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Pajiba Dirty Talk: Don’t Slow Down, You’re Gonna Crash

By Dr. Pisaster | Pajiba Dirty Talk | April 6, 2011 |

By Dr. Pisaster | Pajiba Dirty Talk | April 6, 2011 |

Last week, as study was published in the International Journal of Sexual Health on the prevalence of postcoital dysphoria (PCD) in women. Postcoital dysphoria is a fancy medical term for feeling depressed, irritable, or anxious after sex, rather than the more usual relief and relaxation, and the fact that somebody came up with a medical term for the problem means it’s hardly unknown. It has not, however, been well studied. This particular study is in a journal that I don’t have access to, so I can’t analyze it in depth, but from the abstract and comments made by one of the authors to the press, it seems that the researchers were working under the hypothesis that women might experience these feelings after sex because of trauma from past abuse.

They interviewed 222 college students about the prevalence of feeling of depression after sex for their full lifetime and for a four-week period. 32% of the subjects reported that they had felt post sex blues at least once in their life and 10% reported having experienced it in the 4 week period. (The blogosphere is of course reporting that a third of all women experience post-sex depression as if it’s a regular thing and not an “oh, yeah, one time that happened,” sort of response.) The experience correlated slightly with past abuse for women who experienced PCD over their lifetimes but not for those who experienced it during the four-week period under study. The researchers do not appear to have looked at other possible factors for the feelings of depression, but they do say it’s the next step.

There are several possible reasons why women may feel this way after sex. Lack of sexual satisfaction is one. Getting all worked up without a payoff is pretty frustrating. Feelings of shame or guilt about sex due to internalized cultural norms could also be a factor, but at least one women interviewed said the feelings of depression after sex were unrelated to her feelings about her partner. The most likely explanation may not actually be purely biological. Thanks to the focus on women in this particular study, PCD is being reported on as if it only occurs in women, but in fact it happens to men too. Dr. Richard Friedman, writing in the New York Times a couple of years ago, described several patients - two men and one woman - who experienced this phenomenon after sex on a regular basis. I can’t tell from the abstract how the researchers of the recent study measured dysphoria, but in the case of the patients Friedman describes, the depression was too intense and long lasting to be due to psychological causes such as guilt about sex. Rather, he theorized that the issue was due to a sort of neurochemical crash. Sex floods your brain and body with all sorts of hormones and neurotransmitters. The sudden absence of these chemicals after sex may, in some people, create a feeling similar to coming down hard after a drug-induced high.

The researchers of the PCD study on women also seem to think that the reason some of their subjects experienced post-sex depression may be due to biological factors rather than psychological ones, since their findings do not support the view of PCD being caused by past sexual abuse. Interestingly, when Dr. Friedman prescribed his patients selective serotonin uptake inhibitors, they felt relief from their symptoms but also experienced sex as less intensely pleasurable. These drugs are known to cause sexual side effects, so the reduced pleasure is expected. The correlation between intensity of sexual pleasure and the post-sex depression indicates that this issue is indeed likely caused by a neurochemical imbalance caused by sexual stimulation.

We tend to think of hormones and neurotransmitters as having a single function - dopamine makes you feel good, adrenaline makes you feel alert. In reality hormone reaction are dependent on the level of hormone present and the interactions of other hormones. Dopamine makes you feel good at moderate levels, for example, but too high a concentration of it and you will start to feel anxious. Sex changes the balance of hormones running through your body, and some people may not return to normal levels quickly enough and instead crash. After sex, dopamine, testosterone levels drop while serotonin (which counterbalances dopamine) and endorphin levels rise. The effectiveness in serotonin inhibitors on Friedman’s patients implies that their dopamine levels are dropping and serotonin levels are rising too fast post-sex.

In the vast majority of people, the period just after sex (known in clinical terms as the resolution phase) is wonderful. Your blood pressure drops and your muscles relax, and you generally have an overall sense of wellbeing. For some people, however, this period is miserable. Fortunately in cases where these symptoms are extreme, treatment does seem to be possible.

Dr. Pisaster has a doctorate in biophysics, not actually anything sexy. She does however enjoy having sex, reading about sex, and talking about sex. Especially when she’s had a little whiskey.