Wendy Wolf (whose name has been changed to respect her privacy), 62, of Boca Raton, a slim, attractive blonde with green eyes and the ability to still turn heads, is vivacious, pretty and popular. Attracting men is never a problem. Men find her pretty, sexually desirable and vie for her attention.
Married three times, the first at 19, Wolf, the mother of two grown children and the grandmother of one, is now single and liking it.
Although happy to see them and socialize, Wolf has no desire to enter into a sexual relationship, despite their persistent attempts to woo and bed her.
"At 62, my libido has petered out. I have no interest in sex, and the thought of it, especially with an overweight, middle-aged man, has no appeal. If he was a hot 20-something with a taut six-pack, I might consider it," Wolf half-jokes.
Wolf is not alone.
According to the Diagnostic and Statistical Manual of Mental Disorder IV, there are four official categories of female sexual disorder: hypoactive sexual desire disorder, or decreased sex drive; arousal disorder; female orgasmic disorder; and genital pain (dyspareunia and vaginismus).
HSDD, first identified in the 1970s, is a common disorder affecting 43 percent of women (or 40 million women) and 31 percent of men between the ages of 19 and 59, according to the 1999 National Health and Social Life Survey, a survey of sexual functioning among men and women in the U.S.
A hallmark of this disorder is an ongoing and long-term loss of desire to the point it interferes in relationships and causes stress or interpersonal difficulties. Certain medications, including SSRI antidepressants, birth control pills and anti-hypertensives, may suppress sex drive. If a woman is unconcerned about her loss of libido, it is not classified as problematic.
"For a sexual concern to be considered a medical problem, it must be associated with distress, so it's important to assess this in both research studies and patient care," said Dr. Jan Shifren, a researcher at Massachusetts General Hospital in a study she co-authored in the November 2008 issue of Obstetrics & Gynecology.
The study, known as the PRESIDE Study, found that of the 40 million women affected by the disorder, only 12 percent admitted to problems that caused distress. Women ages 45 to 64 were most likely to report a distressing sexual problem (14.8 percent), followed by those ages 18 to 44 (10.8 percent) and those older than 64 (8.9 percent).
James E. Clark, OB/GYN and medical director of the Central Florida Female Sexual Dysfunction Clinic, said women's sexual dysfunction is more complicated than men's. While men typically suffer from mechanical issues, they can take medications that increase blood flow to the area (think Viagra, Cialis, Levitra). Women's sexuality is more involved.
"Increasing blood flow to the clitoris is not the answer for women," said Maureen Whelihan, OB/GYN and sexual health expert at the Comprehensive Women's Medical Center in West Palm Beach. "Women's No. 1 sexual complaint is low desire. And in women, there are many environmental factors influencing our desire. Desire starts in the brain. We need to focus research on how to stimulate the sexual centers of desire in the female brain."
Said Clark, "There is a difference between pre- and post-menopausal women. In premenopausal women, dysfunction may be rooted in the brain or associated with family and psycho-social dynamics; is she stressed at home, dealing with kids or taking antidepressants. In postmenopausal women, the reality may be tied to loss of hormones, which decrease as both women and men age."
Whelihan, who writes an online healthy sex column for a Palm Beach Post blog, is an advocate of hormone therapy for "those who need it." She said low sexual desire in women has many factors, taking into consideration physical changes, relationship status and social, psychological and cultural mores.
"It's much easier to treat post-menopausal women, as the reason is usually hormone-related," she said. "In women younger than 29, we look at mood disorders or stressors at home. I have been known to take out my prescription pad and write a prescription for official R&R time for the patient. It's not uncommon for women to go through periods of low sexual desire, depending on environmental circumstances. Sexual desire ebbs and flows."
The most important thing for women to know is that it's OK to talk to their doctor about sexual complaints, and if the doctor is not receptive or is uncomfortable, the woman should find a sexual health expert.
Resources for finding sexual health physicians include the professional society, the International Society for the Study of Women's Sexual Health (ISWWSH.org) and the American Association of Sexuality Educators, Counselors and Therapists (AASECT.org).
Since the advent of Pfizer's Viagra in 1998, and other erectile dysfunction drugs for men, the search has been on for the "little pink pill," the female version of "the little blue pill."
Clark said it's "unfair" that most of the research is focused on men.
"It's been 14 years since Viagra came out, and there is still nothing for women," he says, although many pharmaceutical companies are spending millions in the hopes of coming up with the next blockbuster drug.
With the potential to make billions, some products are in the pipeline. Pharmaceutical company BioSante has a product called LibiGel, a transdermal testosterone gel for the treatment of HSDD, which is in Phase III clinical development. They hope to obtain FDA approval and go to market next year.
A Proctor and Gamble product, Intrinsa, a trans-dermal testosterone patch is in use in Europe but has not been granted FDA approval in this country.
"The FDA standard for lifestyle drugs is higher than for drugs that treat disease," Clark said. "This is a challenge for pharmaceutical companies."
He points to rejection of Flibanserin, a compound created by Boehringer Ingelheim, as a non-hormonal drug treatment for HSDD which failed to win FDA approval but has now been sold to a new pharmaceutical company, Sprout, which hopes to have more success in bringing it to market.
Stanley Althof, Ph.D., a psychologist at the Center for Marital and Sexual Health of South Florida in West Palm Beach, is an advocate of the search for a female counterpart to Viagra.
"Patients come to me in real pain and distress," he said. "They've lost something important to them that interferes in a relationship with someone they love. Anything that can help these women achieve a more satisfactory sexual experience is a good thing."