Depending on your symptoms or function of your desire disorder, you may need one or several of the following options:
- Adjust your meds. Working with your doctor, you may need to switch to a higher estrogen birth control pill or use a barrier contraceptive. Gradually lower your SSRI dose or try Wellbutrin (bupropion) which boosts the production of dopamine, a chemical messenger linked to sexual desire. In one study comparing the effects of SSRIs, Wellbutrin-treated patients reported a significant increase in libido, arousal and orgasm; patients on other SSRIs had a decrease. Even non-depressed women may benefit from Wellbutrin, recent studies show. There's more good news. "Preliminary evidence shows that Viagra — the highly touted remedy for flagging erections — may help override the side effects of SSRIs in women when used before sex," says Dr. Berman.
- Restore vaginal lubrication. Depending on the severity of vaginal dryness, there are a range of options available to restore vaginal moisture, plump up thinning tissues and make penetration more comfortable. For severe dryness, prescription estrogen regimens provide effective relief. Choices include creams, suppositories (such as the recently FDA-approved Vagifem), or the diaphragm-like E-string vaginal ring. For mild dryness, try over-the-counter vaginal moisturizers such as Replens (designed to be applied regularly) or Lubrin (applied just prior to sexual intercourse.). Herbs — in liquid or pill form — purported to help relieve mild vaginal dryness include black cohosh or dong quoi.
- Try a dose of testosterone. Dubbed the "hormone of desire," testosterone replacement in women has become the focus of intense study. While no preparations are as yet FDA-approved, a spate of studies show that in women nearing or beyond menopause, the administration of oral or topical testosterone may help switch on sexual urges and re-sensitize the genitals. Testosterone may also boost energy and well-being and override the libido-lowering effects of SSRIs.
If you choose to experiment with taking testosterone, it's important to note that "we don't have long-term randomized clinical studies and there have been no conclusive studies on testosterone in younger women," notes Sharon Youcha, M.D., general gynecologist at Lankenau Hospital in Wynnewood, Pa. and clinical faculty member at Thomas Jefferson College of Medicine in Philadelphia. Because testosterone has the potential to change HDL (high density lipoprotein — the "good" cholesterol) and LDL (low-density lipoprotein — the "bad" cholesterol), your cholesterol levels should be monitored carefully.
Women at risk for heart or liver disease may not be good candidates for testosterone. Women at risk for breast cancer should avoid testosterone since a percentage of this hormone converts to estrogen, believed to fuel certain breast cancers. Start with a low-dose regimen.