Magazines

Magazine Articles

	Elle Magazine - June 2002 Issue GETTING TO YES YES! OH, YES!

	New York Magazine - April 23rd Issue Beyond Viagra -Getting to O

	Glamour - August 1999 Issue LUST LOTIONS: Move over Viagra - a Batch of New Women's Love Drugs Are Coming.

	GQ Magazine Men's Drugs, Women's Orgasms

	Mode Magazine - July 2000 Issue Love Potion Number 9

	SELF Magazine - December 1999 Issue Women Give Thanks To Viagra

	Harper's Bazaar - March 2000 Issue Sex Drugs For Women?

Articles

GETTING TO YES YES! OH, YES!
Elle Magazine - June 2002 Issue

Millions of women find it mysteriously difficult or impossible to achieve orgasm. Until recently, there wasn't much they could do about it- but that's changing. Zoe Nelson gets scientific with a team of doctors and finds some encouragingly specific remedies.

Beginning with that first time on the pull-out couch in my parents' den, I've had difficulty reaching orgasm with a partner. I had a running joke with a friend: With each new lover, she'd ask if I'd met my penis in shining armor. After two decades of Trojan horses, I decided to get serious, which is how I found myself lying on an examining table in a doctor's office, naked from the waist down, FDA-approved vibrator (the only such model) in hand, watching a couples hillside picnic rapidly turn into afternoon delight through 3-D surround-sound video glasses. "Go ahead and stimulate yourself", the medical technician instructed before leaving the room. "I'll be back in twenty minutes."

She'd already taken baseline measurements of the blood flow to my labia and clitoris and would record them again after I became "maximally aroused"- the theory being that not enough blood supply to the genitals can hamper orgasm. This, in addition to a physical exam, a psychological assessment, and various lab tests (to detect, among other things, inadequate levels of sex hormones and medical conditions such as diabetes that might impede blood flow) are the diagnostic tools of the Connecticut Surgical Group's female sexual evaluation team. With nurse practitioner Jill Siskind at the head, the Hartford-based team follows the model developed by Jennifer and Laura Berman, the eurologist/sex therapist sister duo who run a similar clinic at UCLA and are known for embracing Viagra as a potential cure for women's sexual dysfunction (though the FDA has approved the drug only for use in men).

While she was setting up the video, Siskind explained that since contractions during climax send blood out of the genitals, it would be harder to get a good read if I actually had an orgasm. "But many women who come here haven't had on in years," she continued, "so if you are able to in this strange environment, we're delighted."

In fact, a vibrator and pornography are my idea of a good time, and the doctor's office-with its stirrups, prostate-gland poster, and messy desk-was mildly exciting in a forbidden-thrill kind of way. If anything, I'd have to work to delay orgasm for twenty minutes. Put a man I'm in love with in the room, however,and it's a different story.

In the bedroom: A national survey shows that 43 percent of American women are in some way sexually dissatisfied.

It's not that I don't ever have orgasms with boyfriends: With the prolonged attention of a partner's hands or mouth, I can get there about once every five times --- But forget about t during intercourse. Inevitably, my difficulty takes a toll on my relationships. I shy away from sex, and my boyfriend feels rejected. Or else I try to instruct him about my various quirks, and our love making starts to seem like we're trying to assemble some complicated toy. Recently, Daniel, the man I'm dating, complained that he didn't want to run a marathon every time we fooled around. But the only other option was to remain content to never break a sweat. I suspected that my problems were psychological: issues of trust and vulnerability that left me reluctant to cede control or to be on the receiving end of sexual attention. Often when I got excited, I'd immediately start to fret---would I or wouldn't I?---which diverted me from the matter at hand. Sometimes, I'd hop off the train before it even left the station because I couldn't stand to be disappointed again. If Daniel so much as paused of shifted position, I'd begin to doubt his interest in pleasing me, and I've been known to roll over in a sulk, mumbling, "Just forget it." Particularly frustrating, I consider myself a very sexual person. Men have always described me as more sexy than beautiful, and I've been a fan of erotica---low and high---all of my adult life. I relish giving my partners pleasure. It seemed so unfair that I couldn't get a little more of it myself.

I questioned my friends about what worked for them. Jennifer shared her secret: "Get on top; move your hips counterclockwise; squeeze at 12:00 and at 6:00. Works every time." Liz: "You just have to decide to be selfish. No offense, but I wouldn't think that would be such a problem for you." Amanda suggested more foreplay and a vibrator during intercourse. Sarah shrugged and said, "I can have an orgasm with my boyfriends Adam apple."

AN EPIDEMIC OF DISSATISFACTION

But I am not alone. A 1999 study in The Journal of the American Medical Association found that 43 percent of American women suffer from one of the carious types of what's called Female Sexual Dysfunction (FSD), which includes lack of desire, pain during sex, difficulty becoming aroused, performance anxiety, and failure to achieve orgasm (23 percent of the latter, my category).

Until recently, there wasn't much a woman could do about her sexual complaints. When I raised the subject with my ob/gyn, she recommended Kegel exercises to strengthen my vaginal muscles, though she couldn't tell me if they were particularly weak to begin with. (In Hartford, I learned that they weren't.) The only other option for women has been sex therapy, but that won't uncover the medical causes for which the Hartford group screens.

The clinic aspires to a holistic approach: mind and body. During the psychological assessment, Siskind reviewed my sexual history (patients normally meet with a psychologist, but she'd been called away on an emergency), and I learned my self-consciousness during arousal was common and had a name: spectatoring. But she couldn't offer much help beyond confirming that, yes, the more you try to have an orgasm, the harder it becomes.

I soon found out that trying not to have an orgasm wasn't so easy either. The FDA-approved vibrator hummed with an intensity that Pavarotti would admire, and as the actor in the video began diligently cleaning some spilled honey off the actress, I started down that path from which there is no turning back. I closed my eyes, breathed deeply, felt a tremor start in my belly and head south, when knock! knock! The ultrasonographer burst in. I jerked the vibrator out from under the paper sheet and tried to throw off the glasses. "Keep watching," she commanded, and then jelly was being smeared against my vulva, and the ultrasound wand began flitting up and down my clitoris. Baseball, I thought. Baseball.

Despite the fact that I felt very aroused indeed, my blood flow hadn't doubled over the baseline readings, which is the increase that Berman & Co. look for as a result of their research. More studies need to be done before understanding the exact amount of flow required, and more fundamentally, how the clitoris filling with blood leads to orgasm, anyway. But Siskind told me there were a couple of treatments I could try.

CREAMS, DREAMS, AND VACUUMS

I left the clinic with samples of Viagra, which is in clinical trials for use in women, and a prescription for the Eros Therapy device, the only FDA-approved remedy for FSD. A mini-vacuum placed over the clitoris for three to five minutes to stimulate blood flow, it can be used to prime yourself for lovemaking, or as a three-to-four-times-a-week treatment to clear the collagen deposits that can clog tiny arteries over time.

When I got home, I smugly reported to Daniel that I had an actual physical problem: female sexual dysfunction, specifically an arousal disorder. "If you have a physical problem, then why can you sometimes come easily with me and almost always by yourself?" he answered, matching my tone. He had a point, but what was the harm in test-driving the various cures?

There's no time like the present, so I popped a Viagra, and he said, "You better give me one, too." We had sweaty, every-which-way sex for almost an hour. My loins were more alert than usual, which wasn't without costs. After a while, I grew numb from all the attention, and nothing, it seemed, could lift me from my plateau of excitement over that final peak. Also, I ended up with the typical side effects-runny nose, headache-which didn't seem worth the sexual benefit of the $10 price per pill. Daniel, however, kindly offered to take the prescription off my hands-not that he needed it or anything.

