成交技巧不下百种，在过去十七年里，我尽可能地涉猎书报杂志上所有的成交资讯，并且把我认为有道理的技巧一一加以测试。就像炒菜一样，每位推销员都必须选择自己认为最拿手和证实效果最好的技巧。
有些广受欢迎的成交技巧可以回溯到19世纪。比如说有一种叫做“小狗狗”的成交技巧，也就是先让准客户试用你的产品或服务，直到他割舍不下(就好像他对从宠物店里的小狗狗难分难舍一样)，而终于决定把产品留下来为止。
有一种叫作“本•富兰克林”的成交技巧，也就是你让客户在笔记本中画一条线，请他们把乐于购买的原因写成一栏，然后把不乐于购买的原因写在另一栏。
有一种叫作“锐角”的成交技巧，让你把反对意见转换成购买的理由。比如说，未来客户：“我没有办法负担每月的费用。”推销人员：“假如我们能够把这笔钱分摊到更长的还款期限，让每月费用降低，那么你会接受吗？”
还有“走开”、“带走”、“只限今天”等各种不同组合的结案技巧。身为专业人员，你必须是一位不会让人感到太大压力，甚至毫无压力的销售人员。你不可有任何意图操纵别人的言行，而危及维系销售．关系基础的脆弱信任感。
你对未来客户应行事光明磊落，直截了当，有凭有据，绝对不可以使用一些诡计，让客户觉得被迫做出违反自己最大利益的事。绝对不可以企图用任何方法操纵未来客户。
有十种和以上原则相互呼应的方法，能够将销售对话引导到对你有利的结论，并且维持日后的关系品质。我以我十七年的销售经历向你保证，这十种成交方法绝对会对你的推销事业有一生的帮助。
一、“我要考虑一下”成交法
我们在提议成交之后，一定会有客户作出拖延购买的决定，因为所有的客户都知道这些技巧。他们肯定会常常说出“我会考虑一下”、“我们要搁置一下”、“我们不会骤下决定”、“让我想一想”诸如此类的话语。
如果你真的听到你的客户说出了这样的话，我告诉你，这个客户已经是你的了。如果你已经掌握了这个技巧的话。
你可以说：“某某先生／女士，很明显地你不会说你要考虑一下，除非对我们的产品真的感到有兴趣，对吗？”说完这句话后，你一定要记得给你的客户留下时间作出反应，因为他们作出的反应通常都会为你的下一句话起很大的辅助作用。
他们通常都会说：“你说得对，我们确实有兴趣，我们会考虑一下的。” 接下来，你应该确认他们真的会考虑，“某某先生／女士，既然你真的有兴趣，那么我可以假设你会很认真地考虑我们的产品对吗？”注意，“考虑”二字一定要慢慢地说出来，并且要以强调的语气说出。
他们会怎么说呢？因为你一副要离开的样子，你放心，他们会回答的。此时，你应该跟他说：“某某先生，你这样说不是要赶我走吧？我的意思是你说要考虑一下不是只为了要躲开我吧!”
说这句话的时候，你得表现出明白他们在耍什么花招的样子，在他们作出反应之后，你一定要弄清楚并更有力地推他们一把。你可以问他：“某某先生。我刚才到底是漏讲了什么或是哪里没有解释清楚，导
致你说你要考虑一下呢？是我公司的形象吗？”
后半部问句你可以举很多的例子，因为这样能让你分析能提供给他们的好处。一直到最后，你问他：“某某先生，讲正经的，有没有可能会是钱的问题呢？”如果对方确定真的是钱的问题之后，你已经打破了“我会考虑一下”定律。
而此时如果你能处理得很好，就能把生意做成，因此你必须要好好地处理。询问客户除了金钱之外，是否还有其他事情不好确定。在进入下一步交易步骤之前，确定你真的遇到了最后道关卡。
但如果客户不确定是否真的要买，那就不要急着在金钱的问题上去结束这次的交易，即使这对客户来说是一个明智的金钱决定。如果他们不想买，他们怎么会在乎它值多少钱呢？
二、“太棒了，钱是我最喜欢的问题”成交法
不知各位在你的推销经历中有没有听过“啊，价格比我预期的高得太多啦”，“我没有想过会有这么高的价钱”等等诸如此类的话。
在我十七年的推销生涯中，我听过已不下十万次了，不过好在我很早就学会了突破这道障碍的方法，所以我的业绩总是我们公司第一名。现在，我就把它提供给大家。
这种成交法的第一步就是确定你的产品价格与你的目标客户的预期价格的差额。现在我们假设你销售的产品是一种高速打印机，其价格10000元人民币，而你的目标客户的预期价是8000元，这时你必须弄清楚你们之间的价格差异是2000元。
但遗憾的是我们的业务员在遇到“价钱太高了”的问题时，通常都会从整个投资来着眼。这实在是一个很大的问题。
事实上，一旦确定了价格差额，金钱上的问题就不再是10000元，而是2000元了，因为你的客户绝对不会平白无故地得到你的产品或服务。
现在你对你的目标客户说：“某某先生，照这样看来，我们双方之间的价格差距应该是两千元，对吧？现在，我认为我们应该小心地以客户的想法来处理这个问题了。”
我们假设这台高速打印机的正常使用寿命是五年。把你的微型计算机拿给你的目标客户，跟他说：“某某先生，我们这台打印机的使用年限是五年，这点你已经确定了，对吧？”
“很好，现在我们把两千元除以五年，那么一年贵公司的投资是400元，对吧？”“很好，贵公司一年用得到打印机的时间应该有五十周，对吧？如果你把四百元除以五十周，那么每周贵公司的投资应该是八元，对吧？”
现在你说：“某某先生，我知道贵公司的工作时间很长，你们经常加班，所以我假定这台打印机一星期要用六天应该是很合理的，对吧？麻烦你用八块钱除以六，那么答案是？”“是一块三”，记住这个答案让你的客户说出来，因为到最后，你的客户觉得再跟你争执每天一块三毛钱已经很可笑了。
你微笑着对你的客户说：“某某先生，你觉得我们要让这每天一块三毛钱来阻碍你们公司获得利润，增加产量吗？来阻碍这种超速打 ，印机为你们带来的扩张能力吗？” 他回答说不知道。
你再问他：“某某先生， 我还要问你一个问题，这个高速打印机的功能 ，齐全，而且还有省时的优点，我们已经谈过它 的优点了，这部机器在一天之内为你们公司创造的利润，应该比一个最低工资人员在一小时里创造的利润多，对吧？”
你的客户会回答：“对，我想是这样的。”因为如果不是昧着良心，他没有其他的回答选择。你是否心里在想：“哇，真的就这么简单。”为什么不会这么简单呢？
我想我可以确定作为一个业务员，金钱总是你最常会碰到的问题，既然如此，你不妨把这项技巧运用到你的工作上，跟你的同事、拍档一起练习，记住每一句话，并把数字给记下来，然后去使用它。
我敢肯定，你的销售数字会有惊人速度的增加，如果你用了这个结束法还是不行的话，这对你的业绩并没有任何损害，但不去学习并且使用它们，那就问题大了。
设下目标要将这种以及其他几种成交法各使用十次，当然每一次在使用它时，都要尽力去冲刺。你会有一些成果。试着每种结束法都尝试十次，你将会有很大的收获，如果再多尝试十次，你就很快可以拥有你的豪华别墅和开着奔驰6．0去推销了。
三、“不景气”成交法
现在有许多人都生活在恐惧中，有些人被认为是乐观主义者，其他人则是顽固分子，但大部分的人是左右摇摆不定。毫无疑问，新闻媒体报忧不报喜的态度使得数以千计的具有影响力的人不敢作出决定。
因为许多人在此时摇摆在恐惧与乐观中——甚至是在一分钟——你可以作出决定，释放出能量来。不景气成交法的目的便在此。接下来是适用于一般人的结束法。
"某某先生，多年前我学习了一个真理：成功者购买习惯是这样的，当别人卖出时买进，当别人买进时卖出。最近有很多人谈到市场不景气，而在我们公司我们决定不让不景气来困扰我们，您知道为什么吗？(留时间让客户问你为什么)
然后回答：“因为今天很有财富的人都是在不景气时代建立了他们成功的基础，他们看到了长期的机会而不是短期的挑战，因此他们作出购买决定而成功，当然他们愿意作出决定。某某先生，今天你有相同的机会，你也愿意作出相同的决定，对吧？”
这个成交方法最重要是要灵活运用预先框式的技巧。
第一步你预先框式他是一位成功者，而一位成功者是不会因为经济不景气成为困扰自己或公司的因素。第二步是框式他作为成功者总是会泎出明智的决策。第三步则是框式他作出购买的决定才是正确的选择。事实上，只要预先框式运用得恰当、适宜，在许多销售场合你都可以随心所欲地完成你的销售。
四、“没有预算”成交法
在经济不景气时，每个销售人员在拜访公司或政府机构时一定都会听到这个理由。这个结束法是用在当你跟公司的总裁或一级主管见面时，当你听说你的产品或服务不在他们的预算中时，以真诚的语气这么跟他们说：“不是啦!所以我才会跟你联络啊。”
在这时千万别打住了，但你要如何推进，要看你是在跟营利性或非营利性机构做生意，我们来看看适用的方法吧。对一般公司的方法：
“某某先生，我完全可以了解这一点，一家管理完善的公司需要仔细地编制预算，预算是帮助公司达成目标的重要工具，但工具本身是具有弹性的，对吗？你身为高级主管，应该有权为了公司的财务利益跟未来的竞争性来弹性地利用预算，对吧？”(给出时间让你的客户作出反应。)
