"There are a lot of physical reasons a woman can experience a decrease in sexual desire. But for many women who are otherwise healthy, a drop in testosterone that occurs at midlife is the reason," says Braunstein, who is one of the nation's leading researchers on testosterone treatment in women.

Complicating matters further, studies show that sometimes the very treatments women take to control midlife symptoms -- such as HRT or low-dose birth control pills -- can actually disrupt desire by robbing the body of testosterone.

"When these hormones are taken orally, they are metabolized by the liver, which in turn puts out a protein that binds to testosterone, causing a deficiency," says Braunstein. This, he says, can also be true for younger women using birth control pills for contraception.

And while in younger women the answer may be to simply switch brands of birth control pills, in women over 40, Braunstein says, adding tiny amounts of testosterone back into the body is the solution.

But not everyone agrees. Goldstein says the jury is still out on whether it really can help or even if it's safe. And the FDA advisory panel ruled that the testosterone patch for women needed more safety data before approval is granted.

Still, many doctors do prescribe testosterone "off label" -- frequently turning to drugs like Estratest, a combination estrogen-testosterone prescription approved for hot flashes and other menopause symptoms. But if you're at all worried about taking estrogen, experts say this is not the drug for you.

Finding Your Mojo Again

Admittedly, there are far more options for men seeking to rediscover their libido than there are for women trying to find theirs. In fact, despite rumors -- and even some early clinical evidence -- that Viagra can encourage both genders to jump in the van and head for the all-night love fest, studies show it had disappointing results in women.

That said, the picture is not as grim as one might think. Experts WebMD consulted suggest talking to your doctor about the following:

• A blood test for low thyroid function and iron deficiency anemia, two common disorders that can affect sex drive.
• Discuss whether or not you may be suffering from low-level depression -- which can affect libido. If you are already taking an SSRI antidepressant drug, discuss switching to another type of medication, which won't dampen sex drive. Some studies show that taking Viagra in this setting may improve sexual desire.
• Localized estrogen therapy. Placing estrogen directly into the vagina soothes vaginal tissue, and allows the secretions necessary for comfortable sex and possibly even an increase in sexual desire, says Goldstein. Unlike oral estrogens that carry some cancer risks, he says estrogens applied locally to the vagina are generally safe. They are available as suppository tablets, creams, or "rings," which sit inside the vagina and give off small doses of the hormone over time.
• Compounded testosterone cream. Many compounding pharmacies (they make medicines from scratch) offer testosterone creams and gels, but you'll need a doctor's prescription. Corio says they can be applied to the vagina to increase sensation, or to the clitoris to increase orgasm.
• Vitamin E. When used locally in the vagina it can help rehydrate tissue and may possibly increase sensation. No need for a prescription here; Corio says just stick a pin in a vitamin E capsule and apply to the vagina several times a week, even if you're not having sex. And be sure to use a lubricant when you are having sex - either vitamin E or a commercially prepared product such as K-Y Jelly or Astroglide.
• Zestra. A small, placebo-controlled trial published in the Journal of Sex and Marital Therapy in 2003 showed that when used as a genital massage oil, this proprietary blend of botanicals (including borage seed and evening primrose oils, Angelica root and vitamins C and E) provided a statistically significant increase in arousal, desire, genital stimulation, ability to orgasm, and pleasure, in 20 women with or without sexual desire problems. The treatment also worked equally well on women using SSRI antidepressant medicines.
• ArginMax. In a study of 77 women, a controlled double blind study found the nutritional supplement ArginMax increased sexual desire and satisfaction in more than twice the number of women taking placebo. The research was published in the Journal of Sex and Marital Therapy in 2001.

Before using of supplements, you should first have a discussion with your doctor as side effects or drug interactions can occur.

Don't Be Driven by Declining Sex

Drive As frustrating as a lagging libido can be for some women, for others, it can simply be a rite of passage to a quieter, gentler time. In fact, Goldstein says that for many women, and their partners, a lessened sex drive is not a problem and is often replaced by other intimate and bonding experiences.

As such, Goldstein reminds us that a reduced need for sex and a declining drive are not medical problems -- and if they don't cause you distress, there is no need to seek treatment.

"Just because your sex drive is different, doesn't mean there is something wrong or that you have to try and fix it. If less sex isn't bothering you, your partner, or your relationship, then take heart -- you are maturing in the way nature intended," says Goldstein.

SOURCES: Laura Corio, MD, clinical instructor of obstetrics and gynecology, Mt. Sinai Medical Center, New York City. Steven Goldstein, MD, professor, ob-gyn, NYU School of Medicine, New York City. Glenn Braunstein, MD, chair, department of medicine, Cedars Sinai Medical Center, Los Angeles. Ferguson, D; Journal of Sex and Marital Therapy, Sept. 2, 2003; vol 29. Polen, M, Journal of Sex & Marital Therapy, 2001; vol 27.

Reviewed on August 20, 2008

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