I began the Eros Therapy, but I never wanted to use it just prior to lovemaking-holding a little suction cup against my genitals didn't exactly get me in the mood-and I felt bashful even about performing the regular tune-ups when Daniel was around. For the few weeks I managed to be diligent, I did detect an increase in sensation. I was also more turned on than usual-probably from spending so much time thinking about my clitoris and when in the world I was going to vacuum it.

In the end, what worked best for me was a topical remedy..... The active ingredient, L-arginine, is a natural amino acid (sold in health-food stores) that, when absorbed by the body, increases-you guessed it-blood flow. Indeed, ten minutes after I applied it, my clitoris sprang to attention under Daniel's touch. As I became more excited, so did he, and we had to be careful to avoid over-stimulation problem, but it worked pretty darn quick. My orgasm wasn't as intense as usual, which I attribute to the fact that my buildup time was less than half as long. On another occasion, I tried the cream during intercourse and, with a little self-help, I managed to have an orgasm. Yee-haw!

With every success came more willingness to try for another, but it bothered me the Cream precluded oral sex (Daniel worried his tongue becoming engorged with blood, though manufacturer assures that doesn't happen). Also, these shortcut, minor-key orgasms left me feeling a little wanting, as if I'd been put on a diet of meal-replacement therapy.

Again, Daniel was skeptical. I didn't seem to suffer from constant low desire. Rather, my interest ebbs and flows according to how well we're getting along and how I feel about myself, particularly physically: i.e, thin, rested, and frizz-free. We worried that some of the possible side effects of taking a testosterone-replacement agent-facial hair, acne, weight gain---would actually douse my desire (and his, I suspected, although he was tactful enough not to say so). Also, any replacement therapy requires that you stay on the supplement indefinitely. Given how new the science is---there is ongoing debate about what the normal range of testosterone is for women---the risks of following this course seemed too great. (And since I hope to have children on day, I was put off by the lack of information about the long-term effects of the hormone---along with the warning given to women trying to conceive that it can cause reproductive and genital problems in fetuses.)

MAYBE IT IS ALL IN MY HEAD

I wasn't yet prepared to give up on my quest for the holy "O". For one thing, the experience helped to change the sexual dynamic between Daniel and me. After a few months of feeling opposed in bed, we were on the same side of the sheets again. I decided to call Marian Dunn, a sex therapist who directs the Center for Human Sexuality at SUNY/Downstate Medical Center in Brooklyn. As we were scheduling the appointment, she asked if my partner was willing to come in with me. Indeed he was.

The presence of a third party made certain things easier to say, so I explained that Daniel's comments about marathons and the like made me wonder if he cared anout making me happy, and he admitted that my orgasm difficulties exacerbated the occasional performance anxiety that comes with being in his mid-forties. We took turns describing what happened when he tried to get me off, and I was surprised to realize that I often blamed him when it didn't happen.

Over the course of four sessions-two individually and two together-Dun helped us, particularly me, to understand exactly where that tripwires and triggers lay on my was to orgasm. First, we determined my mode of arousal: Was it dramatic play (dirty talk, wrestling), union (looking into your lover's eyes), hypnotic trance (becoming inwardly focused), or the lucky fourth, which combines all three? Since any interruption tends to throw me, we settled on the hypnotic-trance category.

Then Dunn coached me to view climax not as a single wave but as a series: If this one didn't carry me to shore, then I could float back out and ride the next one in. That way, if I temporarily lost focus, I might feel less disposed to give up. She also pointed out that many women say they don't need frequent orgasms for a good sex life. In a recent study by the Kinsey Institute presented at the Female Sexual Function Forum in Boston in October 2000, respondents were asked which factors contributed most to their sexual happiness: Less than a third considered it "very or extremely important" to have an orgasm, compared to 78 percent for "partner being satisfied" and 79 percent for "feeling emotionally close to your partner during sex." (Call me a skeptic, but I'm guessing that the women who ranked intimacy and partner satisfaction so high come like clock-work-I'd be able to concentrate on that stuff, too, if I was getting off all the time.)

Finally, Dunn helped me understand the impact of my parents' sexual relationship. My father was unfaithful throughout most of their marriage, which hurt my mother deeply. As a result, out therapist speculated, I had become acutely sensitive to shifts in a lover's attentions---be it flagrante delicto or during a dinner party. The history of ambivalence in my relationship with Daniel---I'd met him shortly after he separated from his wife but before he was divorced-didn't help. "I think it would be better for you not to see yourself as 'dysfunctional' but as someone who needs time and good communication," Dunn said at our final session. "That way you might not work at having an orgasm but just relax and see what feels good."

In other words, all the blood flow in the world wasn't going to do any good if I couldn't let go-which more or less took me back to where I'd started. Once I was assured nothing was seriously wrong with me, I was content to rely on the old-fashioned type of sexual chemistry-part love, part lust, with some patience and trust mixed in.

At first, out lovemaking after seeing Dunn was stilted as Daniel tried to implement some of the techniques we'd discussed. But his willingness to suffer through this awkwardness touched me. And then one might we threw our old sexual script and started fresh. With Dunn, we'd discovered that I had an antipathy for "cold starts." I needed to flirt, to anticipate sex, to kiss and feel Daniel's body against me before he touched my breasts or genitals. If my desire was allowed to build, by the time we moved on to more intimate contact I'd be too far gone to fixate on being caressed in one particular way. This time, when he started to take off his shirt, I took charge: I pushed him away and rolled on top of him. I rubbed my clothed body against his, and we made out fervently. I felt like I was sixteen again, with all the attendant desire and determination to resist my increasingly excited boyfriend. I took his hand, and we got started.

Beyond Viagra -Getting to O
New York Magazine - April 23rd Issue

Viagra raised the flag on a new sexual revolution, and women, with the help of doctors and drug companies, are finally getting in on the fun. Will they find better loving through chemistry?

By Hillary Rosner

"For so long there's been nothing to help make sex more pleasurable for women."

As recently as two or three years ago, a woman talking to her doctor about orgasms was a highly unusual occurrence. The medical community showed virtually no interest in women's sexual problems. "The chairman of my department where I trained told me, 'I don't think anybody will hire you with that as your focus,' " says Dr. Jennifer Berman, a urologist, researcher, and co-founder of a groundbreaking women's-sexuality clinic at Boston University Medical Center. "It was and still is an attitude among the medical field in general."

But Viagra, by removing the stigma from male sexual inadequacy, seems to have spurred a new openness about sexual problems among women as well. Nationwide, women are knocking on their doctors' doors seeking satisfaction, and doctors are beginning to welcome them with open arms -- sometimes even a vibrator.

The phenomenon has particular resonance in New York, where the assumption is that everyone is having great sex -- and heaps and heaps of it. We're not living Ally McBeal here, after all; we're living Sex and the City. Or supposed to be. "There is a lot of guilt about being unable to have an orgasm, certainly, and about having sexual dysfunctions," says Manhattan psychiatrist Barbara Bartlik, who treats men, women, and couples with sexual problems. There's also less time for sex. "For many of our couples who come in for treatment, it's a major event if they're well rested at the same time and long enough for them to have sex. That's a very big problem."

Female sexual response is -- surprise -- a highly complex affair, affected in equal measures by factors physiological and psychological: Problems could have vascular, hormonal, or neurological causes, or they could be symptomatic of a bad relationship, a house full of demanding kids, or a voice in a woman's head that says good girls don't care about orgasms. Remarkably little has been known about the role of hormones in a woman's libido, or even the location and function of nerves in the pelvic area.

