These Are the Aphrodisiacs That Might Actually Work

For as long as humans have been mating and reproducing, they’ve been searching for ways to boost desire, Michael Krychman, MD, executive director of the Southern California Center for Sexual Health explained to Health. Even today, people are frequently on the hunt for natural solutions, like foods or herbal products to make sex more fun (or as the case may be, more successful).

Take oysters, chocolate, and the ridiculously named horny goat weed, for example—we’ve all heard these touted as aphrodisiacs, but do they really work?

RELATED: Low Libido? 11 Drugs That Affect Your Sex Drive

To find out, Dr. Krychman and his co-author decided to take a look at any and all published research on the subject, looking at 50 previous studies that examined the effects of various foods, herbs, and commercially available supplements. Their analysis, published this month in the journal Sexual Medicine Reviews, found that oysters and chocolate probably don’t help (womp, womp).

While these foods contain ingredients that are important for healthy sexual functioning—like zinc and serotonin (in oysters) and caffeine and cannabinoid-like fatty acids (in chocolate), no clinical trials have shown that either actually improve sex drive or performance.

Other supposed aphrodisiacs, like saw palmetto, wild yam, rhinoceros horn, and yep, horny goat weed, also had no evidence to support the marketing claims often associated with them.

The researchers did find that some natural remedies might be helpful, however.

Among the things with “early but promising data behind them,” Dr. Krychman says: The root vegetable maca and the herbs ginseng, ginkgo biloba, and tribulus terrestris (often sold in supplement form). Ginseng, for example, was shown to be effective at treating erectile dysfunction (ED) in several double-blind, placebo-controlled studies.

RELATED: 10 Ways to Deal With Painful Sex

Zestra feminine arousal oil, which is essentially lube with a mixture of botanical ingredients including primrose oil and angelica root extract, also appeared to have some benefit among women with various troubles getting and staying aroused in a handful of small studies.

A caveat: While it’s exciting (pun intended) to hear that these natural remedies may offer a boost, you still have to be careful buying them in supplement form. The U.S. Food and Drug Administration doesn’t test or approve supplements with the same rigor as other products. A 2013 study published in the same journal looked at “natural” supplements claiming to help ED, and found that 74 of 91 products tested were spiked with pharmaceutical ingredients like Viagra. Be sure to buy from trusted sources, and especially if you’re taking other prescription medications, talk to your doctor about any supplements you’re taking to avoid drug interactions.

Probably the most important findings though is the information about the things that you shouldn’t even consider trying. For example, in the case of mad honey (a type of honey made from the nectar of the Rhododendron plant), the authors cite a case study of a married couple who both suffered heart attacks after eating it over the course of a week.

Meanwhile, ingesting Spanish fly (which is made of beetle remains, ick) has been associated with burning of the mouth and throat and inflammation of the urinary tract. These ingredients should be avoided, the authors write, as their risks outweigh their possible benefits.

It’s worth noting that because sexuality is complex, there are no magic pills or miracle ingredients to fix every problem, Dr. Krychman says. “Many facets, both medical and psychological, can affect both men and women. Men may be more biologically focused, with [sexual problems stemming from] more influence on veins arteries and nerves, but they are also influenced by stress and fatigue. Women, on the other hand, may have more of a psychological influence—but are also subject to hormonal shifts and biological facets as well.”

RELATED: 8 Ways Sex Affects Your Brain

Currently, pharmaceutical medications for the treatment of sexual problems are only available for men. (These drugs, like Viagra and Cialis, are used to treat erectile dysfunction.) However, the FDA is expected to approve the drug flibanserin in August, for the treatment of low libido in women. “It will likely be a game-changer for women who have a biological issue that is influencing sexual desire,” Dr. Krychman says.

For many people experiencing sexual problems, though, there may be something else going on.

“My advice is to get an evaluation,” says Dr. Krychman. “There maybe an underlying medical issue that is impacting sexuality; some treatable conditions may masquerade as sexual problems.” Erectile dysfunction, for example, can be a sign of heart disease or diabetes.

Couples may benefit from improving communication skills, solving marital discord, or addressing testosterone or estrogen imbalances, he adds. Treating vaginal dryness with lubricant may also help, if loss of desire is due to pain during sex.

Overall, Dr. Krychman encourages patients to be open with their doctors about all of their symptoms. “You cannot be treated if you do not disclose your concerns.”

RELATED: 20 Weird Facts About Sex and Love

The Experimental Treatment That Might Prevent Herpes


By Amy NortonHealthDay Reporter

WEDNESDAY, Aug. 5, 2015 (HealthDay News) — A drug applied as a vaginal gel may substantially cut women’s risk of contracting genital herpes, a common and incurable sexually transmitted infection.

