Imagine not being able to afford one of life's great pleasures - sex.
Soaring prices in the US for prescription medicines for impotence and other problems have put the remedies out of reach for some - especially older men and women.
Without insurance coverage, Viagra and Cialis cost about $US50 (A$67) a pill, triple their 2010 list prices.
The new "female Viagra", a daily pill for low sex drive called Addyi, costs $US800 per month.
Older products for women have also seen huge price run-ups, Truven Health Analytics data show.
"Many of them don't get past the pharmacy counter once they see the price," said Sheryl Kingsberg, a behavioural psychologist and researcher who counsels men and women.
Some insurance prescription plans, including Medicare, cover some of the medicines while other plans don't cover any, arguing they're not medically necessary.
Many require steep co-payments or limit the number of impotence pills per prescription.
"Once you get to a certain price point, sex becomes a financial decision," says Dr Elizabeth Kavaler, a sexual dysfunction specialist at New York's Lenox Hill Hospital.
"It takes a lot of the joy out of this."
Five of six specialists interviewed by The Associated Press say patients have told them they have given up sex because of the cost.
Now, a little relief is coming. Late next year, Viagra and Cialis will get at least one generic competitor costing slightly less; prices will plunge later when more generics reach the market.
For women, an Addyi rival is in late-stage testing while a few other products now have generic versions and other options are in development.
Kavaler said while long-married couples accepted their sex lives trailing off with age a generation ago, today divorced or widowed men and women often seek new partners and sex becomes important again.
"Couples in their 50s, 60s and 70s are more sexual than they've ever been," Kavaler said.
