Bette, 72, who asked that her last name be withheld, testosterone therapy has restored a sex drive that virtually vanished after she underwent a hormonal treatment for breast cancer. She was terribly distressed, she says, when the "terrific sex life" she and her husband had enjoyed for 52 years crashed. So she traveled from her Kansas City home to see whether Irwin Goldstein, director of sexual medicine at San Diego's Alvarado Hospital, could help. He could, it turned out. He treated her with a low dose of a testosterone gel that has been approved for men with certain medical conditions. The medicine isn't FDA approved for use in women, but doctors like Goldstein can legally prescribe it "off label" if they think it might help
While Bette may be happy with her treatment, experts advise that breast cancer survivors must be especially cautious about taking hormone-based treatments for low libido. The body converts some testosterone into estrogen, which could raise a woman's risk of recurrence, says Eric Winer, director of the Breast Oncology Center at the Dana-Farber Cancer Institute. Aromatase inhibitors, which Bette and many other breast cancer survivors take, can prevent this conversion from happening, Goldstein says.Some doctors don't recommend off-label treatments at all. "Whenever you're using a drug [to treat] an indication for which it has not been tested, you're playing russian roulette," says Steven Nissen, who oversees cardiovascular medicine at the Cleveland Clinic. "It's risky business."
His message won't sway everyone, though. Says Bette: "I'd rather have something worth living for right now, rather than living in the old folks' home. I'm not going to miss any fun."
Saturday 29 March 2008
Women Lacking Libido Aren't Sick
After 10 years of buzz about a Viagra-like drug for women, nothing has been approved to date. Two companies are racing to change that. Both have active, advanced research programs working on prospective female libido drugs, one of which is available now to women who qualify to join a clinical trial.
Illinois-based BioSante Pharmaceuticals has launched several late-stage studies of a testosterone gel intended to remedy libido loss after menopause. About 100 U.S. medical institutions are now on board to test the drug's safety and effectiveness among thousands of women; volunteers, some of whom will unknowingly receive a placebo, are still being recruited. Earlier trials found the gel useful in women bothered by low desire following medically needed surgery to remove their ovaries. (Those sex organs produce roughly half a woman's natural testosterone. Though often thought of as a "male hormone," testosterone is tied to libido in both sexes.) A dollop a day of the gel on their arm boosted the frequency of satisfying sexual events compared with a placebo.
An approved medication for low female libido may be in higher demand than Viagra ever was for men, says Stephen Simes, president and CEO of the company. His rationale: 1.4 million off-label testosterone prescriptions were written for women in 2006 alone. He forecasts the drug will be available by 2011, as long as no snags arise. (Women interested in enrolling in the trial can E-mail the company's investigators to see if they're eligible.)A nonhormonal treatment is also on the horizon, with late-stage testing well underway. Boehringer Ingelheim's once-daily pill acts on serotonin receptors in the brain, which, after all, is the organ most heavily involved with sexual desire. Studies involve pre-menopausal women bothered by a low sex drive.Too soon to tell. Still, excitement might be premature at this point, experts say. In 2004, a testosterone patch poised to be the first-ever treatment was denied approval by an FDA advisory committee. Long-term safety was a major worry. Procter & Gamble had demonstrated the patch's effectiveness with minimal side effects, but that couldn't shake concern that it might carry health risks down the line. After all, painkiller Vioxx had just been yanked off the market and the unforeseen ills of female hormone replacement therapy had recently surfaced.
"Before we approve a therapy that could be used by millions of women, I'd like to know that we're not going to hurt them, particularly when the benefit is modest," says Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic, who was involved in deciding the patch's fate. "This is not a lack of sympathy for those who are unable to have a satisfying sexual relationship, but about balancing risks and benefits." The patch is approved in Europe.
One reason for the delay is that the FDA has set its approval standards high: A drug for women must not only elicit desire but also yield an increased number of sexually satisfying events. That's a requirement that Viagra never had to meet, says Anita Clayton, professor of psychiatry at the University of Virginia, and coauthor of Satisfaction: Women, Sex, and the Quest for Intimacy.