That’s the conclusion of a study published in the Aug. 6 issue of the New England Journal of Medicine. Researchers found that the gel, applied vaginally before and after sex, halved women’s risk of infection with herpes simplex virus (HSV) type 2.

HSV-2 is the strain of the herpes simplex virus that causes most cases of genital herpes. It’s a common infection: In the United States, an estimated 16 percent of 14- to 49-year-olds have an HSV-2 infection, according to the U.S. Centers for Disease Control and Prevention.

The virus is even more common in some other parts of the world. In sub-Saharan Africa, up to 80 percent of sexually active women and half of sexually active men are infected. The new study took place in South Africa, one of those hardest-hit countries.

The gel, which contains a drug called tenofovir, is still experimental, stressed study leader Dr. Salim Abdool Karim, director of the Center for the AIDS Program of Research, in Durban, South Africa.

Further research will probably be necessary for drug regulators in various countries to consider approving the medication, Karim said.

The current trial was not primarily designed to test tenofovir gel against HSV-2; its main aim was to curb the risk of HIV transmission. The oral formulation of tenofovir, which is marketed as Viread, is already used to treat HIV, the virus that causes AIDS.

Earlier results from the trial had suggested the gel version can reduce women’s risk of contracting HIV. However, follow-up research yielded disappointing results—largely because many women were not able to use the gel consistently.

With any such preventive therapy, “how people use it is important,” said Dr. Connie Celum, a spokeswoman for Infectious Diseases Society of America and a professor at the University of Washington, in Seattle.

Still, she called the gel a “promising intervention that could reduce herpes acquisition.”

Celum, who was not involved in the research, has studied oral tenofovir as a way to prevent herpes simplex virus type 2 infection. In a trial reported last year, her team found that the medication had a modest benefit among the African adults they studied.

The gel formulation, Celum said, contains much higher concentrations of the drug than the tablet form.

HSV-2 infection itself is not usually dangerous. It sometimes causes painful sores around the genitals, rectum or mouth. More often, though, it causes no symptoms or only mild ones — which means most people with the infection are unaware of it.

However, in rare cases, the virus invades the brain and triggers potentially deadly inflammation. And if it’s passed from mother to newborn, HSV-2 can be fatal for the baby.

What’s more, Celum said, genital herpes can double the risk of becoming infected with HIV—which is especially troubling in areas of the world where both infections are prevalent.

“We don’t have a cure for HSV-2, and we don’t have a vaccine,” Celum pointed out.

Once a person is infected, the virus hides out in nerve cells and reactivates periodically, sometimes causing symptoms. In wealthier countries, there are a few medications that can treat symptoms and, if taken daily, help suppress new outbreaks. They include acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex).

Daily treatment with those drugs can also reduce the chances of passing herpes simplex virus type 2 to a sexual partner, but it doesn’t eliminate the risk.

Both Celum and Karim said tenofovir gel could offer an additional weapon against HSV-2 not only in developing countries, but wealthier ones, too.

The current study looked at a subgroup of women who’d taken part in the larger trial testing tenofovir gel against HIV. The group included 422 who were free of HSV-2 when they were randomly assigned to use either the drug or an inactive placebo gel; they were told to apply it vaginally before and after having sex.

Over 18 months, women who used the drug-containing gel were 51 percent less likely to contract HSV-2, compared to the placebo group, the investigators found.

Condoms, when used consistently, can also lower HSV-2 risk. But worldwide, many women have a difficult time “negotiating” condom use with their partners, Karim pointed out.

The gel could give them an option they can better control, he said.

One looming question is what the cost would be.

Karim’s trial was funded by the U.S. and South African governments and CONRAD, a non-profit. Gilead Sciences, the U.S. maker of Viread, donated the drug’s active ingredient, and the gel-filled applicators were manufactured locally in South Africa.

The cost was about $2 per applicator, Karim said. “For the product to be viable,” he added, “it will have to cost only a few cents.”

More work will be needed to figure out how to bring costs down, Karim said.

More information

The U.S. Centers for Disease Control and Prevention has more on genital herpes infection.

10 Ways You're Using Condoms Wrong

It’s been a while since that awkward moment in health class when you learned how to put a condom on a banana. Whether you were actually paying attention or too preoccupied chatting with your friends (and avoiding saying the word “penis” at all costs), it’s possible you may have missed a thing or two about the proper way to wrap it up.

Now that you’re an adult, you may think you’ve mastered these simple sheaths. But believe it or not, the CDC estimates there’s a typical use failure rate of 18%. The takeaway: even as an adult, you’re not immune to teenage-status condom errors. However, when used correctly, condoms are 98% effective at preventing pregnancy, and they’re your best line of defense against STDs. To help you avoid joining that 18%, stop making these common mistakes.

