New York Magazine

Dream Cream - Elle Magazine

The Science of O

Viagra raised the flag on a new sexual revolution, and women, with the help of doctors and drug companies, are finally getting in on the fun. Will they find better loving through chemistry?
By Hillary Rosner

Dr. Jed Kaminetsky, a prominent urologist and clinical assistant professor at New York University Medical Center, used to keep a large model of a penis on his desk. But last year, Kaminetsky, in a symbolic nod to the growing number of women seeking his services, banished the plastic Johnson to an examination-room shelf. "That penis is gone," Kaminetsky acknowledges, glancing out his office window to where the Empire State Building rises stiffly and proudly toward the heavens.

Kaminetsky is an important figure in a new sexual revolution. By his own account, he's prescribed Viagra to roughly 3,000 men in the three years since Pfizer began marketing the drug. But no sooner had he begun dispensing the male wonder drug than he realized he was only treating half the problem. "Women felt left out, and in relationships that had adapted to having no sex, now men had this new toy, an erect penis, and the women in a lot of cases wanted no part of it," says Kaminetsky.


"For so long there's been nothing to help make sex more pleasurable for women," says Janet, one of Kaminetsky's satisfied patients.

After some experimentation, Kaminetsky whipped up a concoction that came to be known as Dr. K's Dream Cream -- a "sexual enhancer" that functions much like Viagra, by increasing blood flow to the vaginal area. Happily, the cream, unlike Viagra pills, appears to have no side effects. Kaminetsky has no hard data on the cream's effectiveness; what he does have are the testimonials of hundreds of women who swear by the stuff. Since he began selling a version of it in April 1999, Kaminetsky has sold several hundred pounds of Dream Cream from his office and, more recently, via his Website, loveenhancement.com. "For so long there's been nothing to help make sex more pleasurable for women," says Janet, one of Kaminetsky's satisfied patients.

"Most women don't assume they're going to have an orgasm when they have sex." Janet uses Dream Cream to up her "orgasm-to-sex ratio." "My husband wants to have sex so much more often than I do -- I want to increase my chance of coming and make it more pleasurable."

As recently as two or three years ago, a woman talking to her doctor about orgasms was a highly unusual occurrence. The medical community showed virtually no interest in women's sexual problems. "The chairman of my department where I trained told me, 'I don't think anybody will hire you with that as your focus,' " says Dr. Jennifer Berman, a urologist, researcher, and co-founder of a groundbreaking women's-sexuality clinic at Boston University Medical Center. "It was and still is an attitude among the medical field in general."

But Viagra, by removing the stigma from male sexual inadequacy, seems to have spurred a new openness about sexual problems among women as well. Nationwide, women are knocking on their doctors' doors seeking satisfaction, and doctors are beginning to welcome them with open arms -- sometimes even a vibrator.

The phenomenon has particular resonance in New York, where the assumption is that everyone is having great sex -- and heaps and heaps of it. We're not living Ally McBeal here, after all; we're living Sex and the City. Or supposed to be. "There is a lot of guilt about being unable to have an orgasm, certainly, and about having sexual dysfunctions," says Manhattan psychiatrist Barbara Bartlik, who treats men, women, and couples with sexual problems. There's also less time for sex. "For many of our couples who come in for treatment, it's a major event if they're well rested at the same time and long enough for them to have sex. That's a very big problem."

Female sexual response is -- surprise -- a highly complex affair, affected in equal measures by factors physiological and psychological: Problems could have vascular, hormonal, or neurological causes, or they could be symptomatic of a bad relationship, a house full of demanding kids, or a voice in a woman's head that says good girls don't care about orgasms. Remarkably little has been known about the role of hormones in a woman's libido, or even the location and function of nerves in the pelvic area.

At the turn of the century, when Victorian attitudes virtually banned women from any claim to sexual enjoyment, patients suffering from "female hysteria" -- what might now be referred to unscientifically as "needing some action" -- sought treatment from physicians who "manipulated" them to orgasm, by hand at first, later with vibrators.