“我们在这里讨论的是一个系统，能让贵公司具备立即并持续的竞争性。告诉我，某某先生，假如今天有一项产品，对你公司的长期的竞争力和利润都有所帮助，身为企业的决策者，你会让预算来控制你还是你来控制预算呢？”
对非营利公司及政府单位的方法：“我知道每一家管理良好的机构会以精密的预算来控制他们的财务，所以我知道你的办公室(机关，机构)会随着大众快速改变的需要而改变。事实上真的也是如此吧？”
在客户有反应后，继续说：“这表示你身为这么有效率的机构总裁，一定可以灵活地运用你们的预算，而不是死守在规定里，不然你的民众如何能快速地经由你的机构受利于新发展和新科技呢？”
“所以您身为总裁应该有权弹性使用预算，让组织可以履行它的责任。”“我们在这里讨论的是一个能立刻持续地节省成本的方法(获得注意，增加访客安全和舒适——什么样的好处都行)，告诉我，某某先
生，在这些条件下，你的预算是有弹性的还是硬梆梆的规则呢？”
五、鲍威尔成交法
在我们这个社会中，总有办事很拖沓、犹豫的人，他们明明相信我们的产品质量和服务非常好，也相信如果作出购买决定会对他们的业务产生很大的帮助。但他们就是迟迟不作出购买决定。
他们总是前怕狼，后怕虎。对于他们来说，主导他们作决定的因素不是购买的好处，而是万一出现的失误。就是这“万一的失误”使他们不敢承担作出正确的购买责任。对于这样的顾客，我们就可以采用“鲍威尔”成交法。
你可以对他说：“某某先生，美国国务卿鲍威尔说过——拖延一项决定比做错误决定浪费更多美国人民、企业、政府的金钱和时间，而我们今天讨论的就是一项决定，对吗？
“假如今天您说好，那会如何呢？假如您说不好那又会如何呢？假如说不好，明天将和今天没有任何改变，对吗？假如今天您说好，您即将获得的好处是很明显的，这点我想您会比我更清楚。某某先生，说好比说不好对您的好处更多是不是呢？”
对于这种性格比较软弱的顾客，推销人员必须主导整个推销过程，他的潜意识里面需要别人替他作出购买决定。他总是需要听取别人的意见而自己却不敢拿什么主意。
这种顾客，推销员就必须学会主导整个购买过程，你千万不要不敢为你的客户作决定，你要明白，你的决定可能就是你的客户的购买行为。
六、“一分钱一分货”成交法
在我们的推销生活中，价格总是被顾客最常提起的话题。不过挑剔价格本身并不重要，重要的是在挑剔价格背后真正的理由。因此，每当有人挑剔你的价格，不要和他争辩。
相反，你应当感到欣喜才对。因为只有在客户对你的产品感兴趣的情况下才会关注价格，你要做的，只是让他觉得价格符合产品的价值，这样你就可以成交了。
突破价格障碍并不是件困难的事情。因为客户如果老是在价格上绕来绕去，这是因为他太注重于价格，而不愿意让你把产品介绍注重在他能得到哪些价值。
在这种情况下，你可以试试下面的办法。你温和地问：“某某先生，请问您是否曾经不花钱买到过东西？在他回答之后，你再问：“某某先生，您曾买过任何便宜货。结果品质却很好的东西吗？”你要耐心地等待他的回答。他可能会承认，他从来就不期望他买的便宜货后来都很有价值。
你再说：“某某先生，您是否觉得一分钱一分货很有道理？”这是买卖之间最伟大的真理，当你用到这种方式做展示说明时，客户几乎都必须同意你所说的很正确。
在日常生活中，你付一分钱买一分货。你不可能不花钱就能买到东西，也不可能用很低的价格却买到很好的产品。每次你想省钱而去买便宜货时，却往往悔不当初。
你可以用这些话结尾：“某某先生，我们的产品在这高度竞争的市场中，价格是很公道的，我们可能没办法给您最低的价格，而且您也不见得想要这样，但是我们可以给您目前市场上这类产品中可能是最好的整体交易条件。”
接下来，“某某先生，有时以价格引导我们作购买决策，不完全是有智慧的。没有人会为某项产品投资太多，但有时投资太少，也有它的问题所在，投资太多，最多您损失了一些钱，投资太少，那您所付出的就更多了。因为你所购买的产品无法带给你预期的满足。
在这个世界上，我们很少有机会可以以最少的钱买到最高品质的商品，这就是经济的真理，也就是我们所谓的一分钱一分货的道理。”
这些话的优点是它们永远是真理。未来客户了解你是绝对诚实而爽快的人，他必定会了解你的价格无法减让。这不是拍卖会，你并不是在那里高举产品，请有兴趣的人出价竞标。你是在销售一项价格合理的好产品，而采购决定的重点是，你的产品适合客户解决问题和达到目标。
七、"别家可能更便宜”成交法
我想在你的推销生涯中，可能会经常碰到“别家的产品比你的产品便宜”之类的话。这当然是一个价格问题。但我们必须首先分辨出他真的是认为你的产品比别家的贵，或者只是用这句话来跟你进行讨价还价。了解他们对你的产品的品质、服务的满意度和兴趣度，这将对你完成一笔交易有莫大的帮助。
不过无论他是什么态度，你用下面的成交法都能有效地激发他们的购买欲望，除非他们真的对你的产品和服务不感兴趣。但如果你的客户真的不感兴趣，他也不会跟你在价格上纠缠来纠缠去，你说对吗？我们来看下面的成交法，他们也许只不过想以较低的价格购买最好的产品和服务罢了。
既然这样，你就跟他说：“某某先生，别家的价格可能真的比我们的价格低。在这个世界上我们都希望以最低的价格买到最高品质的商品。依我个人的了解，顾客购买时通常都会注意三件事：①产品的价格；②产品的品质；③产品的服务。
我从未发现有任何一家公司可以以最低价格提供最高品质的产品和最好的服务，就好像奔驰汽车不可能卖到桑塔纳的价格一样，对吗？”
说完这句话后，你最好留下时间给你的客户作出反应。因为你说的是经济上不折不扣的真理，你的客户几乎没有办法来反驳你，他只能说“是”。接下来，你对你的客户说：“某某先生，根据您多年的经验来看，以这个价格来购买我们的产品和服务，是一种很正当的交易条件，您说对吗？”
让你的顾客作出回答，因为你的产品的品质和服务确实符合这样的价格，你的客户如果不是故意刁难，应该不会作出否定的回答。然后，你再继续问他：“某某先生，为了您长期的幸福，您愿意牺牲哪一项呢？您愿意牺牲产品的品质呢？还是我们公司良好的服务？
某某先生，价格对您真的那么重要吗？有时多投入一点来获得他们真正所想要的产品，也是蛮值得的，您说是吗？事实上，大公司的低层采购人员都致力于从供应商那里尽量获得最低的价格。然而，有
经验的采购人员都了解，低价位产品产生的问题往往比它能够解决的问题还要多。
资深的采购人员，基于他们的经验，更在意获得最高品质的产品，远胜于那些低价位的产品。他们似乎都能因此为公司作出较好的决定。某某先生，您说对吗？”
如果你的产品和服务真的够好，你只要将上面的语言记下来，并且说出去，你的订单就会足够多了。
八、“十倍测试”成交法
还有一种很好的成交方法就是“十倍测试”成交法，具体运用如下：“某某先生，多年前我发现完善地测试某项产品的价值，就是看他是否经得起十倍测试的考验。
例如你可能投资在房子、车子、珠宝及其他为您带来乐趣的事物，但拥有了之后，您是否可以肯定地回答这个问题呢？您愿意不愿意付出比它多十倍的价格来拥有它？
例如，您可能投资在健康咨询上的费用，而使您的身体得到大大改善，或是您改变了自己的形象，而提升了自己的自信而增加了收入，那您所付出的也就值得了。有些产品，当我们拥有了一阵子之后，发现它对我们的改变，我们会愿意出它十倍的价格来拥有它。
九、“不要”成交法
你曾遇到过客户直接跟你说“不要”，而没有其他的话加以润饰吗？你迟早都会遇到的，先思考一下这个问题，以便当你听到“不要”时，不会太震惊。通常你会听到一些柔性的拒绝，像是“您的产品都非常好，我们需要你的产品(或服务)，但我得拒绝”。
在这些场合中，学习超级推销人员所使用的成交法吧，为了增加你的订单，仔细地学习它。“某某先生，在这个世界上有很多销售人员在推销很多产品，他们都有很好、很具说服力的理由来要你投资在他们的产品和服务上，对吧？ ”
“当然，某某先生，您可以向任何一位或全部的推销员说不，但是，在我的行业(说出你的产品和服务)，我是一个专业人员，我的经验告诉我一个无法抗拒的事实，没有人可以对我的产品说不。当他对我的产品说不，事实上，他在对他自己未来的幸福、快乐和财富说不。”
“某某先生，假如今天您有一项产品，顾客非常需要他，非常想拥有它，您会不会因为顾客一点小小的问题而让他对您说不要呢？所以，我今天肯定不会让你对我说不。”
十、“是，是”成交法
如果你推销的产品品质优良，而且若干产品的优点正符合客户的需要，在客户承认这些优点之前，要先准备一些让客户只回答“是”的问题。例如：“某某先生，我们的产品比A产品省电20％，对吗？”“我们的机器比A公司的机器便宜500元，是吗？”