RELATED: 9 Types of Condoms You Should Know About

Waiting too long

Your health teacher wasn’t lying to you, “There’s plenty of sperm in pre-ejaculation,” says Lauren Streicher, MD, Associate Clinical Professor of Obstetrics and Gynecology at Northwestern University, and author of Sex Rx: Hormones, Health and Your Best Sex Ever ($14; “So even if he doesn’t ejaculate, you’re still at risk of both pregnancy and a sexually transmitted infection.” In other words: quit procrastinating. As soon as you’re ready to get going, grab a condom.

Forgetting to check for damages

About 83% of women and 75% of men failed to check condoms before use in an Indiana University review of studies. We get it—in the heat of the moment, you aren’t thinking about much more than getting that condom on as quickly as possible. But before you assume that rubber is ready for action, take a beat to make sure the wrapper doesn’t look worn out and the condom isn’t sticky, brittle, discolored, or damaged. Also, if it expired back your college days, it’s time to trade up to a fresh box.

Faulty application

While it may seem pretty self-explanatory, there are plenty of ways to mess up the simple act of putting on a condom. So here’s a quick throwback to the banana lesson: After unwrapping the condom and checking that it’s not inside out, place the rolled tip on top of the penis. Then unroll it to completely cover the shaft. If you only bother going halfway down, you’ll be exposed to way more skin, putting you at risk of contracting (or transmitting) an STD. Also, while putting it on, pinch out excess air inside the condom and make sure you leave half an inch of space at the tip where semen can collect, reminds Dr. Streicher.

Doubling up

If one condom is great at preventing pregnancy and STDs, then two condoms should be even better, right? Definitely not. More is not merrier in this case. Layering two condoms can dramatically increase the chance of slipping off, especially if you’re using a lubricated type, explains Dr. Streicher. “If the first condom rolls off, then it usually takes the second one with it.”

RELATED:Â 13 Healthy Reasons to Have More Sex

Taking it off too soon

Just like waiting too long to put the condom on is problematic, so is taking it off too early. Yet, researchers from Indiana University found between 13.6% and 44.7% of individuals removed the condom before intercourse was over. Of course, pulling off protection puts you at risk of both STDs and pregnancy. So instead of giving up on a condom before you’ve reached the final act, consider trying out different kinds to figure out which one works best for you and your partner.

Buying the wrong size

Condoms aren’t a one-size-fits-all deal, and let’s face it, not every man is an XL (sorry, fellas). “There’s always that guy who buys the extra-gigantic condom, when he’s not,” says Dr. Streicher. When it comes to staying safe, it’s important to be realistic about size. If the condom is too small, it could break. If it’s too large, it could slip off during sex. The most important thing is not to focus on stroking your guy’s ego, but rather finding a condom that actually fits properly.

Forgetting about oral

You can’t get pregnant from oral sex, but you can still get an STD, says Dr. Streicher, which means you’ve still got to wrap it up. And here’s a trick they probably didn’t teach you in health class: women can use condoms when receiving oral as well. “Since no one ever uses dental dams, instead, take a condom and cut the tip off,” instructs Dr. Streicher. “This will give you a square to put over your vulva for protection.” If you decide to try out this tip (no pun intended), make sure you use an un-lubricated condom; otherwise the barrier will fly right off.

RELATED: Everything You Need to Know About the ‘New’ STD

Using the wrong lube

Speaking of which, lube can be a great addition to your condom experience. Not only can it make sex more enjoyable, but it also helps prevent the latex from tearing or ripping. However, if you choose the wrong lubricant, it could spell disaster. “Not all lubricants are condom-compatible,” says Dr. Streicher. “Any oil-based product can cause break-down of condoms. You always want to stick with water-based or silicone-based, or a mixture of both.”

Storing them improperly

You were told in high school health class not to store condoms in your wallet. Well, that wasn’t just a myth to scare you into celibacy. All the bending and friction can cause tiny holes, rendering the rubber totally useless, and if you keep your wallet in your pocket, your body heat can also degrade the sheath. Instead, make sure you keep condoms in a cool, dry place away from sunlight or heat.

Not using one at all

You already know you need to be using condoms, but the advice is worth repeating: “Any time there’s skin-to-skin contact, you should really use a condom,” says Dr. Streicher. Educate yourself on the nine types of condoms, and stock up.

RELATED: 8 Ways Sex Affects Your Brain

Oscars 2017: Nominees Will Receive a Vagina Fitness Tracker

Every year, Oscar nominees receive the Everyone Wins Nominee Gift Bag, an assortment of extravagant, brand-sponsored gifts ranging from vacation getaways to personal training sessions to a year’s worth of Audi car rentals. This year’s standout gift is the Elvie, a fitness tracker for—wait for it—your vagina.