But not until very recently have doctors and scientists again taken an interest in a woman's orgasm. "There's been a void in terms of where women take these kinds of concerns," says psychologist Sue Chenoweth, who screens patients at a new women's-sexuality clinic in Hartford.

Some of this new interest is, of course, stimulated by money. Pharmaceutical companies, turbo-charged by Pfizer's $1.3 billion in sales of Viagra last year alone, are racing against one another to develop new pills, creams, suppositories, and therapeutic devices. There is also a slew of new over-the-counter aphrodisiacs, with names like Niagara and Rendezvous.

As science struggles to catch up with the market, a dizzying variety of sexual complaints have been newly categorized under the umbrella term female sexual dysfunction (FSD). FSD is actually a broad description that encompasses four distinct classes of sexual problems, which often have both physical and psychological causes. There's female sexual-arousal disorder, a lack of sensitivity or inability to be aroused. Then there's lack of libido, the absence of desire. There's also the condition called female orgasmic disorder. And there's pain during sex, which can occur along a broad spectrum.

Not surprisingly, FSD is highly controversial. For one thing, it allows doctors (read: the Patriarchy) to decide what's normal for women. And the huge potential for moneymaking makes some doubt the motives of these new Drs. Feelgood. "It seems a little odd now that suddenly there's a deficit of female sexuality," says the feminist writer Barbara Ehrenreich, who co-wrote the 1978 book For Her Own Good: 150 Years of the Experts' Advice to Women. "This is not to say that there may not be some women who could use this. But to declare a new widespread disorder and start marketing the drugs to treat it, that's a kind of commercial hype or fraud."

But many who are on the vanguard of this new movement speak a language not of profit but of empowerment. "We have two generations of women now who are struggling with this," says Dr. Laura Berman, a psychologist and a co-founder of the Boston clinic with her sister Jennifer Berman. "One is the baby-boomer generation that are saying, 'Wait a minute, I worked so hard for these rights, I'm not going to let go of them now.' Then we have younger women who are very empowered, very strong, very professionally successful women who still struggle with how to negotiate for their rights in the bedroom: 'How can I give him instructions on how to be in bed? It would totally emasculate him.' "

At first glance, there's nothing unusual about Jill Siskind's office, an ordinary room in the midst of examination rooms and cubicles at Connecticut Surgical Group. Siskind's office has all the trappings you'd imagine: framed diplomas from nursing school, soothing nature photos, a snapshot of her Vizsla puppy on top of her computer monitor, which itself is lined with Viagra stickies.

Probe a little deeper, though, and you might find some surprising loot: a collection of videotapes, like The Bridal Shower by women's-porn pioneer Candida Royalle, whose boxes feature men and women in various stages of seductive undress. A high-tech gogglelike headset that lets users watch films in total privacy. And a vibrator, which Siskind, in the midst of a March-afternoon snowstorm, is cradling in her hands like a newscaster's microphone as she demonstrates its features.

"This is the lightest setting," says Siskind, a nurse-practitioner, adjusting a dial on the bottom of the greenish device, which resembles a medium-size flashlight. "It can go way up," she giggles, turning the knob until the vibrator begins to sound like a blender, "but I don't know any woman who's ever needed that."

Siskind, along with Sue Chenoweth and an ultrasound technician, modeled the clinic after the Women's Sexual Health Clinic at Boston Medical Center, which was founded in 1998 by the Berman sisters and Dr. Irwin Goldstein, a respected urologist who gained fame as the guy who prescribed Viagra to Bob Dole. The Boston clinic spawned a handful of others across the country; the Hartford clinic is the closest to New York.

Women usually first meet with Chenoweth for an hour-long psychological-screening session, at which she asks questions about sexual history, attitudes, and practices, to determine how much of a patient's "dysfunction" is psychological, and whether she's a candidate for physiological testing. If a woman has deep-seated fears about sex, or has experienced a sexual trauma, or is just too uncomfortable, Chenoweth may recommend that she not proceed with the ultrasound tests.

