Many aspects of the treatment for hypoactive sexual desire disorder are similar to spe­cific suggestions for resolving other sexual problems. These include

■ Encouraging erotic responses through self-stimulation and arousing fantasies

■ Reducing anxiety with appropriate information and sensate focus exercises

■ Enhancing sexual experiences through improved communication and increased skills— both in initiating desired sexual activity and in refusing undesired sexual activity

■ Expanding the repertoire of affectionate and sexual activities

Most therapists combine suggestions for specific activities with insight therapy, which can help a person understand and resolve any subconscious conflicts about sexual plea­sure and intimacy. When low sexual desire is a symptom of unresolved relationship problems, therapy focuses on the interactions between partners that contribute to the lack of sexual desire (Alperstein, 2001).

Medical Treatments

Men with low levels of testosterone often use testosterone supplementation—usually a transdermal gel—to increase their sex drive (Tomlinson et al., 2006). The number of testosterone prescriptions has tripled in recent years as a growing number of men are taking testosterone to offset the normal age-related decline of the hormone (Harvard Health Publications, 2006).

A review of controlled studies on estrogen and testosterone and postmenopausal women’s sexual functioning found that both estrogen and testosterone therapies are

associated with increased sexual interest, arousal, and satisfaction with masturbation and partner sexual activity (Davis, 2007; Leventhal-Alexander, 2005). Testosterone can also increase sexual interest for premenopausal women with below-normal levels of testosterone (Berga & McCord, 2005; Reinberg, 2006). In 2004 the FDA turned down an application for Intrinsa, a testosterone patch for women, in spite of studies showing improvement in desire and pleasure for postmenopausal women (Dennerstein & Goldstein, 2005; Herper, 2011). Therefore, testosterone is available to women only by prescription for off-label use. Physicians wrote over 2 million such prescriptions for women in 2006 and 2007, a rate that indicates a need for FDA-approved testosterone products for women (Snabes & Simes, 2009). Research about side effects, especially cancer and heart disease, from testosterone therapy for both men and women continues in order to clarify risks and benefits (Reinberg, 2006). The testosterone patch has been available in several European countries since 2007 (Whittelsey, 2007).

The search for the "female Viagra" remains elusive, and several medications have not met FDA approval. Research into other medical possibilities for improving sexual inter­est and arousal in women is under way (Jordan et al., 2011; Nappi et al., 2010). Two nonprescription products that have been researched in accordance with FDA standards and published in peer-reviewed journals are Zestra, an oil applied to the clitoris and vulva, and ArginMax, a nutritional supplement. Zestra was found to increase sexual response (Ferguson et al., 2010), and study participants using ArginMax reported increased clitoral sensation, sexual desire, vaginal lubrication, frequency of orgasm, and sexual satisfaction (Ferguson et al., 2003; Ito et al., 2001).