SEXUAL DYSFUNCTION

Female Sexual Dysfunction

Blame Christian Grey. The trend articles written in the wake of Fifty Shades made it sound like every housewife-next-door was chained to the bed, having mind-blowing orgasms. But the fantasy was just that: A Yale School of Medicine study discovered that, in fact, close to 50% of women in the United States are affected by female sexual dysfunction. Rather than getting whipped by a millionaire, they’re getting whupped by FSD.

SYMPTOMS

FSD is an umbrella term that covers lack of desire, inability to become aroused or have orgasms, and painful sex. The issues frequently overlap, complicating the matter. For example, if you have trouble becoming aroused, you don’t lubricate and then sex hurts. “And you can’t be interested in sex if it’s painful,” says Cathy K. Naughton, M.D., director of the Metropolitan Urological Specialists Center for Sexual Health in St. Louis. “So it’s a vicious cycle.”

Some women, such as those for whom sex is painful because of certain physical conditions, may require the “big guns” of pharmaceuticals or surgery (see “Three Hidden Causes of Sex Problems”).

REMEDIES

But most women can find relief from the symptoms of the four most common causes of FSD by trying the natural solutions below. And don’t worry, dudes: Although sexual dysfunction “hardly ever happens to me, I swear,” we have fixes for you, too.

IF YOU HAVE …

A low libido

After Gail Smith (not her real name) had a hysterectomy at age 52, her desire for sex plummeted. “My husband and I previously had a very active and pleasurable sex life, and we were both devastated,” she says. Prescription hormones provided little help. Finally, Smith’s doctor suggested the problem was “all in her head.” “I’m both a registered nurse and a psychologist. I know my body very well,” Smith says. “This was not psychological. I could feel it.”

While it’s true that stress often causes loss of libido, hormone imbalances that result from antidepressant use, hysterectomy, hormonal birth control, pregnancy, perimenopause or menopause can also be culprits.

“The ovaries’ production of hormones actually begins to change in our 30s,” explains Genie James, M.M.Sc., executive director of The Natural Hormone Institute of America and coauthor with gynecologist and compounding pharmacist C.W. Randolph, Jr., M.D., of In the Mood Again: Use the Power of Healthy Hormones to Reboot Your Sex Life—at Any Age. Starting then, she says, “Progesterone drops 120 times faster than estrogen, and when estrogen is dominant, low libido is a frequent result.” We still make testosterone, which helps fuel our sex drive, James adds, but we also make more sexual hormone-binding globulin (SHBG), which prevents it from circulating in the body.

APPLY NONPRESCRIPTION PROGESTERONE CREAM

Those made with progesterone derived from soy and wild yam and converted into bioidentical progesterone can help mitigate estrogen dominance. Look for brands with 450 milligrams of USP (prescription-grade) progesterone per ounce. Two to try (they’re rubbed into the skin) are Emerita Paraben-Free Pro-Gest ($29 for 2 ounces; emerita.com) and Natural Woman Progesterone Cream ($27 for 2 ounces; pronature.com).

Take Femmenessence MacaHarmony, a potent form of maca. The Peruvian root helps stimulate the hypothalamus, pituitary and adrenal glands to support and balance your hormones, including estrogen, progesterone and thyroid ($35 for a one-month supply; naturalhi.com).

TRY TRADITIONAL CHINESE MEDICINE (TCM)

Low libido can be a sign of kidney yang deficiency, says Jamie Koonce, L.Ac., D.O.M., of Phoenix, who recommends consulting a practitioner (find one at nccaom.org) and trying Passion Potion by Sage Solutions or Bu Zhong Yi Qi Tang Jia Wei by Blue Poppy Herbs ($17 for 90 caplets). Her home remedy suggestion is to add fresh lychee and durian fruit to your diet. Acupuncture can also successfully treat a low libido, says Koonce.

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Three hidden causes of sex problems

1. ANTIDEPRESSANTS AND OTHER DRUGS

Female sexual dysfunction symptoms are a common side effect of antidepressants such as Prozac, Paxil and Zoloft. Hormone-based contraceptives and blood pressure medications are other possible culprits. Women with diabetes or who have undergone chemotherapy also may tend to suffer from FSD.

