Let’s Read Books – Sex is not a Natural Act, conclusion and final thoughts

04/20/2010 at 10:36 pm | Posted in Uncategorized | 1 Comment
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Well everyone, I did it. I finished reading the feminist & sexologist text Sex is not a Natural Act and Other Essays. Three months and 244 electronic annotations & highlights later, bloggin’ all the way. I felt a huge sense of relief upon completion. My brain is fried, so finally, I can settle down, decompress, play some video games and read a fun book! …Just as soon as I get to bloggin’ the last section…!

The last section in the book is titled The Creation of FSD. These five essays were written in the late 1990s and early 2000s. Actually, I don’t have much to say about the final chapters individually, and I am anxious to articulate my final thoughts on Sex is not a Natural Act as a whole.

Although I learned a great deal about social construction, feminism (especially second-wave feminism,) and the modern history of sexual medicine from Sex is not a Natural Act, my understanding, experience and opinion of female sexual dysfunction remains largely unchanged. Sex is not a Natural Act is a feminist response to sexuality and medicine, but I certainly hope it is not the only feminist response. I feel that there are several points which need improvement. In fact I’m frustrated that Tiefer rarely, if ever, seemed to consider the other other (othered) side of the equation. In shielding as many women as possible from receiving the diagnosis of and medical treatment for FSD, much of what Dr. Tiefer says is alienating and stigmatizing to me, someone who benefitted from that very type of intervention.

What I mean by that is on the one side we (supposedly) have goons in white lab coats promoting quick & e-z, if expensive, medicalization as the solution to all of our sexual health problems. On the other side stands feminism, social construction and anti-medicalization. According to Sex is not a Natural Act, the two positions are incompatible. The media serves as mercenary in this sex war, serving both sides. The talking heads on the side of mainstream sexual models and medicalization far outnumber the feminist & sociological sexologist journalists, but I think it is the feminist counter-attacks that cut me the most deeply.
And trapped in the gulf separating the two, the no-man’s land, are all ordinary folks who experience sexual problems. Who do you trust? Here in the gulf too, is is the third perspective – someone like me – for I’m a feminist living with sexual dysfunction, and ultimately I am the one who is burned by the fire from both sides. Dr. Tiefer does a good job looking out for women who in her judgment do not have sexual dysfunction, but in doing so, her work inadvertently stigmatizes those who do identify with the term. And I fear the strong anti-medicalization stance with little or no wiggle room for those who can be treated with medication makes getting effective treatment (and respect & understanding from peers and doctors) harder, even for the minority who would benefit from that option.

So I don’t have much to say about these last five or six chapters because: The last section of the book is a relatively smooth, easy ride. The bulk of the challenges – figuring out how to decipher Tiefer’s writing style, learning about social construction, tamping down on my own rage-rage-rage reactions – are behind me, in the earlier sections of the book. Most of the essays in the last section were written for laypeople and an audience outside of academia. That means there’s less academic jargon and less re-reading of passages for me. Nonetheless, there’s still some far-out there statements, for example, “The impact of all these long-lasting hard erections on women’s anatomy, women’s preferences, and women’s well-being is unknown” (location 2774). Even with the context of this quote available to me (the purpose and use of Viagra,) I still don’t understand what’s suggested here… frequent intercourse with an erect penis alters a woman’s anatomy, craving for erect penis, and sense of well-being long term?
The last section of the book is short – on the Kindle E-book version, the last section starts 75% of the way through, or so it seems at first glance. I thought I was facing a huge chunk of material, but it turns out that the last 15% or so of the Kindle edition is bibliography and index (which is basically useless on the Kindle because the index is micro-print small. Besides, having an index in an e-book is moot since you can use the built-in search feature.) So the last of the written material is actually about 10% of the E-book. Some of the essays in the last section can be found elsewhere online for free, and I’d read the available essays previously.

