When Sex Pales, Women May Need More Than Viagra
The problem was simple, says Hendy Lund, a 30-year-old from Mountain View, Calif. "I had no interest in sex." Married in 1997, Lund was working what she called "obscene" hours as a training manager for Redback Networks, a small Internet company. She competed in triathlons. And she was an avid belly dancer. By last year, "I was tired all the time," Lund says. "Sex just seemed like too much effort." She felt this way for months, causing tension in an otherwise happy marriage. So when she read an ad for a clinical trial to test a nutritional supplement made of the amino acid L-arginine, herbs, and vitamins in women whose libido had flagged, she decided to try it. "One month into the trial, I could feel my interest begin to return," she says, even though she kept her hectic schedule.
Millions of other women are looking to reignite their sexual desire or improve their satisfaction. Some are trying dietary supplements like ArginMax, the compound Lund took, which is meant to stimulate blood flow and appeared to be effective in this small clinical trial. Others are testing Viagra, the little blue pill that has helped many men overcome impotence. Still others are trying to correct hormone imbalances by applying testosterone creams or patches. More drugs are in the works. Behind all this activity in the lab--and the bedroom--is a broader change: Women and doctors are coming to view sexual dysfunction as a condition that can be treated. "If Viagra has done anything for women," says Mary Lake Polan, head of gynecology and obstetrics at Stanford University School of Medicine, "it was that it allowed them to talk about the problems they were having."
Not tonight, dear. Viagra also underscores the limits of the medical approach to women's sexuality, because the results in women have so far been disappointing. "I don't think it's time yet to pull the plug on Viagra for women," says Steven Kaplan, vice chairman of urology at Columbia University. "But I also don't think it will have the wide appeal people were hoping for." Many researchers think that will be the case for other drug treatments too, as sexuality, especially in women, is a complex mix of the physical and the emotional. Stress, anger, or a cooling relationship can kill desire as surely as a disturbance in hormones or blood flow, and "no pill is going to fix that," says Aline Zoldbrod, a sex therapist in Peabody, Mass.
For women who lose interest in sex, "the stakes are fairly substantial," says Edward Laumann, a professor of sociology at the University of Chicago. "Women who report sexual dysfunction also say they are less happy and satisfied in general." And the numbers are large: More than 40 percent of women report a sexual complaint, according to a survey of nearly 2,000 women that Laumann published last year.
Sometimes a broader medical problem, such as depression or heart disease, is to blame. Antidepressants and other drugs can also lead to a loss of sex drive. But perfectly healthy women can lose interest in sex when hormone levels plummet. Testosterone, which fuels libido in both men and women, diminishes with menopause and may also take a dive after the birth of a child. During menopause, estrogen levels also drop, a change that can make sex more difficult by causing vaginal dryness. But it's the drop in testosterone that saps a woman's desire. "I see hordes of women in their early 60s who have never had a problem with sex and suddenly have lost interest," says Philip Sarrel, codirector of Yale University's Sex Counseling Service. "Often it is the result of low testosterone."
Louann Brizendine, director of the program in sexual health at the University of California-San Francisco, treated one couple that "had a wonderful sex life for 30 years," she says. When the woman lost interest, the husband was alarmed. "He really thought she didn't love him anymore," says Brizendine. She found the woman had very low levels of testosterone. "As soon as I saw them sitting in the waiting room after treatment, the husband looked at me and gave me two thumbs up."
Another 41-year-old from New Hampshire says she spent decades regretting her lack of sex drive. Just a year ago she learned about the hormone that makes her feel like an adolescent. "Suddenly my head and body work in sync," she says.
So far, testosterone replacement products are all designed for men and contain doses much higher than women need. Because the hormone can cause acne, foster hair growth, and deepen the voice, doctors have to prescribe small doses. An estrogen/testosterone product for women called Estratest is now in clinical trials for sexual dysfunction. And Unimed, which sells AndroGel, a testosterone gel for men that came on the market last week, is developing a product for women. (Pregnant women should avoid testosterone altogether, as it can harm a fetus.)
Other drugs would work differently. The antidepressant Wellbutrin looked promising in a pilot study of women who weren't depressed but had a low sex drive. And although Viagra failed to help women with low libido, it and other erectile-dysfunction drugs under development may still aid women who have trouble becoming physically aroused.
Mommy mode. But for most women, pills and creams alone will not be the answer. Desire often takes a holiday when life is full of other demands. "A woman in her 30s coming into my office is typically juggling a full-time career, young children, and is basically overwhelmed," says Sheryl Kingsberg, assistant professor of reproductive biology and psychiatry at Case Western Reserve University. "It is virtually impossible for her to switch gears from mommy mode to lover mode just by walking from one room to the next."
A loss of interest can also be a red flag that a woman is feeling angry. "In many relationships, the woman feels like her partner is only attentive to her when he has a sexual urge," says Dorothy Strauss, a sex therapist in Brooklyn, N.Y. "[That] is a terrible turnoff." She and others say that women need a supportive emotional context for sex, which a partner can provide by helping with chores and expressing feelings. As Zoldbrod puts it: "For some women, foreplay is everything that happened in the last 24 hours."
Women should not try to mask a flagging libido by having sex for harmony's sake, says Kingsberg. "When sex becomes an obligation or is always about someone else's needs, it creates a lot of problems." Instead, women should talk to their partners about their concerns, says Linda Banner, a sex therapist in San Jose, Calif. But "make the conversation less emotional or personalized" by keeping it out of the bedroom.
You should also discuss concerns with your doctor, even though it can be awkward. "Many physicians are not trained in how to talk about sexuality," says Margaret Nusbaum, codirector of the family practice residency program at the University of North Carolina-Chapel Hill School of Medicine. But she urges women to broach the subject.
Hendy Lund is glad she took action. Now, she says, when her husband turns to her in bed, "I'm very receptive."
Women and sexual problems
Women in the United States report different sex-related problems at different ages.
[Data for chart are not available]
[Chart labels]: Lack of desire; Trouble reaching orgasm; Pain during sex; Low physical arousal; Age: 18-29, 30-39, 40-49, 50-59
Source: National Health and Social Life Survey
This story appears in the June 26, 2000 print edition of U.S. News & World Report.