It's the kind of thing no one wants to talk about, but it's the kind of thing that can destroy a relationship. What it is ... is sex. In the case of many couples, it's the absence of sex.
While Americans have grown accustomed to seeing advertisements for all sorts of products aimed at treating male sexual dysfunction, there hasn't been much talk about women's libidos or sexual health.
A recent study concluded that almost half the adult women in America are not happy with their sex lives and they don't know why. Many are too embarrassed to talk about it with their partners, or to get help.
But more and more women are finally beginning to admit to an awful feeling they've avoided discussing. Sex isn't enjoyable for them.
Female Sexual Dysfunction
"Women are feeling more entitled to their sexual response and are being more proactive about doing something about it," says sex therapist Laura Berman.
She and her sister, Dr. Jennifer Berman, a urologist, are pioneers in the new field of female sexual dysfunction, or FSD.
According to a study published in the Journal of the American Medical Association in 1998, some 43 percent of sexually active women of all ages experienced sexual dysfunction.
The Bermans say FSD includes four particular complaints: trouble achieving orgasm, not being aroused properly, pain during sex, and the one they hear most often: low libido.
To learn more about the Bermans' work, visit their Web site: www.newshe.com.
Often, doctors have told women that their problems are emotional, not physical. But the Bermans feel differently.
In their work, the Bermans emphasize the importance between the mind and the body and physiological responses to emotional issues.
Sorting Out the Emotional From the Physical
Low libido is the most common female sexual complaint, and the Bermans recommend couples counseling.
To help a woman overcome her lack of sexual desire, they often begin with a three-hour, mind/body exam by talking with her about her feelings.
After getting her perspective, they will talk with her partner. They will then examine the woman's medication history. It turns out that a wide variety of medications can affect sex drive, from antihistamines to antidepressants to birth control pills.
They sometimes recommend discontinuing birth control pills and sometimes even prescribe a very small dose of testosterone, a controversial new treatment being offered to women. Some doctors consider testosterone the female Viagra, even though the Food and Drug Administration hasn't cleared it for treating FSD, and some women report negative side effects like facial hair and acne.
Too Quick to Diagnose and Prescribe?
Leonore Tiefer, a New York psychologist and sex therapist, is one of a small but vocal number of critics who say doctors shouldn't quickly turn to drugs to cure women's sexual complaints. "It's easy to get a pill, but pills have side effects and they have interaction problems and they're being given to young people," she says. "Are they supposed to take it their entire life?"
In fact, Tiefer insists that lagging sex drive is just a normal part of life for many women, especially those overwhelmed by work and children, and that medicine isn't the answer.
Jennifer Berman disagrees. "The reality is … that there are medical reasons why women experience sexual dysfunction," she says. "We didn't create them. We didn't make it happen. It's the way it is. Were just acknowledging their existence."