲也会降低，” 多奈利博士说，“她们会在心里说：‘嗯，我什么都听你的，但至少在拒绝做爱这件事情上我还能做点主。’”
康涅狄格州纽黑文(New Haven)的性治疗专家古德伯格(Carole Goldberg)说，最常见的导致性欲降低的非医学原因在于压力、疲劳和缺少时间。“我认识一些夫妻，他们忙得必须拿出日程表说：‘这个周六的6点钟我们做爱行吗？’”
一方对性的需求往往比另一方更强烈一些，而性趣稍低的那方通常来说更占据一种优势，多奈利博士说。她对“非自愿独身关系”(involuntarily celibate)婚姻进行过研究，认为这种现象要比人们想象的更为普遍。很多接受调查的夫妻说：“我爱自己的另一半，我们在各方面都相处得非常好，除了性生活。”然而，性需求的不平衡往往会导致双方关系的变数。“总有一方忍不住会想，到底性生活出了什么问题，从而导致一些不稳定因素的产生。” 多奈利博士说道。
这也许又是个先有鸡还是先有蛋的问题。专家强调，高质量的性生活并不要求外界环境的完美以及对方的完美。“有些人一无所有，但还是能过很棒的性生活，” 摩根塔勒尔医生说，“真正的关键在于，要对你的另一半敞开心扉。”
Melinda Beck
从理论上说，性欲意味着需要性爱的冲动、本能或精神能量。从荷尔蒙分泌减少和养育孩子，到工作晋升或失业，所有的一切都可能会抑制的性欲水平。专家们正在研究“性渴望”(desire)与“性冲动”(arousal)之间的区别，无论是在男性还是女性身上。
“性爱本身以及人们对性爱的感觉，这两者之间的关系比我们想象的更为错综复杂。”印第安纳大学(Indiana University)金赛性、性别与生殖研究所(Kinsey Institute for Research in Sex, Gender and Reproduction)研究员詹森(Erick Janssen)说，“一般来说，你感觉有性欲时，身体不一定会出现冲动迹象；同样，你的身体出现冲动时，心里不一定会有性欲。”不过，专家已经建议在《精神疾病诊断与统计手册》(Diagnostic and Statistical Manual of Mental Disorders)这本精神病学指导书籍的下一个修订版中，将女性的性冷淡（医学上称之为“性欲低下失调症”）与难以被挑起性冲动的现象合并为同一种失调症。男性的这类症状也可能同样会在手册中做出类似的修订。
在性生活频率方面，很多人就想问一个问题：多少天一次算正常？但这是个很难回答的问题。研究发现，美国夫妻平均每周有一次性生活，但个体差异很大，部分原因跟年龄有关。乔治亚州立大学(Georgia State University)的社会学家多奈利(Denise Donnelly)称，有高达15%的美国夫妻在过去半年到一年内都没有过性生活。此外，同性恋夫妻的性生活频率也差异巨大。
“所谓的正常有很多种形态，关键问题在于，你自己觉得多久一次属于正常？”耶鲁医学院(Yale School of Medicine)妇产科临床教授米金(Mary Jane Minkin)提出自己的主张，“只有当你和你的另一半出现隔阂时，性生活频率才成为一个问题。如果两个人能够和谐共处，那么无论多久一次都可以。”
这是一个很虚无缥渺的“如果”。芝加哥大学(University of Chicago)从1992年就开始一项研究，并经常被广为引用。研究发现，约15%的美国男性以及30%的美国女性至少在以往一段时间内缺乏对性的兴趣。在两人相处的过程中，如果一方的性趣起初更高一些或消退得更快一些，不好的情绪就会接踵而至。
要想解决这一问题，首先要做的（往往也是最难做到的）就是开诚布公的沟通。“性欲降低会引发各种问题，从‘你太让我生气了，但我就是说不出来’到‘我整天带孩子，都累死了’等等，不一而足，” 多奈利博士说。
“如果一个女人说‘我很爱你，但真的没有想做爱的感觉，’那就应该去看医生，”米金博士说。这种情况同样适用于男性。
心脏病、高血压和其他健康问题会降低人们对性生活的渴望。抗组胺（antihistamine）药品和β受体阻滞药品（beta-blocker）会降低人体的性欲，选择性血清再吸收抑制剂（selective serotonin reuptake inhibitor）的一种常见副作用就是降低性欲，比如治疗精神抑郁的药物百忧解(Prozac)等。
年龄增长也会降低人的性欲。无论男性还是女性，荷尔蒙水平都会随着年龄增长而自然降低，而这往往伴随着对性生活需求的减少。对处于绝经期以及围绝经期（perimenopausal，指妇女从40岁左右开始至停经后12个月内的时期）的女性来说，雌性激素的减少可能导致阴道干涩，让性交过程变得痛苦，米金博士说道。在这种情况下，她推荐使用局部润滑剂。“只有疯子才会去尝试痛苦的性交。” 米金说。如果这样也不奏效，她建议服用雌性激素或睾丸素药物，或者两者同时服用。
很多女性并不清楚的是，一些口服避孕药（特别是那些通过降低睾丸素来减少粉刺痤疮的药物）也会降低人体内的性欲。
男性体内性欲降低的情况也很复杂。许多男人分不清对性生活的抽象渴望和性生活本身有什么区别。“一个男人会说：‘我很喜欢做爱，我妻子很漂亮，性生活对我来说很重要。’但这并不是性欲，”波士顿男性健康中心(Men's Health Boston)的负责人摩根塔勒尔医生(Dr. Morgentaler)说。这家机构专门解决男女性生活和不孕不育问题。
