Women, Sex and Alcoholism

An article about women’s sexuality and alcoholism recovery

Peggy was to be discharged from alcoholism treatment in one week. Both she and her counselor were concerned about her return home because of her escalating fears of her husband’s sexual expectations. When Peggy was drinking she and her husband, Larry, were sexually active. Now she found that she did not want to be touched when Larry visited her. Even though she had never enjoyed sex, alcohol had allowed her to endure contact and even feign excitement. Without the anesthetic effects of alcohol, feelings about sex and intimacy were beginning to surface that she had ignored for years. At the same time, Larry was feeling hurt and angry about her negative reactions to his expressions of affection. He had expected improved sexual contact to accompany her sobriety and was now beginning to question Peggy’s decision to quit drinking. Would it mean that he would be deprived of sex? Peggy’s sobriety would be threatened if these issues were not addressed during treatment. Fortunately, Peggy’s counselor recognized this dynamic and felt comfortable asking Peggy and Larry about their sexual concerns. At this stage of recovery, they both needed permission to talk as well as information and suggestions to help them deal with their anxiety about sex. Some basic information that was helpful to Peggy and Larry included the following:

Physiological Effects of Alcohol on Female Sexual Functioning

In the early stage of alcoholism, alcohol depresses the control centers of the brain which may increase a woman’s sexual desire and create more ease in initiating sexual experiences. Alcohol also dilates the blood vessels and can enhance one’s sense of sexual well-being, warmth and sexual adequacy. During the middle stage of alcoholism other sexual changes are likely to develop. Sexual desire may diminish due to a decrease in testosterone – an important hormone that mediates sexual desire and functioning. In addition, the woman in the middle stage of alcoholism is likely to notice that she lubricates less, and her capacity to have orgasms is impaired. Women state they can be sexual but that no matter what they do or try, it’s difficult or impossible to reach orgasm.

By the time the woman is in the late stage of alcoholism, major physiological changes may have occurred within her body. She may notice that her menstrual cycle is irregular and unpredictable. If there is severe liver damage, the liver metabolizes less estrogen, which may result in the total cessation of ovulation and menstruation. In addition, the vaginal walls may atrophy or shrink resulting in very little lubrication.

An understanding of other pharmacological factors that may be influencing the woman’s sexual functioning is paramount, since certain medications or polydrug abuse in combination with alcohol abuse can increase or compound sexual difficulties. Narcotics, as well as sedatives, anti-anxiety drugs and antihypertensives all have been reported to have negative effects on sexual response.

Sexual Dysfunctions of the Female Alcoholic

Over time, the physiological effects of alcohol disrupt the sexual response cycle and lead to sexual dysfunctions.  These dysfunctions typically develop throughout the middle and late stages of alcoholism, although in many cases the problems are not apparent until after the alcoholic has stopped drinking and is in recovery. The dysfunctions that are most commonly found in alcoholic women are: inhibited desire, orgasmic dysfunction, dyspareunia, and vaginismus.

Inhibited Sexual Desire. Inhibited sexual desire may be the result of several complex physiological, psychological, and relationship factors. Because of the many physical, social, and interpersonal problems that often accompany the disease of alcoholism, the alcoholic’s sexual desire is vulnerable to a partial or total shut down. A woman may notice her lack of desire only after she is in recovery, since it is at this time that she begins to become aware of her sexual feelings, or lack of such feelings. Desire may be inhibited because the alcoholic is physically and psychologically anesthetized and thus not capable of obtaining any pleasurable stimulation.

Orgasmic Dysfunction. Primary and secondary orgasmic dysfunction may result from lack of information, poor communication with one’s partner, and/or inadequate clitoral stimulation. Alcohol compounds the problem by depressing the central nervous system and disturbing sensory awareness and sexual reflexes, thus inhibiting orgasm.

Dyspareunia. Painful penetration among alcoholic women is often an indirect result of shrinkage of the ovaries. This happens because estrogen production decreases and causes drying and shrinking of the vaginal wall. This can be very painful during intercourse. Dyspareunia may also occur because of decreased or absent lubrication due to inadequate stimulation and arousal.

Vaginismus. Vaginismus is the involuntary spasm of the muscle surrounding the vagina, causing difficult or impossible penetration. Vaginismus is often the result of painful intercourse, painful pelvic exams, sexual abuse, or any traumatic sexual experience.

Psychological Effects of Alcohol on Female Sexual Functioning

Although the pharmacological action of alcohol has adverse physiological effects on sexual functioning, these effects are mediated by other factors, such as the woman’s expectations of what the drug will do, her relationship with her partner, her history, her personality, and her feelings about herself. Women alcoholics tend to experience high levels of guilt, low self-esteem, and general loss of power in their lives. All of these factors psychologically inhibit her from enjoying her sexuality.

