Researchers are unveiling the breakthroughs that truly work for grown-up women (we promise: not a stiletto or silly gadget among them)

A fulfilling sex life is one of the most important ways to stay connected to your partner and boost self-esteem. But great sex doesn't just happen on its own--and less so as you age. Your need for intimacy changes, and your body may not respond the same way it did when you were younger. Here, five common reasons that women over 40 find their libido lagging, and the scientific interventions that can get it happily humming along again.
REASON: You Have Low Testosterone

We tend to think of testosterone as a "male" hormone. But small amounts--delicately balanced with estrogen--fuel a woman's sex drive. Unfortunately, at menopause testosterone starts to decline, which can cause desire to plummet. Hormone therapy throws off the balance even more. A blood test and your gynecologist can determine if low testosterone is to blame. Luckily, studies show that stabilizing testosterone levels can rev up arousal in postmenopausal women--and improve all areas of sexual response, from lubrication to stronger, more powerful orgasms.

• TESTOSTERONE GEL Although the FDA has not yet approved a testosterone gel specifically for women, many doctors simply prescribe the male version off-label or have a compound created by a pharmacist (a female gel is in the works--see "2 Libido-Enhancing Drugs"). And no, it won't make you grow hair on your chin or give you huge muscles. "The doses prescribed for women aren't large enough to stimulate male characteristics," says Anita Clayton, MD, clinical professor of obstetrics and gynecology at the University of Virginia and author of Satisfaction: Women, Sex, and the Quest for Intimacy.

• LIBIDO-BOOSTING HERBS Certified sex researcher Beverly Whipple, PhD, professor emerita at Rutgers University and coauthor of The Science of Orgasm, recommends ArginMax for Women, a nutritional supplement containing ginseng, ginkgo, multivitamins, and minerals. Science backs her up. ArginMax increased sexual desire, including clitoral sensation and orgasm frequency, in several studies. In one, women taking the supplement daily for 4 weeks reported a 74% improvement in satisfaction with their sex lives. In another study, men taking the male version of ArginMax experienced similar results.

• BIRTH CONTROL WITH BENEFITS "Ironically, oral contraceptives increase levels of a protein that binds with testosterone and makes it less available to get our brains thinking about sex," says Clayton. But hormonal contraceptives that are inserted into the vagina and release a minimal amount of localized hormone (such as the NuvaRing), or are administered through the skin (such as a patch) and nonhormonal methods (such as condoms or spermicides) can free up that testosterone--and your sexual desire.
REASON: You're Distracted During Sex

It's not just those endless to-do lists that make your mind wander. You're wired that way. According to brain scan research, women's brains are naturally more active than men's, even during sex. The reason: lower levels of the neurotransmitter dopamine. "Dopamine creates the desire to go after a reward--in this case, an orgasm," explains Clayton. Dopamine also increases the flow of sensory impulses to the genitals, essential for arousal. But low levels of dopamine caused by chronic stress or medical conditions can distract you during sex.

• A SUPPLEMENT THAT CONTAINS THE HORMONE DHEA This hormone (dehydroepiandrosterone) may increase dopamine production and normally spikes right before orgasm to enhance desire and focus. Taking 300 mg of DHEA an hour before sex significantly increased both mental and physical arousal in postmenopausal women, according to a study published in the Journal of Women's Health & Gender-Based Medicine. Clayton only recommends 25 to 50 mg and warns that DHEA can affect some people's cholesterol levels, however. So be sure to check with your doctor before taking it.

• A SIMPLE TEST FOR ADD Up to 2 million adult women in the United States suffer from attention deficit disorder, which may be associated with low dopamine levels, says Daniel G. Amen, MD, a psychiatrist, brain imaging specialist, and author of Sex on the Brain. This can literally make it difficult to pay attention during lovemaking. However, "when a woman is finally treated for ADD, usually with a combination of drug therapy and behavior modification, it improves her sex life--not to mention the rest of her life as well," he says. To get a test for ADD, go to
REASON: You Have Trouble Reaching Orgasm

Women typically blame this on psychological problems, but the reasons are often physical. Poor blood flow to the genitals, for example, caused by cardiovascular conditions like diabetes or heart disease, makes it harder to have an orgasm. Another common culprit: declining hormone levels due to perimenopause and menopause. Smoking can also disrupt blood flow by constricting blood vessels.

• THE AMINO ACID L-ARGININE Like Viagra, this naturally occurring amino acid increases the production of nitric oxide, a chemical released by the genital nerves during arousal, sending much-needed blood to the area. Amen suggests taking 1,000 to 3,000 mg of L-arginine supplement (available at drugstores) right before sex.

• A NEW ANTIDEPRESSANT The inability to experience orgasm is a common side effect of antidepressants called selective serotonin reuptake inhibitors (SSRIs). That's because the serotonin boost you get from these drugs decreases dopamine, which leads to sexual problems. Clayton often switches her patients to bupropion HCI, an antidepressant that doesn't affect serotonin levels, enhances dopamine function, and, in several studies of women, has boosted desire.
REASON: It's Dry Down Below

The lining of the vagina is extremely estrogen sensitive, and when hormone levels fluctuate during perimenopause, women produce less lubrication prior to and during intercourse. Hormone therapy is a solution for some women. But there are other alternatives.

• A LUBRICANT THAT GOES STRAIGHT TO THE SOURCE Whipple recommends Zestra (available at drugstores), a nonprescription feminine arousal fluid made from botanical oils, which stimulates nerves and blood vessels to increase arousal. Women who used Zestra five times in a 2- to 3-week period (many described a warm feeling in the genital area) boosted their sexual pleasure significantly, even if they were taking libido-dampening antidepressants or had sexual arousal disorder, according to a study on women ages 31 to 57 published in the Journal of Sex & Marital Therapy.

• LOCALLY APPLIED ESTROGEN This can significantly improve the lubrication situation--without the dangers (such as increased breast cancer) of oral hormone therapy. Whipple prefers insertable vaginal estrogen rings or tablets over vaginal estrogen creams.
REASON: You Feel Disconnected From Your Partner

The demands of family and work life can often make long-married couples feel like strangers in the bedroom.

• AN OVULATION KIT Oxytocin, often referred to as the bonding hormone, spikes right before ovulation, a time when most women are in the mood. According to Amen, oxytocin also helps dull your memory of your partner's annoying traits (like his dirty socks on the floor) enough to let you feel attracted to him. Chart your cycle and schedule "date night" right before you ovulate.




By Nancy Kalish



Obstructive sleep apnea (OSA) could be an unrecognized cause of sexual dysfunction. In one 2006 study, researchers found that women's problems reaching orgasm increased with the severity of their OSA. Treating men and women for OSA (using continuous positive airway pressure, or CPAP) improved sex drive in all of them, according to another study. For tips on diagnosing and treating OSA, go to the National Sleep Foundation at




Ask your doc to keep an eye out for these higher-desire meds that are in the works:

1. LIBIGEL The only prescription testosterone gel to boost sexual desire in women, this hormone treatment should receive FDA approval by 2011.
2. BREMELANOTIDE NOSE SPRAY First in a new class of drugs called melanocortin agonists, this nasal spray--just click once and breathe through a small inhaler, 15 to 30 minutes before sex--increases blood flow to the genitals. Unlike Viagra, it has no effect on the cardiovascular system (it works via the central nervous system). In clinical trials of both premenopausal and postmenopausal women with sexual dysfunction, it significantly increased desire and genital arousal. Expect FDA approval for women in 2011.

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