This women’s health device costs $199 and is paired with a smartphone app so users can track their Kegels. These exercises involve tightening and contracting the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum. A strong pelvic floor means more intense orgasms, improved bladder control, and easier pregnancy recovery. In other words, Kegels are your lady parts’ best friend, and if you don’t practice them regularly, you should start.

The Elvie is one of a few Kegel-tracking devices that have cropped up in the past few years. If using one reminds you (and Emma Stone, Ruth Negga, and all the other female Academy Award nominees) to exercise down there, we’re all for it. To use the Elvie, slide the device inside your vagina like you would a tampon, keeping its tail outside of you. Then, turn on your phone’s Bluetooth setting, connect the device to the app, and start tightening and relaxing your muscles. The app transforms Kegels into a follow-along game that instructs you when to relax, tighten, hold, or pulse down there. There are even training levels (beginner, intermediate, advanced) so you can challenge your lady friends to a Kegel-off or track your results from week to week.

And yes, the device is totally safe to stick inside your vagina, unlike other sketchy devices (looking at you, jade egg). The Elvie is made of top-grade medical silicone, is completely waterproof, and is simple to clean.

If you didn’t get that Oscar nomination you were hoping for and aren’t interested in shelling out 200 bucks for the Elvie, you’re in luck: you don’t need special equipment to do Kegels. You can do these exercises anywhere without anybody knowing, whether it’s at work, binge-watching Netflix, or waiting for your dinner to finish cooking. Simply tighten and relax your muscles down there. Happy squeezing!

Why a Swedish Town Might Be Swapping Lunch Breaks For Sex Breaks

A Swedish lawmaker is proposing a way to make the midday slump a little more, well, active. A council member in the town of Övertorneå wants to give the municipality’s 550 employees a one-hour break for sex each week, according to a report from the New York Times. The best part? Everyone would be paid the same as they normally would to sit at their desk.

“I believe that sex is often in short supply. Everyday life is stressful and the children are at home,” councilman Per-Erik Muskos said in his motion earlier this week. “This could be an opportunity for couples to have their own time, only for each other.”

Talk about work perks! But seriously, Muskos isn’t wrong about the value of a regular romp. Sex is known to improve sleep, reduce stress, boost immunity, strengthen relationships, and more.

Another, more obvious reason to subsidize sex, says Muskos: to encourage baby-making, and give the small town’s population a bump.

Sweden is famous for its efforts to create better work-life balance (think 480 days of paid parental leave!). And the Swedes consider their coffee breaks, known as fika, a sacred ritual. We’ll see if the folks in Övertorneå get even luckier with a paid break for sex. The new proposal will be voted on this spring.


Viagra: The Little Blue Pill May Improve Sex for Women on Antidepressants

TUESDAY, July 22, 2008 — Viagra is used by millions of aging men for erectile dysfunction, but most research suggests it doesn’t do much for women’s sex lives.

However, a new study suggests that the “little blue pill” could benefit some women. The small, Pfizer-funded trial found that it improved orgasm in premenopausal women who had sexual difficulties due to antidepressant use.

About 1 in 10 women in the U.S. take an antidepressant drug, according to a 2004 survey. And those drugs, particularly selective serotonin-reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft), are known to be sex-drive killers for men and women.

Study suggests drug works in select womenIn the study, H. George Nurnberg, MD, of the University of New Mexico School of Medicine in Albuquerque, and colleagues randomly assigned 98 women, with an average age of 36, to take sildenafil (Viagra) or a placebo.

All of the women were taking antidepressants (mostly fluoxetine or sertraline), and they took a Viagra or a placebo pill about one to two hours before they had sex during an eight-week period, according to the report in Journal of the American Medical Association. (Both researchers and the women were blinded as to who received the placebo and who did not.)

Almost three-quarters of the women who received the placebo reported no improvement in their sex lives compared with only 28% of those who took Viagra. On average, the Viagra users were more likely to reach orgasm (and were more satisfied with them) than placebo-takers.

That sounds promising. However, you have to keep in mind that it’s a manufacturer-funded study, a type of trial that is generally not considered as reliable as research that is conducted independently. And, as the report discloses, Dr. Nurnberg and other co-authors have received research funds and acted as paid consultants to Pfizer and other drug companies in the past.

Needs to be confirmed in larger group of womenAbout 22% of the women dropped out of the trial, so only 39 Viagra users completed the study, notes Marjorie Green, MD, director of the Mount Auburn Menopause and Female Sexual Medicine Center in Cambridge, Mass., and a clinical instructor at Harvard Medical School.

“All of the other studies on sildenafil [in women] have not been positive,” says Dr. Green. And the patient group is so small in this study, “I think it would be hard to use the results without further study.”