The first chapter, “Female Sexual Dysfunction” Alert: A New Disorder Invented For Women, is a re-printed article from now-defunct US-based feminist periodical Sojourner: The Women’s Forum. (As of the time of this blog post, unfortunately Sojourner’s website no longer exists and their archive.org backup does not include full text of the article in question.) I’m not too fond of the title right off the bat for reasons that I’ve probably harped on about on this blog before. (Notice that FSD is in scare quotes. Two little grammar punctuation marks inadvertently nullify even my experience of FSD as a falsehood.) To put it briefly, the Sojourner article is a call-to-arms to protest a medical conference on FSD held in Boston in 1999. In the article, Dr. Tiefer asked, if the doctors and drug companies were truly so interested in women’s sexual well-being, then why weren’t feminists and representatives who could speak for women included in FSD research? (location 2782). The conference nonetheless took place.

The next chapter, A New View of Women’s Sexual Problems by the Working Group on a New View of Women’s Sexual Problems, can be found online in two parts at Our Bodies, Ourselves. This is Part one, this is Part two, so you’ve got the full text there. It’s a brief summary of an alternative, feminist perspective on women’s sexual health problems. It looks fine on paper, right? Well I believe that there is still room for improvement, particularly in the execution.

The third chapter, The Selling of “Female Sexual Dysfunction,” can be read as a follow up to the first chapter in this section, and as a feminist response to the big 1999 conference on sexual dysfunction. The essay was printed in the Journal of Sex and Marital Therapy in 2001, but the text reads as a speech. I’m not 100% certain that it was given at the conference in question though – I know Dr. Tiefer attended and gave a presentation but I can’t confirm that this is the one. There’s two quotes in this essay I’d like to draw your attention to. When addressing readers (presumably conference attendees,) Tiefer states, “Fortunately, women started not only the women’s liberation movement, but the consumer movement” (location 2876). Then, “As both a feminist and a sister researcher, then, let me call on you to include these five issues in your research:” (location 2881).
I’m going to articulate some of my final thoughts on the book as a whole here in the middle of the post.
I’m interested in focusing on something other than the five areas to be considered in future research, but they’re important and the real reason Dr. Tiefer wanted to get the conference’s attention in the first place. So if you’re curious, the five areas can be summed up as: studying all sides of medical intervention for sexual problems, looking outside of a bio-mechanical model of sex, not caving in to commerce, remaining critical of scientific studies, and opening the field for study by non-doctors. There’s actually a sixth point too, integrating feminist studies into sex research (Locations 2882-2992). Which is all fine & dandy.
But there’s one thing about these two quotes that tripped me up while I was reading. And that thing is…
Waaait a minute… “Sister researcher?” As in… some grand sisterhood of women? Of feminism? What sisterhood? A sisterhood among researchers only? Whose liberation movement? Are you my sister? These were two key words that made me think of Renee, who recently has had to write, for what must feel like the hundred millionth time, that she is not a feminist, there is no but, so don’t confuse her with one. She’s not part of that sisterhood. Why would Renee do that?
A long-term criticism of feminism is that the history of feminism (especially that which developed in the USA) hasn’t been very kind to marginalized women. The history of feminism largely favors white, able and cis-bodied, middle class women. Women who do not match that description are still to this day excluded from feminist activism, sometimes deliberately, sometimes as a function of privilege. (Admittedly, I could probably be doing a better job of reaching out to marginalized women too.) Believe it or not, there are feminist icons of historical importance who have made racist, classist and/or transphobic statements. So bear in mind that many women do not identify as feminists and do not identify as part of any monolithic sisterhood… and not because of stereotypes of feminism perpetuated by the media. It’s not always because the media says feminists are all a bunch of hairy-legged man-eaters. Rather, not all women identify as feminists because feminism has burned them. That is a carefully thought out, calculated, conscious decision: rejection. Because feminist icons erased women whose experiences did not match their definitions of what feminism stood for.
So these two quotes, combined with some additional statements throughout the book, make me think that perhaps Dr. Tiefer’s type of feminism is not as inclusive and welcoming as it could be. It should be welcoming to all; however, I certainly do not feel safer after Dr. Tiefer speaks out on my behalf. This is in spite of the fact that she does acknowledge the importance of considering race and class on society and sexuality, and even though she does think about the sexual health & well-being of LGBT persons – at least in her academic writing. It’s a bummer chug along reading about theory that’s all well & good on paper, then to trip over stumbling blocks in the execution.

One area where I’m tripping up in the execution of a new, improved view of women’s sexuality, is on several instances of ablist language throughout Sex is not a Natural Act. Little instances of ablist or at least questionable language appear at multiple points throughout the book, particularly with regards to mental illness. It’s not meant to be inciteful – I think – pretty sure it’s just privilege – but little flippant uses of ablist terms like “Crazy” can add up over time. I lost track of how many ablist statements there after awhile – and keep in mind that these essays were written over the course of many years. So unfortunately, it’s not a bug, it’s a feature, and an area where there’s room for improvement.
On the one hand, the fact that I notice the ablism throughout the book is partly because I myself am aware of people with disabilities as an oppressed group, a point of view made prominent recently by the participants of FWD, and prior to FWD, disability activists on the internet at large. But FWD, and the feminist blogosphere as we know it, did not exist while Dr. Tiefer was writing most of her work. However, Dr. Tiefer has been a feminist activist and a psychologist for more years than I have been alive. It’s clear to me that she’s very well read and has done her homework. In all that time, did she encounter critiques of feminism by people with disabilities? Maybe, something just like this interview with Anna?
On another hand, the picture becomes even more complicated if we are willing to entertain the idea of FSD as a disability in and of itself (an interesting, new-to-me idea which I cannot claim as my own.) This is a very different perspective, and one that even I struggled to accept – precisely because Dr. Tiefer’s work so far has made it so hard to consider. So it’s still new to me and I’m still thinking about how this alternative view would work as a theory & in practice. Yet this FSD-as-disability may very well make sense for at least some people, seeing as chronic pain falls onto the spectrum of disability, and sometimes disability & sexual expression overlap.

The fourth chapter is a bit meta – It’s a book review! Book Review: A New Sexual World – Not! is a review of the 2001 version of For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming your Sex Life. What a coincidence – I have a copy of For Women Only! I have the revised 2005 version of For Women Only, which changed the subtitle to, A Revolutionary Guide to Reclaiming Your Sex Life – the Sexual Dysfunction part of the title was removed for some reason. So we don’t have the same exact copy, Dr. Tiefer reviewed the 2001 version. I’m wondering if she maybe got a preview copy that was altered a bit more before it’s final release?
Unfortunately I am caught with my pants down, as I have the book, but haven’t gotten around to reading the whole thing yet. But since Dr. Tiefer and I are on the same page with having access to a book, I took some time to skim through and see what she was so skeptical of.
And here again is where some of my final thoughts come out, in the middle of the post instead of at the end:
The introduction to the revised edition of For Women Only says that the authors don’t take an exclusively medical perspective when treating their patients. At their practice, “Most problems tend to have both medical and emotional roots, and feed on each other” (Berman & Berman, xiv). They’re willing to use medical intervention AND sexual psychotherapy. Which is more like the balance I’m looking for in addressing FSD. According to Dr. Tiefer, sexual problems are treated with either one approach (medicine) or the other (sex therapy) exclusively, and never the twain shall meet. I interpret Dr. Tiefer’s position as pushing for an exclusively therapeutic approach without the involvement of medical doctors. This is because non-biological problems “Account for the lion’s share of women’s sexual problems,” (location 2785) so if you fall into the minority with a diagnosable physical problem, I can only conclude that you’re a minority of little interest. So I interpret Dr. Tiefer’s approach as pushing for a one-size-fits-all social construction treatment in much the same way she claims doctors push for a one-size-fits-all biological approach to FSD. Neither way alone works for me; I need both. In practice I’ve been doing the social construction side alone, on my own, through a feminist lens.
And in looking through For Women Only, some, but not all, of the patients have both physical and intangible (emotional, relationship, etc.) problems which complicate their sex lives. There’s a duality that might benefit if addressed from both sides instead of one side exclusively. Nicole had surgery for vulvar cancer (Berman & Berman 2005, 4) as well as relationship problems and insecurity with masturbation. Paula had cancer and was treated with multiple surgeries, including surgeries in her pelvis (2005, 11). An anonymous patient went through surgery for vaginal prolapse without actually having vaginal prolapse (pressured by her boyfriend,) and lost sensation inside of her vagina (2005, 16). Gail had never had an orgasm, but she did have vulvodynia (2005, 39.)

For example, in the one case study Dr. Tiefer focuses on, new patient Nicole noticed sexual side effects following laser surgery for vulvar cancer, and use of antidepresants. Not tricyclic antidepressants for pain either; we’re talking about SSRIs which can sometimes have sexual side effects (Berman & Berman, 2001, 4). So I honestly do not see how medical intervention for sexual side effects following pelvic surgery and use of SSRIs is inappropriate. I mean, what a coincidence, I had vulvovaginal surgery too and yeah, things feel different down there now. I don’t miss the excess nerve endings and I still self-lubricate when aroused (maybe not as much as I used to, but that’s what bottled lube is for.) For Nicole maybe having surgery so close to her nerves wasn’t a good thing. So how is medical examination and intervention not an appropriate post-op treatment to offer to cancer patients? Especially since Nicole had laser surgery. Now I don’t know if this is true of vulvar cancer, but what I read in the journal articles suggested that, IF you must go through a surgical approach for vulvodynia, talk to your doctor and see if you can avoid lasers.
Nicole’s treatment wasn’t limited to medical intervention, but she couldn’t be given long-term sex therapy counseling at the Berman clinic, probably since it’s so far away from her home in Kentucky. So in addition to a prescription for Viagra, Nicole was “Referred to a trained sex therapist in her hometown for further treatment” (Berman & Berman 2001, 8).
None of this is satisfactory to Dr. Tiefer and she runs down a long list of criticisms with the handling of Nicole’s care under the Drs. Berman, followed by a more general critique of For Women Only. She expresses a hope that For Women Only is just a flash in the pan while the ubiquitous feminist health text Our Bodies, Ourselves book continues to sell. The same Our Bodies, Ourselves that as of 2005 printing has about 1 & 1/2 pages on vulvodynia. In fairness, OBOS is currently working on a revised edition which will maybe, hopefully contain more details on sexual health problems that do not make up “The lion’s share of women’s sexual problems” (location 2785). Because I gotta tell you, it’s real frustrating and time-consuming (needlessly so) to not be aware of medical factors that can make sex turn out to be a bad experience. Dr. Tiefer claims that “The message of the Berman’s book is that… there’s more to know about (and worry about) in your genital neuroanatomy and blood flow than you’ve ever dreamt of” (location 2908). So to her, the book is designed in such a way as to make women worry about all the things that can possibly go wrong downstairs. Meanwhile, I wanted to know everything about my own anatomy, because I couldn’t even identify what was causing my pain at first. I like one of the lines in the intro for The V Book… “Your Private Parts Shouldn’t be Private to You” (i).
Basically, I still cannot reconcile Dr. Tiefer’s anti-medicalization stance with the fact that every once in awhile, women with FSD genuinely benefit from medical intervention. The anti-pill sentiment freaks me out because I don’t know if the sentiment extends to managing chronic pain. But even if it doesn’t – I still can’t dismiss from my mind the way other women who do not have pain but do have other sexual problems must feel. Why should I be helped but not them?

Last chapter in this section, and it’s a short one. We’re almost done now. The Pink Viagra Story: We have the Drug, but What’s the Disease? is one of the newer essays, printed in 2003, and can be read as a brief recap of the history of the medicalization of sexuality, with a splash of culture & current events mixed in. I think the most interesting part of this chapter is the slow creep of women’s sexual medicine. It’s 2010 now, and this essay was written 7 years ago, but there still isn’t a magic pill for FSD. Turns out diagnosing women’s seuxal problems wasn’t as easy as everyone expected, and “This has led to scientists’ epiphany that women’s sexual lives are contextualized, that is, that sexual experience depends as much or more on social context (relationship, cultural background, past sexual experiences) as on genital functioning” (location 3023). However, men still get to enjoy the benefits of male privilege so the context of the formation of men’s sexuality is ignored (location 3030.) I would say that that context is at least in part, what is now called Rape Culture by some feminists. The book doesn’t say that, but I think that’s what it’s getting at. Anyway, the quest for Pink Viagra continues. (Really, though, I think much of the quest for Pink Viagra depends on people not understanding how Viagra works in the first place. According to Violet Blue, regular ol’ blue Viagra has the same effect on women as it does on men. It’s just that cis women don’t have a penis, which when erect is considered a visible sure sign of arousal & desire. Even if that’s not why it is erect.)

And that’s pretty much all. There’s a short conclusion, We Need Theory, We Need Politics, which much to my own surprise acknowledges the importance of understanding “How psychology, biology and society interact and change” sexual excitation (location 3554). There’s some case studies of Dr. Tiefer’s clients cited as examples of problems in US sexual culture. Basically in the end, there’s still a lot of story left to be told. Dr. Tiefer offers a little advice on where to start studying sexology and tells the reader to “Figure out how those gender theories actually apply to yours sexual desires.” (Location 2074). Okay. Can we get some practice going too? Can we see how these theories actually apply to real life?
That’s basically what I’m trying to do with this blog. Figuring it out. Working on it. I’m still under 30, so I’ve got plenty of time…

And sometimes, all those theories… don’t do a very good job of applying to me. Sometimes they do! Sometimes sex & gender theories are great! Sometimes I appreciate being able to look at FSD through a feminist lens! But sometimes, to someone like me, maybe some of the theories… not so much. I recently read this very interesting essay by Carol Hanisch, better known now as The Personal is Political. And I’m still mulling it over in my mind and reading interpretations of what the essay meant. But one line in the introduction to the essay explains,

“Political struggle or debate is the key to good political theory. A theory is just a bunch of words— sometimes interesting to think about, but just words, nevertheless—until it is tested in real life. Many a theory has delivered surprises, both positive and negative, when an attempt has been made to put it into practice.” (Hanisch, online.)

So to me, I think that revising the dialog on FSD has yielded some unexpected, and, at times, unpleasant surprises.

But what right do I have to complain & critique in the first place? Let’s face it – I’m no expert on sex; I have very limited experience with any sex. I have no relevant credentials to my name, no Ph.D., no M.D., no relevant degree, no published books, no license (except to drive,) no medical authority. I cannot offer advice, merely perspective… And even that perspective is skewed. I’m a regular person with female sexual dysfunction. All I have is this blog and a history of pelvic pain problems. A blogger with sexual dysfunction, which some sex & gender theories state is an invented falsehood and from which I believe stem some very ugly statements about FSD and the women who live with it. Can anyone then trust me, take me at my word, at face value? Or have I been brainwashed by the media and the phallocentric medical community and so am a lost cause, a casualty, collateral damage.

Yet I am compelled to speak my experience aloud, though it flies in the face of mainstream wisdom. In doin’ things different, I may very well be doin’ it wrong. It wouldn’t be the first time.

Whew. What a trip. That certainly was a journey into reading. Finally, so far when I finish books for book review purposes, I like to suggest who might be interested in reading the work in question. For Sex is not a Natural Act, I think that the target audience is primarily feminists, sex therapists and/or sexologists, college students and teachers. I’m not sure if it would be appropriate for everyone living with sexual dysfunction. It sure wasn’t easy for me to get through, that’s for sure. Maybe the book would be of interest to people with sexual dysfunction who already have at least a basic knowledge of feminism or a budding interest in it. I’m not sure I’d advise going in without some scaffolding to build on.

But you want to know the worst part of finishing Sex is not a Natural Act…?

Cover for New View book

[Description: A white lady's hand holding a green-and-purple book over a yellow background. The book is clearly titled "A New View of Women's Sexual Problems.]

There’s another book just like it!
“There is another Skywalker!” Omg, you guys, come on, you guys. You’re killin’ me over here. You can’t be serious! There’s more?? I have do this all over again??

Okay, fine, I will read this. I will do this task. But not right now. I need to chill out for awhile & read some fun books first. Looks like I’ve got a lot left to learn… I wonder though, if perhaps anyone else, has something of value they can learn from me, too.

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  1. [...] to be heavily invested in investigating and addressing biology and sexual problems. Reading through Sex is Not a Natural Act, author Dr. Leonore Tiefer, who is affiliated with the New View, she came down pretty hard on sexual [...]


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