At the turn of the century, when Victorian attitudes virtually banned women from any claim to sexual enjoyment, patients suffering from "female hysteria" -- what might now be referred to unscientifically as "needing some action" -- sought treatment from physicians who "manipulated" them to orgasm, by hand at first, later with vibrators.

But not until very recently have doctors and scientists again taken an interest in a woman's orgasm. "There's been a void in terms of where women take these kinds of concerns," says psychologist Sue Chenoweth, who screens patients at a new women's-sexuality clinic in Hartford.

Some of this new interest is, of course, stimulated by money. Pharmaceutical companies, turbo-charged by Pfizer's $1.3 billion in sales of Viagra last year alone, are racing against one another to develop new pills, creams, suppositories, and therapeutic devices. There is also a slew of new over-the-counter aphrodisiacs, with names like Niagara and Rendezvous.

As science struggles to catch up with the market, a dizzying variety of sexual complaints have been newly categorized under the umbrella term female sexual dysfunction (FSD). FSD is actually a broad description that encompasses four distinct classes of sexual problems, which often have both physical and psychological causes. There's female sexual-arousal disorder, a lack of sensitivity or inability to be aroused. Then there's lack of libido, the absence of desire. There's also the condition called female orgasmic disorder. And there's pain during sex, which can occur along a broad spectrum.

Not surprisingly, FSD is highly controversial. For one thing, it allows doctors (read: the Patriarchy) to decide what's normal for women. And the huge potential for moneymaking makes some doubt the motives of these new Drs. Feelgood. "It seems a little odd now that suddenly there's a deficit of female sexuality," says the feminist writer Barbara Ehrenreich, who co-wrote the 1978 book For Her Own Good: 150 Years of the Experts' Advice to Women. "This is not to say that there may not be some women who could use this. But to declare a new widespread disorder and start marketing the drugs to treat it, that's a kind of commercial hype or fraud."

But many who are on the vanguard of this new movement speak a language not of profit but of empowerment. "We have two generations of women now who are struggling with this," says Dr. Laura Berman, a psychologist and a co-founder of the Boston clinic with her sister Jennifer Berman. "One is the baby-boomer generation that are saying, 'Wait a minute, I worked so hard for these rights, I'm not going to let go of them now.' Then we have younger women who are very empowered, very strong, very professionally successful women who still struggle with how to negotiate for their rights in the bedroom: 'How can I give him instructions on how to be in bed? It would totally emasculate him.'"

At first glance, there's nothing unusual about Jill Siskind's office, an ordinary room in the midst of examination rooms and cubicles at Connecticut Surgical Group. Siskind's office has all the trappings you'd imagine: framed diplomas from nursing school, soothing nature photos, a snapshot of her Vizsla puppy on top of her computer monitor, which itself is lined with Viagra stickies.

Probe a little deeper, though, and you might find some surprising loot: a collection of videotapes, like The Bridal Shower by women's-porn pioneer Candida Royalle, whose boxes feature men and women in various stages of seductive undress. A high-tech gogglelike headset that lets users watch films in total privacy. And a vibrator, which Siskind, in the midst of a March-afternoon snowstorm, is cradling in her hands like a newscaster's microphone as she demonstrates its features.

"This is the lightest setting," says Siskind, a nurse-practitioner, adjusting a dial on the bottom of the greenish device, which resembles a medium-size flashlight. "It can go way up," she giggles, turning the knob until the vibrator begins to sound like a blender, "but I don't know any woman who's ever needed that."

Siskind, along with Sue Chenoweth and an ultrasound technician, modeled the clinic after the Women's Sexual Health Clinic at Boston Medical Center, which was founded in 1998 by the Berman sisters and Dr. Irwin Goldstein, a respected urologist who gained fame as the guy who prescribed Viagra to Bob Dole. The Boston clinic spawned a handful of others across the country; the Hartford clinic is the closest to New York.

Women usually first meet with Chenoweth for an hour-long psychological-screening session, at which she asks questions about sexual history, attitudes, and practices, to determine how much of a patient's "dysfunction" is psychological, and whether she's a candidate for physiological testing. If a woman has deep-seated fears about sex, or has experienced a sexual trauma, or is just too uncomfortable, Chenoweth may recommend that she not proceed with the ultrasound tests.

At the first visit, Siskind also does a complete physical and pelvic exam, identifying possible medical conditions, such as cardiovascular disease, that could be contributing to sexual dysfunction. She reviews patients' medication history, noting drugs -- cholesterol reducers, anti-depressants, even birth-control pills -- that can have an impact on libido. And she draws blood for a hormone analysis. Siskind also begins what she calls the education phase of the treatment, offering women basic information about anatomy and what she refers to as "sensate-focus therapy." "I don't like to use the term 'masturbatory points,' because depending on your cultural attributes, masturbation is a negative word."

The "sensate-focus" lesson is often crucial to the next phase of evaluation, the ultrasound tests, conducted during a second visit, in a small examining room co-opted by the clinic twice a month. "My dream," says Siskind, "is a bed, curtains, aromatherapy." In the meantime, patients must settle for a sterile examining table and the clinic's staff vigilantly guarding the door from the other side.

The ultrasound -- which measures blood flow to the genital area at normal levels and then during arousal -- is the reason Siskind is holding the vibrator, which, it turns out, is the only such device that's FDA-approved. Meaning you could, if you wanted to, obtain a prescription for the $300 apparatus, and if your insurance company covers "durable medical equipment," you might even be covered for it. Slim chance, but not out of the question. Patients are sent into the room (lovingly described by one woman as "the torture chamber"; "I don't think she was a good candidate," deadpans Siskind) with a film, a headset, and, if they wish, the vibrator, which is called a Ferti Care and manufactured in Denmark. A technician measures and records blood flow to the clitoris and labia. She then leaves the room for fifteen minutes or so while the woman "self-stimulates," then returns and measures blood flow again. "Normal" blood flow -- based on research by the Bermans -- is approximately twice as high during arousal. There is a broad range, but women whose levels fall on the lower end may be candidates for Viagra or other vasodilators in order to help increase both arousal and desire.

Because blood flow decreases again after orgasm, some clinics ask women to become aroused but stop short of having an orgasm because of its effect on the ultrasound data. But Siskind says she certainly doesn't want to stand in a patient's way. "Some of our patients have problems related to achieving orgasm. If they can achieve orgasm in our office, I'm not gonna tell them not to do that," she says. "But I do ask them just to let me know so we know how to interpret the data."

Interestingly, some women may watch an erotic video and not feel turned on -- but according to the ultrasound readings, they are physically aroused. "It may be that they're not connected with how they're physiologically responding," explains Siskind. "Because they'll say that it's not arousing, that it's doing nothing for them, but their blood levels have quadrupled."

Based on the outcome of the screening, Siskind and Chenoweth may recommend a variety of treatments: Viagra, testosterone, sex therapy, even low doses of Wellbutrin, one of the few anti-depressants that does not come with the nasty side effect of a curbed libido. Siskind says she's had significant success prescribing topical estrogen for arousal disorders, and testosterone replacement for lack of desire. Some women may have no apparent physical problems. "They may be fine, their hormone levels are fine, but they're not satisfied because they don't have a level of completeness and sharing," says Siskind. "Lots of times, one of our therapies is back off, start courting again. Don't have sex. One of the first things we do when it comes to desire or arousal is tell people to rediscover each other. Go on a date. Find out what their partner did that day."