低睾丸素是男性性欲的头号杀手，摩根塔勒尔医生说，45岁以上的男性有三分之一存在因睾丸素过低导致性欲低下和勃起障碍的情况。
真正的性欲杀手可能在于双方的关系。“女性有时候会自以为已经失去吸引力，或者长得太胖了，但实际情况通常并非如此，” 摩根塔勒尔医生说，“如果我只能给来我诊所的女性一个建议，那就是：‘给自己的男人至少一点空间，别总是埋怨他这也不是那也不对。’男人需要有自信，才能更性感。”
“如果听由丈夫来做各种决定，女性的性欲也会降低，” 多奈利博士说，“她们会在心里说：‘嗯，我什么都听你的，但至少在拒绝做爱这件事情上我还能做点主。’”
康涅狄格州纽黑文(New Haven)的性治疗专家古德伯格(Carole Goldberg)说，最常见的导致性欲降低的非医学原因在于压力、疲劳和缺少时间。“我认识一些夫妻，他们忙得必须拿出日程表说：‘这个周六的6点钟我们做爱行吗？’”
一方对性的需求往往比另一方更强烈一些，而性趣稍低的那方通常来说更占据一种优势，多奈利博士说。她对“非自愿独身关系”(involuntarily celibate)婚姻进行过研究，认为这种现象要比人们想象的更为普遍。很多接受调查的夫妻说：“我爱自己的另一半，我们在各方面都相处得非常好，除了性生活。”然而，性需求的不平衡往往会导致双方关系的变数。“总有一方忍不住会想，到底性生活出了什么问题，从而导致一些不稳定因素的产生。” 多奈利博士说道。
这也许又是个先有鸡还是先有蛋的问题。专家强调，高质量的性生活并不要求外界环境的完美以及对方的完美。“有些人一无所有，但还是能过很棒的性生活，” 摩根塔勒尔医生说，“真正的关键在于，要对你的另一半敞开心扉。”
Melinda Beck
When a Food and Drug Administration panel last month recommended against approving a proposed treatment for low libido in women from a German pharmaceutical company, it was billed as the latest setback for a 'female Viagra.'
But contrary to popular belief, erectile-dysfunction drugs like Viagra don't fix male libido problems, either. By enhancing blood flow, ED medications may help create or maintain an erection, but they don't provide the desire for one in the first place. They don't deliver what Boston urologist Abraham Morgentaler calls 'the hunger for sex -- that grrrr.'
Libido technically means the urge, instinct or psychic energy to have sex, and everything from falling hormones and child rearing to rising responsibilities and job loss can dampen it. Experts are pondering the distinction, in both men and women, between 'desire' and 'arousal.'
'The relationship between what happens in the genitals and how people feel about it is more complex than we realized,' says Erick Janssen, research scientist at the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University, in Bloomington. 'You can, in principle, feel desire without necessarily showing any signs of physical arousal, and you can have signs of physical arousal without feeling desire.' Yet, proposed changes for the next edition of the Diagnostic and Statistical Manual of Mental Disorders, a psychiatric handbook, would combine a lack of interest in sex in women ('hypoactive sexual desire disorder') and difficulty being aroused into a single disorder. A similar change may be proposed for men.
