Q What can cause a lack of sexual desire in women, especially during menopause?

Dr. Liberto: There are many factors, including hormonal changes, chronic illness, alcohol and recreational drugs as well as some prescription medications. But it's important to bear in mind that menopause occurs at a time in life when other major life changes are occurring, so there may be underlying psychological issues that need to be addressed.

Q What other issues are troubling at midlife?

Dr. Liberto: Many women, who once felt pressured to be a super-mom or look like a supermodel, are adjusting to empty-nest syndrome and even feeling somewhat invisible in a culture that emphasizes youth. These experiences can lead to low self-esteem, poor body image and depression, any one of which can have a profound impact on a woman's ability to respond sexually.

Q What can women do to put some "zing" back in their love lives?

Dr. Liberto: Get a physical evaluation to assess any medical causes. Once assessed, women need to learn to care for themselves so they have the desire, energy, and self-esteem to invest in another person. This may mean seeking professional counseling. The final step is to evaluate one's relationship. Is it nurturing and respectful? Then make time to improve it. A date night, for example, can help break routines and widen the boundaries of a couple's sexual expression.