In addition, Viagra is not FDA-approved for use in women, so the risks to women are not completely clear. (Pfizer dropped its effort to get FDA-approval for women after disappointing trials in pre- and postmenopausal women with sexual arousal disorder, according to the study.)

In the recent research, Viagra users suffered from more headaches, nasal congestion, flushing, and visual problems than those who took the placebo.

Viagra and similar drugs inhibit an enzyme (phosphodiesterase type 5) found in eye tissue, male genitals, and other parts of the body. Blocking the enzyme causes smooth muscle to relax and increases arterial blood flow to the penis. This is beneficial to men with erectile dysfunction because it allows more blood to fill the vessels and increases their ability to sustain an erection.

Female sexual dysfunction is more complicated, but similar enzyme signaling is thought to take place in female genital tissue. So it’s possible that phosphodiesterase type 5 inhibitors may help some women.

Select group of women may benefitAndrew T. Goldstein, MD, cautions that the findings should not be extrapolated to patients outside the range of the trial. However, he said that sexual medicine experts do think Viagra is worth trying in some female patients.

“This would not be a drug to be used for a 55-year-old woman who complains of decreased desire who is not on SSRIs,” says Dr. Goldstein, an obstetrician and gynecologist at Johns Hopkins School of Medicine and an associate professor at George Washington University, who specializes in treating women’s sexual dysfunction. “If it’s used for that, you’re not going to get results, and you’re going to have a frustrated patient.”

However, for patients who are having sexual side effects of antidepressants, Dr. Goldstein says, “It’s worth trying.”

According to Dr. Green, many women start taking antidepressants without even being told that they can cause sexual side effects.

An ongoing Internet survey being conducted by the Women’s Sexual Health Foundation (Dr. Green is on the advisory board) suggests that more than half (54%) of women taking antidepressants were never informed of the potential side effect. In all, 75% of those surveyed said they’ve had a decrease in sexual desire since starting the drugs.

Antidepressant-induced sexual dysfunction is “a big problem,” says Dr. Goldstein. “Premenopausal women 18 to 50 often will discontinue their antidepressants because of sexual side effects. So they are focusing on a very important group of women with a very important problem.”


By Theresa Tamkins

Related Links:

How SSRIs Relieve Depression

What Kind of Doctor Treats Low Sex Drive?

3 Signs You Should Stop, Adjust, or Switch Antidepressants

Medical Reasons for Low Libido

News Roundup: Antidepressants Hurt Sperm, Docs Seek Ban on Fake

Antidepressants may damage spermMen who take antidepressants may damage their fertility, according to a report in New Scientist. After four weeks of taking Paxil, 35 healthy men had their sperm DNA fragmentation rates increase from 13.8% to 30.3%. The increased rates are a sign of sperm damage, and they’ve been associated with a more difficult time with embryo formation and implantation during in vitro fertilization treatment. (Read more about antidepressants.)

Ban those big, unrealistic breasts, surgeons say Plastic surgeons in the U.K. would like to nix cosmetic-surgery ads that feature “anatomically impossible” breasts. The British Association of Aesthetic Plastic Surgeons say these digitally altered photos give women unrealistic expectations of cosmetic surgery. Another concern? Ads that promise impossible-to-achieve “lunchtime face-lifts,” which should be banned as well, they say. (Read more about breasts in our Boob Blog.)

When COBRA bites, bite backIf you lose your job, your one hope for health insurance is usually COBRA, the federally mandated program that allows you to keep your old job’s health insurance for 18 months (if you pay for it). But you may have more options than you think. You should check out to compare the cost of COBRA with other health-insurance plans, according to the Wall Street Journal’s Health blog. Your chance of finding a cheaper plan is—no surprise—better if you’re young and healthy. (And has a whole new Money and Health Journey.)

Two drugs to be pulled off marketThe Food and Drug Administration (FDA) told manufacturers to stop selling two unapproved products this week—a topical cream used to treat diabetes-related ulcers and a saline solution used during eye surgery. The Rx cream is made by Hospira and contains papain, a papaya derivative that can cause allergic reactions, according to Reuters. The eye solution can cause eye inflammation and permanent vision loss. There are FDA–approved versions of the eye solution—both of which are still suitable for sale—made by Alcon as well as Akorn. The FDA targeted an unapproved eye solution made by Baxter Healthcare.

Hospital workers snap patient pics, lose jobsWe’re not sure why hospital workers would want to post close-up pictures of patients’ injuries to their MySpace page—it just sounds like a bad idea. In fact, two University of New Mexico hospital employees lost their jobs for doing just that, according to the Associated Press. The workers snapped the pics using cell-phone cameras, a problem that’s interfered with patient privacy in other states, including California, Arizona, and South Dakota. (Read our related story, Is Your Doctor Laughing at You Behind Your Back?)