While Siskind and Chenoweth are undoubtedly bringing pleasure to many women, they're not pleasing everyone. Leonore Tiefer is part of a group of doctors, therapists, professors, and health-care activists fighting against what she calls the "hijacking" of female-sexuality research by the pharmaceutical industry. Tiefer is concerned about the trend to medicalize -- and medicate -- women's sexual problems.

It's not that Tiefer is against enhancing women's sex lives. An associate clinical professor of psychiatry at NYU School of Medicine and Albert Einstein College of Medicine, she's devoted her career to it. But she believes that the current research and treatment are on a dangerous course, one that undermines feminist notions of gender politics and sexual equality. Tiefer worries that unrealistic representations of sex in pop culture lead inevitably to disappointment with the real thing. (She likens some of the new sex-enhancing products to "snake-oil.") "People have been set up by the commercial hyperbole saying that sex is the greatest part of life, the most important part of a relationship, the biggest source of pleasure. You've been told this since you were old enough to watch television. And then you come to adulthood and it doesn't measure up." The myth that everyone else's sex lives are approaching nirvana propels women to seek help for something that's "wrong" with them.

"The whole thing about erectile dysfunction was getting that ol' penis so it could function at a 25-, 30-year-old level until the guy is in the grave," says Tiefer, drinking tea one frigid morning in the lobby of the NYU Medical Center. "So we have these 70-year-old guys with 20-year-old penises; now we have to get women with 20-year-old vaginas. That's what this whole thing is about: getting that vagina in peak condition for that Viagra-enhanced erection." In other words, even the doctors attempting to empower women by giving them back their sexuality are doing it within the confines of a male-centric view of what sex should be.

"From the feminist point of view, it's an extremely narrow take on women's sexual potential," Tiefer continues. "Women want romance, tenderness, pleasure, intimacy. They are perfectly content with other forms of sexual satisfaction. Penetration is not at the top of the list."

"I hear women all the time worry about breast cancer, health insurance, their children's illnesses, their husband not going to get medical care for chest pains because he's too afraid," says the feminist writer Susan Faludi. "But I never hear anyone talking about the fact that they don't come every time they have sex." Faludi, like Tiefer, believes that much of what's referred to as the "medicalization" of female sexuality is really a veil for the "commercialization" of female sexuality -- a move on the part of doctors and pharmaceutical companies to tap into a lucrative field. "It's the same mentality that pushes these anti-depressant drugs on women when they're a little off," she says, "the idea that the body is a machine and must be running at top performance all the time."

What happens when you slap the label dysfunctional on a woman who just doesn't want to have sex? Many women, particularly menopausal women, are deeply distressed by the loss of their libido, which researchers have discovered can often be due to decreased testosterone levels. But what about those who are not distressed? Are they dysfunctional? And what if they're not bothered by the situation -- but their husbands are? Whose problem is it? "Some women come in here, and they're perfectly happy doing the grocery list while they're having sex," says Siskind. "But their husband is bothered by it. Maybe it's not the woman's problem."

As sex therapists are fond of saying, no drug will cure a woman who simply hates her husband. (Or as a friend recently quipped, "Most women don't need Viagra. They just need a pill that will turn their husbands into Johnny Depp.")

"I didn't feel passionate. My 22-year-old daughter is so passionate, and I was feeling so blah. I needed to take something to get back to being me."

Tiefer is also adamant that the entire basis for diagnosing a woman with FSD is flawed, citing as evidence the fact that there are few established norms for sexual function in women (although those are precisely what the Bermans are trying to develop at their clinics): "Nobody studies normal people, so we don't have any idea what the range is."

Dr. Beverly Whipple, a Rutgers professor and sex researcher (best known for helping locate the G-spot) who was on the panel that determined the criteria for diagnosing FSD, takes issue with the criteria that made the cut. "One thing that was voted down was satisfaction as a criterion," says Whipple. "A woman could have no desire but she could have arousal and orgasm and be very satisfied, and yet she would be seen to be dysfunctional. Or she could have desire, arousal, and orgasm and yet not be satisfied. And yet that wouldn't be considered dysfunction."

"There's been so much brouhaha about this," says Chenoweth. "Should the criteria be personal stress or relationship stress? There are different camps about whose distress we're talking about, whose dysfunction."

Female sexual dysfunction is not a disease. It's a symptom of another problem."

In some cases, the problem might be abysmal sex education. Tiefer recently counseled a 27-year-old college-educated woman who was convinced she was anatomically abnormal. "She had no idea that there was such a range of women's genitalia," Tiefer exclaims. "Had she ever seen photographs? No. She needed comprehensive sex education. I'm not saying that her whole sexual problem was lack of knowledge. But that was a piece of it."

There's also the powerful Puritanism that still makes people -- men and women -- uncomfortable discussing female sexuality. Chenoweth recalls teaching a human-sexuality course to undergraduates in which she displayed diagrams of male and female anatomy. "When I threw up the anatomy of the male, people were looking at it and taking it in," she says. "Then I threw up the comparable picture of female anatomy, and I looked at the class and everyone's head was down."

There are subtle distinctions among the sexual problems that men confront, but the bulk fall into the relatively simple category of mechanics: Either a guy can get it up, or he can't. Like so many things female, though, women's problems are vastly more complicated. The already complex symptoms of FSD cycle into one another: If having sex is painful, then desire might very quickly vanish. Without sensitivity, it's rather tough to have an orgasm. There are medical and psychological factors, too, that contribute to each of the problems -- not to mention factors specific to a given relationship.

Which is why the Bermans' goal from the start was to create a place that would treat women's problems holistically, providing help whether the problems were in their body, in their head, or both. Heartened by the success of the clinic and Goldstein's support but frustrated by what Jennifer Berman describes as "a constant uphill battle" against sexually and politically conservative attitudes in the hospital and in Boston, the Bermans relocated to Los Angeles, where they opened the Female Sexual Medicine Center at UCLA this winter. "It's not a matter of medicalizing sexuality but really 'relationizing' it," says Laura Berman. "It's about the relationship between mind and body, and treating the cause. It's not about treating a sexual-function complaint with medicine when it's caused by poor body image. The key is in diagnosis. So we can make a holistic evaluation."

But even the efforts of health-care professionals like the Bermans to emphasize the mind-body connection and the need for education won't stop some women from looking for a miracle pill. "A lot of Americans or women in Western society want that quick fix," says Siskind, who is optimistic that there are just as many women who will opt for the holistic route. "They want the pill. They want the magic button."

Now that Viagra has given medical legitimacy to the quest for more pleasure between the sheets -- and particularly now that pharmaceutical companies are dumping dollars into research -- data and remedies are already piling up.

One treatment gaining in popularity is testosterone. "Testosterone is really the most promising development in terms of facilitating effective female response," says Dr. Sandra Leiblum, professor of psychiatry and director of the Center for Sexual and Marital Health at Robert Wood Johnson University Hospital in Piscataway, New Jersey, and president of the 900-member fledgling Female Sexual Function Forum. "It does for women what Viagra does for men."

Dr. Lauri Romanzi, a uro-gynecologist affiliated with New York Hospital-Cornell Medical Center, has begun screening some patients for low testosterone levels, based on their answers to a new questionnaire that asks all patients about their libido, sexual sensitivity, and orgasmic intensity. "I'm finding, with women in their late forties and early fifties and sometimes beyond, that very often if they complain of a sudden drop in their appetite for sex, and there doesn't seem to be anything else -- there wasn't a death in the family, they haven't suddenly started taking four different types of blood-pressure medication -- their testosterone levels are often quite low," says Romanzi, seated at her desk in her high-ceilinged Park Avenue office.