2. PSYCHOLOGICAL PROBLEMS

“Body issues are huge in female sexual dysfunction,” says Cathy K. Naughton, M.D. In fact, studies have shown that societal emphasis on youth and slimness negatively impacts female sexual dysfunction even more than menopause.

3. HYSTERECTOMY

If the uterus is removed, everything in the pelvis—bladder, small intestine, rectum—can become displaced, and with a partial hysterectomy the cervix can drop down into the vagina. “As you can imagine, that can all cause pain,” Naughton says.

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CONSIDER BIOIDENTICAL HORMONES

Gail Smith eventually found relief from a personalized regimen that included estrogen, testosterone and DHEA, a precursor to male and female sex hormones secreted by the adrenal glands. She experienced some results immediately, and within a year her sex drive was back to where it had been. “My husband and I are thrilled!” she says. Personalization is the key, according to James. Bioidentical hormones, which have the same molecular structure as naturally produced ones, can restore optimum balance but only when compounded for your particular hormone levels, she says. It’s best to start by discussing bioidenticals with your OB-GYN, but if he/she is not familiar or comfortable with them, look for a center that specializes in them, make sure it’s staffed with OB-GYNs, M.D.s and N.D.s.

GIVE AROMATHERAPY A SHOT

Aura Cacia Love Potion essential oil could get your juices flowing ($9 for 0.5 ounces; auracacia.com). The massage you get from your partner alone will give you a great start.

GET INTO THERAPY

If body-image or relationship issues have caused you to lose interest in sex, you might want to seek therapy alone or, better yet, with your partner. Find a qualified sex therapist by asking friends, if you have some that you can talk candidly with, or if you’re already in marriage counseling, ask that therapist. If you can’t find referrals, check the American Association of Sexuality Educators, Counselors and Therapists (aasect.org). Always check on a prospective sex therapist’s education and credentials—he/she should have a Ph.D. or PsyC, a marriage and family or social workers license or a masters’ in counseling, with a special certificate or training in sex counseling and, of course, lots of experience. Always book a five- to 10-minute interview first (and beware of a therapist who won’t), and during your first face-to-face meeting, take a read: Can you relate to her? Do you feel comfortable enough that you can be completely honest, even if she doesn’t look like Helen Hunt in The Sessions? Then you’ve got a good start.

IF YOU HAVE …

Difficulty getting aroused

Sometimes, the spirit is willing but the flesh would rather be playing Words with Friends. You try and try and yet your clitoris doesn’t swell and become sensitized, and the lubrication never comes. This is the female equivalent of erectile dysfunction.

NATURAL R_X

TRY THE AMINO ACID L-ARGININE

Like Viagra, it produces nitric oxide, which helps relax muscles and widen blood vessels. In men, this leads to erections; and in women, to engorgement of the genital area. ArginMax for Women combines it with circulation-enhancing extracts of Korean ginseng, ginkgo and damiana ($25 for a one-month supply; arginmax.com). Dream Cream, an L-arginine-based topical lotion formulated by a doctor, also claims to improve sensation and arousal ($50 for 1 ounce; dreamcream.com).

PLAY AROUND WITH SEX TOYS

A number of manufacturers now produce safe and green versions. Look for those made from silicone (pleasuremenow.com), Pyrex glass (glassfantasy.com), stainless steel (njoytoys.com) or wood (nobessence.com). All can be easily washed, a must after every use. When in doubt about any device, use a condom on it.

SEEK INSPIRATION

Check out adult sex education DVDs (about $30 for a three-disc set; bettersex.com) or female-friendly erotica available at ellorascave.com. Don’t be embarrassed: If you’re willing to read Fifty Shades on the beach, this is your next step.

IF YOU HAVE…

Trouble achieving orgasm

Jennifer Justice, 34, of Doylestown, Pa., who suffered from interstitial cystitis (a painful inflammation of the bladder), also takes medications for vulva pain and chronic neck and back pain. When her soldier husband returned from a year in Afghanistan, she was dismayed to find that while she wanted sex and was able to get aroused, she was no longer able to have orgasms. For many other women, the problem stems less from a medical condition and more from a miscommunication with their partner or misinformation about how their own orgasms occur. Some natural remedies can help.

