What about sex?

In a small, downtown Toronto sex store, two dozen women huddle together between shelves of videos and vibrators to learn the secret of the orgasm. In order to climax, the speaker at the workshop tells us, we must relax, we must stop thinking about our grocery lists.

That is not what I want to hear. Nor is it helpful to my friend, whose expectations are already low after recently asking her doctor about vaginal dryness and being told: "Watch some porn." If only the solutions for sexually frustrated women were that simple. Or as simple as popping a pill.

Pfizer began its quest for the "pink pill," the female Viagra, in 1996. But after eight years of research and studies involving about 3,000 women, the drug company's researchers were flummoxed. The scientists cited a disconnect between a woman's brain and her genitals that does not exist in men; a woman's arousal, unlike that of a man's, is triggered by a complex network of emotional, intellectual and relationship-based factors.

And so, while Viagra became the wonder drug for men, there is still no equivalent for women. Instead, there is only heated debate: Are we over-medicalizing the problem? Is low libido caused by hormonal imbalances, or is it all just in a woman's head? Is female sexual dysfunction even real?

The term did not even exist a decade ago. The Diagnostic and Statistical Manual of Mental Disorders describes it as an inability to get aroused, painful intercourse, orgasmic disorder or the absence of desire or urges prior to sexual activity.

So controversial is the diagnosis -- and its myriad suggested treatments -- that the British Medical Journal published an article calling female sexual dysfunction the "freshest, clearest example" of a "corporate-sponsored creation of a disease."

Lenore Tiefer is among those who are wary. A clinical associate professor of psychiatry at the New York University School of Medicine, she spearheaded a campaign to reject the medical framework of female sexual dysfunction, arguing that the belief that a woman is "broken in the hot-and-wet department" will lead to a dependence on drugs and wrongly diminishes the role of emotions in sex.

"After Viagra was approved, journalists started writing, 'Where is the Viagra for women?' " said Dr. Tiefer. "This was a perversion of gender equality. In some strange commodified world, the idea of sexual equality had become product equality."

The prevailing, although somewhat disputed, statistics suggest that as many as 43% of women aged 18 to 59 suffer from some sort of sexual dysfunction. But there are experts who say that large percentages of women report having no sexual urges, and these women also claim to be satisfied.

"You might be like the women in Sex and the City, but the evidence is very clear that that is less common," said Rosemary Basson, a physician and director of sexual medicine at the University of British Columbia. "What is more common is having a flexible, adaptable desire that is higher earlier in a relationship when everything is new, and is less spontaneous as the relationship continues, but still remains trigger-able." If more women knew this, they might be less distressed, she added.

Unable to orgasm and unmotivated to have sex, Carlyle Jansen suffered sexual anxiety in her twenties. "I had so many dating experiences in my late teens and early twenties where I avoided sex or I'd drink to numb everything," she said. "I'd curl up in bed, face the other way and lie there thinking, 'I really hope he doesn't want to have sex tonight.' "

Ms. Jansen, now a 41-year-old sexuality educator and therapist who founded the Toronto sex shop Good For Her, says she still does not have a high libido but now considers that normal.

"We're pathologizing women's experiences because they don't match men's," she said.

Researchers have offered various theories to explain why women may be more "turned off " than men. One is that sexual inhibition in women is a protective mechanism evolved to discourage women from having children when conditions for motherhood are not favourable; for example, when a partner is unsupportive or the woman has emotional problems.

There is even a movement to re-brand a woman's sometimes limited sexual appetite as the norm, with new books such as I'd Rather Eat Chocolate: Learning to Love My Low Libido.

Still, the search for a "cure" continues. Dr. Thuy-Tien Dam, clinical director of prevention studies at the University of California, San Diego, says a flagging sex drive may be a "treatable condition, not just a personal problem."

"We assume it's normal because we don't know how to treat it and we don't know what's going on ? Just like with depression. Before they said, 'It's just in your heads, there's nothing wrong with you.' But later on, we found out that there were imbalances with serotonin levels."

Andre Guay, a clinical assistant professor of medicine in endocrinology at Harvard Medical School, said research shows that women who complain of decreased drive may have testosterone deficiency, and there has been some success in treating menopausal, hysterectomized women with androgens or male sex hormones.

But even that breakthrough cannot address one of the root causes of low sexual desire: relationship problems.

"I treated a woman for six months with androgens. She was definitely deficient," Dr. Guay said. "Finally, after I had treated her for six months and she was not better, I went over the differential again. When we started [talking about] relationship problems, she said, 'You know,' with a tear in her eye, 'my husband really is a jerk.' "

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BY THE NUMBERS

6.9 Awoman's average number of sexual partners.

29 Percentage of women worldwide who want sex more often.

41 Percentage of women who told a date they loved them because they hoped it would lead to sex, compared with 55% of men.

71 Percentage of women who have bought sexy lingerie or sex toys because they thought it would lead to sex.

22 Percentage of women who have had a cyber-affair (a sexually explicit conversation or video or photo exchange) with someone other than their significant other, compared with 25%of men.

Harlequin Romance Report 2007