"I think the holdup is really our lack of understanding of female sexuality and applying this greater complexity to how we're studying potential treatments," says Clayton. "For women, a lot of our sexuality is above the neck, not below the waist," she says, which could explain why Viagra failed to produce results when tested in females. Viagra helps men with their most typical sexual problem—the inability to achieve and maintain an erection during sex—by causing blood to pool where it's needed. But female sex problems are more complicated and can be caused by a combination of hormonal, psychological, and interpersonal factors.
Illinois-based BioSante Pharmaceuticals has launched several late-stage studies of a testosterone gel intended to remedy libido loss after menopause. About 100 U.S. medical institutions are now on board to test the drug's safety and effectiveness among thousands of women; volunteers, some of whom will unknowingly receive a placebo, are still being recruited. Earlier trials found the gel useful in women bothered by low desire following medically needed surgery to remove their ovaries. (Those sex organs produce roughly half a woman's natural testosterone. Though often thought of as a "male hormone," testosterone is tied to libido in both sexes.) A dollop a day of the gel on their arm boosted the frequency of satisfying sexual events compared with a placebo.
An approved medication for low female libido may be in higher demand than Viagra ever was for men, says Stephen Simes, president and CEO of the company. His rationale: 1.4 million off-label testosterone prescriptions were written for women in 2006 alone. He forecasts the drug will be available by 2011, as long as no snags arise. (Women interested in enrolling in the trial can E-mail the company's investigators to see if they're eligible.)A nonhormonal treatment is also on the horizon, with late-stage testing well underway. Boehringer Ingelheim's once-daily pill acts on serotonin receptors in the brain, which, after all, is the organ most heavily involved with sexual desire. Studies involve pre-menopausal women bothered by a low sex drive.Too soon to tell. Still, excitement might be premature at this point, experts say. In 2004, a testosterone patch poised to be the first-ever treatment was denied approval by an FDA advisory committee. Long-term safety was a major worry. Procter & Gamble had demonstrated the patch's effectiveness with minimal side effects, but that couldn't shake concern that it might carry health risks down the line. After all, painkiller Vioxx had just been yanked off the market and the unforeseen ills of female hormone replacement therapy had recently surfaced.
"Before we approve a therapy that could be used by millions of women, I'd like to know that we're not going to hurt them, particularly when the benefit is modest," says Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic, who was involved in deciding the patch's fate. "This is not a lack of sympathy for those who are unable to have a satisfying sexual relationship, but about balancing risks and benefits." The patch is approved in Europe.
One reason for the delay is that the FDA has set its approval standards high: A drug for women must not only elicit desire but also yield an increased number of sexually satisfying events. That's a requirement that Viagra never had to meet, says Anita Clayton, professor of psychiatry at the University of Virginia, and coauthor of Satisfaction: Women, Sex, and the Quest for Intimacy.
"I think the holdup is really our lack of understanding of female sexuality and applying this greater complexity to how we're studying potential treatments," says Clayton. "For women, a lot of our sexuality is above the neck, not below the waist," she says, which could explain why Viagra failed to produce results when tested in females. Viagra helps men with their most typical sexual problem—the inability to achieve and maintain an erection during sex—by causing blood to pool where it's needed. But female sex problems are more complicated and can be caused by a combination of hormonal, psychological, and interpersonal factors.
Dinner date, which could be purchased for $150, to a 24-hour date that cost customers $1,500. Other services offered include bondage
Two local women were arrested Tuesday night on misdemeanor sex charges after the pair reportedly offered to "put on a show" for a bachelor party that turned out to be a police sting operation.Prattville Police Chief Alfred Wadsworth confirmed Thursday that Dawn Renee Williams and Ashley Lynn Whitesell, both 33-year-old Prattville residents, are each charged with one count of promotion of prostitution in the third degree. The charge is a misdemeanor, and the women, both of whom are married, were each released on a $500 appearance bond.
Williams, known as "Dixie" on the pair's Web site, and Whitesell, who goes by the name "Darlin'," maintained a site that included racy pictures of themselves, along with a list of services and prices.