NATURAL R_X

MASSAGE DOWN BELOW

Zestra, a botanical arousal oil that increases warmth, sensitivity and sensation when topically applied to the vaginal area, worked for Justice, who says her ability to climax makes her feel “emotionally and physically better.” ($50 for 12 individual packs; zestra.com)

GET HELP FROM EROS

Not the love god, but the NuGyn Eros Therapy device, a small gadget that draws blood to the clitoris, increasing sensation and orgasms. It’s available by prescription, FDA-approved and covered by some insurance plans ($400; eros-therapy.com).

EXPERIMENT SOLO OR TOGETHER

Masturbating or using a vibrator might help you find your orgasm triggers. “Some women only have orgasms with manual stimulation,” says Naughton. See a sex therapist if you want to try to work the problem out together, or ask your partner to wield the sex toys or to touch you in ways and places that work for you.

IF YOU HAVE …

Pain during sex

This is perhaps the most complex FSD. There can be a psychological component in women who have been abused or had a painful first sexual experience, but just as often there’s a medical or anatomical reason. The most common is dryness caused by atrophy of the vaginal tissues when estrogen levels drop during perimenopause or menopause. (Breastfeeding can also cause temporary dryness.) Other possible medical causes, says Naughton, are urinary tract or yeast infections, chronic vulva pain, constipation or hysterectomy.

Whatever the cause, once you experience pain, your pelvic muscles can reflexively contract in anticipation when you attempt to have sex, making penetration even more painful and sometimes impossible. A physical exam of all the systems in the pelvic area—reproductive, urinary and digestive—should help identify any medical or anatomical causes.

NATURAL R_X

GET A LUBE JOB

Aloe Cadabra is an all-natural, plant-based lubricant made with organic aloe vera ($6 for 2.5 ounces; livewellbrands.com). Yes makes water- and oil-based lubricants with no petroleum products or irritants ($15 for 2.6 ounces; yesyesyes.org).

TRY DO-IT-YOURSELF DILATION

In cases of a painfully tight vagina, if no medical cause is diagnosed, a doctor can gently insert progressively larger dilators to stretch the tissue. You can try the same at home by inserting increasingly larger tampons dipped in a lubricant.

DO YOUR KEGELS

We tend to think of these exercises for tightening the pelvic-floor muscles, but “Kegels help you learn to relax those muscles as well,” says Naughton. (See “How to Do a Kegel Correctly”.)

EAT SOME ROOTS AND BERRIES

Koonce says that vaginal pain caused by dryness can signal a kidney yin deficiency and suggests adding black mulberries to amaranth and cow or goat’s milk yogurt, snacking on goji berries and spooning maca root powder into smoothies and cereals.

TRY HOMEOPATHY

Staphysagria, a homeopathic remedy that helps ease pain in the genital region, is recommended for a sore or tender vaginal area; it may help lubrication. Boiron pellets are available at health food stores for about $5.

APHRODISIACS FOR ALL

L-ARGININE

As we just said, this amino acid helps with nitric oxide production, which increases blood flow throughout the body and to the genitals, says Mark Blumenthal, of the American Botanical Council. According to research published in The Journal of Sex & Marital Therapy and reviewed in 2013 by Memorial Sloan-Ketting Integrative Medicine Center, an average of 70% of women with low libidos reported that they were more satisfied with sex after taking ArginMax (for perimenopausal women it was 86%!); this contains L-arginine as well as damiana (see below), ginseng and ginkgo, for one month. These women also saw an increase in desire, lubrication, clitoral sensation and orgasms.

DOSAGE: 2,500 milligrams daily

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Yes, the skeptical shopper in you might be wary of any sexual-enhancement cures; the ones we recommend contain combinations of the ingredients listed above, which have been shown to improve sexual function. Whether they work better together is your call. It might be worth a try; and remember that the placebo effect can sometimes be quite powerful. But remember also, most herbal remedies require use for at least 12 weeks before real results. Plan ahead—way ahead.