At the first visit, Siskind also does a complete physical and pelvic exam, identifying possible medical conditions, such as cardiovascular disease, that could be contributing to sexual dysfunction. She reviews patients' medication history, noting drugs -- cholesterol reducers, anti-depressants, even birth-control pills -- that can have an impact on libido. And she draws blood for a hormone analysis. Siskind also begins what she calls the education phase of the treatment, offering women basic information about anatomy and what she refers to as "sensate-focus therapy." "I don't like to use the term 'masturbatory points,' because depending on your cultural attributes, masturbation is a negative word."

The "sensate-focus" lesson is often crucial to the next phase of evaluation, the ultrasound tests, conducted during a second visit, in a small examining room co-opted by the clinic twice a month. "My dream," says Siskind, "is a bed, curtains, aromatherapy." In the meantime, patients must settle for a sterile examining table and the clinic's staff vigilantly guarding the door from the other side.

The ultrasound -- which measures blood flow to the genital area at normal levels and then during arousal -- is the reason Siskind is holding the vibrator, which, it turns out, is the only such device that's FDA-approved. Meaning you could, if you wanted to, obtain a prescription for the $300 apparatus, and if your insurance company covers "durable medical equipment," you might even be covered for it. Slim chance, but not out of the question. Patients are sent into the room (lovingly described by one woman as "the torture chamber"; "I don't think she was a good candidate," deadpans Siskind) with a film, a headset, and, if they wish, the vibrator, which is called a Ferti Care and manufactured in Denmark. A technician measures and records blood flow to the clitoris and labia. She then leaves the room for fifteen minutes or so while the woman "self-stimulates," then returns and measures blood flow again. "Normal" blood flow -- based on research by the Bermans -- is approximately twice as high during arousal. There is a broad range, but women whose levels fall on the lower end may be candidates for Viagra or other vasodilators in order to help increase both arousal and desire.

Because blood flow decreases again after orgasm, some clinics ask women to become aroused but stop short of having an orgasm because of its effect on the ultrasound data. But Siskind says she certainly doesn't want to stand in a patient's way. "Some of our patients have problems related to achieving orgasm. If they can achieve orgasm in our office, I'm not gonna tell them not to do that," she says. "But I do ask them just to let me know so we know how to interpret the data."

Interestingly, some women may watch an erotic video and not feel turned on -- but according to the ultrasound readings, they are physically aroused. "It may be that they're not connected with how they're physiologically responding," explains Siskind. "Because they'll say that it's not arousing, that it's doing nothing for them, but their blood levels have quadrupled."

Based on the outcome of the screening, Siskind and Chenoweth may recommend a variety of treatments: Viagra, testosterone, sex therapy, even low doses of Wellbutrin, one of the few anti-depressants that does not come with the nasty side effect of a curbed libido. Siskind says she's had significant success prescribing topical estrogen for arousal disorders, and testosterone replacement for lack of desire. Some women may have no apparent physical problems. "They may be fine, their hormone levels are fine, but they're not satisfied because they don't have a level of completeness and sharing," says Siskind. "Lots of times, one of our therapies is back off, start courting again. Don't have sex. One of the first things we do when it comes to desire or arousal is tell people to rediscover each other. Go on a date. Find out what their partner did that day."

While Siskind and Chenoweth are undoubtedly bringing pleasure to many women, they're not pleasing everyone. Leonore Tiefer is part of a group of doctors, therapists, professors, and health-care activists fighting against what she calls the "hijacking" of female-sexuality research by the pharmaceutical industry. Tiefer is concerned about the trend to medicalize -- and medicate -- women's sexual problems.