Paula, a 50-year-old patient of Romanzi's, experienced a loss of libido after menopause. "I didn't feel passionate," she says. "My 22-year-old daughter is so passionate, and I was feeling so blah. I used to have that passion." Paula began taking testosterone and says her libido is back in action. "The blues definitely subsided. I needed to take something to get back to being me." Paula says the testosterone has also helped her relationship with her husband. "He knew that it was my hormones, but you can't help but take it personally. So it was hard for him. Plus it's a big part of our relationship, because the more intimate we are, the closer we are."

Sarah, a patient at the Hartford clinic, lost her interest in sex a few years ago. "It was just like, things weren't happening," says the happily married 47-year-old. "It never bothered me to participate, but I wasn't starting sexual activity. It became not part of my life. I just didn't know what was going on."

"It wasn't the same, but I accepted it," says her husband, "thinking, that's how it is, I'm not gonna leave her for some younger woman just because the sex isn't as good as it used to be. I just figured this is what happens to women, her hormones change, that's life."

After undergoing testing, Sarah learned she had low testosterone, and began taking a nutritional supplement called DHEA, which breaks down into usable testosterone, as well as Viagra for a "good, immediate fix" until the testosterone took effect. She also began a low dosage of Wellbutrin. Now, she says, the sex is better than ever. "I feel like I have my life back. My reason for being is back again. The zing is back."

Testosterone comes with its own set of problems, though: powerful -- and irreversible -- side effects. Women need only between one-tenth and one-twentieth the amount of testosterone as men, and too high a dosage can have disastrous consequences: deepening of the voice, excessive hair growth, and even enlargement of the clitoris. "If you get androgenic effects, if you start to sprout terminal black hairs, or the clitoris enlarges, or you start to have hair on your chest or back," says Romanzi, sounding suitably grave, "those things may very well be permanent." Not content with the dosage level of the only commercially available, FDA-approved testosterone replacement for women, called Estratest, Romanzi enlists a local pharmacist to whip up her own preparations -- low-dosage vaginal suppositories. "We're treating something that's not life-threatening -- it affects quality of life, but having a low libido is not going to kill you," Romanzi says, explaining the need for extra caution as far as side effects. "It's not like having coronary-artery disease."

Leiblum also cautions against a rush to declare testosterone the new miracle drug. "I've heard various people on TV lately saying that women who have no desire are testosterone-deficient and the way to deal with it is to put all women on testosterone. Which is ridiculous. In peri- and post-menopausal women, many will have low testosterone. But that's not true of the normal 25-year-old."

The "normal 25-year-old" might, however, respond to Viagra, side effects or no. This is the hope of Pfizer, which is currently conducting clinical trials of Viagra in women; the results of preliminary studies indicated that the drug "did not appear to significantly increase sexual arousal in women," according to a company spokesman. It did, however, increase blood flow. And in testimonial evidence, many women have responded well, saying they've achieved their first orgasm ever on Viagra, or, like actress Kim Cattrall, who has publicly discussed her Viagra fetish, that it enables them to have multiple orgasms.

While Pfizer continues its studies, virtually every pharmaceutical company on the planet is testing a product for FSD, whether a new medication or an adaptation of a drug originally designed for men. "In men, it's simple -- it's a plumbing problem. But until we get a handle on this, it's like shooting in the dark," says Dr. Carl Spana, president and CEO of Palatin Technologies, a small biotechnology company in Princeton, New Jersey. Palatin is evaluating a product called PT141 -- an "initiator" of erectile response in men -- for use in women. But Spana believes that the medical community is still in need of more female leadership in research. "At one of our initial meetings, we had five guys sitting around a table talking about female sexual dysfunction," he recalls with amusement. "Five guys. I don't even know how to figure out women when they're healthy. It was absurd."

Last summer, Pharmacia introduced a new product called Vagifem, and on Valentine's Day, the company became the first to devote an advertising campaign to a drug that treats a symptom of FSD. Vagifem helps relieve the common condition in women after menopause in which the genital skin becomes dry. Despite its unappealing name (don't they have focus groups for that sort of thing?), Vagifem, say its proponents, represents a breakthrough in its delivery system: It's a tiny estrogen tablet, smaller than a baby aspirin, which is administered vaginally. It replaces estrogen levels locally, allowing the body to absorb only as much as it needs. "The major point is that you're correcting a problem, which is that the vagina isn't functioning in a way that makes sexual exchange pleasurable for a woman, and that is a turnoff," says Dr. Gloria Bachmann, chief of the OB-GYN service at Robert Wood Johnson and a participant in Pharmacia's clinical testing for Vagifem.

But while the drug companies rush to get products into the testing phases, only one product has thus far been FDA-approved specifically for female sexual-arousal disorder. It's called Eros-CTD, and it's a small suction device intended to increase blood flow to the clitoris, both by vacuum action (like a vacuum pump for the penis) and, through daily use, by breaking up collagen deposits in the bloodstream. On a recent Oprah segment (featuring Jennifer and Laura Berman), Oprah Winfrey was skeptical, proclaiming the Eros unlikely to gain mass-market appeal.

Testing the Eros on my palm in her office in Hartford, Siskind admits that "it takes time to see the effects." A patch of skin the size of a penny is sucked into the Eros's cup, leaving me with a hand hickey. The Eros apparently has no side effects -- though women are cautioned not to fall asleep while using it.

Beverly Whipple is unimpressed by the device. "It makes the clitoris larger," Whipple muses in her home in Medford, New Jersey, and you can almost hear her head shaking in exasperated wonder through the phone. "Why, pray tell, do we want the clitoris to be larger?"

But if the Eros-CTD is not necessarily the be-all and end-all, the good news is its lack of side effects. Which brings us back to the Viagra-type creams. "My own feeling is that women have to contend with a lot to enjoy their sexuality," says Sandra Leiblum. "So anything that can be helpful for women in terms of getting past their inhibitions should be encouraged."

"If you give these medications topically to women, that should enhance blood flow," says Barbara Bartlik, who also enlists a pharmacist to mix creams for her patients. "And where you have greater engorgement, you have greater pleasure, greater sensation, greater lubrication. It stands to reason. So I think that we're on the verge of something."

LUST LOTIONS:
Move over Viagra - a Batch of New Women's Love Drugs Are Coming.
Glamour - August 1999 Issue

Health Report by Curtis Pesmen

After the orgasmic hype surrounding the 1998 introduction of the male erection drug Viagra, you'd have thought that doctors and researchers in the sex-drug field were ready to roll over and fall asleep. Well, women are in luck!

Instead of dozing off, sex scientists are finally waking up to women's needs-and scrambling to test and develop drugs that enable or enhance women's ability to achieve orgasm.

Today, a batch of new lust potions aimed directly at your sex life are on the horizon. Due for possible release in the next six months to three years, many of the inventions would employ drugs already approved for use by men.

But unlike many of the male-sexual-dysfunction drugs, which come in pill form or are injected directly into the penis (ouch!), most of the products for women will be gels or creams, designed for pre-sex application right where it counts.

It's about time. "The success of Viagra has caused women to ask, 'Hey, what about us?' It's just becoming much less taboo to address women's sexuality," explains Julie Phillips, clinical project coordinator of Pentech Pharmaceuticals in Buffalo Grove, Illinois. Pentech is conducting test involving 50 women to see if the drug apomorphine-which has been shown to remedy the psychological as well as the physical aspects of male erectile dysfunction-"can also increase women's sexual desire and functioning," Phillips says. Results are expected next year.

"We're going full speed ahead with our development plans for a product for women," confirms Leland Wilson, president of Vivus, Inc., the Silicon Valley pharmaceutical firm that makes MUSE, a male erection drug that predates Viagra but hasn't been as financially successful (perhaps because it is inserted directly into the urethra rather than taken orally in pill form!).

