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Q. I have low libido. Should I try testosterone therapy?
A. You might want to consider other solutions first, says ob-gyn Leah Millheiser, M.D., director of the female sexual medicine program at Stanford University Medical Center. Low libido has many causes, which your doctor can help address, including stress, side effects from medication and, yes, hormonal shifts. "Testosterone, a hormone associated with sex drive in women, decreases by about 50% between the ages of 20 and 50. But most women won't notice a change until they transition into menopause," she says. Testosterone therapy isn't approved for women by the FDA, however, doctors sometimes recommend it off-label to postmenopausal patients. If your MD suggests testosterone, make sure you understand exactly how to use it (options include gels, creams or patches) and are aware of the risk factors and side effects.
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Q. Our family is complete, and I'd like to stop using birth control. My husband doesn't want a vasectomy. Is having my tubes tied the only option?
A. No. The FDA has approved two newer nonsurgical procedures. With Essure or Adiana, a gynecologist puts a tiny insert (either a coil or a piece of silicone) into your fallopian tubes that blocks sperm from reaching eggs for the rest of your life. "Unlike tubal ligation, either can be done in-office and without anesthesia, so the price (for those with insurance) is usually in the hundreds or less, not the thousands," says Cindy Basinski, M.D., a gynecologist in Newburgh, Indiana. "You can be in and out of your doctor's office in less than 10 minutes, compared with the hours you'd spend in the hospital. Patients often return to work the same day." Downside: You may cramp or spot for a few days.
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Q. What's the best way to ease menstrual cramps?
A. You're most likely to find relief with a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen. NSAIDs ease uterine contractions and prevent blood clots, the two main causes of menstrual discomfort. Take the recommended dosage for only a few days during each cycle, whenever your pain peaks, says Jane Marjoribanks, a researcher at Cochrane Menstrual Disorders and Subfertility Group in New Zealand.
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Q. My 45-year-old husband has been tired, moody and not that interested in sex. What could be wrong?
A. The symptoms you describe are usually associated with menopausal women, but they can occur in men too. Testosterone begins to drop in males after age 40. "When levels dip some men experience a lack of energy and low libido, plus moodiness," says Robert Brannigan, M.D., a urologist at Northwestern Memorial Hospital in Chicago. "This condition, male hypogonadism, impacts 5 million men, yet 95% of cases go undiagnosed because symptoms are ignored." A simple blood test will reveal whether your husband needs testosterone replacement therapy—through a daily gel or patch, a weekly or monthly shot, or a pellet that's injected into the buttocks two to four times a year.
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Q. I'm so over sex. How can I get my husband on the same page?
A. Sorry, you probably can't. But we sympathize: "Between work, dinner and the kids, sex tends to fall to the bottom of a mom's priority list," says Jennifer Landa, M.D., co-author of The Sex Drive Solution for Women. Biology also interferes. During a woman's 40s and 50s, the stress hormone cortisol increases while levels of libido-igniting testosterone decline. But you can put yourself back in the mood. Dr. Landa suggests experimenting with scents (like lavender massage oil) or a specific touch to turn you on. "At first these things aren't triggers, but the more you experience them, the more they become associated with sex," she says. Scheduling some between-the-sheets time can also help you make intimacy a priority.
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Q. What's the difference between a lubricant and a moisturizer?
A. A vaginal moisturizer (like K-Y SILK-E or Replens) is absorbed by your skin to add hydration for up to four days if dryness has made sex or even a 3-mile run uncomfortable. A lubricant (such as Astroglide) sits on top of your skin and just makes penetration easier, whether you're being examined by your ob-gyn or about to get intimate. You can use lubricants and moisturizers together or buy a hybrid product (like Luvena). "These over-the-counter options help alleviate dryness and chafing," explains Susan Kellogg Spadt, R.N., Ph.D., professor of ob-gyn at Drexel University and director of vulvar pain and sexual medicine at the Pelvic & Sexual Health Institute of Philadelphia. "But if sex is painful or you think you have an infection, see your doctor." You may need a vulvar soothing cream, like Neogyn, or a prescription-strength medication.