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MACA

Ancient Incans consumed this energizing Peruvian plant before battle or a bout of sex, says Chris Kilham, an ethnobotanist at the University of Massachusetts at Amherst. Maca increases sexual appetite, stamina, endurance and even fertility. One 2008 study conducted at the Depression Clinical and Research Program at Massachusetts General Hospital in Boston found that maca helped people with antidepressant-induced sexual dysfunction to regain their libidos.

DOSAGE: 400 milligrams daily

YOHIMBE BARK EXTRACT

This African tree bark extract sends blood flow to the genitals and stimulates the sensitive tissue of the clitoris, says herbalist Ed Smith, a founding member of the American Herbalist Guild, who adds a warning that yohimbe can cause nervousness and sleeplessness and raise already-existing high blood pressure (so avoid taking it if you have heart or kidney disease)—and can also negatively interact with antidepressants.

DOSAGE: 200 milligrams of a standardized extract containing 4% yohimbines (the plant’s active ingredient) for no longer than six weeks

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Just for Her

Here are libido-boosting combinations of the above formulated for women:

ArginMax for Women contains L-arginine and damiana leaf, both proven in clinical setting to boost desire and cut inhibition.
Dosage: Three capsules daily ($40 for 180 capsules; arginmax.com)

Hot Plants for Her contains maca, ashwagandha, Rhodiola rosea, Eleutthero senticosus root extract and catuaba.
Dosage: One to two tablets daily ($33 for 60 capsules; enzymatictherapy.com)

Intimate Response contains standardized ginkgo leaf extract, ginseng, L-arginine, horny goat weed and yohimbe bark extract.
Dosage: One to two tablets daily, do not use for more than 30 days at a time, take a two-week break in between use ($11 for 30 tablets; sourcenaturals.com)

Women’s Libido contains maca, damiana herb and horny goat weed.
Dosage: One capsule, three times daily between meals ($25.99 for 60 capsules; gaiaherbs.com)

Emerita Libido Formula contains damiana leaf extract, muira puama, Ginkgo biloba and ginseng.
Dosage: One tablet daily ($16 for 30 tablets; emerita.com)

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DAMIANA LEAF (Turnera diffusa)

Because it reduces anxiety and inhibitions, this nervous system tonic helps you become more relaxed and amenable to arousal, says registered herbalist Roy Upton, R.H., executive director of the American Herbal Pharmacopoeia. Damiana leaf’s aphrodisiac abilities are also linked to a compound it contains, progestin, which is similar to the female sex hormone progesterone (which drops, and dampens libido, as we head toward menopause).

DOSAGE: 1 gram daily

CATUABA (Rythroxylum catuaba)

This Amazonian aphrodisiac comes from a tree native to Brazil, where tribes traditionally use it to remedy a lagging libido, impotence and nervousness (a well-known mojo-killer). The plant’s active compounds, catuabine A and B, appear to act on the sex centers in the brain, says Kilham, so you may experience erotic dreams when taking catuaba.

DOSAGE: 100 milligrams daily

HORNY GOAT WEED (epimedium)

Traditional Chinese Medicine (TCM) views low libido as a deficiency of kidney yang qi, or energy, so Upton advises taking the aptly-named horny goat weed to boost kidney function and—hey now!—your sexual vitality.

DOSAGE: 250 to 500 milligrams daily

MUIRA PUAMA (Ptychopetalum olacoides) aka marapuama

A 2000 study conducted at the Institute of Sexology in (where else?) Paris found that muira puama and Ginkgo biloba, which is another stimulating sex herb, increased desire, intercourse regularity, sexual fantasies, ability to reach orgasm, intensity of orgasm, and, therefore, satisfaction with their sex lives in women who had been experiencing low libido. Other studies show that this happy-making herb from a tree native to the Brazilian Amazon also counteracts chronic stress, depression and nervous exhaustion.