Even individual doctors are recognizing that men aren't the only ones with below-the-belt problems and sex lives that need a jolt.

The results, ranged from disappointing to explosive; in Glamour's small and by no means conclusive test, the Cream was even more effective that the one containing sildenafil, but both produced a noticeable difference in genital sensation before and during sex. And that's not all-not by a long shot. "I had 12 orgasms!" Janice, 36, a New York City personal trainer, reported after one lovemaking session. "For me, three or four a night might be normal, sometimes only two, depending on my mood. Twelve is the most I've ever had." (For the record: Her orgasms were not all intercourse-induced; manual stimulation and a vibrator were also involved.)

After experiencing good between-the-sheets results with the sildenafil cream, one Glamour editor mused: "Was the sex better because of something in my head, where I think 90 percent of sexual arousal takes place? In other words, did the cream actually make a difference? Or was the sex better because I expected it to be?"

These questions highlight an obvious but relevant point: Achieving orgasm depends on psychological and emotional factors, not just physical ability. With this in mind, several companies are now also developing drugs that address the mental side of women's libido and desire. One aim of Pentech Pharmaceutical's planned sex drug for women, for example, is to make the brain release the feel-good chemical dopamine, which could put women more in the mood to have sex. Meanwhile, Atlanta-based Solvay Pharmaceuticals, the creators of a hormone-replacement therapy called ESTRATEST, is studying the drug's effect of women's libido.

But before you line up to buy the new lust lotions and potions, know this: The potential side effects of many of the new drugs are still unknown. Because they're applied topically to just one part of the body and contain low drug dosages, they're presumable safer than taking a pill, which introduces drugs to the liver because it is ingested orally. However, no large-scare clinical tests have been done of either drug on women. In addition, "any topical drug applied to the genital area increases the risk of skin or mucous membrane irritation," which can make it easier to contract and STD, says Jean Marie Guise, M.D., director of clinical research at the department of ob-gyn at Oregon Health Sciences University in Portland. In fact, one of Glamour's editors experienced genital irritation the day after using the sildenafil cream.

Nonetheless, a time is close when women with real sexual dysfunctions will have fresh options and the rest of us will get to choose whether chemically enhances sex is better than going au naturel.

Finally, women are getting a piece of the passion pie!

So slide over Viagra-your partner's coming. Soon, and often.

Men's Drugs, Women's Orgasms
GQ Magazine

It's difficult to argue orgasms with a man who has an upright plastic penis perched on his desk. New York University School of Medicine Urologist Jed C. Kaminetsky is talking about diffuse (or, if you will, "diff-use") effects of a new drug, and he is talking on the record but quite off-label.

Almost since Viagra's approval last year, word has been spreading about a possible female use of the stuff, and Kaminetsky has prescribed the erectile drug to more than twenty women to good climactic effect over the last year.

In short, Viagra boosts blood flow not only to a man's penis but also to a woman's clitoris. Even more important targets, Kaminetsky believes, may be the bundles of nerve-rich tissues that lie beneath the clitoris and alongside the inner labia and the mons pubis. "We have a long history of using drugs off-label," he says of doctors in general. In this instance, he is talking about a long-playing buzz his female patients feel lucky to have found, one that may take the FDA (too many) years to confirm. Kaminetsky and a few of his cohorts have gotten creative with other male sex medications as well.

He takes pride in having concocted an off-label vaginal suppository made from Muse, one of the more popular pre-Viagra erectile-dysfunction drugs. For women looking for more memorable orgasms, a pellet of Muse mixed with insert jelly like compounds is applied prior to intercourse to the anterior wall of the vagina- otherwise known as the G-spot. "Personally, I think Viagra worked better and is a little less cumbersome," Kaminetsky says. "But the suppository is really comfortable, and there is a company doing tests on this right now."

PICK ME UP, SLOW ME DOWN

Not every man needs Viagra, of course. Especially those afflicted with the condition known as premature ejaculation (PE). In an odd twist, those who come too soon too often may benefit from not coming down. Consider: Now that the "new" antidepressants Prozac, Zoloft and Anafranil have been prescribed to millions of patients throughout the 1990's, some of the lesser-known uses of these drugs have been discovered. One of these uses is decidedly off-label; it evolved because one of the frequent side effects of these drugs is low libido. Why not harness this loss of drive, the thinking goes, to tame the overeager?

Outside his private practice, as an assistant clinical professor of Urology, Kaminetsky sees evidence of off-label medicine far beyond his specialty. "It's a clear case of using a drug to "capture" side effects of the drug-in this case (to control) premature ejaculation. And some of my happiest patients are those who have used this, (PE is) embarrassing, upsetting, and patients are at their wit's end." A word of caution is in order, though. Anyone who uses Prozac, Zoloft or Anafranil for PE should be prescribed a lower-than-normal and possibly periodic, (not continual) dose. And if someone knows he's not having sex for a while, he'd be well advised to lay off the drug temporarily.

Love Potion Number 9
Mode Magazine - July 2000 Issue

Move over Viagra. Doctors and drug companies have learned that women Want to feel that rush just as much as men do.

By Karen Moline

"Nice girls don't." How many timed did we hear that when we were growing up? Nice girls don't smoke or drink or eat that second piece of chocolate cake. They don't fool around on a first date or complain about their husbands' performance in the boudoir or dare to do anything to enhance their own pleasure. And nice girls certainly don't write books with graphic sexual scenes in them.

But this nice girl did just that, and I discovered how squeamish and repressed many people are when it comes to dealing with sexual behavior and fantasies, whether modest or explicit. Especially when I gave a draft of my second novel, Belladonna, to a lawyer friend to critique. I wanted his blustery, type A perspective on the male characters, even though I had a feeling he wouldn't like it.

He didn't. He really didn't.

After slashing my characters and plot to shreds, this normally glib and superconfident man had one last comment: "Um...er...um...well, I know I've been critical," he stuttered. I could practically feel him blushing over the phone. "But...um...do you have any of that cream?"

"What cream?" I asked.

"You know," he said, "that aphrodisiac cream."

"Oh, that," I replied, laughing. He was referring to the cinnamon-scented potion I had conceived as part of my plot, It was a concoction that, once applied to a woman's most private parts, was guaranteed to make her delirious with desire. "Sorry, I don't have any. I made that up. It's a novel. It's fiction."

"Well," he said, "if you ever do have some, let me know." Soon there may very well be something to tell my friend. A few drug companies have been developing, or at least investigating, "female Viagras," topical sex stimulants in cream form that would basically drive women crazy.

This is a breakthrough for the gentler sex. A staggering 43 percent of women have some form of sexual dysfunction, according to a University of Chicago study recently reported in the Journal of the American Medical Association. That's nearly half of the female population-a truly shocking figure.

"Unfortunately for women," says Natan Bar-Charma, MD, a urologist at Mount Sinai Hospital in New York City, "it's physiologically easier to induce an erection than it is to enhance female sexual pleasure."

You may have heard that women can take Viagra, too- it apparently has helped many people. It works by increasing blood flow to the genital area (the clitoris in particular). However, women who take it risk getting what's called a Viagra effect, nasty complications like migraines and blurred vision.

Dr. Kaminetsky believes that products like these will have a major impact on female sexuality. "Women who haven't wanted sex for a long time now want it and are getting pleasure out of it," he says. "and that's going to change the dynamics of a couple's sexual behavior. It can help you get out of a rut in the bedroom and make you excited to be having sex again."

