I frequently hear complaints of decreased libido in perimenopausal and menopausal women on hormone replacement therapy, even after they have tried estrogen and progesterone replacement or testosterone therapy. Is there an OTC product or herbal remedy that has proven effective?—DEBORAH WARD, PA-C, Greenville, N.C.

The word “proven” is problematic here, since performing a rigorously scientific trial of as vague an endpoint as “increased libido” is nearly impossible. Numerous naturopathic remedies exist, but like all nonprescription items, these products are hampered by nonstandardized content and often dubious origin. Is a pill the only answer? Psychotherapy is a cornerstone of sex therapy and should not be overlooked; while time-consuming and expensive, its benefits (if successful) can be long-lasting.—Reuben W. Zimmerman, PA-C (138-6)

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