当然，这些问题必须能表现出产品的特点，同时在你有把握客户必定会回答“是”的情况下才提出。掌握了这个诀窍，你就能制造一连串让客户回答“是”的问题。最后，你要求客户签订货单时，他也会心甘情愿地回答“是”了。
在我们的推销世界中，会开口要求的人才是赢家。但遗憾的是太多人都因为害怕失败和被拒绝，而不愿意开口要求他们想要和需要的东西。他们会用猜测、含蓄、暗示的各种方式，却不愿冒被拒绝的风险而直接提出要求。你的生活是否成功、快乐，大都取决于你的能力，以及开口要求所想事物的意愿。
要学习如何积极地要求，愉快地要求，有礼貌地要求，有所期待地要求，要求资讯，要求安排见面，要求别人告诉你他犹豫不决的理由，以及了解客户的言外之意。最重要的是，你得要求客户下订单。要在所有的解说完毕，进入销售活动，进入尾声之际，请求客户作出购买决定。
正如圣经所云：“向他祈求，必有应允，凡祈求者，皆有收获。”勇气和胆识是构成顶尖销售人员的基本特质。那是能够发挥最大潜能的销售人员，个个都是能克服恐惧，勇往直前，不畏失败、挫折、遭拒等枪林弹雨的勇土。
一旦你决定自己要的是什么，就表现出一副不可能失败的架势，而你就绝对会实现!
在销售业里，除非你怀疑、恐惧或自我设限，否则你的成就是没有上限的。当你练习大胆行动，表现出一副不可能失败的架势时，你立刻会把勇敢纳入你人格的重要特质，一生受用不尽，你在销售上的成功也将指日可待。
Thursday, September 6, 2007
Sunday, August 26, 2007
The New Science of Sensational Sex
Researchers are unveiling the breakthroughs that truly work for grown-up women (we promise... not a stiletto or silly gadget among them).
A fulfilling sex life is one of the most important ways to stay connected to your partner and boost self-esteem. But great sex doesn't just happen on its own—and less so as you age. Your need for intimacy changes, and your body may not respond the same way it did when you were younger. Here, five common reasons that women over 40 find their libido lagging, and the scientific interventions that can get it happily humming along again.
Reason: You Have Low Testosterone
We tend to think of testosterone as a "male" hormone. But small amounts—delicately balanced with estrogen—fuel a woman's sex drive. Unfortunately, at menopause testosterone starts to decline, which can cause desire to plummet. Hormone therapy throws off the balance even more. A blood test and your gynecologist can determine if low testosterone is to blame. Luckily, studies show that stabilizing testosterone levels can rev up arousal in postmenopausal women—and improve all areas of sexual response, from lubrication to stronger, more powerful orgasms.
How science can help
Testosterone gel: Although the FDA has not yet approved a testosterone gel specifically for women, many doctors simply prescribe the male version off-label or have a compound created by a pharmacist (a female gel is in the works—see "2 Libido-Enhancing Drugs" below). And no, it won't make you grow hair on your chin or give you huge muscles. "The doses prescribed for women aren't large enough to stimulate male characteristics," says Anita Clayton, MD, clinical professor of obstetrics and gynecology at the University of Virginia and author of Satisfaction: Women, Sex, and the Quest for Intimacy.
Libido-boosting herbs: Certified sex researcher Beverly Whipple, PhD, professor emerita at Rutgers University and coauthor of The Science of Orgasm, recommends ArginMax for Women, a nutritional supplement containing ginseng, ginkgo, multivitamins, and minerals. Science backs her up. ArginMax increased sexual desire, including clitoral sensation and orgasm frequency, in several studies. In one, women taking the supplement daily for 4 weeks reported a 74% improvement in satisfaction with their sex lives. In another study, men taking the male version of ArginMax experienced similar results.
Birth control with benefits: "Ironically, oral contraceptives increase levels of a protein that binds with testosterone and makes it less available to get our brains thinking about sex," says Clayton. But hormonal contraceptives that are inserted into the vagina and release a minimal amount of localized hormone (such as the NuvaRing), or are administered through the skin (such as a patch) and nonhormonal methods (such as condoms or spermicides) can free up that testosterone - and your sexual desire.
