Coping With 5 Common Sex Problems

Video: Erectile Dysfunction

A nonhormonal option targets the hub of sexual desire: the brain. The antidepressant bupropion has been shown to lift libido in premenopausal women and may be helpful for others, too, says the University of Virginia's Clayton. She has studied its effects in research sponsored by the manufacturer of Wellbutrin, a brand name for bupropion.

One thing remains clear: As men have gotten pill after pill to combat a chief sexual problem, women who've lost their sexual appetite have been left hungry. Although pharmaceutical companies are racing to change that—drugs in the pipeline include a testosterone gel and a pill that reduces serotonin action in the brain—women will have to wait for their "pink Viagra." For now, treatment remains largely experimental and in the hands of a skilled few, agree Goldstein and Clayton, who have both done work for companies developing new medications. "We just don't have many options right now," says Clayton. "We're looking for equality."

When Sex Hurts

For Michele G., 38, pain with sex has been the norm from the very first encounter—and the burning discomfort that follows can last for hours or days afterward. "What is supposed to be pleasurable and fun is not," says the Somerset, N.J., woman. In relationships, Michele hasn't always disclosed her condition, choosing to bear the pain of intercourse silently. And while her most recent partner was understanding when she shared her condition, his fear of hurting her put a damper on their attempts.

While many women experience the itching or burning of a yeast infection from time to time, experts say that's nothing like the pain suffered by women with more serious conditions, which can range from endometriosis to an ovarian cyst to a disorder called vulvodynia. Millions of women experience pain associated with one or another of these conditions; vulvodynia alone may account for as many as 1 million new cases per year, according to a recent University of Michigan study.

Like many women, Michele saw multiple doctors in vain. Some initially told her to "relax, have a few drinks, calm down," recalls the senior account specialist at Merrill Lynch. Others misdiagnosed. "I was put on so many different yeast infection medications it was ridiculous," she says. Five gynecologists and two urologists later, she was finally diagnosed with vulvodynia, which made the entryway of her vagina become irritated with penetration.

The causes of vulvodynia, which can produce pain even when sex is not being attempted, are not well understood. Aside from the genitals, the nervous system is thought to be involved, says Jennifer Gunter, director of pelvic pain and vulvovaginal disorders at Kaiser Permanente San Francisco Medical Center. And because no medications are approved for the condition, she says, it's difficult for some to get treatments covered. Gunter and other experts retool therapies such as tricyclic antidepressants, antiseizure drugs, steroid and Botox injections, implantable devices to stimulate misfiring nerves, and surgery.

For Michele, relief has finally come with lidocaine cream, the drug Cymbalta, and physical therapy that involves techniques to pinpoint and relax muscle tension. She also found support in the National Vulvodynia Association. Getting help from multiple sources—including a sex therapist—is often critical to treating the causes of painful intercourse, experts agree.

Gunter, who says Kaiser Permanente covers a full arsenal of treatments, estimates about 80 percent of her patients improve considerably. But patients who wait months or years let their pain become entrenched, complicating treatment. Says Gunter: "Pain begets pain; the more your nervous system is stimulated by pain, the more pain becomes your norm."