The services ranged from a dinner date, which could be purchased for $150, to a 24-hour date that cost customers $1,500. Other services offered include bondage, couples action and "nude housekeeping." According to the Web site, Williams even offered to travel anywhere in the U.S. or overseas, for a fee of $5,500.
The price list included a chart for converting the U.S. dollar amounts to the Euro, British pounds, Canadian and Australian dollars and Japanese yen.
Posted on the site were statements such as, "I love what I do and would like to show you that I do," and, "I am a lady and expect to be treated that way."
The duo also advertised that they were available for bachelor parties, birthday parties or private parties. That's what ultimately led to their arrests.
According to Wadsworth, his department began an investigation into the pair's activities after several citizens notified the mayor's office of the online solicitations. Police set up a fake bachelor party, then arrested the women when they showed up to fulfill the promises they made on their Web site.
"Some citizens called the mayor's office to complain about the Web site, and he notified us," the police chief said. "Our officers selected the bachelor party (which came with a cost of $300, plus tips) and booked a room in a local motel. The women were arrested after they arrived at the motel."
Police and local prosecutors then searched the Williams residence and seized several pieces of evidence, including a home computer and a client list that included the names and phone numbers of several men in the River Region, including "a few" from Prattville, Wadsworth said.
"We're not releasing the names of the clients, because there isn't any crime we can charge them with," he said. "At this point, the only name I can tell you that is not on there, is former New York Gov. Eliot Spitzer."
He said police are continuing their investigation into the online operation, and speculated that other charges could evolve from that investigation.
"Our Computer Forensics Unit will evaluate her computer and see if there were any other violations of the law," he said.
The police chief said realization that such an enterprise was being conducted in the Fountain City caught him a little unaware. He added that police acted promptly to bust the operation in order to show that such criminal activity would not be tolerated within the city limits of Prattville.
"In the past, we've had some women from Montgomery who rented motel rooms here and did this type of thing," he said. "But it was really surprising to be notified that this business was operating so much in the open, in our city. We hope these arrests will deter other people from doing this type of thing here, and will cause the people who utilize these services to go somewhere else."
Williams, known as "Dixie" on the pair's Web site, and Whitesell, who goes by the name "Darlin'," maintained a site that included racy pictures of themselves, along with a list of services and prices.
The services ranged from a dinner date, which could be purchased for $150, to a 24-hour date that cost customers $1,500. Other services offered include bondage, couples action and "nude housekeeping." According to the Web site, Williams even offered to travel anywhere in the U.S. or overseas, for a fee of $5,500.
The price list included a chart for converting the U.S. dollar amounts to the Euro, British pounds, Canadian and Australian dollars and Japanese yen.
Posted on the site were statements such as, "I love what I do and would like to show you that I do," and, "I am a lady and expect to be treated that way."
The duo also advertised that they were available for bachelor parties, birthday parties or private parties. That's what ultimately led to their arrests.
According to Wadsworth, his department began an investigation into the pair's activities after several citizens notified the mayor's office of the online solicitations. Police set up a fake bachelor party, then arrested the women when they showed up to fulfill the promises they made on their Web site.
"Some citizens called the mayor's office to complain about the Web site, and he notified us," the police chief said. "Our officers selected the bachelor party (which came with a cost of $300, plus tips) and booked a room in a local motel. The women were arrested after they arrived at the motel."
Police and local prosecutors then searched the Williams residence and seized several pieces of evidence, including a home computer and a client list that included the names and phone numbers of several men in the River Region, including "a few" from Prattville, Wadsworth said.
"We're not releasing the names of the clients, because there isn't any crime we can charge them with," he said. "At this point, the only name I can tell you that is not on there, is former New York Gov. Eliot Spitzer."
He said police are continuing their investigation into the online operation, and speculated that other charges could evolve from that investigation.
"Our Computer Forensics Unit will evaluate her computer and see if there were any other violations of the law," he said.
The police chief said realization that such an enterprise was being conducted in the Fountain City caught him a little unaware. He added that police acted promptly to bust the operation in order to show that such criminal activity would not be tolerated within the city limits of Prattville.
