why do sex therapists and educators suggest a glass of wine?

In a browse around the internet, I ran into this: Feminists with FSD: the almighty glass of wine. The author – a self-identified feminist who also identifies as having a female sexual dysfunction – is frustrated by sex educators and therapists talking about wine as an alternative to medication.

It’s true that sex educators and therapists talk about having a glass of wine. When I was a clinical intern at the Kinsey Institute Sexual Health Clinic, the notes we gave new clients included a sentence about “have a glass or two of wine if you like,” and there was good reason for that. The sexual response system is governed by a “dual control” mechanism in the central nervous system, a pairing of “brakes” and “gas.” As you know, alcohol is a central nervous system depressant, meaning it slows things down or turns things off in the central nervous system. A small amount of alcohol – a glass or two of wine, for example – turns off the “offs” in the CNS More than that begins to turn off the “ons.”

The result is that many people, whether they’re experiencing sexual dysfunction or not, find that a small amount of alcohol (not enough to take you over the legal limit) helps to turn off the sexual “brakes.” This is “disinhibition” in its technical sense of impairing the parasympathetic nervous system, not in the general sense of shyness. Basically it’s turning down the volume on the noise in your prefrontal cortex.

It helps a lot of folks. Partly this us due to the cultural permission that goes with having consumed alcohol – the placebo effect is very much at work with alcohol. But partly it’s the real impact of the drug on the central nervous system. It quiets the noise in your head, turns down the volume on negative self-talk, which creates space for noticing sexually relevant stimuli.

Does it work for everyone? Heck no. Some people don’t like alcohol, some people are in recovery from alcohol abuse or addiction… and then there was the couple who came into the Clinic specifically because they found they HAD to be drunk in order to have sex. The “glass of wine” line doesn’t help any of those folks.

And if the noise in your head is VERY VERY LOUD INDEED, or if your challenges around sexual functioning are not your central nervous system but in your PERIPHERAL nervous system (as with the author of that blog I started with), then a small amount of alcohol will not make much of an impact. A large amount of alcohol may have “an impact,” but that impact will include a ton of not-so-good other effects, not least among which are hangover, blacking out, vomiting, doing things you regret, eliminating your ability to give or receive consent, and oh yes, potentially death.

So I can’t recommend that.

Folks for whom alcohol is not a useful option would be better helped by mindfulness training, which is much more difficult to use, requiring daily practice and the ability to sit still through emotional discomfort, but which is also much more (and more universally) effective.

Also, it’s becoming clearer and clearer to me that a surpising number of physicians – even gynecologists – are either woefully ignorant about sexual functioning or else completely terrible at communicating with patients about it. Or possibly both. Another thing for my List of Things To Do: write a fast-to-read guide for gynecologists and GPs, “What Your Patients Need to Know When They Ask You about Sexual Desire, Arousal, and Orgasm Problems.” Also known as “What YOU Need to Know about Your Own Sexual Desire, Arousal and Orgasm.”