As for sexual frequency, many people simply want to know: What's normal? But that's a trick question. Studies have found that American married couples on average have sex about once a week, but there's a vast range, depending in part on age. As many as 15% of married couples haven't had sex in the past six months to a year, says Denise Donnelly, a sociologist at Georgia State University. Wide variation exists among same-sex couples too.
'There are all different kinds of normal -- the key thing is, what's normal for you?' says Mary Jane Minkin, clinical professor of obstetrics and gynecology at Yale School of Medicine. 'There's really only a problem when there's an asymmetry' between you and your partner, she contends. 'If it's peaceful coexistence, it's fine.'
That's a big 'if,' though. An oft-quoted University of Chicago study from 1992 found that some 15% of men -- and 30% of women -- nationally reported a lack of interest in sex for at least some part of the previous year. In a relationship, when one partner's interest starts out higher or wanes faster than the other's, hard feelings can ensue.
The first step -- and often the hardest -- is honest communication. 'Low libido can be a proxy for all sorts of other things, from 'I'm really angry at you and can't tell you' to 'I took care of the kids all day and I'm exhausted,' ' Dr. Donnelly says.
'If the woman says, 'I love you, but I really don't have any libido,' look for medical issues,' Dr. Minkin says. The same applies to men.
Heart disease, high blood pressure and other health problems can put the kibosh on desire. Medications from antihistamines to beta-blockers also can lower libido. Reduced sex drive is a common side effect of selective serotonin reuptake inhibitors, such as Prozac.
Getting older can dampen sexual appetite. In men and women, hormone levels drop naturally with age, often taking desire with them. In menopausal and perimenopausal women, falling estrogen levels can lead to vaginal dryness and make intercourse painful, Dr. Minkin says. In such cases, she recommends a topical lubricant. 'Only a crazy person would have sex if it hurts,' she says. If that doesn't work, she may suggest estrogen or testosterone replacement or both.
And many women aren't aware that some birth control pills -- especially those that help reduce acne by lowering testosterone levels -- also can lower libido.
Low libido in men is complicated too. Many men don't separate the desire for a sex life in the abstract from the desire for sex. 'A man may say, 'I want to have sex very much. I've got a beautiful wife. It's important to me.' That's not what libido is,' says Dr. Morgentaler, director of Men's Health Boston, which specializes in sexual and reproductive problems.
Low testosterone is the No. 1 killer of male libido, he maintains, and as many as a third of men age 45 and older have testosterone levels low enough to diminish desire and interfere with erections.
The real libido killer may be the partners' relationship. 'Women sometimes assume they're no longer attractive, or they've gained weight. But that's usually not it,' says Dr. Morgentaler. 'If there was one thing I could say to every female partner of the guys I see in my office, it's this: 'Let the man be the man in at least one area of the relationship, instead of always telling him what he's doing wrong.' ' He adds, 'Men need to feel powerful to feel sexy.'
'Exactly the same thing happens with women whose husbands make every decision,' counters Dr. Donnelly. 'They're thinking, 'Hmm, sex is the one thing I can withhold.''
Carole Goldberg, a certified New Haven, Conn., sex therapist says the most common nonmedical problems she sees are stress, fatigue and lack of time. 'I have couples who get out their day planners and say, 'How about Saturday at 6 o'clock?''
One partner may simply want sex more often than the other. The one who wants sex less usually has the upper hand, notes Dr. Donnelly. She has studied 'involuntarily celibate' marriages and thinks they are more common than generally believed. Many couples she studied said, 'I love my partner. This is a perfect relationship in every way except sex.' But uneven sexual appetites often make for unstable relationships. 'One partner is always wondering what's wrong with them, and that makes them very ripe for the picking.,' she says.
But maybe the problem is just the cat or the lumpy mattress. Conditions, and partners, need not be perfect, experts stress. 'People can have absolutely nothing in life and still have a great sexual relationship,' Dr. Morgentaler says. 'The key is being really generous to your partner.'
Melinda Beck
But contrary to popular belief, erectile-dysfunction drugs like Viagra don't fix male libido problems, either. By enhancing blood flow, ED medications may help create or maintain an erection, but they don't provide the desire for one in the first place. They don't deliver what Boston urologist Abraham Morgentaler calls 'the hunger for sex -- that grrrr.'
Libido technically means the urge, instinct or psychic energy to have sex, and everything from falling hormones and child rearing to rising responsibilities and job loss can dampen it. Experts are pondering the distinction, in both men and women, between 'desire' and 'arousal.'