"In the past, we've had some women from Montgomery who rented motel rooms here and did this type of thing," he said. "But it was really surprising to be notified that this business was operating so much in the open, in our city. We hope these arrests will deter other people from doing this type of thing here, and will cause the people who utilize these services to go somewhere else."
Don't believe the hype! We're misled that "good" sex is lots of penetration with g-spot stimulation and huge orgasms.
1 Don't believe the hype! We're misled that "good" sex is lots of penetration with g-spot stimulation and huge orgasms.
The truth is that the average person has sex once a week or less. What's more important is the quality of sex rather than quantity, as is exploring all your erotic zones from toes to clitoris to earlobes.
2 Things outside the bedroom cause most sex problems. Women who get time to rest, have help with housework or childcare report more satisfying sex lives.
3 Poor body image is a cause of women's sexual problems. Build your confidence and you'll feel more like being intimate. Try taking classes on assertiveness, drama or dance.
4 Many women aren't sure what turns them on, or they know what they fancy but are too shy to say. Help yourself by exploring masturbation and fantasies on your own, then with your partner. Dr Sprinkle's Spectacular Sex (Tarcher, £14.99) helps you work out what you'd like to do, while Carol Queen's book Exhibitionism For The Shy (Down There Press) explains how to ask for it.
5 Condoms are the new sex toys. As well as making him last longer, they're guaranteed to turn you on with their different textures or added lubricants. They're also free from family planning or GU clinics (find one at www.condomessentialwear.co.uk) and protect you from STIs and pregnancy.
Sara Nasserzadeh is an award winning certified psychosexual therapist and a couples counsellor.
6 Dare to ask for what you want - but not when you're having sex. You might laugh, but I have manuals to give to couples on when to talk about sex. Choose a time when you're both relaxed, not hungry and never be critical while you're actually having sex.
7 Take your time over things. It shocks couples when I ask them how long it takes for love-making and they think this means how long it takes to have sex. Love-making might lead to intercourse or it might not. Make time to caress, massage and enjoy each other's company.
8 Women suffer brewer's droop too. Alcohol may take away your inhibitions but it can also affect libido, interfere with lubrication and cause a loss of sensation. Over time alcohol and cigarettes will seriously affect your sexual function as they affect your nervous system and circulation.
9 Orgasm is an experience - not a goal. Many couples come to me disappointed they can't reach orgasm together. It's not the same experience for men and women. Clitoral stimulation leads to a sharp, intense orgasm - like a man's - but with penetrative sex women may be able to reach multiple, less intense orgasms.
10 Good sex is the result of physical and mental well-being. Eating a well-balanced diet, not smoking, not drinking large amounts of alcohol and caffeine, sleeping well and exercising regularly could guarantee a better sex life for most people.
Paula Hall is a sexual and relationship psychotherapist.
11 Focus on intimacy not performance. Getting close to your partner is one of the greatest things about sex. Feeling sexually connected with your partner is one of the most erotic experiences.
12 Boost your adrenalin. It is a key chemical in sexual arousal. If you're feeling tired or stressed, perk yourself up by watching a scary movie, have a pillow fight or drink a shot of espresso coffee. Anything that will get your heart racing can make arousal faster and more intense.
13 Have sex - then go to bed. Don't leave sex until last thing at night when you're knackered. Make time earlier in the evening. A bit of basic rescheduling can avoid the "too tired syndrome" that can leave couples procrastinating about their sex life indefinitely.
14 Play "OK, Not OK, Give It A Try". Get a sheet of paper and brainstorm with your partner every sexual activity and technique you can possibly imagine. Watch the new Lovers Guide Interactive DVD to get you thinking. Then separate your list together into OK, Not OK and Give It A Try.
If it's Not OK with either of you, then obviously that's out, but make sure you regularly use your OK list and experiment with the Give It A Try list.
15 Fake it! If you're not feeling sexy or in the mood but you want to be, pretend. Tell yourself you're a seductive sex kitten and slip into something that makes you feel the part.
Rachel Foux is a maternity sexual educator and counsellor. The author of New Mums Guide To Sex (Fusion Press, £8.99), Rachel runs retreats for mums and mums-to-be.
