If focusing on psychological, intimacy and relationship issues isn't the hoped-for fix, medical treatment options are available to compensate for hormonal imbalances and increase genital blood flow. These include:

• Artificial Lubrication. Over-the-counter vaginal lubricating creams, gels or suppositories, such as Replens, Astroglide or K-Y Jelly, may make sex more comfortable and enjoyable.
• Topical Estrogens. Menopausal women who are uncomfortable during sex might want to try estrogen creams such as Estrace or Premarin or a vaginal insert such as Estring. Another option, the Vagifem vaginal tablet, can combat vaginal dryness.
• Hormone Therapy. For menopausal women, an estrogen-progestin combination therapy or estrogen alone can improve clitoris sensitivity, ease pain from vaginal thinning and dryness, and improve blood flow. Hormone use should be carefully considered, though, according to the Food and Drug Administration (FDA), because of potentially increased risks for heart disease, stroke and breast cancer.
• Androgen Therapy. Supplementation with the sex hormone androgen may help with sexual arousal. Testosterone, a type of androgen, is sometimes prescribed to counter reduced desire after hysterectomy, but it is unclear whether androgen supplementation can increase desire in all menopausal women. The risks from this type of therapy include increased facial hair, enlargement of the clitoris, and for the oral form, liver damage, blood cholesterol changes and acne.
• DHEA. Dehydroepiandrosterone, produced by the adrenal glands, may benefit women with diminished sexual interest and arousal problems caused by low levels of naturally produced DHEA. The supplement form is available over the counter, but medical guidance is suggested based on its risks, such as acne, hair growth and possibly, according to the National Women's Health Resource Center, an increased risk of breast cancer.
• Clitorial Therapy Device. The FDA-cleared Eros device for female sexual arousal disorder has a suction cup that is placed over the clitoris before sex, and a battery-operated vacuum pump that draws blood into the clitoris.

Think About Sex Therapy
If a man's impotence could be caused by performance anxiety or a woman's desire has dropped off without a physical explanation, sex therapy can sometimes work wonders. A common technique emphasizes sensate focus exercises — concentrating on the pleasure of touch with your partner without engaging in intercourse.

Your sexual relationship with your partner deserves work just like every other aspect of your life, emphasizes Barnaby Barratt, Ph.D., president of the American Association of Sex Educators, Counselors and Therapists. "In this culture, couples often assume that their sexual relationship should run by itself. But every couple needs to work on keeping their sexual life alive and well."