A Libido Boost over the Counter?

According to a recent New York Times article, women now have available a plethora of products meant to boost “feminine arousal.” And they’re appearing not behind the pharmacist’s counter, but in over-the-counter products in major pharmacies, right beside the Vaporub and Ace wraps.

Yahoo—I think.

Many of these products contain blends of botanicals and oils and “secret-recipe” ingredients designed to boost a woman’s sexual response. I wish some of them would carry more information for the user so that, for example, some oils aren’t unintentionally used internally when they’re best only for external massage. As with many beauty products, some strike me as setting unrealistic expectations (or even sending unfortunate messages), as with “anti-aging creams” for the vagina, clitoris, and inner thighs.

Few of these products have been objectively tested for efficacy or safety, so it’s a “buyer beware”—or, I’d rather say, “buyer be informed” marketplace.  Zestra’s oil is the only arousal product that has been subjected to a randomized clinical trial in which it “significantly” outperformed a placebo. Too many products are promoted with only survey results, which are not the same thing as a clinical trial.

As the Times article noted (and we’ve stated many times), the trouble with female libido is that it’s complicated. Everything from mood to culture and personal beliefs to hormonal imbalances can affect a woman’s ability to “get it on.”

And in fact, a woman’s lack of libido also affects her partner’s sexual pleasure. Dr. Michael Krychman, gynecologist and MiddlesexMD advisor, notes that men often neglect to fill their Viagra prescriptions because their partner’s sexual issues remain unaddressed.

Finding a one-size-fits-all silver sex bullet is like looking for fairy dust. Most of us have to develop a multi-pronged regimen to keep our sex drive functional, especially as we get older. We could abide by the Hippocratic principle to “do no harm,” and given that these products are, by-and-large, indeed harmless, and that they may do some good, why not give them a trial of your own? Use a site like ours to inform yourself about what might be worth looking for or avoiding (we have this advice, for example, about choosing a lubricant), and then make some room for some playfulness.

“Do they work for serious issues? No. But do they work to make your sex life more fun? Maybe. There’s certainly no harm in trying,” says Dr. Bat Sheva Marcus in the Times article.

Q: Do other women orgasm more easily than I do?

From what you describe, you sound like a typical patient of mine! About 4 percent of women never can have an orgasm. "Orgasmic dysfunction," or difficulty with orgasm, is reported in 9 to 27 percent of women. Sixty to 80 percent of us cannot have an orgasm with intercourse only; we need more direct stimulation, whether manual or "battery powered."

There are lots of reasons for "dysfunction," including neurological disorders, post-surgical complications, endocrine or medical disorders, side effects of medications or drugs; most often the reason is sociologic or psychologic, which includes everything from unsuitable stimulation, poor relationships or communication, history of sexual trauma, and more.

And as we grow older, vascular and hormonal changes don't make orgasm any easier.

If the vibrator you're using isn't quite doing the job, you might trade up to a more powerful model. We've chosen the vibrators we offer at MiddlesexMD (most rechargeable instead of battery-powered) in part because they have stronger motors, which equals stronger vibrations and more sensation. Take your time and focus on arousal as well as the "end game." Even if you're not experiencing dryness, a lubricant can encourage more touch and playfulness. Warming lubricants or oils can also increase sensation.

Perhaps the most difficult advice to follow: While orgasm is quite lovely (and good for our health!), making it a required outcome of intimacy can make it more difficult to achieve. The more you can focus in the moment, on each sensation and touch, the lower the obstacles!

Q: Any cautions for oils to use for total body massage near the vagina?

You're right to be concerned, since the vulva and opening to the vagina can be easily irritated--and more so after menopause without estrogen therapy. Vitamin E oil can be used both for massage and lubrication. Liquid Silk is a lubricant that many women find soothing applied in the vaginal area. Most things that are flavored or heavily scented have the potential to be irritating to that delicate skin.

We've also liked Zestra, an arousal oil designed to use externally on the vulva. Its warming characteristics can be helpful in "reawakening" sensations as part of an intimate massage. As with any warming product, try just a small amount first to be sure it isn't irritating.