Related Links:

3 Signs You Should Stop, Adjust, or Switch Antidepressants

Get Your Free Boobs Here!

How to Get Insurance Coverage for a Preexisting Condition

5 Money-Saving Questions to Ask Before Your Doctor Writes a Prescription

Testosterone Patch May Kick

Procter & Gamble

By Anne HardingWEDNESDAY, Nov. 5, 2008 ( — Postmenopausal women who have lost interest in sex may be able to bring their libidos back to life with a testosterone patch, according to new research published Wednesday in The New England Journal of Medicine.

However, the use of the male hormone to boost sex drive in women may not be risk-free. Four women in the study who were taking testosterone developed breast cancer, but none of the women on placebo did. It’s not clear whether this was a statistical blip or a warning sign that excess testosterone could cause or spur the growth of a malignancy. Some women also reported excess hair growth, although none stopped using the hormone for this reason.

Susan R. Davis, MD, PhD, of Monash University in Australia, and colleagues in the United States, Canada, and Sweden, evaluated two different doses of testosterone delivered by Procter & Gamble Pharmaceuticals’ Intrinsa patch. In 2004, a U.S. Food and Drug Administration (FDA) panel gave Intrinsa the thumbs down and called for larger, longer studies to ensure that the medication was safe, in addition to proving that it actually helped women’s sex lives.

As the new findings show, it did. Wearing the higher-dose testosterone patch boosted a woman’s “satisfying sexual experiences” by an average of 2.1 times every four weeks, compared to an increase of just 0.7 such experiences for women taking a placebo. Both testosterone doses used in the study seemed to increase desire and decrease distress.

“Although the change in activity is modest, that’s something that is appropriate and I think most women would be more than happy with it,” says study investigator Sheryl A. Kingsberg, PhD, chief of behavioral medicine at University Hospitals Case Medical Center in Cleveland. “They wanted to return to the level of desire they had in their premenopausal years, and that’s what they got.” Before starting treatment, the women in the study had been having satisfying sex about twice a month on average, Kingsberg points out; the higher-dose patch increased that to once a week.

“For most women and providers of health care for women, that modest benefit is clinically meaningful,” agrees North American Menopause Society president JoAnn V. Pinkerton, MD, a professor of obstetrics and gynecology at the University of Virginia, in Charlottesville, who did not participate in the study.

Next: Why some women lose interest in sex

Some women lose interest in sex during and after menopause, due in part to the drop in estrogen that comes with the “change of life.” While taking estrogen can increase lubrication and possibly restore a woman’s sex drive, hormone replacement is now understood to up the risk of heart disease and stroke. Many physicians prescribe testosterone instead, although there is currently no testosterone product that’s FDA–approved for treating women with “hypoactive sexual desire disorder.” The European Union has approved Intrinsa, but only for women who have had their ovaries removed, a procedure also known as surgical menopause.

In the current study, 814 women who had undergone either surgical menopause or natural menopause were randomly assigned to use daily a placebo patch or an Intrinsa patch containing either 150 or 300 micrograms of testosterone. The trial lasted for a year, and a subset of women was followed for an additional year. Procter & Gamble Pharmaceuticals sponsored the study and helped design the trial as well as collect and analyze the data.

“Based on these data and other studies we’ve conducted, we are continuing our talks with [the] FDA to explore new opportunities and pathways forward,” says Procter & Gamble spokesperson, Tom Milliken.

One of the women on the 300-microgram dose was diagnosed with breast cancer three months after the study ended; three others in the testosterone groups were diagnosed with the disease between 4 and 12 months after treatment began.

“We do not know if the testosterone patch contributed to proliferation or metastasis of the breast cancer in women diagnosed in the earlier months of the study, potentially affecting their long-term survival,” says Leslie R. Schover, PhD, a behavioral scientist at the University of Texas M.D. Anderson Cancer Center, in Houston, who recently wrote an article analyzing research on testosterone for low libido. “A valid safety study needs at least a five-year follow-up period in a large, randomized trial. If women use Intrinsa without such a trial, I believe they are risking their lives to gain a very modest increase in sexual desire.”

Next: Some doctors are not as concerned about breast cancer risk

But Dr. Davis says she is not concerned about the increased breast cancer risk seen in the study. Four breast cancer diagnoses among 814 women during a two-year period “is not unexpected,” she says, and given that twice as many study participants were taking testosterone than were on placebo, “it is probably a chance finding that they were in the two treatment groups.”

Many doctors who treat postmenopausal women—and prescribe testosterone off-label to some of them—say a treatment tailored to women is sorely needed and would probably be safe with short-term use. “We don’t have enough safety data to say it’s safe for long-term use, but I think short-term, the benefits clearly outweigh the risks,” Dr. Pinkerton says.