Reason: You're Distracted During Sex
It's not just those endless to-do lists that make your mind wander. You're wired that way. According to brain scan research, women's brains are naturally more active than men's, even during sex. The reason: lower levels of the neurotransmitter dopamine. "Dopamine creates the desire to go after a reward—in this case, an orgasm," explains Clayton. Dopamine also increases the flow of sensory impulses to the genitals, essential for arousal. But low levels of dopamine caused by chronic stress or medical conditions can distract you during sex.
How science can help
A supplement that contains the hormone DHEA
This hormone (dehydroepiandrosterone) may increase dopamine production and normally spikes right before orgasm to enhance desire and focus. Taking 300 mg of DHEA an hour before sex significantly increased both mental and physical arousal in postmenopausal women, according to a study published in the Journal of Women's Health & Gender-Based Medicine. Clayton only recommends 25 to 50 mg and warns that DHEA can affect some people's cholesterol levels, however. So be sure to check with your doctor before taking it.
A simple test for ADD
Up to 2 million adult women in the United States suffer from attention deficit disorder, which may be associated with low dopamine levels, says Daniel G. Amen, MD, a psychiatrist, brain imaging specialist, and author of Sex on the Brain. This can literally make it difficult to pay attention during lovemaking. However, "when a woman is finally treated for ADD, usually with a combination of drug therapy and behavior modification, it improves her sex life—not to mention the rest of her life as well," he says. To get a test for ADD, go to prevention.com/links.
Reason: You Have Trouble Reaching Orgasm
Women typically blame this on psychological problems, but the reasons are often physical. Poor blood flow to the genitals, for example, caused by cardiovascular conditions like diabetes or heart disease, makes it harder to have an orgasm. Another common culprit: declining hormone levels due to perimenopause and menopause. Smoking can also disrupt blood flow by constricting blood vessels.
How science can help
Like Viagra, this naturally occurring amino acid increases the production of nitric oxide, a chemical released by the genital nerves during arousal, sending much-needed blood to the area. Amen suggests taking 1,000 to 3,000 mg of L-arginine supplement (available at drugstores) right before sex.
A new antidepressant
The inability to experience orgasm is a common side effect of antidepressants called selective serotonin reuptake inhibitors (SSRIs). That's because the serotonin boost you get from these drugs decreases dopamine, which leads to sexual problems. Clayton often switches her patients to bupropion HCI, an antidepressant that doesn't affect serotonin levels, enhances dopamine function, and, in several studies of women, has boosted desire.
Reason: It's Dry Down Below
The lining of the vagina is extremely estrogen sensitive, and when hormone levels fluctuate during perimenopause, women produce less lubrication prior to and during intercourse. Hormone therapy is a solution for some women. But there are other alternatives.
How science can help
A lubricant that goes straight to the source: Whipple recommends Zestra (available at drugstores), a nonprescription feminine arousal fluid made from botanical oils, which stimulates nerves and blood vessels to increase arousal. Women who used Zestra five times in a 2- to 3-week period (many described a warm feeling in the genital area) boosted their sexual pleasure significantly, even if they were taking libido-dampening antidepressants or had sexual arousal disorder, according to a study on women ages 31 to 57 published in the Journal of Sex & Marital Therapy.
Locally applied estrogen: This can significantly improve the lubrication situation—without the dangers (such as increased breast cancer) of oral hormone therapy. Whipple prefers insertable vaginal estrogen rings or tablets over vaginal estrogen creams.
Reason: You Feel Disconnected From Your Partner
The demands of family and work life can often make long-married couples feel like strangers in the bedroom.
How science can help
An ovulation kit: Oxytocin, often referred to as the bonding hormone, spikes right before ovulation, a time when most women are in the mood. According to Amen, oxytocin also helps dull your memory of your partner's annoying traits (like his dirty socks on the floor) enough to let you feel attracted to him. Chart your cycle and schedule "date night" right before you ovulate.
Sleep Your Way Sexy: Snoring can hurt your sex life Obstructive sleep apnea (OSA) could be an unrecognized cause of sexual dysfunction. In one 2006 study, researchers found that women's problems reaching orgasm increased with the severity of their OSA. Treating men and women for OSA (using continuous positive airway pressure, or CPAP) improved sex drive in all of them, according to another study. For tips on diagnosing and treating OSA, go to the National Sleep Foundation at sleepfoundation.org.
Coming to a Bedroom Near You: 2 Libido-Enhancing Drugs
Ask your doc to keep an eye out for these higher-desire meds that are in the works:
LibiGel: The only prescription testosterone gel to boost sexual desire in women, this hormone treatment should receive FDA approval by 2011.
Bremelanotide Nose Spray: First in a new class of drugs called melanocortin agonists, this nasal spray - just click once and breathe through a small inhaler, 15 to 30 minutes before sex - increases blood flow to the genitals. Unlike Viagra, it has no effect on the cardiovascular system (it works via the central nervous system). In clinical trials of both premenopausal and postmenopausal women with sexual dysfunction, it significantly increased desire and genital arousal. Expect FDA approval for women in 2011.
A fulfilling sex life is one of the most important ways to stay connected to your partner and boost self-esteem. But great sex doesn't just happen on its own—and less so as you age. Your need for intimacy changes, and your body may not respond the same way it did when you were younger. Here, five common reasons that women over 40 find their libido lagging, and the scientific interventions that can get it happily humming along again.
Reason: You Have Low Testosterone
We tend to think of testosterone as a "male" hormone. But small amounts—delicately balanced with estrogen—fuel a woman's sex drive. Unfortunately, at menopause testosterone starts to decline, which can cause desire to plummet. Hormone therapy throws off the balance even more. A blood test and your gynecologist can determine if low testosterone is to blame. Luckily, studies show that stabilizing testosterone levels can rev up arousal in postmenopausal women—and improve all areas of sexual response, from lubrication to stronger, more powerful orgasms.
How science can help
Testosterone gel: Although the FDA has not yet approved a testosterone gel specifically for women, many doctors simply prescribe the male version off-label or have a compound created by a pharmacist (a female gel is in the works—see "2 Libido-Enhancing Drugs" below). And no, it won't make you grow hair on your chin or give you huge muscles. "The doses prescribed for women aren't large enough to stimulate male characteristics," says Anita Clayton, MD, clinical professor of obstetrics and gynecology at the University of Virginia and author of Satisfaction: Women, Sex, and the Quest for Intimacy.
Libido-boosting herbs: Certified sex researcher Beverly Whipple, PhD, professor emerita at Rutgers University and coauthor of The Science of Orgasm, recommends ArginMax for Women, a nutritional supplement containing ginseng, ginkgo, multivitamins, and minerals. Science backs her up. ArginMax increased sexual desire, including clitoral sensation and orgasm frequency, in several studies. In one, women taking the supplement daily for 4 weeks reported a 74% improvement in satisfaction with their sex lives. In another study, men taking the male version of ArginMax experienced similar results.
Birth control with benefits: "Ironically, oral contraceptives increase levels of a protein that binds with testosterone and makes it less available to get our brains thinking about sex," says Clayton. But hormonal contraceptives that are inserted into the vagina and release a minimal amount of localized hormone (such as the NuvaRing), or are administered through the skin (such as a patch) and nonhormonal methods (such as condoms or spermicides) can free up that testosterone - and your sexual desire.
Reason: You're Distracted During Sex
It's not just those endless to-do lists that make your mind wander. You're wired that way. According to brain scan research, women's brains are naturally more active than men's, even during sex. The reason: lower levels of the neurotransmitter dopamine. "Dopamine creates the desire to go after a reward—in this case, an orgasm," explains Clayton. Dopamine also increases the flow of sensory impulses to the genitals, essential for arousal. But low levels of dopamine caused by chronic stress or medical conditions can distract you during sex.
