“How is your sex life?” I often ask patients.

It’s amazing how often I get the response, “Finally, someone I can trust will discuss this matter with me.”

So what can be done to make the bedroom a happier place? It’s important, even though good sex may be only 5% of a relationship. But I stress to patients that it’s the first five percent! Besides, it can also affect physical health.

Dr. Leonard DeRogatis, director of sexual medicine at Johns Hopkins University, emphasizes a major difference between men and women. He says that men have the desire, but as they age can’t be aroused.

Still, they’re the lucky sex. Erectile dysfunction (ED) drugs solve their problem in most cases by increasing blood flow to the ‘you know what’. (If I use the anatomical word, many newspapers block this column).

Women are less fortunate.

Some suffer from what’s called the ‘Hypoactive Sexual Desire Disorder (HSDD).’ In effect, sex may never have been high on their list of priorities. So would ED drugs help to start sexual desire for women too?

In one study 202 women were given Viagra.

As expected it increased blood flow to the genitals, improved sexual satisfaction for some women who had arousal problems, and provided the stimulus to engage in sex. But it had no effect on those who suffered from HSDD.

So, as has been pointed out many times, there’s a major difference between men and women. For males all that’s needed is an engorged organ for a happy bedroom. Their brains are always primed for sex. But for women, ED drugs will not turn those who have HSDD into raving sexual maniacs.

Is there anything that will do it?

Many experts believe that the male hormone testosterone will also govern a woman’s sexual desire. At 50 years of age women produce 50% less testosterone than those in their 20s.

That’s one reason why sexual desire gradually diminishes. Boosting testosterone levels, they say, will also boost their libido.

Does it work?

The International Journal of Impotence Research analyzed 12 studies and concluded it does help. The North American Menopausal Society reached the same conclusion and endorsed its use.

But getting testosterone is easier said than done in this country. Like the controversy surrounding the use of estrogen for menopause, there is an underlying worry that testosterone might increase the risk of breast cancer.

But according to Dr. Jerald Bain, a prominent Toronto endocrinologist, some doctors are using small amounts of testosterone to treat sexual problems in women.

Dr. DeRogatis believes it unlikely testosterone increases the risk of breast cancer and that the greater possibility is growth of facial hair and transient acne. This can occur if too much testosterone is prescribed.

Non-hormonal treatments are also available.

For instance, Wellbutrin has been available for many years to treat depressed patients. But it has also been shown to increase sexual desire in women who are not depressed.

But for women there’s more to sex than hormones. They don’t enjoy a happy bedroom if there’s discontent in a marriage, financial problems, lack of communication or no love.

A woman recently said to me, “I’m bored with my husband and wish I’d never married him.”

It would take the coming of a Messiah to solve this problem.

And not all sexual problems confronting women are in the head. All too often the reason postmenopausal women shy away from sex is medical.

But the diagnosis is missed by doctors who neglect the pelvic examination.

Lack of estrogen in menopausal women results in thinning of the vaginal lining. This may cause pain and inability to have sex or an orgasm. Some women with this condition have been unable to have sex for years.

It’s tragic when they could have been cured within a few weeks by Premarin cream or Vagifem pills.

I remind these patients that if Engelbert Humperdinck is unable to sing with a sore throat, neither can they be expected to enjoy sex with an inflamed vagina.

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