It's not that Tiefer is against enhancing women's sex lives. An associate clinical professor of psychiatry at NYU School of Medicine and Albert Einstein College of Medicine, she's devoted her career to it. But she believes that the current research and treatment are on a dangerous course, one that undermines feminist notions of gender politics and sexual equality. Tiefer worries that unrealistic representations of sex in pop culture lead inevitably to disappointment with the real thing. (She likens some of the new sex-enhancing products to "snake-oil.") "People have been set up by the commercial hyperbole saying that sex is the greatest part of life, the most important part of a relationship, the biggest source of pleasure. You've been told this since you were old enough to watch television. And then you come to adulthood and it doesn't measure up." The myth that everyone else's sex lives are approaching nirvana propels women to seek help for something that's "wrong" with them.

"The whole thing about erectile dysfunction was getting that ol' penis so it could function at a 25-, 30-year-old level until the guy is in the grave," says Tiefer, drinking tea one frigid morning in the lobby of the NYU Medical Center. "So we have these 70-year-old guys with 20-year-old penises; now we have to get women with 20-year-old vaginas. That's what this whole thing is about: getting that vagina in peak condition for that Viagra-enhanced erection." In other words, even the doctors attempting to empower women by giving them back their sexuality are doing it within the confines of a male-centric view of what sex should be

"From the feminist point of view, it's an extremely narrow take on women's sexual potential," Tiefer continues. "Women want romance, tenderness, pleasure, intimacy. They are perfectly content with other forms of sexual satisfaction. Penetration is not at the top of the list."

"I hear women all the time worry about breast cancer, health insurance, their children's illnesses, their husband not going to get medical care for chest pains because he's too afraid," says the feminist writer Susan Faludi. "But I never hear anyone talking about the fact that they don't come every time they have sex." Faludi, like Tiefer, believes that much of what's referred to as the "medicalization" of female sexuality is really a veil for the "commercialization" of female sexuality -- a move on the part of doctors and pharmaceutical companies to tap into a lucrative field. "It's the same mentality that pushes these anti-depressant drugs on women when they're a little off," she says, "the idea that the body is a machine and must be running at top performance all the time."

What happens when you slap the label dysfunctional on a woman who just doesn't want to have sex? Many women, particularly menopausal women, are deeply distressed by the loss of their libido, which researchers have discovered can often be due to decreased testosterone levels. But what about those who are not distressed? Are they dysfunctional? And what if they're not bothered by the situation -- but their husbands are? Whose problem is it? "Some women come in here, and they're perfectly happy doing the grocery list while they're having sex," says Siskind. "But their husband is bothered by it. Maybe it's not the woman's problem."

As sex therapists are fond of saying, no drug will cure a woman who simply hates her husband. (Or as a friend recently quipped, "Most women don't need Viagra. They just need a pill that will turn their husbands into Johnny Depp.")


"I didn't feel passionate. My 22-year-old daughter is so passionate, and I was feeling so blah. I needed to take something to get back to being me."

Tiefer is also adamant that the entire basis for diagnosing a woman with FSD is flawed, citing as evidence the fact that there are few established norms for sexual function in women (although those are precisely what the Bermans are trying to develop at their clinics): "Nobody studies normal people, so we don't have any idea what the range is."

Dr. Beverly Whipple, a Rutgers professor and sex researcher (best known for helping locate the G-spot) who was on the panel that determined the criteria for diagnosing FSD, takes issue with the criteria that made the cut. "One thing that was voted down was satisfaction as a criterion," says Whipple. "A woman could have no desire but she could have arousal and orgasm and be very satisfied, and yet she would be seen to be dysfunctional. Or she could have desire, arousal, and orgasm and yet not be satisfied. And yet that wouldn't be considered dysfunction."

"There's been so much brouhaha about this," says Chenoweth. "Should the criteria be personal stress or relationship stress? There are different camps about whose distress we're talking about, whose dysfunction."

"A lot of these women are not dysfunctional," says Kaminetsky. "They don't have a disease. Female sexual dysfunction is not a disease. It's a symptom of another problem."

In some cases, the problem might be abysmal sex education. Tiefer recently counseled a 27-year-old college-educated woman who was convinced she was anatomically abnormal. "She had no idea that there was such a range of women's genitalia," Tiefer exclaims. "Had she ever seen photographs? No. She needed comprehensive sex education. I'm not saying that her whole sexual problem was lack of knowledge. But that was a piece of it."

