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.