Poor health can put a crimp in your love life. But the opposite is true, too: Good sex may help keep you healthy.

“A satisfying sex life can foster good emotional health, which in turn can promote good physical health,” says Julia Heiman, Ph.D., director of The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University. Moreover, sex itself may have direct health benefits. For example, orgasm or any loving touch may cause the body to release substances that ease pain, bolster immunity, or elevate mood long after the immediate pleasure passes. Indeed, people who have strong, intimate relationships tend to have fewer chronic diseases and to live longer, some research suggests. So there are good reasons beyond just pleasure to address any significant loss of sexual appetite or activity, regardless of your age.

The introduction of sildenafil (Viagra) and related drugs has graphically demonstrated that sexual problems can be solved. But it has also fed the misconception that every sexual difficulty can be cured by popping a pill. More and more doctors are now prescribing not only those drugs but also the hormone testosterone to boost libido in both sexes. And many consumers are buying DHEA, a potent hormone sold as a dietary supplement that the body converts to both testosterone and estrogen.

However, psychological issues, not physical ones, are usually the major culprits in the two most common sexual problems--lack of desire in women and premature ejaculation in men. Even with largely physical problems, such as vaginal dryness or erectile difficulties, nondrug steps can often help.

This report will help you talk intelligently with your doctor about when sex-enhancing drugs may be appropriate and when other steps should be tried first.

Despite the increasing use of testosterone to stoke waning sexual desire, guidelines on the treatment, issued by the Endocrine Society in 2006, emphasize that it’s rarely worthwhile. The age-related decline in testosterone in both sexes is seldom large enough to substantially reduce libido. There’s little evidence on the therapy’s long-term efficacy and safety. And many other factors--from stress and lack of sleep to changed feelings about a partner--can contribute to decreased sex drive.

When low testosterone levels do contribute, the reduction may stem from correctable health problems, notably pituitary or testicular disorders.

When those causes have been ruled out, taking testosterone for its possible but unproven benefits is a gamble. In men, it may increase the risk of prostate cancer, prostate enlargement, and blood clots. In women, it can cause hair growth and acne, and may raise the risk of breast cancer. And its other possible risks are largely unknown. Moreover, the only testosterone product approved for women uses a combination that can reduce the “good” HDL cholesterol.

The reservations about testosterone apply doubly to DHEA, since there’s even less evidence on its safety and benefits, and since it may increase both estrogen and testosterone levels. Further, dietary supplements are largely unregulated, so you don’t know whether you’re getting the labeled dosage. And your use of this potentially potent hormone is unlikely to be monitored by a physician.

What to do: Our medical consultants advise avoiding DHEA entirely, and taking testosterone only when it’s clearly needed and with great caution (see the accompanying table, “Testosterone Treatment in Men and Women”).

Other measures--treating underlying disorders, adjusting drug dosages, reducing stress, or addressing problems in your relationship, with a therapist’s help if necessary--should generally be tried first. The therapist could be either a traditional one, a marriage counselor, or a sex therapist who focuses on negative sexual attitudes or beliefs.

While anxiety sometimes causes erectile dysfunction, that disorder usually stems from physical problems, often the same ones that cause heart disease.

Sildenafil, tadalafil (Cialis), and vardenafil (Levitra) help restore men’s potency by dilating blood vessels in the penis. However, such drugs should be used cautiously, since they can cause potentially serious side effects.

What to do: Addressing coronary risk factors--reducing blood pressure, cholesterol levels, and weight, stopping smoking, exercising more, and rigorously treating diabetes--may help correct erectile dysfunction. Pelvic-muscle exercises called Kegels--where you tightly tense the muscles that interrupt the flow of urine or passage of gas--may be worth trying as well. One successful method involves squeezing for 5 to 10 seconds, then slowly relaxing, and repeating the exercise about 10 times, twice a day, most days of the week.

If reducing risk factors and performing Kegels don’t help, men could consider erection-boosting medication. Tadalafil, which lasts for about 36 hours compared with 4 hours for the other two drugs, may be a good choice for men who value spontaneity, though sildenafil is generally a better choice, since it may be safer. Men considering any impotence drug should first have their vision and heart health tested.


Reduced vaginal lubrication and clitoral sensitivity may sometimes stem from the same cardiovascular problems that can cause erectile dysfunction. Declining estrogen levels after menopause can also reduce vaginal moistness and possibly clitoral sensitivity.

Sildenafil and related drugs may improve clitoral sensitivity in a small minority of women, although supplemental estrogen appears to be more effective for that problem as well as for vaginal dryness. But caution is warranted because of potentially serious side effects.

What to do: In theory, reducing coronary risk factors may improve clitoral sensitivity. Extended foreplay and nonpetroleum lubricants like K-Y Jelly and Replens can usually provide sufficient moisture. Staying sexually active may also help keep the vagina moist and responsive. Those steps, combined if necessary with treatment of a partner’s sexual problems or of issues that impair libido, may improve a woman’s ability to achieve orgasm as well.

Women who want to try estrogen for dryness or possibly insensitivity can use creams (Estrace, Premarin) or vaginal inserts (Estring), which allow you to use smaller, safer doses. If those don’t help, consider short-term use of low-dose estrogen pills or patches, provided you’re not at high risk of heart disease or breast cancer. There’s currently no reason for women to try sildenafil and related drugs.

Some doctors now prescribe antidepressants such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), all available generically, for premature ejaculation, since they tend to inhibit orgasm. But they probably have to be taken daily, not just before sex. And it’s generally best to try nondrug steps first.

What to do: You may be able to ease the anxiety and overexcitement that seem to underlie premature ejaculation by having sex more often, prolonging foreplay, and trying not to worry during or after sex, regardless of the outcome.

Other approaches train men to gain physical control over ejaculation. In the stop-start method, the partner manually stimulates the penis, stopping when the other person signals a pending orgasm, and resuming when the sexual tension wanes. In the pause-squeeze method, the partner squeezes the penis, with thumb between the head and the shaft, when ejaculation is imminent. Both techniques should be practiced several times before attempting intercourse. If that doesn’t help, counseling from a sex therapist often can.

Despite its increasing use, testosterone should be prescribed only in very limited circumstances, described below.



Before resorting to medication or hormones to treat sexual problems, you and your doctor should first consider whether the problem stems from an underlying disorder or a medication you take. In some cases your doctor could ease or eliminate the problem by changing the prescription or treating the disorder. Note that some side effects listed here may be only theoretical, particularly in women, or based on limited evidence.