There's also the powerful Puritanism that still makes people -- men and women -- uncomfortable discussing female sexuality. Chenoweth recalls teaching a human-sexuality course to undergraduates in which she displayed diagrams of male and female anatomy. "When I threw up the anatomy of the male, people were looking at it and taking it in," she says. "Then I threw up the comparable picture of female anatomy, and I looked at the class and everyone's head was down."

There are subtle distinctions among the sexual problems that men confront, but the bulk fall into the relatively simple category of mechanics: Either a guy can get it up, or he can't. Like so many things female, though, women's problems are vastly more complicated. The already complex symptoms of FSD cycle into one another: If having sex is painful, then desire might very quickly vanish. Without sensitivity, it's rather tough to have an orgasm. There are medical and psychological factors, too, that contribute to each of the problems -- not to mention factors specific to a given relationship.

Which is why the Bermans' goal from the start was to create a place that would treat women's problems holistically, providing help whether the problems were in their body, in their head, or both. Heartened by the success of the clinic and Goldstein's support but frustrated by what Jennifer Berman describes as "a constant uphill battle" against sexually and politically conservative attitudes in the hospital and in Boston, the Bermans relocated to Los Angeles, where they opened the Female Sexual Medicine Center at UCLA this winter. "It's not a matter of medicalizing sexuality but really 'relationizing' it," says Laura Berman. "It's about the relationship between mind and body, and treating the cause. It's not about treating a sexual-function complaint with medicine when it's caused by poor body image. The key is in diagnosis. So we can make a holistic evaluation."

But even the efforts of health-care professionals like the Bermans to emphasize the mind-body connection and the need for education won't stop some women from looking for a miracle pill. "A lot of Americans or women in Western society want that quick fix," says Siskind, who is optimistic that there are just as many women who will opt for the holistic route. "They want the pill. They want the magic button."

Now that Viagra has given medical legitimacy to the quest for more pleasure between the sheets -- and particularly now that pharmaceutical companies are dumping dollars into research -- data and remedies are already piling up.

One treatment gaining in popularity is testosterone. "Testosterone is really the most promising development in terms of facilitating effective female response," says Dr. Sandra Leiblum, professor of psychiatry and director of the Center for Sexual and Marital Health at Robert Wood Johnson University Hospital in Piscataway, New Jersey, and president of the 900-member fledgling Female Sexual Function Forum. "It does for women what Viagra does for men."

Dr. Lauri Romanzi, a uro-gynecologist affiliated with New York Hospital-Cornell Medical Center, has begun screening some patients for low testosterone levels, based on their answers to a new questionnaire that asks all patients about their libido, sexual sensitivity, and orgasmic intensity. "I'm finding, with women in their late forties and early fifties and sometimes beyond, that very often if they complain of a sudden drop in their appetite for sex, and there doesn't seem to be anything else -- there wasn't a death in the family, they haven't suddenly started taking four different types of blood-pressure medication -- their testosterone levels are often quite low," says Romanzi, seated at her desk in her high-ceilinged Park Avenue office.

Paula, a 50-year-old patient of Romanzi's, experienced a loss of libido after menopause. "I didn't feel passionate," she says. "My 22-year-old daughter is so passionate, and I was feeling so blah. I used to have that passion." Paula began taking testosterone and says her libido is back in action. "The blues definitely subsided. I needed to take something to get back to being me." Paula says the testosterone has also helped her relationship with her husband. "He knew that it was my hormones, but you can't help but take it personally. So it was hard for him. Plus it's a big part of our relationship, because the more intimate we are, the closer we are."

Sarah, a patient at the Hartford clinic, lost her interest in sex a few years ago. "It was just like, things weren't happening," says the happily married 47-year-old. "It never bothered me to participate, but I wasn't starting sexual activity. It became not part of my life. I just didn't know what was going on."