How science can help
A supplement that contains the hormone DHEA
This hormone (dehydroepiandrosterone) may increase dopamine production and normally spikes right before orgasm to enhance desire and focus. Taking 300 mg of DHEA an hour before sex significantly increased both mental and physical arousal in postmenopausal women, according to a study published in the Journal of Women's Health & Gender-Based Medicine. Clayton only recommends 25 to 50 mg and warns that DHEA can affect some people's cholesterol levels, however. So be sure to check with your doctor before taking it.
A simple test for ADD
Up to 2 million adult women in the United States suffer from attention deficit disorder, which may be associated with low dopamine levels, says Daniel G. Amen, MD, a psychiatrist, brain imaging specialist, and author of Sex on the Brain. This can literally make it difficult to pay attention during lovemaking. However, "when a woman is finally treated for ADD, usually with a combination of drug therapy and behavior modification, it improves her sex life—not to mention the rest of her life as well," he says. To get a test for ADD, go to prevention.com/links.
Reason: You Have Trouble Reaching Orgasm
Women typically blame this on psychological problems, but the reasons are often physical. Poor blood flow to the genitals, for example, caused by cardiovascular conditions like diabetes or heart disease, makes it harder to have an orgasm. Another common culprit: declining hormone levels due to perimenopause and menopause. Smoking can also disrupt blood flow by constricting blood vessels.
How science can help
Like Viagra, this naturally occurring amino acid increases the production of nitric oxide, a chemical released by the genital nerves during arousal, sending much-needed blood to the area. Amen suggests taking 1,000 to 3,000 mg of L-arginine supplement (available at drugstores) right before sex.
A new antidepressant
The inability to experience orgasm is a common side effect of antidepressants called selective serotonin reuptake inhibitors (SSRIs). That's because the serotonin boost you get from these drugs decreases dopamine, which leads to sexual problems. Clayton often switches her patients to bupropion HCI, an antidepressant that doesn't affect serotonin levels, enhances dopamine function, and, in several studies of women, has boosted desire.
Reason: It's Dry Down Below
The lining of the vagina is extremely estrogen sensitive, and when hormone levels fluctuate during perimenopause, women produce less lubrication prior to and during intercourse. Hormone therapy is a solution for some women. But there are other alternatives.
How science can help
A lubricant that goes straight to the source: Whipple recommends Zestra (available at drugstores), a nonprescription feminine arousal fluid made from botanical oils, which stimulates nerves and blood vessels to increase arousal. Women who used Zestra five times in a 2- to 3-week period (many described a warm feeling in the genital area) boosted their sexual pleasure significantly, even if they were taking libido-dampening antidepressants or had sexual arousal disorder, according to a study on women ages 31 to 57 published in the Journal of Sex & Marital Therapy.
Locally applied estrogen: This can significantly improve the lubrication situation—without the dangers (such as increased breast cancer) of oral hormone therapy. Whipple prefers insertable vaginal estrogen rings or tablets over vaginal estrogen creams.
Reason: You Feel Disconnected From Your Partner
The demands of family and work life can often make long-married couples feel like strangers in the bedroom.
How science can help
An ovulation kit: Oxytocin, often referred to as the bonding hormone, spikes right before ovulation, a time when most women are in the mood. According to Amen, oxytocin also helps dull your memory of your partner's annoying traits (like his dirty socks on the floor) enough to let you feel attracted to him. Chart your cycle and schedule "date night" right before you ovulate.
Sleep Your Way Sexy: Snoring can hurt your sex life Obstructive sleep apnea (OSA) could be an unrecognized cause of sexual dysfunction. In one 2006 study, researchers found that women's problems reaching orgasm increased with the severity of their OSA. Treating men and women for OSA (using continuous positive airway pressure, or CPAP) improved sex drive in all of them, according to another study. For tips on diagnosing and treating OSA, go to the National Sleep Foundation at sleepfoundation.org.
Coming to a Bedroom Near You: 2 Libido-Enhancing Drugs
Ask your doc to keep an eye out for these higher-desire meds that are in the works:
LibiGel: The only prescription testosterone gel to boost sexual desire in women, this hormone treatment should receive FDA approval by 2011.
Bremelanotide Nose Spray: First in a new class of drugs called melanocortin agonists, this nasal spray - just click once and breathe through a small inhaler, 15 to 30 minutes before sex - increases blood flow to the genitals. Unlike Viagra, it has no effect on the cardiovascular system (it works via the central nervous system). In clinical trials of both premenopausal and postmenopausal women with sexual dysfunction, it significantly increased desire and genital arousal. Expect FDA approval for women in 2011.
Friday, August 24, 2007
Save Thousands on Your Health Care
10 surprising — and easy — ways to trim costs on everything from your yearly physical to specialized surgery.
After a car accident left Michelle Katz, a Washington, DC, nursing student, with persistent back pain and numbness in 1998, she consulted a neurosurgeon, who told her she'd need an operation to repair her slipped disk. Katz, then 26, didn't have health insurance, so she did the only thing she could think of: She negotiated.
Katz offered to pay her surgeon and anesthesiologist a portion up front in exchange for a hefty discount and arranged a payment plan for the rest. When she got her hospital bill, she haggled with the billing department to drop some charges. All told, she ended up paying just half of the original $28,000 estimate.
"Before this, I didn't think you could negotiate with your doctor," says Katz, 35, now a corporate health care consultant and author of "Healthcare for Less," which was inspired by her own experience. "But all you have to do is ask."
And ask you should—repeatedly. In 2007, a family of four covered by a typical preferred provider organization insurance plan (PPO) is expected to receive an average of $14,500 in medical services. If you fit that profile, about $5,100 of that will be your responsibility—in the form of premiums, co-pays, and deductibles. That's an increase of more than 8% over last year, following 5 straight years in which costs jumped more than 9% annually.
With a little research and some hard bargaining, though, you can cut that figure by half or more. Here are 10 ways to get started, along with the savings you can expect.
1. Shop for Tests
Need an expensive test that's going to cost you a hefty out-of-pocket sum? It might be worthwhile to compare prices among different labs and clinics; fees can vary widely. To compare prices, you need to know the CPT (Current Procedural Terminology) code, a universally accepted number that corresponds to an MRI, a specific lab analysis, or any other billable service. The American Medical Association's Web site, ama-assn.org, has an easy-to-use CPT search engine. Once you have the code, you can get price quotes from several providers. You may be surprised at how well you'll do. "For a CT scan, the price could range between $500 and $1,500 at two different facilities," says Devon Herrick, PhD, a senior fellow at the National Center for Policy Analysis in Dallas.
Save: 20 to 66%
2. Negotiate Your Hospital Bill
For patients with insurance, the hospital co-pay or deductible can represent a very large amount of money. Some insurance companies will deduct this amount from the hospital's contracted rate. The unpaid portion is then your responsibility. Here's a fact many hospitals won't openly admit: They're often willing to waive or reduce an account balance if a patient can demonstrate that the co-pay or deductible is a hardship. But you have to ask. "The patient can go back to an account administrator and say, 'This is really difficult for me. Is there anything you can do?' And we can," says Ruth Levin, vice president for managed care at Continuum Health Partners in New York City. "The number of payers, including patients and insurance plans, who pay hospitals 100% of our charges is probably less than 2%."
Save: 10 to 30%
3. Question Follow-Up Appointments
"When a doctor tells you to come back, whether it's in 3 weeks, 6 months, or a year, ask why. A phone call might suffice," says Arthur Garson Jr., MD, dean and vice president of the University of Virginia School of Medicine and author of "Health Care Half Truths: Too Many Myths, Not Enough Reality."
When a specialist orders a test, such as an x-ray or MRI, ask your primary-care doctor if it's necessary. Seventeen percent of US adults say their doctors have ordered duplicates of medical tests, according to a recent survey by the Commonwealth Fund, a nonpartisan health care foundation in New York City. If you're going for a second opinion, sign out your x-rays or MRI scans from your doctor and bring them with you.
