As baby boomers age, more and more women report they've lost their sex drive. But experts say it may just be matter of knowing where to look.
By Colette Bouchez
Reviewed by Brunilda Nazario, MD
Has the "free love" generation lost its mojo?
If you talk to baby boomer gals, it seems the answer is yes. Indeed, as millions of women enter perimenopause and then transgress to menopause and beyond, many say they check their sex drive at the door - and most are not happy about it.
"I don't think a day goes by when at least one patient - and usually more - complain that their sex drive is dropping off and want to know what they can do about it," says Laura Corio, MD, a gynecologist and clinical instructor at Mt. Sinai Medical Center in New York City.
Clinically known as HSDD (hypoactive sexual desire disorder) Corio says she doesn't think more women are affected now than in the past, but she does believe more are coming forward -- prompted, at least in part, by the success male potency drugs like Viagra.
"The man gets a prescription for Viagra and he's ready to rock and roll while she's thinking 'Hey, where's my pill?' If she's not ready to jump in the old van and join him for a ride, there can be real problems," says Corio.
Discovering What's Wrong
While male sex drive is easy to define -- and relatively easy to restore -- that's often not the case for women. Because the female sex drive is multifactorial, the desire to make love is not only influenced by physical issues, but emotional ones as well.
"Part of the desire to make love is clearly physical, but part is also emotional - depression can make a difference, so can any emotional issue in a woman's life; female sex drive is very multidimensional," says Glenn D. Braunstein, MD, an endocrinologist and chair of the department of medicine at Cedars Sinai Medical Center in Los Angeles.
While emotions are frequently behind a loss of sex drive in younger women, doctors say it is frequently the aging process itself that's causes changes in desire in women over age 45.
"The very fact that a woman is no longer ovulating regularly, or not ovulating at all, automatically takes her sex drive down a few notches," says Steven Goldstein, MD, professor of ob-gyn and NYU Medical Center in New York City.
Nature's Design for Sex
Indeed, as many women are aware, Mother Nature built in a natural increase in the desire for sex beginning just prior to ovulation, and lasting several days afterwards -- not coincidentally, the only time of the month conception is possible.
Stop ovulating, says Goldstein, and you automatically lose that regularly scheduled boost in your sex drive that has been present since puberty -- and you're probably going to notice.
"There's nothing wrong with you; it's just the way nature works," says Goldstein.
Moreover, around menopause, when there is also less estrogen circulating in your body, that too can bring your sex drive down for the count.
"Estrogen is a mood elevator, it works in the brain to maintain interest in sex, but it also works at the level of the genitals, helping to increase sensation and just making sex more pleasurable," says Corio.
Without it, she says, not only can desire take a dive, vaginal tissue begins to dry and shrink. As a result, intercourse can become uncomfortable, or even painful. Problems with desire, say experts, are easy to understand.
"Who wants to make love when making love hurts?" asks Goldstein.
Moreover, he says, avoiding sex because of pain only leads to more pain. The old "use or lose it" theory really does apply.
"From a strictly physical standpoint, the less sex you have the more painful it is when you try to have it," he says.
Put the Sizzle in Sex
While estrogen levels are important, the latest research shows that the male hormone testosterone also plays a role in a woman's sex drive. Though present in only tiny amounts, some doctors say it's the seasoning that makes her sex drive sizzle.
Moreover, when levels become erratic, as they do at midlife, that sizzle can fizzle fast.
"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.
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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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