Despite some alcoholic women‘s beliefs about the positive effects of alcohol consumption on female sexual functioning, there is a “dark side” of the effects of alcohol on women‘s sexual and reproductive functioning. Alcoholic women are often characterized as having sexual problems including “frigidity,” anorgasmia, dyspareunia, and vaginismus. Most of the evidence supporting this view has been gleaned from clinical studies that lack adequate controls. There are, however, a number of studies involving nonalcoholic or other psychiatric control groups. For the most part, the present analysis only touches on the earlier clinical studies that lack control groups, focusing instead on the control group and recent national survey results.
Types of female sexual dysfunction include low sexual desire, difficulties in sexual arousal, primary organismic disorder, secondary organismic disorder, vaginismus (contractions of the vagina that interfere with intercourse and can make it impossible to achieve intercourse), and dyspareunia (painful intercourse). Clinical studies suggest that lack of sexual interest and sexual inhibition in alcoholic women ranges between 23 and 100%. Rates of primary and secondary organismic dysfunction combined range from about 15 to 64%. Most studies do not report rates of vaginismus or dyspareunia separately nor do they report on difficulties in sexual arousal distinct from organ-ismic dysfunction. Two exceptions are Hammond et al. and Murphy et al. Hammond et al. reported that 12% of their sample of 4.4 alcoholic outpatients reported vaginismus on 50% or more of sexual encounters and 7% reported dyspareunia 95% or more of the time. Murphy et al. found that only 2% of their sample reported vaginismus on 50% or more of sexual occasions and 6% reported dyspareunia on 50% or more of occasions. These rates are considerably below rates of problems of sexual desire (23% and 30%, respectively) and primary or secondary organismic dysfunction (54% and 28%, respectively).
Although rates of sexual problems and sexual dysfunction of alcoholics in treatment appear to be higher than for the general population, the socio-demographic characteristics of alcoholic women in treatment do not mirror those of the general population. Therefore, studies that have included control groups of demographically similar nonalcoholic women are particularly important when trying to establish an association between alcohol use and sexual dysfunction. Pinhas compared 34 alcohol and 34 nonalcoholic women matched on age, ethnicity, education, socioeconomic status, marital status, and religious preference. Using a standardized questionnaire she found that alcoholic women reported more guilt surrounding sexual behaviors and sexuality than did the nonalcoholic women. In a second study, 35 middle-class white alcoholic women were compared with 35 white nonalcoholic women matched on age, education, marital status, and religious preference. Over 85% of the alcoholic women reported that they had experienced at least one type of sexual dysfunction while they were drinking, while 59% of the control group women reported any sexual dysfunction. As in other studies the most common sexual problems were lack of sexual interest, lack of sexual arousal or pleasure, and difficulty in reaching an orgasm.
A final control group study compared 55 women alcoholics and a control group of 54 nonalcoholics that were selected using a snowball technique and matched on age, marital status, number of children, social class, and education. Their standardized questionnaire was based on Helen Singer Kaplan‘s theory of disorders of sexual desire. They found that alcoholic women were more likely to have negative attitudes toward sexuality (one of their indices of a sexual desire disorder) including severe feelings of depression linked to sexuality and a decrease in sexual desire over time. Alcoholic women also were more likely to evidence antecedents of sexual desire disorders, hypothesized by Kaplan: prematurely turning off sexual feelings with inhibiting thoughts and avoiding intimate situations that may involve sex; greater difficulty in communication with one‘s partner about sexuality; greater hostility toward and from partner; and more fear of physical contact and sexual anxiety. Differences between the two groups in the expected effects of alcohol on sexual enhancement, sexual relaxation, and alcohol as a substitute for sexual satisfaction support the conclusion that alcoholic women appear more likely to self-medicate by using alcohol in the face of sexual problems.
One major issue not answered by these studies is the causal relationship between alcohol consumption and sexual dysfunction. It frequently is assumed that excessive alcohol use precedes development of female sexual dysfunction; but, as suggested above, sexual difficulties may also precede and cause alcohol abuse. Two small clinical studies have provided information on the retrospectively reported temporal relationship between alcohol use and sexual dysfunction. Both report that a large percentage of women experienced sexual dysfunction preceding their problem drinking and reported sexual dysfunction increases after problem drinking begins.
The Wilsnack et al. 5-year follow-up of the 1981 national survey of women‘s drinking provides important data on the temporal interrelationship between drinking practices and sexual dysfunction. Interviews were conducted with two groups of women who had participated in the 1981 survey: 143 identified as problem drinkers and 157 nonproblem drinkers. Among women who were problem drinkers in 1981 the best predictor of chronic problem drinking in 1986 was level of sexual dysfunction (defined as lack of sexual interest, vaginismus, primary or secondary organismic disorder) reported in 1981. This effect was upheld when age was controlled and other demographic, personality, social–environmental, and life history event were entered into the multiple regression equation. In contrast, sexual dysfunction in 1981 did not predict the onset of alcohol problems among women in the nonproblem drinker group by 1986. These findings suggest that women problem drinkers use alcohol to cope with sexual dysfunction, but retrospective reports that sexual dysfunction precedes problem drinking are not supported. Of course, 5 years is a relatively short time period for problem drinking to develop and may not be sufficient to evaluate this relationship. It is noteworthy, however, that in the 1981 survey there was little relationship between level of alcohol consumption and sexual dysfunction; a curvilinear relationship suggested that moderate drinking may have a facilitating effect on sexual functioning. There remains a need for prospective, longitudinal research that examines the relationships between women‘s heavy and problem drinking and types of sexual dysfunction.
Selections from the book: “Recent Developments in Alcoholism. Volume 12: Alcoholism and Women.” Edited by Marc Galanter. An Official Publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism. 1995.