Save: $20 (office visit) to $300 (your share of the average cost of an MRI under an insurance plan that reimburses only 80%)
4. Ask for Cheaper Drugs
Doctors aren't always aware of how much medication costs. "We don't know which drugs are covered and which aren't when we discuss them with patients," says Doug Farrago, MD, a family physician in Auburn, ME. Ask your physician if there's a less expensive but equally effective alternative to the drug you're prescribed.
Save: Up to 75% (the difference between a "preferred" drug and one not covered by insurance)
Caveat "Just be sure your doctor is intimately familiar with the benefits and risks of the alternate drugs for your condition," says Jerome P. Kassirer, MD, distinguished professor at Tufts University School of Medicine in Boston and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health.
5. Plead Your Case Directly with Your Doc
If you're experiencing serious hardship, talk directly to your doctor: They are in the profession because they want to do good and tend to be more forgiving of outstanding balances than many billing managers. "They are the ones who can direct their billing department to give the patient a break," says Levin.
Save: Up to 70%
6. Arrange Independent Lab Work
Cut the cost of blood and urine analyses by using myledlab.com. Once your doctor gives you a prescription for a test, have blood drawn at one of 3,000 collection sites nationwide; the vials are then mailed to independent labs. "You can get more than 30 blood readings and analyses starting at about $95—around 75% less than getting the same tests at a hospital," says Herrick. The lab will mail the results to both you and your doctor. (State laws prohibit this service in California, New Jersey, New York, and Rhode Island, according to the site.)
Save: 50 to 80%
Caveat: "Ask your doctor to confirm the reliability of an 'outside' lab's performance before using it," says Kassirer.
7. Hire an Advocate
The gap between what an out-of-network doctor charges for a procedure and what your insurance will pay can often be considerable, and it's usually your responsibility to make up the difference. The result: a three-way dispute. Patient-advocate services are skilled at resolving such conflicts. Philadelphia-based Healthcare Advocates Inc. charges from $50 to $400 per case—about $300 on average.
Save: Varies widely
Caveat: "Ask a representative if he's had success with your particular type of dispute," advises Kassirer. "With some claims, insurance companies never back down."
8. Fill Prescriptions with Big Retailers
Mail-order pharmacies such as Drugstore.com, Drugs.com, and Costco.com typically beat the prices of neighborhood drugstores hands down. You can do your own price comparisons at Rxaminer.com, which was founded by a cardiologist and has the reputation for independence from special interest groups.
Save: 10 to 20% for name brands, 20 to 40% for generics
9. Split Pills
Most drugs are not priced according to strength, points out Fred Brock, a Kansas State University journalism professor and author of "Health Care on Less Than You Think: The New York Times Guide to Getting Affordable Coverage". Some popular cholesterol drugs come in at least three strengths—why not split the 40 mg pill in half if you only need 20 mg per dose, and have the prescription last twice as long? Some pharmacy benefit managers will even give pill splitters to customers at no cost.
Save: Up to 50%
Caveat: Splitting pills may not always provide the optimal dose of the drug, so check with your doctor first.
10. Try Bartering
"I've had electricians, plumbers, caterers, gardeners, and decorators offer services in exchange for health care," says Farrago. "If I had a solo practice, I'd do it in a second—though I'm blown away by electricians charging more than I do!"
Save: Varies widely
Caveat: None - "as long as you do a good job for the doctor!" says Kassirer.
No insurance? Bargain with cash
If your medical coverage lapses and you need to see a doctor or have a procedure done, offer cash up front. Doctors are often willing to discount their fees in return for guaranteed payment and being able to forgo the hassle of paperwork and administrative costs. Or, offer to match what Medicare would pay—typically about 20% less than what a private insurance plan would provide. Medicare reimbursement rates can be found on the AMA Web site, ama-assn.org.
E-shop for the best plan
It is possible to price-shop for health insurance: Both ehealthinsurance.com and vimo.com offer simple price and coverage comparisons among policies in each state. But never sign up for an insurance plan online. Always talk with a representative before buying, advises Michelle Katz, author of Healthcare for Less. "Get their names and numbers so you can go back to them if you have any questions about the information you've seen on the Internet."
After a car accident left Michelle Katz, a Washington, DC, nursing student, with persistent back pain and numbness in 1998, she consulted a neurosurgeon, who told her she'd need an operation to repair her slipped disk. Katz, then 26, didn't have health insurance, so she did the only thing she could think of: She negotiated.
Katz offered to pay her surgeon and anesthesiologist a portion up front in exchange for a hefty discount and arranged a payment plan for the rest. When she got her hospital bill, she haggled with the billing department to drop some charges. All told, she ended up paying just half of the original $28,000 estimate.
"Before this, I didn't think you could negotiate with your doctor," says Katz, 35, now a corporate health care consultant and author of "Healthcare for Less," which was inspired by her own experience. "But all you have to do is ask."
And ask you should—repeatedly. In 2007, a family of four covered by a typical preferred provider organization insurance plan (PPO) is expected to receive an average of $14,500 in medical services. If you fit that profile, about $5,100 of that will be your responsibility—in the form of premiums, co-pays, and deductibles. That's an increase of more than 8% over last year, following 5 straight years in which costs jumped more than 9% annually.
With a little research and some hard bargaining, though, you can cut that figure by half or more. Here are 10 ways to get started, along with the savings you can expect.
1. Shop for Tests
Need an expensive test that's going to cost you a hefty out-of-pocket sum? It might be worthwhile to compare prices among different labs and clinics; fees can vary widely. To compare prices, you need to know the CPT (Current Procedural Terminology) code, a universally accepted number that corresponds to an MRI, a specific lab analysis, or any other billable service. The American Medical Association's Web site, ama-assn.org, has an easy-to-use CPT search engine. Once you have the code, you can get price quotes from several providers. You may be surprised at how well you'll do. "For a CT scan, the price could range between $500 and $1,500 at two different facilities," says Devon Herrick, PhD, a senior fellow at the National Center for Policy Analysis in Dallas.
Save: 20 to 66%
2. Negotiate Your Hospital Bill
For patients with insurance, the hospital co-pay or deductible can represent a very large amount of money. Some insurance companies will deduct this amount from the hospital's contracted rate. The unpaid portion is then your responsibility. Here's a fact many hospitals won't openly admit: They're often willing to waive or reduce an account balance if a patient can demonstrate that the co-pay or deductible is a hardship. But you have to ask. "The patient can go back to an account administrator and say, 'This is really difficult for me. Is there anything you can do?' And we can," says Ruth Levin, vice president for managed care at Continuum Health Partners in New York City. "The number of payers, including patients and insurance plans, who pay hospitals 100% of our charges is probably less than 2%."
Save: 10 to 30%
3. Question Follow-Up Appointments
"When a doctor tells you to come back, whether it's in 3 weeks, 6 months, or a year, ask why. A phone call might suffice," says Arthur Garson Jr., MD, dean and vice president of the University of Virginia School of Medicine and author of "Health Care Half Truths: Too Many Myths, Not Enough Reality."
When a specialist orders a test, such as an x-ray or MRI, ask your primary-care doctor if it's necessary. Seventeen percent of US adults say their doctors have ordered duplicates of medical tests, according to a recent survey by the Commonwealth Fund, a nonpartisan health care foundation in New York City. If you're going for a second opinion, sign out your x-rays or MRI scans from your doctor and bring them with you.
Save: $20 (office visit) to $300 (your share of the average cost of an MRI under an insurance plan that reimburses only 80%)
4. Ask for Cheaper Drugs
Doctors aren't always aware of how much medication costs. "We don't know which drugs are covered and which aren't when we discuss them with patients," says Doug Farrago, MD, a family physician in Auburn, ME. Ask your physician if there's a less expensive but equally effective alternative to the drug you're prescribed.
