Making Sense of Female Sexual Dysfunction
Awhile back, I mentioned in my post The Female Viagra: If Big Pharma Can't Save Your Sex Life, Who Can? that the FDA was planning an upcoming review of the drug flibanserin for the treatment of hypoactive sexual desire disorder (low sex drive) in women.
On June the 21, the FDA voted 10 to 1 against the drug citing insufficient evidence of effectiveness and such adverse side effects as dizziness, depression, fatigue, and loss of consciousness. Basically, the minuses outweighed the pluses. So, we have the same old story, another "pink Viagra" shot down.
Psychologist Marty Klein has a very interesting take on this issue, and I have been reconsidering mine. He states that the drug had been opposed by a core group of activists who object to the medicalization of female sexuality, and as he wryly notes, "these activists are now celebrating, having made the world safe for, um, low desire."
Female sexual dysfunction (FSD) has inspired more academic cat fighting than any other aspect of female sexuality other than the G-spot. On one hand, you have clinicians like Klein (a sex therapist) who will you, in all honesty, that the comprehensive approach favored by critics of FSD isn't very effective. Desire disorders are notoriously difficult to treat. Klein opines:
Fortunately for sex therapists (and the public), no one’s trying to prevent the public from getting access to us. Or demanding data on the effectiveness of our treatments. If people saw our numbers, I don’t think the public would ever trust us again. And we cost more than a pill - sometimes with side effects that are just as complicated.
Proponents of FSD argue that there are a lot of sexually unhappy women out there and that sometimes there are medical reasons for this unhappiness. Why not find a pharmaceutical cure? What’s the big deal? Why so much resistance from "progressives" who claim to care about women's sexual well-being. I ran across an article in Slate criticizing one of FSD's most vociferous critics, Dr. Leonore Tiefer. The author, Emily Yoffe, accused Tiefer of believing that "Sex is for the birds, and orgasms are for men" and even suggested that "the sex doctor needs a sex doctor". I believe that her comments were not only disrespectful but completely misunderstood Tiefer's position.
There are valid reasons why critics, like Leonore Tiefer, are so against defining female sexual dissatisfaction as dysfunction. Historically, female sexuality has been pathologized, and women themselves considered cheap knocks of a better brand.
In the Middle Ages, we were regarded as inverted men - that is, we had the same equipment, (granted of second-rate quality) on the inside that men had on the outside. This sad fact meant that women were prone to all sorts of problems. The most common was hysteria -- an umbrella term that covered just about anything a woman could do that wasn't cool: Like talking back to her husband, having sexual fantasies, reading French novels. You get the picture. The vibrator was invented as a medical device for hysteria. I got to admit that was a nice little perk to being considered the human equivalent of a Yugo.
In the Victorian era, if a woman had any sexual urges at all (and it was assumed that she didn't), she was accused of nymphomania. One recommended treatment? Circumcision. Yeah, you heard that right; the West also has a history of FGM (female genital mutilation). And Freud -- well, he pioneered the idea that if a woman couldn't come from intercourse, she was frigid. Women got off lucky on that one -- comparatively speaking -- just years of psychoanalysis instead of having our clits cut off.
One could also argue that not everybody likes to fuck, simple as that. Nor, does this mean there is anything wrong them. Everyone has different interests. I, for one, don't like football. Does this mean I need a pill? Of course, not. We all differ from one another in how much we are interested in sex -- some people want less, while some want more. And most of us experience fluctuations in desire over the course of our lives. It is rarely a stable thing.
So, you can see why, a female sexologist might be worried that FSD is the latest incarnation of hysteria.
And let's face it; Big Pharma appears to be on a quest to medicate every single person on the planet. Prior to 1997, the FDA had required that pharmaceutical advertisements list all the known side effects and possible interactions of a drug, which made a lot of marketing plans untenable. Consequently, before the late 90s there were few pharmaceutical ads on American TV. In Europe, direct-to-consumer drug advertising is still uncommon.
On August 12, 1997, the FDA decided that drug companies needed to list only the major side effects, a toll free number, and any possible contraindications. Immediately, the flood gates opened for direct-to-consumer- advertising, Big Pharma's profit margins went through the roof, and many observers wondered if our country hadn't become "comfortably numb" given the Prozac cocktail many were consuming.
There's a lot of money to be made out of your shitty sex life.
But, unfortunately for Big Pharma, some of the causes of FSD are clearly sociocultural. For one thing, our expectations of sex have outgrown our knowledge base. The average child is exposed to 14 thousand sexual images a year. Most of which bear no resemblance to the reality of human sexual response. I don't know how many movie love scenes I have watched over the years with no clitoral stimulation, instant intercourse, and simultaneous orgasms for both parties -- an unlikely sequence of events. And let's not even get started on the lack of realism in porn.
Then we have the self-help genre and the Oprah machine continually reminding us of just how important sex is to a happy relationship. All the while, our young grow up under abstinence based sex ed programs that tell them nothing about how to actually have "mind-blowing" sex. Factor in a culture still mired in sexism, sexual repression, and a hatred of real (but not pornified female sexuality) -- and you have a recipe for sexual dysfunction.
Critics of FSD worry that these very real factors are being ignored at the expense of pill pushers looking to make a quick buck by marketing an image of sexual normalcy that doesn't exist.
That’s a valid point. At the same time, some women do indeed have medical problems that impact their sexuality – hypertension, hypothyroidism, diabetes, low testosterone, and depression all take their toll. Too often, FSD is dichotomized into black and white absolutes when, in reality, we are dealing with a very complex issue. Proctor and Gamble unsuccessfully attempted to solicit FDA approval for Intrinsa (the testosterone patch); in spite of the fact that testosterone's role in female sexuality was (and is) poorly understood. To me, that seems a little like putting the proverbial cart before the horse.
I think more research on both the physical and psychological aspects of female sexual dissatisfaction and how they interact is important. I have read a lot of literature in this field. And there are a lot of gaps. We don't understand the role of hormones on female desire very well, literature on sexual dysfunction in gays and lesbians is minuscule, and very little research has been done on learning theory and human sexuality.
I don't think there are any easy answers to FSD. And maybe there is a role for pharmaceutical interventions, in some cases. FSD is like a knotty, old oak tree that's roots go far and wide and intertwine in weird ways. We need to truly understand what we're dealing with here -- and we don't. I advocate more study, but that's going to be hard. Sex isn't considered to be worthy of scientific scrutiny in some circles. And often, those are the precise circles where funding is found.
So, it looks like we’re in for more cat fighting.