The incidence of past sexual abuse among alcoholic women appears to be disproportionately high. Surveys among Minnesota treatment centers report that 4O-50% of the clients have been incest victims. These findings concur with Benward and Denson-Gerber, who found that of 188 female clients in treatment, 44% had been victims of incest. Another study found that 54% of 48 female patients in treatment reported being victims of rape as an adult or child. The effects of sexual abuse on a woman’s adult sexual functioning are often devastating since repressed feelings of anger, fear, guilt and shame may be triggered during sexual contact. Since alcohol helps numb these unpleasant feelings, sober sex often spells emotional turmoil for these women.

In addition, women in recovery profess a dismal lack of knowledge about their bodies. Many fear their first sexual experience while sober especially if they have never had sex without drinking. Responsible sexual decision-making and assertiveness may need to be learned since many of the women have never learned how to set limits or to take control of love-making for their own pleasure. If she is in a relationship, trust and communication have most likely deteriorated, and intimacy needs to be reestablished before mutually satisfying sexual contact can be generated. For many women alcoholics, the alcohol has served to protect them from experiencing feelings of guilt, shame, remorse and self-hatred. She needs to understand her feelings and learn to take time to work them through and change old patterns of behavior.

Role of the Counselor

The counselor’s and client’s attitudes about sexuality can significantly affect recovery. Lack of information, conflicting value systems, and anxiety or guilt may unwittingly eradicate the best intentions of the counselor in promoting sexual health and recovery. The counselor must also be aware that most clients will not ask direct questions about their sexual concerns. Clients are often subtle and indirect in asking for information, so the counselor must be aware of cues that may indicate a question or problem. Peggy, for instance, had said “I’m not ready to go home and deal with Larry’s anger.” Taking into account Peggy’s initial sexual assessment, her counselor questioned her further and found that she was specifically afraid of Larry’s sexual expectations. Intake information-gathering should include questions that determine if the client is presenting with sexual concerns. Questions that elicit helpful information on client sexual functioning might include:

1. How has your drinking impacted your desire to have sex?
2. It is not unusual for alcohol to cause sexual problems. Do you have any concerns you want to bring up at this time?
3. Do you and your partner feel the same about sex? Do you argue about your differences?

Denial of sexual problems at the initial stage of information-gathering is common for many women. However, having raised the questions early in treatment may well facilitate effective follow-up and intervention later in recovery.

Clients need accurate and honest information about alcoholism and sexuality. Counselors need skills in providing this information so that their clients can develop healthy sexual functioning in recovery.

More specifically, the helping person must have:

• Awareness of how their own and others’ beliefs, attitudes and values affect sexual functioning
• Awareness of their own comfort level and limitations in discussing issues about sexuality
• Knowledge and understanding of healthy sexuality
• Skill in assessing sexual dysfunctions
• Knowledge of referral resources that deal specifically with the sexual concerns of clients

In-service education programs, readings, and sexuality training programs are valuable learning experiences for counselors. Gaining self-awareness, knowledge and comfort in assessing the sexual issues of alcoholic clients in treatment insures a more stable recovery for many. Having learned and talked about the effects of alcohol on sexuality, Peggy and Larry were able to put their sexual situation in perspective. During the years of Peggy’s drinking, their communication and sexual contact were distorted by the alcohol. Although Peggy engaged in sexual activity, she didn’t feel anything. Now that she was in recovery and beginning to feel, Peggy’s negative feelings about sex with Larry were overwhelming to her.

With the help of their counselor, Peggy and Larry decided to postpone sexual activity for the time-being. Larry understood that Peggy’s recovery was not complete simply because she was no longer drinking. He realized that their sexual relationship had been severely damaged by the impact of alcohol. He was willing to readjust his sexual expectations and work with the counselor’s recommendations. Peggy agreed to join a woman’s group to work on her feelings and Larry committed to meeting with his counselor on a weekly basis. They were given the name of a sex therapist whom they agreed they would contact when they both felt ready to work on reestablishing their sexual relationship. In the meantime, they were finding other ways to establish trust and good will without the use of alcohol, a new and exciting change that was the beginning of their sexual recovery.

This article was written by Marilyn McIntyre and Carolyn Livingston and appeared in the Spring issue Alcoholism magazine. Portions of this article also appear in Nancy Fugate Woods, Human Sexuality in Health and Illness, 3rd Edition, C.V. Mosby Co., 1983.