When Sex Is a Problem

Men have Viagra. But what about women with low libido?

5 min read

June 12, 2000 -- The gods of sex have blessed men with Viagra, but what good is it if their female partners have lost interest?

Traditionally, men's sexual problems have gotten the lion's share of attention, prompting remedies from Viagra to vacuum erection pumps to penile implants. The focus has been mainly on men despite the fact that women are more likely to have sexual troubles. A survey published in the February 10, 1999 issue of the Journal of the American Medical Association found that 43% of 1,749 women had complaints about sexual functioning, compared with 31% of the 1,410 men surveyed. Subjects ranged in age from 18 to 59. The women reported low sexual desire, problems with arousal, and pain during intercourse. And these problems increase with age, experts say.

Why has research on women's sexual dysfunction, as it's medically known, lagged in the first place? It's partly due to the difficulty of defining the problem. Even though impotence in men can be organic or emotional, the inability to obtain or maintain an erection is often the target for therapy. In women, sexual problems can get more complicated. They can include, for instance, a lack of desire, insufficient lubrication, an inability to reach orgasm, or pain during intercourse. The causes can be physical, such as poor circulation, or emotional, such as stress or depression.

Finding remedies has also been a challenge because drugs that boost men's sex lives may do nothing for women's. A recent study of Viagra in women, released at the annual meeting of the American College of Obstetricians and Gynecologists, showed that it worked no better than a placebo in improving sexual response.

Lately, however, as researchers have discovered more about the types and causes of women's sexual problems, the outlook is becoming brighter. New drugs are in development specifically for women's sexual problems. And a new clitoral suction device, meant to enhance blood flow, has been approved by the FDA.

Though many of these remedies for women's sexual problems are months or even years away from druggists' shelves, there are still avenues to relief right now -- if a woman doesn't give up easily and finds the right doctor.

Peggie is one of those women who don't give up easily. She and her husband of 25 years had always enjoyed an active sex life. Then, at age 51, she started experiencing hot flashes and, along with them, something she never expected -- a loss of sexual desire.

"No one told me that when you hit menopause, forget about sex," she says. "It was a shock to me." Other women confided that their libidos had plummeted, too, with menopause. They told Peggie, "That's just the way it is when women age."

But like other women who came of age during the sexual revolution, Peggie felt that women's sexual pleasure is as important as men's. So she went looking for help.

First, Peggie tried what millions of other women going through menopause try. She went on hormone replacement therapy (HRT) to relieve menopausal symptoms like hot flashes. But standard HRT (estrogen and progesterone) does not always solve sexual problems. And it didn't for Peggie.

So her doctor suggested another strategy: adding a little of the male hormone testosterone, taken in pill form. Based on studies, including one published in the October 1998 issue of the Journal of Reproductive Medicine, doctors are finding it can improve sexual desire and satisfaction in women. Peggie, too, had good results with it.

Testosterone boosts a woman's sex drive, sexual appetite, sexual fantasies, and the intensity of her orgasms. Why does testosterone, often thought of as a guy-only hormone, work for women? Because the ovaries make not only estrogen and progesterone, both of which decline after menopause, but also small amounts of testosterone. And testosterone, too, declines after menopause.

Younger, premenopausal women can also experience low testosterone levels, says Gloria Bachmann, MD, an obstetrician-gynecologist at the University of Medicine and Dentistry of New Jersey in New Brunswick. Levels can be measured with a blood test. Fears that testosterone will make women grow facial hair or develop deep voices are unwarranted, Bachmann says, because the dose is very small. But some experts caution that the long-term consequences of supplemental testosterone in women are unknown.

Women with sexual problems should also consider getting a comprehensive physical, to determine if poor health, urinary-tract problems, sexually transmitted diseases, or stress might be contributing to their difficulties.

If emotional problems are at the root of the sexual distress, counseling with a competent therapist might help.

In June, another possible solution is due on the market: a genital suction device (called the EROS-CTD), recently approved by the FDA. It's used before intercourse to draw blood to the genitals and increase sensation.

In a test by the manufacturer, UroMetrics, 20 women used the device; sensation improved in 90%, lubrication in 80%, and an increase in orgasms was reported by 55%. The $359 device requires a prescription and is expected to be covered by some health plans.

Several drugs under development also may help women. The first is Uprima. Made by Pentech Pharmaceuticals, Inc., in Buffalo Grove, Ill., it is awaiting final approval from the FDA for use in men and is now being tested in women. Meant to be taken about half an hour before sex, it's held under the tongue for 10 minutes, it quickly enters the bloodstream, and it acts on the brain to stimulate arousal.

Another drug, Vasofem, is under study by Zonagen, Inc., in The Woodlands, Texas. It's also meant to be taken a few minutes before sex and acts on the brain to increase blood flow to the genitals and promote sexual arousal.

Though these developments look promising, solving women's sexual problems won't happen overnight. For their part, women need to become informed about sexual dysfunction, ask questions, and demand new treatments.

Women like Peggie are role models. She's not embarrassed or too shy to ask her doctor about how she can improve her sex life. "After all," she says, "if men can have Viagra, why can't we get help, too?"

Carol Potera is a journalist from Great Falls, Mont., who writes for WebMD, Shape magazine, and other publications.