"I couldn't agree with him more," says Betty, another patient. "After I had my son and many miscarriages, my hormones were shifting and my libido really suffered. It just didn't happen for me anymore. Using the cream gave my husband and me a new project to do together. Sex became fun again, instead of painful and unpleasant. It really revived our sex life. My husband puts the cream on me and then a dab on himself. We know we're going to relax and have fun. It makes us find the time to have "dates" with each other."

Clearly, women have a lot to look forward to as more and more of the big drug companies realize that we want to ride the Viagra wave, too, and so develop better products for us. We certainly deserve no less.

So bring on the dream creams and love potions! We women-and even those skeptical men (like my lawyer friend)-are ready for them. And maybe one day we'll get to the point where moms everywhere will be telling their daughters, "Nice girls do!"

*As with all drugs, both prescription and over-the-counter, please consult with a doctor before use.

Women Give Thanks To Viagra
SELF Magazine - December 1999 Issue

By: Jennifer Conroy

Thanks to Viagra, the lagging libidos of countless aging dads and granddads across the nation have become a hot topic - and for many, a thing of the past. Yet, little attention has been paid to the group hardest hit by sexual problems: women.

According to a study published earlier this year in the Journal of the American Medical Association, four out of ten women experience some form of sexual dysfunction, compared with three out of ten men. Even more surprising: The researchers found that women in their twenties have the highest incidence of many sexual problems, from inability to achieve orgasm to lack of sexual desire. The study leaders theorize that younger women are likely to have high rates of "partner turnover" and "periodic spells of sexual inactivity," which may lead to stressful sexual encounters.

No doubt. But some experts have other ideas about young women's sexual malaise. Judy Kuriansky, Ph.D., a clinical psychologist and certified sex therapist in New York City, attributes the problem in part to increased use of antidepressants, which more than 4 million American women now take.

An estimated 30 to 75 percent of antidepressant users experience some form of sexual dysfunction, from lack of sex drive to vaginal dryness. Libido squelchers include selective serotonin reuptake inhibitors (such as Luvox, Paxil, Zoloft and Prozac) as well as older antidepressants (tricyclics and MAO inhibitors). Fortunately, a number of drugs are less likely to pose this problem. Mirtazapine (brand name Remeron), bupropion (Wellbutrin, Zyban) and nefazodone (Serzone) are all sex-friendly alternatives to earlier mood-improvement medications. If you currently take antidepressants, ask your doctor if it makes sense for you to switch.

And more help may soon be on the way. Researchers are now experimenting on women with Viagra and other drugs that enhance blood flow to the genitals. And so far, so good.

Sex Drugs For Women?
Harper's Bazaar - March 2000 Issue

Steve Fishman charts the progress. Photographed by Frederik Lieberath

Viagra was designed strictly for men. Then researchers learned that Sexual dysfunction is an even bigger problem for women, and the race to Create a female tonic was on.

One day, Maria thought, To hell with it, excuse the language. There had been fights with her husband, whom she adored, but just now she was occupied. The accounting job, and she had a young child. And the new house. It had lovely elm trees in the yards, front and back. The place looked beautiful.

"How about me?" her husband would ask. "What's the point?" she would answer him offhandedly. Maria had reddish-brown hair, a sunset shade, and dreamy eyes-that's how she thinks of them. She touched her hair as she said, "I don't think about sex."

Really, though, she did. She might not want sex, but how could she avoid the thought? On TV, in the movies, there were always women having sex, and looking as if they loved it-though she'd decided those scenes must be unrealistic, since she'd never experienced anything remotely like it.

Maria is 36 and exercises two or three times a week, She has strong, beautiful legs, which her husband says are her best feature, though he likes her smile, too. It shows her bright teeth, though not too much, and makes her cheeks plump a little. Smiling, she'd look in the mirror, and think, I don't look like I've aged a bit since 25. In fact, she'd add, I feel better now about myself than I did when I was 25. So why hadn't her sex life blossomed with everything else?

She'd consulted half a dozen gynecologists. She'd been to counseling. She'd bought books and pornographic movies. She'd masturbated, or tried to. She'd blamed her husband, wondering, at separate times, about his technique and her emotions. Maybe she wasn't wildly in love any longer. "I was on a search", she confessed, without smiling.

A slice of the medical community has recently signed on to that same search for the female orgasm. Since Viagra, Pfizer's billion-dollar-a-year pill, rebooted the sex lives of men two years ago, drug companies seem to be waking up and saying, "What about women?"

Last February, researchers at the University of Chicago publicized survey data showing that sexual dysfunction-the inability to have an orgasm or enjoy sex-is a bigger problem for women than for men. Forty-three percent of women ages 18 to 59 experience some trouble, while only 31 percent of men do.

Before that, there was almost no work being done on women. Now, it's a big race. The pace of research has accelerated to the point where it looks entirely possible that women will have their own tested version-or versions-of Viagra in the works within the next couple of years.

Already, new findings in many laboratories show that Viagra-or at least its main ingredient, sildenafil-does work for women (despite some reports to the contrary last year). Many other sex-enhancing substances designed for men appear likely to work for women too.

The promise of these hectic new efforts isn't only for those, like Maria, who have never had an orgasm. Ultimately, the promise is that any woman who wants an improved sex life might soon be able to take a pill or apply a cream.

"Something women could take," says one impatient doctor in New York, who's already had a pharmacist mix up a couple of what he hopes are orgasm-promoting concoctions, "whenever they want to have sex."

Sex Researchers Discover Women

"We"re 20 years behind where men are," says Irwin Goldstein, M.D., at Boston University School of Medicine, one of the most energetic presences in the science of female sexual response. Last fall, he organized what he says was the largest ever conference on the subject at BU, drawing more that 400 physicians, sex therapists, and psychologists. Spend a little time with him and you get the impression of someone in a rush-as if he might be trying by his quick step to pace the field itself. "Someone has to keep this ball rolling," he says.

In 1998, Goldstein authored a key paper showing that Viagra-conceived as a mere angina drug, which had the unwanted side effect of producing erections-was a safe and effective treatment for what was then commonly called impotence. (Now the preferred, snazzier term is "erectile dysfunction.") By the time Viagra appeared, Goldstein says, "we thought we had everything done in the male world."

Yet in the female world, sexual dysfunction remained, as a paper to be published this month reports, "an under-researched and poorly understood area." There were only a few-perhaps three-labs working on the problem.

The anatomy and physiology of female genitalia wasn't even well under stood. "In the textbooks, you'd see 25 pages on male genitalia and two on female," says Jennifer Berman, M.D. When Berman finished her urologic training at the University of Maryland in 1998, she was advised to get serious-cut her hair, wear glasses, and not tell anyone she was interested in female sexual dysfunction. Why? Because it was not a real medical problem.

If a woman had a sex-related complaint, she usually got shipped off to a therapist.

Sex, of course, does have a lot to do with psychology. Give women a placebo and, in the short term at least, it improves the sex lives of one third. But therapists couldn't do a thing for many women. So there had to be problems outside the patient's head.

Sexual malfunction might be easier to observe in men-an unresponsive penis is unmistakable-but why couldn't women have physiological malfunctions, too? "You're allowed to have a toe problem and an eye problem," says Goldstein. "Why not a clitoris problem?"

Viagra seemed likely to help. The drug promotes blood flow to the penis, which results in erection. Everyone knows that, during sex, the clitoris and labia swell with blood. Wouldn't Viagra boost that kind of blood flow too?

Pentech's Uprima, another sex drug for men (expected to get government approval within a few months) works not on the circulatory system but on the brain. Researchers have theorized that apomorphine, Uprima's active ingredient, might be especially good for women because it could affect both sensitivity and desire for sex. So far this much is known: In men, apomorphine initiates erections; in female rabbits, it promotes blood flow to the clitoris and vagina.