But some experts warn that a pill or patch isn’t always the answer to a sexual problem.

“For women there are so many other things that can contribute to sexual issues, starting from the fact that the most important sex organ is the brain,” says Marcie Richardson, MD, director of the Harvard Vanguard Menopause Survey in Boston. “I’m glad that people are trying to sort this out with good objective evidence, but I hope we don’t fall victim to the notion that this is all about medication, because it’s not.”

Related Links:5 More Reasons for Women’s Sexual PainApproaching Menopause, She Stopped Wanting SexMy Sexual Pain Felt Like Shards of Glass4 Medical Reasons Why Some Women Don’t Want Sex

CDC: Sexual Pain a Reported Symptom in Food Poisoning Outbreak


By Mara BetschTHURSDAY, March 26, 2009 ( — Food poisoning typically causes nausea, vomiting, and similar symptoms. However, in a small North Carolina outbreak linked to fish consumption, six out of seven people reported sexual pain along with other more common symptoms of food poisoning, according to a report released Thursday by the Centers for Disease Control and Prevention (CDC).

In the 2007 outbreak, nine people fell ill due to ciguatera fish poisoning (CFP), which can occur after consuming predatory ocean fish—such as barracuda, amberjack, red snapper, and grouper—that have eaten contaminated plant-eating fish. Each year there are about 50,000 CFP cases reported worldwide.

Unlike other types of food poisoning, CFP can cause neurological symptoms, such as the reversal of hot and cold sensations, fatigue, and itching and tingling, in addition to typical gastrointestinal symptoms like nausea, vomiting, cramps, and diarrhea. Sexual pain is generally not considered to be a symptom of CFP.

“It could be an unusual side effect of CFP,” says the report’s coauthor Ricky Langley, MD, an internal medicine physician in Burlington, N.C. Or it’s possible that sexual pain is a common side effect of CFP, but people may be “reluctant to talk about sexual side effects or doctors don’t ask the questions,” says Dr. Langley.

Six out of seven people who were sexually active said they had painful intercourse as a symptom of CFP. Two men reported painful ejaculation, and four women described a burning sensation during and after intercourse. The sexual symptoms lasted anywhere from one week to one month, according to the report published in the CDC’s Morbidity and Mortality Weekly Report.

Next page: How you can avoid CFP

Treatment for CFP includes intravenous mannitol, a drug often used to manage kidney failure. In this outbreak, it helped reduce the patients’ other neurological symptoms. However, it’s not clear if the drug is effective for treating the sexual side effects, according to Dr. Langley.

Fish-lovers beware: The toxin responsible for CFP has no odor or taste and can’t be detected before eating fish. The poison has nothing to do with spoilage of the fish or the method of preparation.

Though CFP is endemic to warm water locales such as Puerto Rico, it is less common in cooler waters. However, that may be changing. “There is concern that global warming and global commerce may increase cases in new areas. Fish caught off the coast in North Carolina were contaminated,” says Dr. Langley.

Though the exact amount of ciguatera toxin necessary to trigger severe side effects is unknown, the more toxin you get, the worse you feel, according to Lorraine Backer, a senior environmental epidemiologist at the CDC.

“If you’re concerned about CFP, try to limit consumption of certain types of fish, like barracuda,” says Backer. “Be cognizant of what you’re eating.”

Other more common causes of sexual pain in women are vulvodynia, vaginismus, birth control, and even menopause. Men can also experience sexual pain due to skin conditions, Peyronie’s disease, or inflammation of the prostate gland.

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Jade Goody's Death: How Women Slip Through the Cervical Cancer Safety Net

By Anne HardingMONDAY, April 6, 2009 ( — Jade Goody, the 27-year-old British reality-TV star, died in March of cervical cancer, a disease that rarely gets to a life-threatening stage—particularly in young people in developed countries. How could it happen?

Experts say her case makes it clear that Pap smears alone don’t save lives, and that some women end up with cancer because of inadequate care after a Pap smear.

From a disadvantaged background, Goody first had an abnormal Pap smear at age 16. She did have precancerous cells removed from her cervix, but when the hospital urged her to come back for follow-up care due to another abnormal Pap, she ignored it. “I was too scared,” she told the U.K. magazine Heat.

In contrast, Peri Smilow was age 33 and living in Boston when she had a “suspicious” Pap smear at the doctor’s office, but nobody followed up with her to recommend additional testing. Although she saw her primary care doctor every year, she didn’t return for another Pap smear for five years. By then, she was experiencing some unusually heavy bleeding. Her gynecologist diagnosed a ‘fibroid,’ and Smilow underwent a dilation and curettage (D and C ) to remove it. Lab tests showed that the tissue collected during surgery was cancerous.

