Leonore Tiefer

(WOMENSENEWS)–Maura Kelly remembers the night the spark in her marriage fizzled out.

"A month after I gave birth to my first child, my husband reached for me in bed and started kissing my neck and caressing my thighs," says Kelly, who is using a pseudonym to protect her privacy. "But while he was lighting candles, I was staring at the ceiling and running through the grocery list in my head."

Due to hormonal shifts during her pregnancy, Kelly, a mother of two in South Kingstown, R.I., no longer felt a glimmer of interest in sex. Tests showed that her body was low on testosterone–the hormone that fuels sexual desire in both men and women. Kelly’s doctor prescribed pills containing DHEA (a precursor to testosterone) and a testosterone gel that she applies to her skin once a day. "Now my husband and I are having pull-the-buttons-off-your-shirt sex again," she says. "We can barely wait until our kids drift off to sleep at night."

Following the tremendous success of Viagra, a pill that treats erectile dysfunction in men, drug and supplement manufacturers are working to address the needs of women like Maura Kelly.

This trend has accelerated since Pfizer, the New York-based company that makes Viagra, announced in Feb. 2004 that its wonder drug does not significantly improve sexual functioning in women. Now drug and supplement makers are racing to create the first "Viagra for women"–a feat that is proving difficult because women’s sexual response is physiologically and psychologically more complicated than that of men.

Though the Food and Drug Administration has yet to approve a single drug for women’s sexual functioning, off-label and over-the-counter remedies abound. Some, like the drugs that Kelly took, are prescription remedies still undergoing clinical trials. Others are over-the-counter, nonprescription supplements. Amidst the hype surrounding these products, it’s hard for women to know which remedies might solve their sexual problems–and whether these problems require treatment in the first place. Health experts caution that many sex remedies are unregulated and may pose risks to women’s health.

Sexual Setbacks Affect Most Women at Some Stage

Studies show that at some point in their lives, most women will experience a blip in sexual functioning such as loss of libido, diminished arousal or difficulty achieving orgasm.

"In most cases, these aren’t medical problems but instead have to do with what’s happening in a woman’s relationship, career or family life," says Leonore Tiefer, a clinical associate professor of psychiatry at the New York University School of Medicine. "Usually, the problem is just a passing one."

If trouble persists, experts recommend seeking help from both a counselor and a medical doctor. Psychological evaluation may reveal communication problems in a romantic relationship or trauma stemming from a rape or childhood sexual abuse. Medical tests may reveal hormonal imbalances triggered by pregnancy or by taking prescription drugs. Doctors may discover that a woman has pain during intercourse because birth control pills don’t mix well with her body chemistry. They may find that she has lost sensation in her pelvis due to nerve damage suffered during childbirth or a hysterectomy.

For most of these problems, there are effective solutions. Doctors may suggest counseling or sex therapy. They may give a woman new prescriptions that are less likely to affect her hormone levels. They may perform surgery to repair nerve damage or recommend Kegel exercises to strengthen the muscles of the pelvic floor.

Off-Label Drugs Address Sexual Complaints

In recent years, a growing number of doctors are not only turning to these standard remedies, but to prescription drugs. In 1997, a group of leading urologists met in Boston and coined the term "Female Sexual Dysfunction" to describe women’s problems with desire, arousal and orgasm. In 1999, a study published in the Journal of the American Medical Association found that sexual dysfunction affects more women than men–43 percent versus 31 percent. Since then, doctors have started diagnosing women with sexual dysfunction and giving them drugs like those that Maura Kelly took. Because the federal Food and Drug Administration has yet to approve any sex drugs for women, all of these remedies are prescribed "off-label," that is, administered in a way that is different from their intended use.

Though these off-label applications are still under scientific study, most health advocates approve of them because they are done with a doctor’s supervision. "Many women say off-label treatments have made a terrific difference and literally helped them turn their sex lives around," says Lisa Martinez, director of the Cincinnati-based Women’s Sexual Health Foundation.

Non-Prescription Sex Pills Proliferate

If a woman doesn’t feel comfortable confiding in her doctor about her sexual problems, she may try one of over-the-counter remedies peddled in magazines, on TV and on the Internet. From Viafem, Scream Kreem to Zestra Feminine Arousal Fluid, these remedies have names corresponding to every letter of the alphabet. From bull’s testicles to ginseng, they contain every ingredient believed to stir desire or ignite an orgasm.

Advertised with soft-focus photos and presented as if they were prescription drugs, herbal remedies can rake in big profits. Avlimil, one of the most popular sex supplements for women, has racked up $30 million in annual sales since it was introduced in January 2003. But its ads lack scientific data–a practice that is common with herbal remedies.

"Though some women swear by herbal remedies, these supplements can have a placebo effect 30 to 40 percent of the time," says Julia R. Heiman, director of The Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University in Bloomington. "But is this an enduring response? And, more important, is it safe?"

Because herbal supplements do not contain drugs, they do not require federal approval and are pulled off the market only when users report adverse affects. Some may contain ingredients that trigger adverse reactions when taken with common medications. Some may contain potentially hazardous substances such as ephedra, an herbal stimulant that has been linked to several deaths.

"Unless there are appropriate, double-blind, placebo-controlled studies for these products, I wouldn’t use them and I wouldn’t try them," asserts Dr. Irwin Goldstein, director of Boston University’s Institute for Sexual Medicine.

New Products on the Horizon

Since Viagra hit the market in 1998, it has racked up more than $5 billion in sales and garnered 23 million prescriptions. Two newer drugs for erectile dysfunction–Levitra and Cialis–are also raking in big profits.

Across the U.S., drug and supplement makers are scrambling to create companion pills for women. In Cranberry, N.J., Palatin Technologies is developing a pill that stimulates the area of the brain related to sexual arousal. In Bothell, Wash., Nastech Pharmaceutical Company is testing a nasal spray designed to improve lubricating secretions. In Lincolnshire, Ill., BioSante Pharmaceutical Inc. is developing a testosterone gel for the treatment of female sexual dysfunction. In Cincinatti, Proctor and Gamble is testing Intrinsa, a testosterone patch designed to boost libido in postmenopausal women. Sixty percent effective in clinical trials, Intrinsa is slated to hit the market in 2005 and will likely be the first drug the federal food and drug agency approves for sexual dysfunction in women.

Though encouraged by this research, health advocates say it may be years before science makes sense of women’s sexual functioning.

"The development of Viagra and other drugs has kicked up a lot of interest," says the Kinsey Institute’s Heiman. "But it’s going to take time before we figure out what’s really valuable and for whom."

Molly M. Ginty is a freelance writer based in New York City.



For more information:

FSD Alert:

Boston University School of Medicine
Institute for Sexual Medicine:

The Women’s Sexual Health Foundation: