Female Sexual Dysfunction and the Pharmaceutical Industry

Today we will talk about the myth of female sexual dysfunction – why 43% of American women are not dysfunctional, and why the pharmaceutical industry would like you to believe otherwise. Now, you’ve probably heard this 43% figure – you’ve probably heard the term sexual dysfunction. You’ve probably read that the most common problem facing women is what we call hypoactive sexual desire disorder, in other words, low desire. You’ve seen in newspapers and on television and in magazines, this figure of 43% – 43% of American women have sexual dysfunction. You’ve heard this, but no one has probably explained to you that that’s a false figure that got picked up by the media and literally took on a life of its own. And I doubt very much that any of the articles that talk about sexual dysfunction also talk about the fact that there is enormous controversy over that very phrase – the use of it and what it means. Well, I’m going to explain this to you, and I’m going to show you why the idea that women are, by and large, dysfunctional, is a myth. And I’ll tell you why the pharmaceutical industry particularly doesn’t want you to know the truth about your own sexual experience.

More than ever before, women’s sexual health has been in the forefront, has been getting a great deal of airplay – with drug companies scurrying to find what the media likes to call “the little pink pill” – the “pink Viagra” that will do for women what the blue pill did for men. The pill that will turn women with flagging libidos into lustful she-devils. Well, it was the introduction of Viagra to the marketplace that began to generate all of this interest in women’s sexuality. In 1998 the issue was moved to the front burner from the back burner, because now that you have so many men who previously couldn’t get erections, or couldn’t get them reliably, and didn’t want to have intercourse on a consistent basis, being able to pop a pill and have intercourse at will. You now had their partners saying “that’s a very nice honey, but I’m not all that interested.” Well, if you’re a man, you have a problem. But if you’re a pharmaceutical company, you have a red-hot problem. Obviously, the issue of female desire must be addressed, or the market for the little blue pill will lose its impressive tumescence. The good news about the so-far fruitless search for the little pink pill is that finally, women’s sexuality is getting the attention that it deserves. It’s not news that profit drives pharmaceutical companies, and that pharmaceutical companies don’t spend millions of dollars on research if they can’t point to a verifiable illness to treat. So it isn’t enough for doctors and therapists to say that women have some sexual concerns, or that some relationships produce some pretty serious sexual problems that women may need help overcoming. That’s not good enough. It’s interesting that in our culture, which has repressed female desire for so many years, suddenly the issue of female desire matters – but only to a point. Still, women with high desire are marginalized, while the drug companies would like to help women with low desire have the ordinary desire. But none of this does the trick when we look at ailments through the lens of the medical model, because the goal is always going to be to match an illness with treatment, and if you’re being supported by a drug company, the treatment has to be drug treatment. So what’s needed is a bona fide illness to treat. And that illness, stamped with a medical seal of approval, is the one we are calling female sexual dysfunction, or FSD for short.

FSD is divided into four categories: sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders. That is if you are buying into the medical model. It has been argued, however, that female sexual dysfunction is – and I quote here from the British Medical Journal – “the freshest, clearest example we have of a corporate-sponsored creation of a disease.” By capitalizing on women’s sexual concerns, pharmaceutical companies can research and profit from any pill or cream or patch that shows the promise of sexual enhancement, with the idea that women, once on the road to recovery, can begin racking up notches on their bedposts and tallying up multiple orgasms, and probably collecting bundles of roses from their relieved spouses. And drug companies can start counting their blessings in greenbacks. Thus, everyone lives happily ever after.

Well, not so fast. It doesn’t quite work that way. We all feel comfortable when life seems simple, and when we can point to a leaky faucet and just replace the washer, or point to a leaky libido and figure that a dose of this or that will have us awash in desire once again. As it happens, the frantic search for the magic potion is based on some flawed or, at best, incomplete thinking about how female sexuality actually operates, which I will get to in a minute. But first, it’s based on some flawed thinking about that pesky 43% figure that I mentioned earlier. The media has played up statistics about the rate of female sexual dysfunction, using that figure to blow the issue out of proportion. How exactly did that happen? Well, it happened when the answers to one question in one 1994 survey were re-analyzed in 1999. And it appeared that when you added up the percentages of women – stay with me here, I’m going to take it slow – the percentages of women who said that they experienced any one of seven possible different sexual problems over a period of two months in the prior year, you got a figure of 43 percent. So if 3 percent of the women said that they experienced low lubrication for more than two months in that prior year, there’s your 3%. If 7% of the women said that they felt they had problems with orgasm two months or more in the prior year, there’s 7%. Now if all of those questions reaped certain percentage figures, and then you added them all up, you got your 43%. However, remember that if the woman answered yes to just one, she was characterized as being sexually dysfunctional. There is no study that indicates that having that kind of problem for two months out of a year means that a woman has any dysfunction whatsoever. There are a thousand reasonable explanations for any given woman answering yes to any one of those questions. The figure, however, was cited in the pharmaceutical industry and popular publications, over and over again as evidence that sexual dysfunction is near epidemic proportions. This was an erroneous figure to start with, arrived at through faulty methodology, and even the authors of the study hurried to distance themselves from it. Nevertheless, the figure is still used, and you will probably run across it in your reading. So just remember, it’s not really telling you much of anything at all.

Perhaps the most disturbing aspect of the focus on the medical approach to sexual problems is that the concept of sexual dysfunction is based on certain assumptions about what are universally normal sexual functions. This falls entirely to account for all the complex emotional, relational, and cultural issues that contribute to our sexual experience and our sexual identity. Sex is not just about putting tab an in slot b – it’s a highly nuanced, physical, mental, and emotional process. And any conception of so-called “normal functioning” fails to account for the fact that women are not only different from men but are different from one another. Our sexual experiences are always dependent on the effects of past experiences, on the nature of our current relationship, the immediate context, the pileup of experiences in our lives, and what those mean to us. The cultural messages we receive and the cultural messages we buy into – and those are not always the same. On whether there is trust and consideration in a relationship. On whether there is fantasy fulfillment. On whether a woman is exhausted from working, taking care of kids, living her life. Given that, it’s quite obvious that what is really “normal” is a matter for the individual woman to decide, given her specific life circumstances, her specific upbringing, her specific experiences, and her specific attitude about her own body. Our sexual needs, desires, and feelings do not fit clearly or completely into any one category. Even under the best of circumstances, a woman’s sexual expression ebbs and flows throughout her lifetime – it morphs and changes. It morphs and changes over time, it morphs and changes based on conditions, yet the pharmaceutical companies would rather have you believe that there is one “normal” and anyone who deviates from it needs help – needs drug help. They’d rather you believe in magic potions and in one-course solutions. If a woman doesn’t feel desire like a bolt from the blue, then something must be wrong with her! And they want to find that magic bullet that will enable that. Yet sometimes women feel desire only after they have experienced the pleasurable physical sensation or strong psychological arousal. That is, desire doesn’t necessarily come crashing down on us like a tidal wave – we have to splash around in the waters of erotic experience for a while before we feel that gravitational pull.

But the pharmaceutical companies, though they may pay lip service otherwise, have their profits embedded in a very different way of looking at sexual experience – in a medical way of looking at it. They don’t want to say, they don’t want to admit, that if a woman is having difficulty getting aroused, then maybe, just maybe, she isn’t getting the kind of stimulation – whether that’s mental, emotional, or physical – that she needs. They don’t want to say that there are explanations for the desire not happening at all that have NOTHING to do with what the body is doing on its own. And if a woman isn’t getting the kind of stimulation she needs and she doesn’t feel arousal, or she doesn’t feel desire, is that dysfunctional? Hardly! That’s real life. That’s a very unfortunate set of circumstances that need to be addressed and adjusted, but that is not a dysfunction. And there is no magic bullet that will create desire in the face of an inept or insensitive or unskilled partner. What’s more, before we can label sexual problems dysfunctional, we must understand the social and economic conditions that might limit a given woman’s access to sexual education, sexual healthcare, to information about pleasure. These differences can’t be ignored in the search for this universal sexual norm, no matter how profitable that might be.

Now, this is probably bad news for anybody who wants life to fit into neat categories, who prefers to see things in black and white rather than shades of grey. But for women who can accept that sexuality is as individual as personality, it’s good to know that there are millions of “normals” out there in the world and that one of them has your name on it.

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