“With proper follow-up of an abnormal screening test women really shouldn’t die from cervical cancer,” says Kathleen Brookfield, MD, PhD, of the University of Miami Miller School of Medicine. But they do.

Every year, 10,000 U.S. women are diagnosed with cervical cancer, and 3,600 die from the disease, according to Debbie Saslow, PhD, director of breast and gynecologic cancer at the American Cancer Society in Atlanta. Most—but not all—of these women either were never screened or had not had a Pap test for several years. However, appropriate follow-up is important, too, and it’s far from universally available in the United States.

Next page: Cigarette smoking can increase your risk of cervical cancer

Cigarette smoking can increase your risk of cervical cancerThe American Cancer Society recommends that women who are older than 21 (or younger, if sexually active) be screened for cervical cancer at least every three years. But many doctors will keep it simple and just do an annual Pap smear.

Every year, tens-of-thousands of U.S. women have abnormal Pap smears, get treated, and go on to be perfectly healthy, says Mark Schiffman, MD, director of cancer epidemiology and genetics at the National Cancer Institute. Goody was actually “a success story of Pap smear screening,” Dr. Schiffman notes.

But what about those women who lack health insurance? The Centers for Disease Control and Prevention spends $200 million a year to provide cervical cancer screening for uninsured women, and the CDC and all state governments have mandated that follow-up care be paid for if a test identifies problems. However, Saslow points out, the CDC funding is only enough to cover one in every five women who need it.

Proper treatment can save lives. Dr. Brookfield and her colleagues studied Florida women with invasive cervical cancer and found that white or Hispanic women lived longer than African-Americans (who tended to be diagnosed later than other women), as did those with health insurance or who lived in wealthier neighborhoods.

The recent introduction of vaccines, such as Gardasil, can prevent infection with some strains of human papillomavirus (HPV). Almost all cases of cervical cancer are caused by infection with the sexually transmitted virus—certain strains cause genital warts; others, cancer. However, it won’t be clear for decades how effective the vaccines are in preventing cervical cancer.

Although the majority of women are infected with HPV at some point (80% by age 50),  the virus simply goes away on its own most of the time. Only if the infection persists over time can it result in damage to cells of the cervix (which can be detected during a Pap test) and, eventually, cervical cancer.

Abby Lippman, PhD, a women’s-health researcher at McGill University in Montreal says she’s skeptical that the HPV vaccine will “level the playing field” for all women when it comes to cervical cancer prevention. She argues that the entire system needs to be overhauled to address women’s sexual and reproductive health in a more holistic way. For example, she points out, many women have no idea that cigarette smoking boosts the risk of persistent HPV infection.

Next page: What happens if you have an abnormal Pap test

What happens if you have an abnormal Pap testIf a woman has an abnormal Pap smear, her gynecologist may test for HPV or do a colposcopy, a procedure in which a doctor uses a special scope to closely examine the cervix and take samples.

If this test reveals cells that are abnormal but not precancerous, a woman can have this tissue removed. If cancer has developed and spread more deeply into the cervix, it may still be possible to have the tissue removed—and many woman can go on to have children. But when the disease is more advanced, more extensive surgery is necessary, along with radiation.

That was the case for Smilow. Childless, she was offered the opportunity to take part in a research study to have the tumor removed but retain fertility. Some of the women in the study had become pregnant, but there were no long-term results on the risk of their cancer recurrence. “I did a lot of soul-searching,” Smilow recalls. “I knew that if I was going to have a child, I didn’t want to then die of the disease, so I decided to have a radical hysterectomy.”

She had the surgery and underwent a course of radiation. She was also given the option by her physicians to receive chemotherapy, but she chose not to for several reasons. Chemotherapy drugs available at the time did not specifically target cervical cancer. In addition, the drug of choice was cisplatin, which can sometimes cause deafness. Smilow, a singer and musician, wanted to keep her organs as healthy as possible for as long as possible and didn’t want to risk hearing loss.

Smilow recovered from the surgery, married her boyfriend, and adopted a daughter. But seven years after her diagnosis, doctors found several tumors in both of her lungs. She underwent two surgeries to remove the tumors, which left her with diminished lung capacity. “The next year was emotionally very difficult,” she recalls.

But the disease didn’t return. Smilow has rebuilt her lung capacity by singing and swimming. Her career as a performer and composer has taken off. And she revels in being a mom.

“I feel really good about all the decisions that I made,” Smilow says. “I’m really happy that I was a strong partner in directing my own health care, including the decision to reject chemo. I think that as a result I’m in really good physical and mental health.”

“The only thing I would have done differently in this entire scenario, if I could change anything, would have been to have annual Pap smears,” she says. “I get annual letters from my dentist letting me know that I need a checkup … there’s no excuse for women across this country to not get a letter from their doctor indicating that it’s time for their Pap smear. It’s a simple fix.”