Save: Up to 75% (the difference between a "preferred" drug and one not covered by insurance)
Caveat "Just be sure your doctor is intimately familiar with the benefits and risks of the alternate drugs for your condition," says Jerome P. Kassirer, MD, distinguished professor at Tufts University School of Medicine in Boston and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health.
5. Plead Your Case Directly with Your Doc
If you're experiencing serious hardship, talk directly to your doctor: They are in the profession because they want to do good and tend to be more forgiving of outstanding balances than many billing managers. "They are the ones who can direct their billing department to give the patient a break," says Levin.
Save: Up to 70%
6. Arrange Independent Lab Work
Cut the cost of blood and urine analyses by using myledlab.com. Once your doctor gives you a prescription for a test, have blood drawn at one of 3,000 collection sites nationwide; the vials are then mailed to independent labs. "You can get more than 30 blood readings and analyses starting at about $95—around 75% less than getting the same tests at a hospital," says Herrick. The lab will mail the results to both you and your doctor. (State laws prohibit this service in California, New Jersey, New York, and Rhode Island, according to the site.)
Save: 50 to 80%
Caveat: "Ask your doctor to confirm the reliability of an 'outside' lab's performance before using it," says Kassirer.
7. Hire an Advocate
The gap between what an out-of-network doctor charges for a procedure and what your insurance will pay can often be considerable, and it's usually your responsibility to make up the difference. The result: a three-way dispute. Patient-advocate services are skilled at resolving such conflicts. Philadelphia-based Healthcare Advocates Inc. charges from $50 to $400 per case—about $300 on average.
Save: Varies widely
Caveat: "Ask a representative if he's had success with your particular type of dispute," advises Kassirer. "With some claims, insurance companies never back down."
8. Fill Prescriptions with Big Retailers
Mail-order pharmacies such as Drugstore.com, Drugs.com, and Costco.com typically beat the prices of neighborhood drugstores hands down. You can do your own price comparisons at Rxaminer.com, which was founded by a cardiologist and has the reputation for independence from special interest groups.
Save: 10 to 20% for name brands, 20 to 40% for generics
9. Split Pills
Most drugs are not priced according to strength, points out Fred Brock, a Kansas State University journalism professor and author of "Health Care on Less Than You Think: The New York Times Guide to Getting Affordable Coverage". Some popular cholesterol drugs come in at least three strengths—why not split the 40 mg pill in half if you only need 20 mg per dose, and have the prescription last twice as long? Some pharmacy benefit managers will even give pill splitters to customers at no cost.
Save: Up to 50%
Caveat: Splitting pills may not always provide the optimal dose of the drug, so check with your doctor first.
10. Try Bartering
"I've had electricians, plumbers, caterers, gardeners, and decorators offer services in exchange for health care," says Farrago. "If I had a solo practice, I'd do it in a second—though I'm blown away by electricians charging more than I do!"
Save: Varies widely
Caveat: None - "as long as you do a good job for the doctor!" says Kassirer.
No insurance? Bargain with cash
If your medical coverage lapses and you need to see a doctor or have a procedure done, offer cash up front. Doctors are often willing to discount their fees in return for guaranteed payment and being able to forgo the hassle of paperwork and administrative costs. Or, offer to match what Medicare would pay—typically about 20% less than what a private insurance plan would provide. Medicare reimbursement rates can be found on the AMA Web site, ama-assn.org.
E-shop for the best plan
It is possible to price-shop for health insurance: Both ehealthinsurance.com and vimo.com offer simple price and coverage comparisons among policies in each state. But never sign up for an insurance plan online. Always talk with a representative before buying, advises Michelle Katz, author of Healthcare for Less. "Get their names and numbers so you can go back to them if you have any questions about the information you've seen on the Internet."
Wednesday, August 22, 2007
On call: Wife’s disinterest in sex
Q.My wife and I, who both read your column, have always enjoyed our intimate relations. Since she went through the change last year, however, she’s lost interest in sex. She’s only 53, and although I’m 8 years older, I’m as amorous as ever. Do you have any suggestions for us?
A.We’re glad to have you both as readers; in many households, after all, it’s women who watch over men’s health.
Doctors have learned a lot about the male sexual response in the Viagra era, but there is less information about female sexuality. Menopause signals an abrupt drop in female hormones such as estrogen and progesterone, but that shouldn’t affect the female sex drive. In fact, libido depends on testosterone, the male hormone, in both men and women. Testosterone levels are very much lower in women than men, but they drop even lower as menopause approaches, then remain stable during and after menopause as the adrenal glands continue to produce small amounts of male hormones. Still, some women are testosterone deficient and might benefit from testosterone therapy. Unfortunately, however, data are scant, and much more research is needed to learn if testosterone is safe and effective — and if it is, which women should receive it and what dose and preparations are best. At present, those answers are a long way off; in fact, the same questions about testosterone replacement remain to be answered for men.
Another area for research is the use of Viagra for women. An early trial found the drug safe but not beneficial for healthy postmenopausal women. More research is under way, and other drugs are being developed for sexual dysfunction in both genders. The FDA has already approved a hand-held battery-powered clitoral stimulator for women with sexual dysfunction. Your wife’s problem, though, may be a good deal simpler. Postmenopausal women who do not take hormone therapy (and with research showing more harm than good, most should not) develop vaginal dryness, which can make intercourse unpleasant or even painful. So a simple place to start would be a nonprescription vaginal lubricant such as Replens. If that doesn’t help, your wife should ask herself if she might be feeling subtle stress or unhappiness or if she may be reacting to personal, marital, or family conflicts. Her doctor may be able to help her sort out possible physiological and psychological issues.
Discuss the problem with your wife frankly, but be patient and supportive, always looking for mutually satisfactory ways to achieve intimacy and express love and affection.
A.We’re glad to have you both as readers; in many households, after all, it’s women who watch over men’s health.
Doctors have learned a lot about the male sexual response in the Viagra era, but there is less information about female sexuality. Menopause signals an abrupt drop in female hormones such as estrogen and progesterone, but that shouldn’t affect the female sex drive. In fact, libido depends on testosterone, the male hormone, in both men and women. Testosterone levels are very much lower in women than men, but they drop even lower as menopause approaches, then remain stable during and after menopause as the adrenal glands continue to produce small amounts of male hormones. Still, some women are testosterone deficient and might benefit from testosterone therapy. Unfortunately, however, data are scant, and much more research is needed to learn if testosterone is safe and effective — and if it is, which women should receive it and what dose and preparations are best. At present, those answers are a long way off; in fact, the same questions about testosterone replacement remain to be answered for men.
Another area for research is the use of Viagra for women. An early trial found the drug safe but not beneficial for healthy postmenopausal women. More research is under way, and other drugs are being developed for sexual dysfunction in both genders. The FDA has already approved a hand-held battery-powered clitoral stimulator for women with sexual dysfunction. Your wife’s problem, though, may be a good deal simpler. Postmenopausal women who do not take hormone therapy (and with research showing more harm than good, most should not) develop vaginal dryness, which can make intercourse unpleasant or even painful. So a simple place to start would be a nonprescription vaginal lubricant such as Replens. If that doesn’t help, your wife should ask herself if she might be feeling subtle stress or unhappiness or if she may be reacting to personal, marital, or family conflicts. Her doctor may be able to help her sort out possible physiological and psychological issues.
Discuss the problem with your wife frankly, but be patient and supportive, always looking for mutually satisfactory ways to achieve intimacy and express love and affection.
How To Spice Up Your Sex Life
Since the dawn of time, people have looked toward elixirs and potions to improve their sex lives. Why else, after all, would one consume ground tiger penis, horny goat weed and Spanish Fly?