And what about prostaglandin, a natural fatty acid that, when injected into the penis, has produced such reliable erections? Or testosterone, "the hormone of desire," as one doctor labels it? When added to postmenopausal women's hormone-replacement therapy, testosterone seems to boost their interest in sex.

Another promising agent is the amino acid L-arginine-a nutrient, not a medicine (and therefore not FDA regulated)-which dilates blood vessels. When a supplement containing L-arginine was given to a small group of women, two thirds reported increased clitoral sensitivity.

Now this once underfunded field seems inundated with drug company money. Goldstein has started clinical trials on Uprima and Viagra. In Texas, Cindy Meston, Ph.D., a clinical psychologist who's been studying female sexual response for nine years, says, "I'm turning down offers."

Berman never did cut her hair or buy glasses. She was too busy in the lab. She prescribed Viagra to three female patients in 1998-was possibly the first doctor to do so. When all three reported an increase in sexual satisfaction, she did a small study. She gave Viagra, along with a questionnaire, to 13 women. Seven said their sexual experiences were better.

Things might have stopped there, except Berman went to work with Goldstein at Boston University. Soon, the two of them would co-author one of the first papers to show a physiological cause for impaired sexual functioning in women-diminished blood flow.

Berman wanted to work with patients, too. Others might have hesitated. A female-sexual-dysfunction clinic didn't seem an entirely respectable (or for that matter, moneymaking) part of a big-time urology department. But Goldstein helped shuttle it through the bureaucracy.

As soon as she got the go-ahead, Berman phoned her sister, Laura, a sex therapist, who happened to be looking to relocate. "We'd always fantasized that we'd open a clinic together," Laura says. (Their father, a surgeon, had long made a joke of it around the family dinner table.). In July 1998, they opened the Women's Sexual Health Clinic in the Urology Department of Boston University, the first comprehensive research and treatment program in the country.

The clinic is open just one day a week-and booked two months in advance. You walk in through a door marked Urology/Continence, then follow a beat-up pink rug, patched here and there with silver duct tape. In the waiting room sit impotent males. They're the ones with coats in their laps; the diagnostic medication they're given often produces erections, which they tend to hide.

Once called the Viagra twins, the Bermans share one office with one desk. Both answer the phone, "Dr. Berman."

Last year, the Boston University team reported on 48 women with sexual dysfunction. In virtually all of them, after taking Viagra, "physiologic measurements significantly increased" - and so did sexual satisfaction.

Jennifer's plaques are on one wall: Laura's are on another. A snapshot of the two of them, arm in arm, is on a third. The desk tends to get littered with samples from the orgasm promoters-creams, pills, dietary supplements-though, as Laura complains, "people steal things all the time." There's also a clitoral vacuum-like device called EROS CTD, which the Bermans, are testing on some of their patients.

A Visit To The Viagra Twins

Some women come to the clinic complaining that they just don't feel much like having sex, which bolsters the Chicago study's finding that women's most common "dysfunction" is a lack of desire. But Paula, a recent patient, didn't buy it. A Rhode Islander with a Ph.D., green eyes, and auburn hair, Paula is a self-possessed, successful teacher and administrator and, until recently, had a great sex life with her husband. Then, two years ago, she had surgery for cancer. Surgeons took out her uterus and both ovaries. "It's bizarre," Paula told Jennifer. "Now there's a lack of sensation. I can feel me clitoris, but I have no sexual sensation. It's like I'm touching the tip of my little finger.

When surgeons remove a man's prostate, they use magnifying loupes and carefully dissect around the nerves that are responsible for erections. When women get hysterectomies, their surgeons are oblivious to nerve pathways. Jennifer Berman has seen the operation. Perhaps that was the cause of Paula's lack of sensation. Or else the loss of her ovaries, producers of estrogen and testosterone, deprived her of hormones that feed desire, lubrication, and sensitivity.

Paula was referred for diagnostic tests-some of which are just now being developed. Until recently, the only objective measure of sexual excitement in women was a cumbersome 25-year-old laboratory technique called photoplethysmography, which indirectly measures vaginal blood flow. A small tampon-shaped instrument, inserted in the vagina, emits a light and measures how much light is reflected back. The greater the blood flow, the less light. It seems a rough measure, especially now that women are accustomed to such exquisitely detailed medical images as pregnancy ultrasounds, CT scans, and MRIs.

Recently, these sophisticated technologies have been used to measure arousal. (In France, a couple had sex inside an MRI machine, producing detailed pictures.) And now, Jennifer Berman is experimenting with measuring blood flow to the genital area with ultrasound.

Paula dressed in a hospital gown and slipped on a video headset. She'd selected an erotic video-"This one usually works," a nurse had said. She settled in with a vibrator in an exam room amid jars of Q-tips and cotton balls, and 15 minutes later, a medical team rushed in to read the ultrasound.

It turns out that the physiological changes a woman experiences during sexual stimulation are as striking in their way as a man's erection. During what's called the arousal phase, the vagina lengthens and widens, acidity lowers, sensitivity increases, and the clitoris, labia, and walls of the vagina become engorged with blood. You can see the blood flow on the ultrasound image.

Yet the oddest, and most confounding, aspect of treating female sexual dysfunction may be that even when a woman's genitals register excitement-even when you can see it on ultrasound - the woman will shrug and say, "I don't feel aroused." Berman theorizes that for some of these women, using Viagra to get an extraordinarily large flow of blood to the genitals will boost their sense of excitement.

An hour before her next visit to the clinic, Paula took 100mg. Of Viagra. Her face flushed, but more important, she was aroused. She said, "I could hear my blood pumping on the ultrasound."

Early last year, the first report on Viagra in women gloomily suggested that women were beyond the reach of medications-three in four failed to report a benefit. But that study turned out to have been flawed. Last year, Goldstein and the Berman sisters reported on 48 women who'd gone through the same routine as Paula. Overall, after taking Viagra, physiologic measurements significantly increased,-and so did subjective satisfaction.

Paula was prescribed a small dose of hormones (estrogen and testosterone) and, when she wanted to have sex, 50 mg. of Viagra. Suddenly, she says, "it was like it used to be."

In women as in men, Viagra pills have side effects such as headache and sinus congestion.

Who knows how this might shake out if government safety and efficacy studies are ever done?

Even though many drugs, like Viagra, don't work on the brain's centers of desire, clearly there's a feedback loop. Perhaps some women who tell researchers their desire is off are actually experiencing diminished sensation. "now I think about sex," Maria says, "I think about the feeling and it makes me more motivated to do it."

But the main cause for delay is the nine to 12 months it could take to move new treatments through the FDA-approval process. New pills and potions will exist much sooner. "In the next year we'll know something about Viagra," says Julia Heiman, a professor of psychiatry and behavioral science at the University of Washington, in Seattle. Jennifer Berman and others are also testing apomorphine (Pentech's Uprima). Perhaps someday, Viagra will be prescribed for some women, apomorphine for others.

Some researchers worry that the new treatments will distort attitudes toward sex. Is it really pathological to have a low sex drive? Will new medicines create unrealistic standards? "It could set up Olympic expectations of sexual activity," says Meston, "where a single orgasm isn't enough."

Maybe that will be a problem with men and Viagra first. Doctors acknowledge that a large share of the prescriptions are being written for men whose sexual machinery already works just fine. But the story is likely to be a little different with women, given that nearly half of them (43 percent) fit the definition of sexually dysfunctional. It's probably not going overboard to expect-or hope-that new medicines will help them experience any orgasms at all.

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