Q: I'm a 50-plus woman who used to love sex, but now I have no interest whatsoever. Is there any kind of medication I can take to increase my sexual desire?
A: Unfortunately, not yet. At least one such drug is in development, but the Food and Drug Administration denied its approval earlier this year because it said the medication (an antidepressant) had no significant effect in increasing sexual desire. But stay tuned: I have a feeling we'll see some kind of pharmaceutical product like this in the not-so-distant future.
Meanwhile, some doctors prescribe testosterone to increase female libido, even though the FDA hasn't approved it for this use. But you might try asking your doctor what he or she thinks about that possibility.
Alternatively, some herbal, nonprescription products are on the market that might do the trick. A friend of mine took one such product that is sold at certain organic food markets and was greatly impressed. But who knows how much of this was based on the belief that the drug would work, rather than its actual medicinal properties?
I'd also advise you to think about possible causes for your low sex drive. Take a good look at your overall mood: Are you depressed or anxious? Are you experiencing any other physical symptoms? Do you take hormone replacement therapy, antidepressants or any other medicines that could affect your sex drive?
I suggest making an appointment with a specialist in sexual medicine to try to get to the root of your problem. Or if you think there's a chance there's an emotional component to all this, you should consider seeing a therapist. I know you'd like to get your mojo back — and I'm confident you'll find a way to do so.
Q: I'm a 75-year-old man who can't maintain an erection. I've tried all the popular erectile dysfunction pills — without any success. Is there any hope?
—Michael, New York
A: Yes, you've got a couple of choices. One option is to get a penile implant, an inflatable device that can be pumped up to give you an erection. This requires surgery, but men I know say that implants work extremely well, don't interfere with male orgasm and are rigid enough to be appreciated by partners. (These are often prescribed to guys who've had prostate surgery and who've lost the ability to have an erection.)
Another option is penile injections. This is a medicine that you literally inject into your penis; usually, it works its wonders in about 15 minutes or so. While the idea of giving yourself a shot like that may make you cringe, a lot of men report great success with these injections.
You're insurance plan may not cover either of these treatments, and you'll need to see a urologist for both the implant and the injections. But I'd urge you not to give up hope! Modern medicine has a lot to offer in the area of sexual functioning.
Q: My husband can no longer perform because of medical reasons, but I still have needs. I love him very much, but I've been without sex for two years now. Help!
A: If you and your husband have a good relationship, he can do lots of things for you, even if he cannot have erections, has bad arthritis or some other disabling physical challenges. Unless he is totally immobilized, the two of you can touch and kiss. He can still satisfy you sexually — if both of you have the kind of communication and comfort with each other where you can tell him what you need, and he is pleased to provide it.
There is nothing inferior about intimacy through touch. Though it is different and perhaps less "connected" than having intercourse, it can certainly be enormously satisfying. Many men, even if they cannot enjoy sex themselves, are very proud and happy to help their partner be sexually fulfilled.
If for some reason this is not possible, then I recommend a vibrator that you can use with your husband — or alone. There are plenty of "sex toy" sites on the Web where you can buy one anonymously.
Bottom line: You don't have to live a sexless life. If you love your husband and want to be monogamous, you still have good choices. Talk to him about making love with you in new ways. It could be a wonderful breakthrough for both of you.
Q: What is a comfortable sex position for older adults?
—Mary, New Jersey
A: Great question. As we age, our libidos may be intact, but our backs, knees and hips may sabotage us. So positions that are kind to these parts of our bodies are a good idea.
Many people find the best one is the spoon position: The woman lies in front of the man and both bodies are lined up, full length, close together. Then the guy can either slip in between his partner's legs, or she can bend her outside leg at the knee to offer an easier entrance for the penis. She can also bend both knees up, although this will make it difficult for her to move and he will have to do most of the movement. Advantages: He can nuzzle her neck and touch her breasts, and they can feel the full length of each other's body.
Another approach is for the woman to lie on her back, while her partner lies down next to her and facing her. She then turns slightly toward him and puts her closest leg to him over his hip. This should be gentle on both of their backs, and he can slip into her easily and get fairly deep penetration. Advantage: The lovers can look at each other.
There are lots more, as well. I suggest that you get a copy of The Joy of Sex. You can then look at the various positions you find intriguing. Just flipping through the pages and experimenting with things is all part of the fun.
Q: My wife doesn't seem to be able to have orgasms during intercourse. What can we do about it?
A: For many women, penetration may be exciting but it doesn't lead to orgasm. That's because there are few nerve endings in the vagina or at the cervix. Most of them are in the clitoris itself, and that area isn't necessarily stimulated during intercourse.
Of course, the brain is involved, too. So the psychological pressure can make the whole physical process even more difficult. I recommend just thinking of intercourse as her sexual play — and your sexual event — with her sexual event happening at some point (before or after yours) by using fingers, mouth, or a vibrator or some other sex toy — whatever works for her. The point is to have the intimacy and sexual arousal you want — any way that suits both of you — without creating any performance anxiety on her part or feelings of insufficiency or worry on yours. Rest assured, your story is a common one and easily dealt with as long as neither of you believe that the only normal way for a woman to have an orgasm is to have it during intercourse. Just have sex any way it's easiest and enjoy each other.
Q: Ever since menopause, I've found sex extremely uncomfortable. What can I do so I'm not gritting my teeth every time we make love?
A: One of the things that happen in menopause is that our bodies stop producing estrogen. As a result, the vagina loses its elasticity and the tissues become drier. That makes penetration uncomfortable and even painful, which doesn't feel sexy at all.
A first step is to try using a lubricant as soon as sex play begins. You'll find a decent selection at your local drug store, and a more substantial one at sex shops or online. I like lubricants that are silicon-based because they are super slippery and they don't wear out easily. Water-based ones might feel more natural but they dry up quicker. I recommend trying different ones to see which you prefer.
Another option is topical estrogen: You apply the prescription cream to your vagina and it plumps up the tissues to premenopausal levels. There's also a topical estrogen product that comes in a ring form; it's inserted into the vagina and secretes tiny amounts of estrogen that does its magic. Both of these options have side effects, so you need to talk to your gynecologist before deciding if these are right for you. You also should make sure to rule out any other kind of medical issue, such as vaginal infection.
The good news is almost all pain can be solved. Make solving this problem a priority, and chances are extremely good that you'll happily reclaim your sex life and not experience it as a variety of torture!