"It wasn't the same, but I accepted it," says her husband, "thinking, that's how it is, I'm not gonna leave her for some younger woman just because the sex isn't as good as it used to be. I just figured this is what happens to women, her hormones change, that's life."

After undergoing testing, Sarah learned she had low testosterone, and began taking a nutritional supplement called DHEA, which breaks down into usable testosterone, as well as Viagra for a "good, immediate fix" until the testosterone took effect. She also began a low dosage of Wellbutrin. Now, she says, the sex is better than ever. "I feel like I have my life back. My reason for being is back again. The zing is back."

Testosterone comes with its own set of problems, though: powerful -- and irreversible -- side effects. Women need only between one-tenth and one-twentieth the amount of testosterone as men, and too high a dosage can have disastrous consequences: deepening of the voice, excessive hair growth, and even enlargement of the clitoris. "If you get androgenic effects, if you start to sprout terminal black hairs, or the clitoris enlarges, or you start to have hair on your chest or back," says Romanzi, sounding suitably grave, "those things may very well be permanent." Not content with the dosage level of the only commercially available, FDA-approved testosterone replacement for women, called Estratest, Romanzi enlists a local pharmacist to whip up her own preparations -- low-dosage vaginal suppositories. "We're treating something that's not life-threatening -- it affects quality of life, but having a low libido is not going to kill you," Romanzi says, explaining the need for extra caution as far as side effects. "It's not like having coronary-artery disease."

Leiblum also cautions against a rush to declare testosterone the new miracle drug. "I've heard various people on TV lately saying that women who have no desire are testosterone-deficient and the way to deal with it is to put all women on testosterone. Which is ridiculous. In peri- and post-menopausal women, many will have low testosterone. But that's not true of the normal 25-year-old."

The "normal 25-year-old" might, however, respond to Viagra, side effects or no. This is the hope of Pfizer, which is currently conducting clinical trials of Viagra in women; the results of preliminary studies indicated that the drug "did not appear to significantly increase sexual arousal in women," according to a company spokesman. It did, however, increase blood flow. And in testimonial evidence, many women have responded well, saying they've achieved their first orgasm ever on Viagra, or, like actress Kim Cattrall, who has publicly discussed her Viagra fetish, that it enables them to have multiple orgasms.

Jed Kaminetsky tested Viagra in women, beginning with the wives of his patients, with mixed results. But even some women who claimed they had better sex, greater sensitivity, or more intense orgasms on the drug complained of side effects. The revolutionary little pill made them nauseated or congested, turned their vision blue, and, worst of all, gave them headaches. ("And you know the old jokes about women having a headache, so that was the last thing they wanted," says Kaminetsky.)

Kaminetsky says he can count on one hand the number of impotent men he's treated with Viagra who have stopped taking the drug because of side effects. But he's also given the drug to loads of male friends who want it for presumably more recreational reasons, and about a quarter of them have complained about side effects. "The bottom line is, the side effects are there. It's just your perception of them," Kaminetsky says. "If you're impotent and you need it, the side effects are tolerable. If you're not impotent, they're annoying. In women, the result was not as dramatic. It wasn't that they had a flaccid penis that suddenly they could hang their hat on."

While Pfizer continues its studies, virtually every pharmaceutical company on the planet is testing a product for FSD, whether a new medication or an adaptation of a drug originally designed for men. "In men, it's simple -- it's a plumbing problem. But until we get a handle on this, it's like shooting in the dark," says Dr. Carl Spana, president and CEO of Palatin Technologies, a small biotechnology company in Princeton, New Jersey. Palatin is evaluating a product called PT141 -- an "initiator" of erectile response in men -- for use in women. But Spana believes that the medical community is still in need of more female leadership in research. "At one of our initial meetings, we had five guys sitting around a table talking about female sexual dysfunction," he recalls with amusement. "Five guys. I don't even know how to figure out women when they're healthy. It was absurd."