Perhaps because nearly one in five men in the U.S. suffer from erectile dysfunction, according to a recent study in the American Journal of Medicine. Some researchers have estimated that as many as 40% of U.S. women have low libido or inability to reach orgasm. Most quick fixes simply don't work, and some, like Spanish Fly, a supposed aphrodisiac derived from beetles that can cause kidney damage, are harmful.
But modern medicine has found ways--both proven and experimental--to improve your sex life. One place to start: old-fashioned remedies, which some say work best. Regular exercise can actually improve erectile function in most men, says Andrew McCullough, a urologist at New York University Medical Center--and we're talking jogging, not the acrobatic feats found in the back of a magazine. Not particularly athletic? Therapists say that paying attention to your feelings is as important as any pill, nose spray or cream.
"Have a really wonderful role-play with your partner, have a really great dinner out or watch a romantic movie together," says Robert Dunlap, who has researched aphrodisiacs at the Institute for Advanced Study of Human Sexuality in San Francisco. "The greatest aphrodisiac is your mind."
Hope In A Bottle
But that's not stopping the $600 billion global pharmaceutical industry from trying to think up new sex drugs. Viagra, the little blue pill Pfizer launched a decade ago, brings in $1.7 billion in sales every year. Cialis, the longer-acting imitator made by Eli Lilly, rakes in another $1 billion, with several hundred million more for Levitra, from Bayer and Schering-Plough. Other remedies increase blood flow, like the penis injection Caverject, and bring in $30 million more.
A product that could improve women's sexual function might bring in even more money, if it were truly effective. So far, though, companies have been unsuccessful. Viagra failed in tests on women. Procter & Gamble tried to push a testosterone patch for female sexual dysfunction through the Food and Drug Administration (FDA) but in 2004 the agency balked, citing a lack of long-term safety data.
Now the idea of using testosterone as a sex-booster for women is being pushed by Lincolnshire, Ill.-based BioSante Pharmaceuticals, Inc. Its LibiGel is rubbed on the upper arm daily, delivering testosterone, which is thought to increase libido, to the bloodstream over time. The company just began late-stage trials, and, after discussions with the FDA, will start a big safety trial before submitting data to regulators in 2009.
Palatin Technologies, of Cranbury, N.J., is trying to get in on the game, developing a nose spray, called bremelanotide, to treat men and women with sexual dysfunction. Applied 10 to 15 minutes prior to sex, it travels through the central nervous system to increase blood flow in the penile or vaginal tissue. The company hopes to get FDA approval for men in 2009 and women around 2011. "On the female front, we've got a chance to be first to market," says CEO Carl Spana. "People wonder how many women will come in for treatment, but my gut tells me they will come in."
What Really Works
Right now, the treatment available for women with female sexual dysfunction that has been reviewed by the FDA is a handheld vacuum that can be used with a doctor's prescription to increase blood flow to the clitoris. Called Eros Therapy, it is made by NuGyn of Minnesota. Devices such as this go through fewer hurdles than drugs; the Eros device has been tested in several dozen people, compared with hundreds for a pill such as Viagra.
Joy Davidson, a Manhattan-based certified sex therapist, worries that all this technology may cause some people to ignore important cultural factors that can cause sexual dysfunction. "There are agendas here that are not health-based, they're profit-based," she says. "If you're not looking at these elements--the emotional, psychological and cultural--then giving somebody a so-called magic pill is not going to solve the problem."
Future Fixes
Meanwhile, drug researchers keep coming up with even more out-there approaches. For instance, a gene therapy, which seeks to fix erectile function by altering the DNA of cells in the penis, then injecting them back in to the patient. It should work for six months, according to inventor Arnold Melman, the researcher at New York's Albert Einstein College of Medicine. He has co-founded a tiny biotech, Ion Channel Innovations, to develop the product, which even he doesn't expect to reach the market before 2012. No gene therapy has ever been approved.
"People always say gene therapy doesn't work, but at one point it will," says Melman. "We think this is the one."
Perhaps because nearly one in five men in the U.S. suffer from erectile dysfunction, according to a recent study in the American Journal of Medicine. Some researchers have estimated that as many as 40% of U.S. women have low libido or inability to reach orgasm. Most quick fixes simply don't work, and some, like Spanish Fly, a supposed aphrodisiac derived from beetles that can cause kidney damage, are harmful.
But modern medicine has found ways--both proven and experimental--to improve your sex life. One place to start: old-fashioned remedies, which some say work best. Regular exercise can actually improve erectile function in most men, says Andrew McCullough, a urologist at New York University Medical Center--and we're talking jogging, not the acrobatic feats found in the back of a magazine. Not particularly athletic? Therapists say that paying attention to your feelings is as important as any pill, nose spray or cream.
"Have a really wonderful role-play with your partner, have a really great dinner out or watch a romantic movie together," says Robert Dunlap, who has researched aphrodisiacs at the Institute for Advanced Study of Human Sexuality in San Francisco. "The greatest aphrodisiac is your mind."
Hope In A Bottle
But that's not stopping the $600 billion global pharmaceutical industry from trying to think up new sex drugs. Viagra, the little blue pill Pfizer launched a decade ago, brings in $1.7 billion in sales every year. Cialis, the longer-acting imitator made by Eli Lilly, rakes in another $1 billion, with several hundred million more for Levitra, from Bayer and Schering-Plough. Other remedies increase blood flow, like the penis injection Caverject, and bring in $30 million more.
A product that could improve women's sexual function might bring in even more money, if it were truly effective. So far, though, companies have been unsuccessful. Viagra failed in tests on women. Procter & Gamble tried to push a testosterone patch for female sexual dysfunction through the Food and Drug Administration (FDA) but in 2004 the agency balked, citing a lack of long-term safety data.
Now the idea of using testosterone as a sex-booster for women is being pushed by Lincolnshire, Ill.-based BioSante Pharmaceuticals, Inc. Its LibiGel is rubbed on the upper arm daily, delivering testosterone, which is thought to increase libido, to the bloodstream over time. The company just began late-stage trials, and, after discussions with the FDA, will start a big safety trial before submitting data to regulators in 2009.
Palatin Technologies, of Cranbury, N.J., is trying to get in on the game, developing a nose spray, called bremelanotide, to treat men and women with sexual dysfunction. Applied 10 to 15 minutes prior to sex, it travels through the central nervous system to increase blood flow in the penile or vaginal tissue. The company hopes to get FDA approval for men in 2009 and women around 2011. "On the female front, we've got a chance to be first to market," says CEO Carl Spana. "People wonder how many women will come in for treatment, but my gut tells me they will come in."
What Really Works
Right now, the treatment available for women with female sexual dysfunction that has been reviewed by the FDA is a handheld vacuum that can be used with a doctor's prescription to increase blood flow to the clitoris. Called Eros Therapy, it is made by NuGyn of Minnesota. Devices such as this go through fewer hurdles than drugs; the Eros device has been tested in several dozen people, compared with hundreds for a pill such as Viagra.
Joy Davidson, a Manhattan-based certified sex therapist, worries that all this technology may cause some people to ignore important cultural factors that can cause sexual dysfunction. "There are agendas here that are not health-based, they're profit-based," she says. "If you're not looking at these elements--the emotional, psychological and cultural--then giving somebody a so-called magic pill is not going to solve the problem."
Future Fixes
Meanwhile, drug researchers keep coming up with even more out-there approaches. For instance, a gene therapy, which seeks to fix erectile function by altering the DNA of cells in the penis, then injecting them back in to the patient. It should work for six months, according to inventor Arnold Melman, the researcher at New York's Albert Einstein College of Medicine. He has co-founded a tiny biotech, Ion Channel Innovations, to develop the product, which even he doesn't expect to reach the market before 2012. No gene therapy has ever been approved.
"People always say gene therapy doesn't work, but at one point it will," says Melman. "We think this is the one."
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