Return of Desire

After giving hundreds of seminars to thousands of women I am sure of one thing: our hormones are disrupted and we don't feel as well as we should. Although hot flashes, endometriosis, fibroids, and period problems are the most talked about female complaints, women are telling me that one of the saddest facts is their lack of sex drive.

We often joke about wives and their indifference to sex but from my experience women are concerned that their desire for intimacy is diminished if not gone. Unfortunately, too many women also believe that a lack of interest in sex is a normal part of aging.

According to the March 2003 issue of Women's Health in Primary Care 50 percent of women between the ages 66 and 71 still desire sex and 29 percent of those over 78 are still sexually active.

We know that sex stimulates endorphins (our feel-good hormones). It helps to keep our muscles in shape and can add to our relationships. But many women, especially those with young children or stressful jobs, just don't have the energy or desire.

During menopause and perimenopause (the 10 to 15 years before menopause) our ovaries and follicles don't operate at peak performance; sometimes an egg is released and often it is not. When ovulation is disrupted we do not produce enough testosterone to stimulate the desire for sex. Meanwhile estrogen production may be surging or declining causing vaginal atrophy, painful intercourse, and no sexual desire. Other health factors can affect sex drive, antidepressant medications, hysterectomy, diabetes, heart disease, and fibromyalgia.

Some women are content with no sex drive. Those who want it back have several options. This is one of the few times I recommend hormones. A small amount of natural testosterone gel delivering 0.5 mg of testosterone (about 1/8 to 1/4 tsp), applied daily for two weeks and then reduced to one application per week, works to return desire in a healthy relationship. It is a prescription drug and available through a compounding pharmacy. (To find a compounding pharmacy near you, call the Professional Compounding Centers of America at 1-800-331-2498.) Testosterone gel works quickly and there is no need for high dose for long-term use, which can result in the growth of facial hair.

Although I have yet to find a herbal Viagra for women that works (though I am searching) certain nutritional supplements help improve overall health, brain chemistry, and blood flow. Vitamin E (400 to 800 IU), Black cohosh (40 mg of standardized extract), tyrosine (500 mg) daily along with a multivitamin with minerals containing a good dose of B vitamins will help.

So will exercise, which is essential for the mind and body. Walk everyday. Do Kegel exercises, squeezing and releasing the pelvic muscles to keep them strong.

Stress reduction is another important recommendation. If you are performing super woman duties: working at a full-time job, raising children, and running a household, then you are going to be too tired physically and mentally. If your partner is equally too busy with work and children to make time to talk, intimacy is lost and desire will wane.

Most important: love yourself. Look in the mirror everyday and tell yourself how beautiful, kind, and loving you are.

For more information, read For Women Only by Jennifer Berman, MD and Laura Berman, PhD (Henry Holt, 2001).