By Liah Greenfeld

The July issue of Vogue magazine carries an article on a significant change occurring in the sex-lives of American women. Many of them, the article claims, must now choose between good mood and good sex, and, in some cases, between having a life and having sex altogether. Many, obviously, choose life. Some of the husbands, as one may well expect, object. Such choice must be made because more and more women (over 20 percent at present, the article points out) are suffering from depression severe enough to seek help; they are medicated; and practically all effective anti-depressants have serious sexual side-effects–they destroy libido. Fully one-third of this over-20-percent of sexually active American women on antidepressants are deprived of sexual pleasures as a result. One thinks with sympathy about American men too, who also often suffer from depression, take medications, and suffer from similar side-effects. Since the 20 percent or so of depressed women do not completely overlap with the 20 percent or so of depressed men, it stands to reason that more than one-third of 20 percent in each group are deprived of sex and its pleasures as a result of medication. Add to this that untreated depression does not encourage sexual activity either, because it discourages any activity, and that it prevents enjoying sex, because it makes any enjoyment impossible, and we end with a pretty large group of people, women and men, who are, we may say, sexually disabled. Of course, they suffer from this disability.

This is a problem and it raises some questions. There are the usual ones, often asked, about depression and medication. For instance: how much of the depression that is reported is, in fact, the attack of a real disease–i.e., a condition independent of circumstances of which the patient may be aware and the attitude to which he or she may, therefore, to some extent control, instead of seeking professional help and expose oneself to the dangerous effects of medication? Perhaps, if we understood depression better and did not confuse it with generic bad mood, fewer people would suffer as much from situational, exogenous, and by definition temporary conditions, because, at the very least, they would not be as frightened of them as they are now. Another common question is: to which extent does medication, such as Prozac, Paxil, and so on, help, instead of just substituting one problem for another? To which extent it helps in the case of real, independent of obvious circumstances, depression, and can their side-effects be justified at all when they are prescribed–as they are very often–for dealing with such obvious circumstances. But today I want to raise a different and unusual question, specifically related to women’s sex lives: is it possible, just possible, that women, who are already feeling pretty bad (being truly depressed, oppressed by bad situations, and medicated) suffer in addition from the sexual side-effects of antidepressants not because usually without antidepressants they enjoy sex, but because they were taught to regard exciting sex as natural and, being depressed, they cannot motivate themselves to engage in sexual activity, which is naturally unexciting for them and becomes positively revolting because of their condition and/or medication?

This question may seem strange to the readers of this blog, but this strangeness to a large degree is explained by the nature of the audience, rather than the nature of the question itself. Women in numerous societies around the globe today, and American women as recently as a hundred years ago would not enjoy sex as a rule and, therefore, won’t suffer from this lack of enjoyment and/or consider this a good reason for refusing to engage in sexual activity. For these billions of women sex has been a duty, a kind of work on which their livelihood at least in part has depended, as it has also depended on housework and on bearing and raising children. Some of these women have obviously enjoyed some aspects of their work: sex or cooking or mothering. Fewer, I presume, enjoyed child-bearing than sex, but, on the whole – and for this we have loads of historical evidence – sex has not been the favorite activity for many. Most women would consider it a drudgery and would much prefer baking, making clothes, or reading to their children. For many it was a necessary evil, physically uncomfortable if not painful. In the 19^th century, particularly loving and enlightened husbands, at least in Britain, would avoid consummation of marriage to spare their beloved wives this discomfort and the associated pain and danger of childbirth. Such husbands were very few, of course. More common were those, like Dickens, who turned a blind eye to the suffering they caused the girls they married while they were still fresh and irresistible, and when–after basically constant pregnancy over ten years–by their late twenties or early thirties they were no longer fresh and enticing, interpreted this suffering as deserved and not worth their sympathy, for a woman, once touched by sex, was fundamentally corrupted, a burden rather than companion for a man and the very opposite of the pure, virginal maiden. The great majority would give the matter no thought and accept sex–its enjoyment by men and the lack of enthusiasm for it among women–as a part of life. They certainly would not expect women in their lives to take pleasure in sex. I remember talking to a woman born in the early 20^th century and married in the mid-1920s, before Freud had culturally conditioned us to see ourselves as men’s equals in our sexual appetites. She was recently widowed after 45 years of a good close marriage and three children, felt her loss acutely, and held the memory of her late husband very dear. But, when sex was mentioned, she shuddered in visible and genuine disgust and in response would spit out hardly audible, as if suffocated “Ah, that awful thing?!”

For the generations after hers things changed. Enjoyment of sex is considered natural. We have worked on our enjoyment skills, learned to enjoy it. If we don’t enjoy sex, we feel embarrassed, guilty, afraid that something is wrong with us, and, at the same time, we feel it is our right to refuse sex, if it gives us no physical pleasure we now expect. All this is good, clearly. But, perhaps, understanding that this state of our sexual affairs is historically recent and that it is, to a large degree, a result of cultural conditioning could save us from adding another reason for feeling bad about ourselves when we already feeling very bad and help us to be more in control over our emotions in this one important respect, when depression deprives us of control over so much in our lives.

Food for thought, as they say.

[Originally published on Psychology Today]