16 Childbirth can improve your sex life. There's evidence that the nerve endings are more sensitive after having a baby, increasing the intensity of orgasms. Also, emotionally you've stepped on to a new level as a couple - it's a powerful rite of passage - which can bring you closer.
17 Go for role play. It'll spice up your sex life and take you beyond just being a mum and dad. Try playing master and slave - it will be a challenge, but a great boost to your self-esteem.
18 Get talking - but not about the kids. If you feel you're not being listened to in the relationship, it doesn't take long for resentment to build up, and that's the biggest chastity belt in any relationship. Open up the lines of communication and you'll find your sex life improves.
19 Be spontaneous. Spontaneity in our sex lives is difficult when we're parents. If you see an opportunity, take it. I have couples who say as soon as the baby's eyes are closed for a nap, they make love.
20 Experiment with sex toys. Fantastic to use either on your own or with your partner. Look for the Berman range of dildos at www.sextoys.co.uk They're good at training your pelvic floor muscles, which improves your orgasms, and they'll inject some fun into your relationship.
Dr Catherine Hood is a medical doctor specialising in psychosexual health and presenter of 21st Century Girls' Guide To Sex on Five Life.
21 Don't head straight for the jackpot. Men have all their erogenous zones concentrated in one area but they still like to be teased, stroked and caressed all over.
Drive him wild by stroking the perineum - the space between the bottom and scrotum - and you'll increase the intensity of his orgasm.
22 It's not the size that counts, it's what you do with it. The average penis size is five inches erect, but as only the bottom third of the vagina has the sensitivity, any more than that is wasted! A good position if your partner has a small penis is "spoons" as this gives deeper penetration.
23 Dream on - there's no harm in thinking about someone else when you're having sex. You're using it to enhance your sexual experience and it can help to keep your mind on the job, especially if you're tired or feeling stressed at work.
24 Don't stop having sex. As you get older it can be more of a challenge to keep your sex life exciting and you do have to adapt, increasing the amount of foreplay.
The real trick is to be able to look at your lover and conjure up the feelings you had when you first got together.
25 Sex brings you closer. It anchors you as a person and creates closeness with your partner. Sex gives you a sense of self-worth - that union with someone who values and wants to be intimate with
The truth is that the average person has sex once a week or less. What's more important is the quality of sex rather than quantity, as is exploring all your erotic zones from toes to clitoris to earlobes.
2 Things outside the bedroom cause most sex problems. Women who get time to rest, have help with housework or childcare report more satisfying sex lives.
3 Poor body image is a cause of women's sexual problems. Build your confidence and you'll feel more like being intimate. Try taking classes on assertiveness, drama or dance.
4 Many women aren't sure what turns them on, or they know what they fancy but are too shy to say. Help yourself by exploring masturbation and fantasies on your own, then with your partner. Dr Sprinkle's Spectacular Sex (Tarcher, £14.99) helps you work out what you'd like to do, while Carol Queen's book Exhibitionism For The Shy (Down There Press) explains how to ask for it.
5 Condoms are the new sex toys. As well as making him last longer, they're guaranteed to turn you on with their different textures or added lubricants. They're also free from family planning or GU clinics (find one at www.condomessentialwear.co.uk) and protect you from STIs and pregnancy.
Sara Nasserzadeh is an award winning certified psychosexual therapist and a couples counsellor.
6 Dare to ask for what you want - but not when you're having sex. You might laugh, but I have manuals to give to couples on when to talk about sex. Choose a time when you're both relaxed, not hungry and never be critical while you're actually having sex.
7 Take your time over things. It shocks couples when I ask them how long it takes for love-making and they think this means how long it takes to have sex. Love-making might lead to intercourse or it might not. Make time to caress, massage and enjoy each other's company.
8 Women suffer brewer's droop too. Alcohol may take away your inhibitions but it can also affect libido, interfere with lubrication and cause a loss of sensation. Over time alcohol and cigarettes will seriously affect your sexual function as they affect your nervous system and circulation.