DOSAGE: 800 milligrams daily

MALE SEXUAL DYSFUNCTION

We’ll just cut to the chase, shall we? The most common male sexual disorder is impotence, sometimes called erectile dysfunction, or ED, and defined as the inability to sustain an erection to satisfactorily perform intercourse or ejaculation. Experts estimate that 18 million to 30 million men in the United States experience impotence in some form. Age is not necessarily a factor in pure impotence, although as a man ages, the force and amount of ejaculation does decrease.

ED can occur as a result of certain medications, fatigue, chronic illness or too much alcohol. Lifestyle factors such as smoking, being overweight, a sedentary lifestyle, poorly managed diabetes (which can impact blood flow to the penis), high cholesterol and stress. Low levels of testosterone and a zinc deficiency also can cause ED.

There also are psychological factors that can cause ED, including fear of intimacy and/or feelings of guilt. Primary impotence is rare, and means a male is completely unable to engage in sexual intercourse. Secondary impotence is much more common—men can only engage in intercourse about 25% of the time—and is situational, usually related to psychological reasons, including less than optimal timing or location, boredom, low self-esteem, performance anxiety and depression. Herbs and supplements that may help:

SAW PALMETTO, which helps oppose the influence of estrogen on prostate tissues

ZINC, which boosts immunity and sexual function

NIACIN, to improve circulation

MANGANESE, which is essential to healthy sexual function

LIPOIC ACID, an antioxidant

PROSTATE PMG AND ORCHEX, which directs nutrients to the prostate and testes

Sexy Combos for Him

Herbal aphrodisiacs have been used in every culture ever since men walked upright. Now there are a number of compounds available that combine stimulants from around the world.

Dr. Schulze’s Male “Shot” includes horny goat weed leaf, yohimbe bark, astragalus root, muira puama bark and more to aid with arousal and erections ($66 for a three-pack; herbdoc.com).

ArginMax for Men has shown positive results for maintaining erections in clinical trials. It includes L-arginine, ginseng, ginkgo and zinc ($25 for a one-month supply; arginmax.com).

Steel-Libido for Men contains L-arginine, maca root, ashwagandha root, horny goat weed extract, Tribulus terrestris extract and yohimbe bark. It supports sex drive and erections ($28 for 75 gel caps; hormonewell.com).

How can I treat my sinus infection naturally?

A sinus infection occurs when bacteria, fungus or a virus block the airways in your nose and cause infla—infla—infla—sorry, almost sneezed.

An acupuncturist says:

Typically accompanied by yellowish-green nasal discharge, facial pain, headaches and fatigue, a sinus infection can result from exposure to pathogens, allergens, air pollution, weather changes or stress. Antibiotics will help bacterial infections, but not the more common viral variety.

Treatment: Ease pain with acupressure. Using your index finger, massage each side of the nose at the bottom edge of the nasal bones as well as the grooves at the widest point of both nostrils to the count of 10, three times each day. Or try Metagenics Sinuplex, which contains N-acetylcysteine to thin mucus, quercetin to stop your runny nose, vitamin C to reduce swelling of the mucous membranes and bromelain to relieve your headache and facial pressure. Also use an air purifier with a HEPA filter to clean the air of irritants and keep your home dust-free. If your symptoms do not clear up within a week, see an ear, nose and throat doctor.

—Roberta Roberts Mittman, L.Ac.,
owner of Park Avenue Center for Wellbeing in New York City

An osteopath says:

Taking antibiotics for a sinus infection significantly reduces the amount of good (as well as bad) bacteria in your respiratory and gastrointestinal (GI) tracts, which allows candida to grow and further inflame the mucous membrane. This can contribute to fungal sinusitis in addition to the infection you were originally trying to cure, making you more susceptible to another infection.

TREATMENT: To stop candida overgrowth, avoid sugar, dairy, wheat and alcohol, and take a daily probiotic (even when you’re not sick) with at least two billion CFUs. For the sinus infection, try Allimax (garlic supplement that is also antibacterial, antiviral and antifungal); 200 milligrams of echinacea three times daily; and 1,500 milligrams of the Chinese herb yin chiao three times daily. Also, thin the nasal mucus and flush it out with a steam inhaler and a SinuPulse Elite Nasal Irrigator. Or use a neti pot to rinse out your passages. It also helps to remain hydrated, so drink ½ ounce of water for each pound of body weight daily.