Last summer, Pharmacia introduced a new product called Vagifem, and on Valentine's Day, the company became the first to devote an advertising campaign to a drug that treats a symptom of FSD. Vagifem helps relieve the common condition in women after menopause in which the genital skin becomes dry. Despite its unappealing name (don't they have focus groups for that sort of thing?), Vagifem, say its proponents, represents a breakthrough in its delivery system: It's a tiny estrogen tablet, smaller than a baby aspirin, which is administered vaginally. It replaces estrogen levels locally, allowing the body to absorb only as much as it needs. "The major point is that you're correcting a problem, which is that the vagina isn't functioning in a way that makes sexual exchange pleasurable for a woman, and that is a turnoff," says Dr. Gloria Bachmann, chief of the OB-GYN service at Robert Wood Johnson and a participant in Pharmacia's clinical testing for Vagifem.

But while the drug companies rush to get products into the testing phases, only one product has thus far been FDA-approved specifically for female sexual-arousal disorder. It's called Eros-CTD, and it's a small suction device intended to increase blood flow to the clitoris, both by vacuum action (like a vacuum pump for the penis) and, through daily use, by breaking up collagen deposits in the bloodstream. On a recent Oprah segment (featuring Jennifer and Laura Berman), Oprah Winfrey was skeptical, proclaiming the Eros unlikely to gain mass-market appeal.

Testing the Eros on my palm in her office in Hartford, Siskind admits that "it takes time to see the effects." A patch of skin the size of a penny is sucked into the Eros's cup, leaving me with a hand hickey. The Eros apparently has no side effects -- though women are cautioned not to fall asleep while using it.

Beverly Whipple is unimpressed by the device. "It makes the clitoris larger," Whipple muses in her home in Medford, New Jersey, and you can almost hear her head shaking in exasperated wonder through the phone. "Why, pray tell, do we want the clitoris to be larger?"

But if the Eros-CTD is not necessarily the be-all and end-all, the good news is its lack of side effects. Which brings us back to the Viagra-type creams. "My own feeling is that women have to contend with a lot to enjoy their sexuality," says Sandra Leiblum. "So anything that can be helpful for women in terms of getting past their inhibitions should be encouraged."

"If you give these medications topically to women, that should enhance blood flow," says Barbara Bartlik, who also enlists a pharmacist to mix creams for her patients. "And where you have greater engorgement, you have greater pleasure, greater sensation, greater lubrication. It stands to reason. So I think that we're on the verge of something."

Janet, Kaminetsky's patient, is a suburban woman with school-age children who says the Dream Cream helps her keep pace with her husband, particularly after they've been drinking. "When I drink, I get less sensation, I get numb," Janet says, "so although I'm less inhibited and enjoy sex on that level, on a purely sensation-based level I find it less than perfect. When the cream works, what happens is you can feel more. All your sensations are heightened."

"I've always been very orgasmic and sexual," says Stacy, another patient of Kaminetsky's. "When I started going through menopause, I noticed a decrease in my libido, and an inability to have an orgasm during sex. I had to resort to a vibrator." Stacy has used Dream Cream three times, and had orgasms during sex two out of the three. "It's amazing," she gushes. "It's like the old days. I'm going to use it every single time."

For his part, Kaminetsky may soon be as popular as the Beatles. A bunch of women recently flew up from Palm Beach to visit him, "one friend and then the next friend, who had these 75-year-old husbands and needed a little help," Kaminetsky recalls, grinning. He's also something of a favorite among the nurses in the operating room -- who are more than happy to test new Dream Cream formulas in the name of science -- and among the soccer moms of Greenwich, where he lives with his wife and three children.

Sitting across the desk from Kaminetsky, I ask him if he read a recent article in Esquire about a woman -- also popular -- who road-tested vibrators and other sex toys as part of her job.

Kaminetsky narrows his eyes and smiles coyly at me. "You're not test-driving -- "

"No," I stammer. "No, I'm not."

He leans back in his chair. "Well, if you want to try it . . ." He bends over and rummages through a drawer, emerging with a small syringe-type tube. He passes it -- still grinning -- across the desk.