'The relationship between what happens in the genitals and how people feel about it is more complex than we realized,' says Erick Janssen, research scientist at the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University, in Bloomington. 'You can, in principle, feel desire without necessarily showing any signs of physical arousal, and you can have signs of physical arousal without feeling desire.' Yet, proposed changes for the next edition of the Diagnostic and Statistical Manual of Mental Disorders, a psychiatric handbook, would combine a lack of interest in sex in women ('hypoactive sexual desire disorder') and difficulty being aroused into a single disorder. A similar change may be proposed for men.
As for sexual frequency, many people simply want to know: What's normal? But that's a trick question. Studies have found that American married couples on average have sex about once a week, but there's a vast range, depending in part on age. As many as 15% of married couples haven't had sex in the past six months to a year, says Denise Donnelly, a sociologist at Georgia State University. Wide variation exists among same-sex couples too.
'There are all different kinds of normal -- the key thing is, what's normal for you?' says Mary Jane Minkin, clinical professor of obstetrics and gynecology at Yale School of Medicine. 'There's really only a problem when there's an asymmetry' between you and your partner, she contends. 'If it's peaceful coexistence, it's fine.'
That's a big 'if,' though. An oft-quoted University of Chicago study from 1992 found that some 15% of men -- and 30% of women -- nationally reported a lack of interest in sex for at least some part of the previous year. In a relationship, when one partner's interest starts out higher or wanes faster than the other's, hard feelings can ensue.
The first step -- and often the hardest -- is honest communication. 'Low libido can be a proxy for all sorts of other things, from 'I'm really angry at you and can't tell you' to 'I took care of the kids all day and I'm exhausted,' ' Dr. Donnelly says.
'If the woman says, 'I love you, but I really don't have any libido,' look for medical issues,' Dr. Minkin says. The same applies to men.
Heart disease, high blood pressure and other health problems can put the kibosh on desire. Medications from antihistamines to beta-blockers also can lower libido. Reduced sex drive is a common side effect of selective serotonin reuptake inhibitors, such as Prozac.
Getting older can dampen sexual appetite. In men and women, hormone levels drop naturally with age, often taking desire with them. In menopausal and perimenopausal women, falling estrogen levels can lead to vaginal dryness and make intercourse painful, Dr. Minkin says. In such cases, she recommends a topical lubricant. 'Only a crazy person would have sex if it hurts,' she says. If that doesn't work, she may suggest estrogen or testosterone replacement or both.
And many women aren't aware that some birth control pills -- especially those that help reduce acne by lowering testosterone levels -- also can lower libido.
Low libido in men is complicated too. Many men don't separate the desire for a sex life in the abstract from the desire for sex. 'A man may say, 'I want to have sex very much. I've got a beautiful wife. It's important to me.' That's not what libido is,' says Dr. Morgentaler, director of Men's Health Boston, which specializes in sexual and reproductive problems.
Low testosterone is the No. 1 killer of male libido, he maintains, and as many as a third of men age 45 and older have testosterone levels low enough to diminish desire and interfere with erections.
The real libido killer may be the partners' relationship. 'Women sometimes assume they're no longer attractive, or they've gained weight. But that's usually not it,' says Dr. Morgentaler. 'If there was one thing I could say to every female partner of the guys I see in my office, it's this: 'Let the man be the man in at least one area of the relationship, instead of always telling him what he's doing wrong.' ' He adds, 'Men need to feel powerful to feel sexy.'
'Exactly the same thing happens with women whose husbands make every decision,' counters Dr. Donnelly. 'They're thinking, 'Hmm, sex is the one thing I can withhold.''
Carole Goldberg, a certified New Haven, Conn., sex therapist says the most common nonmedical problems she sees are stress, fatigue and lack of time. 'I have couples who get out their day planners and say, 'How about Saturday at 6 o'clock?''
One partner may simply want sex more often than the other. The one who wants sex less usually has the upper hand, notes Dr. Donnelly. She has studied 'involuntarily celibate' marriages and thinks they are more common than generally believed. Many couples she studied said, 'I love my partner. This is a perfect relationship in every way except sex.' But uneven sexual appetites often make for unstable relationships. 'One partner is always wondering what's wrong with them, and that makes them very ripe for the picking.,' she says.
But maybe the problem is just the cat or the lumpy mattress. Conditions, and partners, need not be perfect, experts stress. 'People can have absolutely nothing in life and still have a great sexual relationship,' Dr. Morgentaler says. 'The key is being really generous to your partner.'
Melinda Beck
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