—Robert Ivker, D.O.,
author of Sinus Survival, cofounder of the American Board of Integrative Holistic Medicine and medical director of Fully Alive Medicine in Boulder, Colo.

An ayurvedic physician says:

Viruses and bacteria may flourish in your nose’s mucous membranes and cause a sinus infection. But whether or not you get sick depends on how susceptible your body will be to the germs. An unhealthy diet (think fried foods, red meat and rich desserts), for instance, could make your digestive and immune systems too weak to fight off infection.

TREATMENT: Eat plenty of easy-to-digest foods like warm soups, steamed vegetables, lentils and cooked whole grains, with the exception of wheat if it stuffs up your nose. To clear sinuses and boost digestion, drink warm herbal ginger tea as often as possible and sprinkle stimulating spices like ginger, turmeric, coriander and black pepper on dishes. Avoid cold foods and drinks because they suppress enzymes needed for digestion and toxin removal, plus constrict your already-blocked nasal passages. Also steer clear of congestion-causing dairy foods as well as alcohol, sugar and red meat—all trigger inflammation, which lowers resistance.

—Nancy Lonsdorf, M.D.,
practices ayurvedic medicine in Fairfield, Ia., and is the author of The Ageless Woman: Natural Health and Beauty After Forty

How can I stop snoring?

This expert advice might just save your night—and your relationship.

An integrative sleep specialist says:

Snoring is often considered “normal” because so many of us snore. However, research suggests that, more often that not, it is a very early sign of chronic inflammation, which is associated with weight gain, heart disease and a host of other conditions. We’ve also discovered that snoring is associated with a lack of muscle tone in the throat. Many of us keep our throat muscles tight during the day and, as a result, those muscles get too lax at night—which then causes snoring.

TREATMENT: If you often feel tightness in your throat that keeps you from saying something you’d like to share, your throat muscles could be the culprits. First, take a look at how well you express yourself. Are you really speaking your truth? Next, sing every day—even if you’re just belting out your favorite song in your car. Singing tones the muscles in the throat to help prevent snoring.

—Rubin Naiman, Ph.D.,
clinical assistant professor of medicine at the University of Arizona Center for Integrative Medicine in Tucson and author of Healing Night: The Science and Spirit of Sleeping, Dreaming, and Awakening

A naturopath says:

Allergic rhinitis—an inflammation of the tissue in the nasal passages due to an allergy—is often to blame when it comes to snoring. Common causes of allergic rhinitis include environmental allergens such as dust mites, pet dander, pollen and molds.

TREATMENT: Buy a high-quality air filter, close your bedroom windows and turn the filter on at least one hour before bed. Other crucial moves: Keep pets out of your bedroom (especially off your bed) and choose hypoallergenic bedding and pillows instead of down. You might also have your home checked for mold—especially if you’ve recently had a leak or plumbing incident. Mold is tough to discover on your own because it grows in the walls. Finally, if your sinuses are congested, use a neti pot before bed every night. The saltwater rinse flushes out allergens and helps ease congestion.

—Nicole Egenberger, N.D.,
clinic director of Remede Naturopathics in New York City

An integrative nutritionist says:

If environmental allergens have been ruled out, a food allergy—often a wheat or dairy sensitivity—might be to blame. To figure out if this is the cause of your nighttime noise, go on an elimination diet: For two weeks, eliminate all wheat products. The following week, slowly add them back into your diet (reintroducing foods you’ve cut out one at a time, every two to three days). If you notice gas, bloating or other digestive issues, you’ve got your culprit.

TREATMENT: In addition to cutting out any foods you’re sensitive to, eat more anti-inflammatory foods (think wild salmon, fresh fruit, vegetables and other fiber- and nutrient-rich whole foods) and reduce your intake of pro-inflammatory foods (anything processed or containing flours or partially hydrogenated fats). Also, ditch alcohol consumption, as that has been linked to snoring.

—Beth Reardon, R.D.,
director of integrative nutrition at Duke Integrative Medicine in Durham, N.C.