9 Orgasm is an experience - not a goal. Many couples come to me disappointed they can't reach orgasm together. It's not the same experience for men and women. Clitoral stimulation leads to a sharp, intense orgasm - like a man's - but with penetrative sex women may be able to reach multiple, less intense orgasms.
10 Good sex is the result of physical and mental well-being. Eating a well-balanced diet, not smoking, not drinking large amounts of alcohol and caffeine, sleeping well and exercising regularly could guarantee a better sex life for most people.
Paula Hall is a sexual and relationship psychotherapist.
11 Focus on intimacy not performance. Getting close to your partner is one of the greatest things about sex. Feeling sexually connected with your partner is one of the most erotic experiences.
12 Boost your adrenalin. It is a key chemical in sexual arousal. If you're feeling tired or stressed, perk yourself up by watching a scary movie, have a pillow fight or drink a shot of espresso coffee. Anything that will get your heart racing can make arousal faster and more intense.
13 Have sex - then go to bed. Don't leave sex until last thing at night when you're knackered. Make time earlier in the evening. A bit of basic rescheduling can avoid the "too tired syndrome" that can leave couples procrastinating about their sex life indefinitely.
14 Play "OK, Not OK, Give It A Try". Get a sheet of paper and brainstorm with your partner every sexual activity and technique you can possibly imagine. Watch the new Lovers Guide Interactive DVD to get you thinking. Then separate your list together into OK, Not OK and Give It A Try.
If it's Not OK with either of you, then obviously that's out, but make sure you regularly use your OK list and experiment with the Give It A Try list.
15 Fake it! If you're not feeling sexy or in the mood but you want to be, pretend. Tell yourself you're a seductive sex kitten and slip into something that makes you feel the part.
Rachel Foux is a maternity sexual educator and counsellor. The author of New Mums Guide To Sex (Fusion Press, £8.99), Rachel runs retreats for mums and mums-to-be.
16 Childbirth can improve your sex life. There's evidence that the nerve endings are more sensitive after having a baby, increasing the intensity of orgasms. Also, emotionally you've stepped on to a new level as a couple - it's a powerful rite of passage - which can bring you closer.
17 Go for role play. It'll spice up your sex life and take you beyond just being a mum and dad. Try playing master and slave - it will be a challenge, but a great boost to your self-esteem.
18 Get talking - but not about the kids. If you feel you're not being listened to in the relationship, it doesn't take long for resentment to build up, and that's the biggest chastity belt in any relationship. Open up the lines of communication and you'll find your sex life improves.
19 Be spontaneous. Spontaneity in our sex lives is difficult when we're parents. If you see an opportunity, take it. I have couples who say as soon as the baby's eyes are closed for a nap, they make love.
20 Experiment with sex toys. Fantastic to use either on your own or with your partner. Look for the Berman range of dildos at www.sextoys.co.uk They're good at training your pelvic floor muscles, which improves your orgasms, and they'll inject some fun into your relationship.
Dr Catherine Hood is a medical doctor specialising in psychosexual health and presenter of 21st Century Girls' Guide To Sex on Five Life.
21 Don't head straight for the jackpot. Men have all their erogenous zones concentrated in one area but they still like to be teased, stroked and caressed all over.
Drive him wild by stroking the perineum - the space between the bottom and scrotum - and you'll increase the intensity of his orgasm.
22 It's not the size that counts, it's what you do with it. The average penis size is five inches erect, but as only the bottom third of the vagina has the sensitivity, any more than that is wasted! A good position if your partner has a small penis is "spoons" as this gives deeper penetration.
23 Dream on - there's no harm in thinking about someone else when you're having sex. You're using it to enhance your sexual experience and it can help to keep your mind on the job, especially if you're tired or feeling stressed at work.
24 Don't stop having sex. As you get older it can be more of a challenge to keep your sex life exciting and you do have to adapt, increasing the amount of foreplay.
The real trick is to be able to look at your lover and conjure up the feelings you had when you first got together.
25 Sex brings you closer. It anchors you as a person and creates closeness with your partner. Sex gives you a sense of self-worth - that union with someone who values and wants to be intimate with
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