Ever since an FDA advisory panel rejected the approval of a so-called "female Viagra" (the drug was deemed no more effective at increasing libido than a placebo) there's been a lot of a debate on the female libido.

Key issue: If a woman's desire for sex is low, is that necessarily a "dysfunction that should be treated? What women—and their partners—need to know…

Is There A Problem?

When it comes to libido, medical experts agree that there is no "normal" or "abnormal." Doctors diagnose a libido dysfunction only when there is a recurrent or persistent problem with libido that causes personal distress to the woman.

Therefore, if a woman has no sexual desire but is undisturbed by this fact, then no dysfunction exists. Alternatively, if a woman wants to have sex twice a week but is distressed because she used to want it more often than that, then the decrease in libido is a dysfunction for her.

To diagnose low libido: A woman needs to answer just one basic question-do you think you have a problem with your level of sexual desire?

Note: When a man and woman's desire don't match, it's called "desire mismatch," which is not truly a sexual dysfunction, though the partners may benefit from sex therapy.

Causes Of Low Libido

Not all doctors ask about their patients' sexual health, so any woman who experiences chronic or recurrent low libido should tell her gynecologist and/or primary care physician. Most common causes…

  • Health problems. Some chronic diseases, such as diabetes and atherosclerosis (clogged arteries), can decrease blood flow-including that feeding the sex organs. Without proper blood flow, sex can feel uncomfortable, and orgasm may be impossible—both of which may negatively impact a woman's libido. And because sexual desire starts in the brain, doctors shouldn't ignore the possibility that low desire could be a side effect of a brain injury from, say, a fall, car wreck or stroke.
  • Medication use. The side effects of many drugs may include a change in sexual desire and/or difficulty reaching orgasm. Common culprits: Antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIS), such as fluoxetine (Prozac) and sertraline (Zoloft)...and cholesterol-lowering statin medications, such as slurvustutin (Lipitol) and simvastatin (Zocor).
  • Psychosocial factors. If a woman is in a relationship that is physically, emotionally or verbally abusive, her sexual desire can diminish. Past physical or sexual abuse can also lower libido. Any woman experiencing abuse should work with her doctor to create a plan to improve the relationship or leave it. Those experiencing current or past abuse may also benefit from therapy.
  • Partner's health issues. If a woman with low libido has a partner who has a sexual dysfunction such as low sex drive, erectile dysfunction or inability to orgasm-both partners can drag each other's desire down even further. Therefore, both people should be evaluated by a sex therapist.
  • Hormone levels. The primary male hormone (testosterone), which is also present in females, plays a crucial role in women's libido. Postmenopausal women, in particular, have decreased testosterone, which lowers libido and makes it more difficult to have an orgasm. Premenopausal women may experience lowered testosterone levels if they take birth control pills.

*To find a sex therapist or MD in your area who specializes in treating sexual dysfunction, consult the International Society for the Study of Women's Sexual Health, www.issuesb.org

While it might seem that taking testosterone would be an easy fix for libido, research has been mixed. Some studies have shown a benefit, while others have shown no or only slight improvement in sexual desire. Because the potential side effects (such as excessive body hair and acne) are serious, women taking testosterone need to be carefully monitored with blood tests every three to six months.

What You Can Do

It's important to work with your doctor to rule out underlying physical problems that may be leading to your low libido. In the meantime, simple therapies may help…

  • Reduce vaginal dryness. Vaginal moisturizers—which are different from lubricants in that they are used two to three times a week, not just before sex-add moisture barriers in the vagina. This helps provide a layer of protection and comfort so that sex is not painful—a common complaint among women who experience vaginal dryness.

Recommended: K-Y Silk-E or Replens ** Follow label instructions.

Important: You must use such vaginal moisturizers for at least two months before judging results.

  • Masturbate. Yes, this simple action can be a powerful libido booster for women-partly because it turns out that sexual desire really is a "use it or lose it" function.
  • Use lubricants. Sexual lubricants help make sex more comfortable—painful sex is a common cause of low libido.

Recommended: Pjur Eros Bodyglide, which is a silicone-based, glycerin-free product. This combination offers several advantages, including a reduced risk for yeast infections or vaginal inflammation, compared with products that contain glycerin.

  • Increase stimulation before and/or dur ing sex. When testosterone drops, some women need more stimulation to become aroused and to have an orgasm. The best method is to use a vibrator for clitoral stimulation. My sexual dysfunction patients report that the best vibrator is the Hitachi Magic Wand-it provides a very strong vibration

**All the products mentioned in this section can be purchased from www.drugstore.com, which ships its orders in a plain box labeled only with the company name.

Helpful: Using an over-the-counter botanical oil with a vibrator has been shown in studies to increase a woman's ability to have an orgasm.

Recommended: Zestra Essential Arousal Oils.

  • Exercise. We know that exercise elevates mood, improves blood circulation and general health, and helps enhance body image. All of these factors can improve sex drive.

Recommended: Any aerobic exercise, but especially walking and dancing because they are low-impact, low-stress exercise and can be fun to do. Aim to get out and walk (or dance) every day for at least 20 minutes.

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