I've lost interest in sex after an abortion

DR THOMAS STUTTAFORD

A Lack of interest in sex after an abortion is so common that it can almost be said to be expected. Before long your libido is likely to have returned, but both you and your partner have to bear in mind that even now having an abortion is a huge event in anyone's life. It is possible, but by no means inevitable, that the changes this will have wrought in the way you feel about a future together may have irretrievably undermined your relationship. If this happens, neither of you should assume blame or feel guilty.

Years of experience with patients have reinforced the teaching I received in my early medical life that even the most ardent affair may not survive an abortion, although both partners often remain good friends. Frequently, there has been too much emotion around, even if there have been no spoken recriminations. The shadow of the decision to have the termination, and any doubts one or other may have had about this deep down in their psyche, means that sooner or later they will be tempted to start again with, as if it were, a clean slate.

You don't tell us how old you are, how long you have been with your partner, or how many weeks pregnant you were when the abortion was performed. All these factors are highly relevant. As you were pregnant, so far as your hormonal balance is concerned, an abortion is physiologically just one of the ways it may end. Although it is said that hormonal changes after a pregnancy are only a relatively minor factor in the cause of any psychological consequences following delivery or termination, they obviously have some bearing on how the woman feels afterwards, and the timing of the resumption of sexual desire and its intensity.

However, far more important considerations than hormonal changes determine how soon a woman is likely to feel sexy again. This depends on the amount of the psychological readjustment that has been necessary before she is again able to think of her genitalia as a source of potential pleasure - rather than the focus of interest for a detached medical team.

About 15 years ago, a large American survey of the psychological effects on a woman of having an abortion was revealing. It showed that although nearly all the women studied felt grief and feelings of guilt, in 90 per cent of cases, the acute feelings of doubt, remorse, anxiety and depression passed within a month.

When the psychological symptoms persisted for longer, the research workers found that usually the underlying cause of the continuing grief was that unavoidable pressure to have a termination, placed on the woman by her family or her partner. My own opinion is that the American research workers were unduly sanguine in expecting women to jettison guilt and overcome their feelings of loss - the grief response - within just a month.

However, if your troubles continue, you should see your GP, discuss your symptoms with him or her, and together decide whether you would benefit from consulting a counsellor, or need a specific treatment for depression. Post-puerperal depression or other psychiatric states can be induced by an abortion, just as they can be by a spontaneous miscarriage or delivery at term.

Dr Thomas Stuttaford, The Times doctor, spent many years working in a genito-urinary clinic

SUZI GODSON

A Having “the right to choose” does not guarantee that the choice made will be the right one, or that a woman will not later regret a course of action that seemed the only sensible option at the time. Women are programmed physically and mentally to respond to the experience of pregnancy; abortion forces them to chose between logic and instinct, so the decision is never easy. Afterwards, some feel so relieved that they never give the procedure a second thought. Others, like you, feel terribly guilty and find it hard to move on.

Women who have abortions are often reluctant to talk about the experience. They don't want to be judged and they don't want to admit to negative psychological consequences for fear of playing into the hands of anti-abortion activists. Recently, the anti-abortion movement has begun promoting the concept of post-abortion stress syndrome, a pseudo-scientific condition that encompasses a range of emotional problems, including sexual dysfunction.

The “pro-choice” movement sees this as a cynical attempt to exploit female vulnerability. However, several studies, including research published in The Journal of Child Psychology and Psychiatry, conclude that abortion in young women might be associated with mental health problems. The Royal College of Psychiatrists recommends updating abortion information leaflets to include the risks of depression.

Though it's been available for 40 years, abortion remains hugely contentious. In the 1970s arguments about abortion were simple and polarised: abortion was either “murder” or “a woman's right to control her body”. But times have changed. Today, technological advances have given the “foetus” a human face. Three-dimensional ultrasounds of perfectly formed 16-week-old babies, sucking their thumbs, make it difficult to remain emotionally detached. The threshhold for viability also keeps shifting. In 1990, the Human Fertilisation and Embryology Act reduced the cut-off for abortion from 28 to 24 weeks; and better neonatal medicine has decreased the age at which a baby is viable by several more weeks. Data from the EPICure Study suggests that 20 per cent of infants born alive at 24 weeks go home to a relatively normal life. If that figure continues to improve, it will become impossible to justify such late abortions.

The irony, of course, is that the “choice” to have an abortion is one that no woman wants to make. Though yours was a mutual decision, abortion often unsettles relationships. Couples can feel subconscious hostility towards each other, and withdrawing from sex is an obvious way of manifesting conflict. You and your boyfriend need to unravel those feelings together. Relate might help (www.relate.org.uk), and you would almost certainly benefit from post-abortion counselling. Three sessions at the British Pregnancy Advisory Service (www.bpas.org; 08457 304030) cost £65.

You also need to investigate a more reliable form of contraception. An implant would eliminate the possibility of user failure, and help to restore your sexual confidence. Erasing the trauma of your recent experience may take a little longer. Be kind to yourself, and your partner, and be grateful that you live in a country where abortion is both safe and legal.

Suzi Godson is author of The Sex Book (Cassell, £16.99) and The Body Bible (Penguin, £16.99)