The ugly things people say about FSD Part 2: Electric Boogaloo

08/04/2010 at 8:12 pm | Posted in Uncategorized | 17 Comments
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Part two in our hopefully never-continuing series on what people are saying about female sexual dysfunction, the women who have it, and how to address it. I hate writing these posts so much. Feeling masochistic? Click here to visit part one.

Around June 2010, the feminist blogosphere went all a-twitter with news and rumblings about the upcoming FDA hearings regarding the potential libido-boosting drug flibanserin. Flibanserin is a drug that was originally intended for use as an antidepressant. In drug trials, it did not perform well as intended. However, it had an interesting side effect: flibanserin was found to have a small but statistically significant effect on women’s sex lives. Flibanserin was found to increase the number of satisfactory sexual encounters ever-so-slightly, moreso than the placebo effect. Although it’s been called “Female Viagra,” it’s worth noting here that flibanserin does not operate the same wasy as Viagra. Viagra works on bloodflow, whereas flibanserin has an effect on brain chemistry – it’s thought that flibanserin has an effect on women’s libido. Naturally, the drugmaker Boehringer Ingelheim took an interest in this result. There is to this day no FDA-approved female equivalent of Viagra in the USA (although some women use it off-label nonetheless, and the hormone-based Intrinsa patch is available in Europe.) However, in the end, the FDA did not approve Flibanserin. There were concerns about the study design and more testing is needed. Boehringer Ingelheim remains interested in getting flibanserin approved and the FDA did not outright reject the condition flibanserin may address as something that may sometimes warrant medical intervention.

This is controversial stuff here, and it raises ethical questions. Some feminists (and one major feminist organization in particular, the New View Campaign,) charge that the very existence of flibanserin (or any other “Female Viagra” drug) is inherently problematic. Potential risks include the possibility that pharmaceutical companies will market such a drug aggressively, creating demand from otherwise healthy but sexually insecure women. There is also concern from the asexual community that such a drug would be used to “Treat” asexuality, which, being a sexual orientation rather than a dysfunction, needs no intervention.
On the other hand some women like myself recognize potential for good in such a drug in managing female sexual dysfunction, even though its application would be limited. Flibanserin would not have any discernable application for sexual pain that I am aware of, for example, and the effects of the drug were small in trials. Nonetheless, for women who’ve felt anguish over a decreased or absent libido  and have been unable to restore their sex drives to a personally satisfactory level, such a drug could be of some use, whether used alone or in conjunction with another treatment. I also have concerns about the way in which FSD broadly is handled in most feminist discussions of women’s sexuality and I believe that even if flibanserin were more effective than it is, there would still be resistance against it.

During this time, some feminist bloggers stayed on top of the flibanserin hearings and criticism of female sexual dysfunction broadly – of particular interest in these discussions of flibanserin was a specific sub-type of FSD: hypoactive sexual desire disorder (HSDD.) One popular feminist critique is that low sexual desire is not a disease and not a valid form of sexual dysfunction. However I do not feel comfortable creating a hierarchy of what and isn’t a valid sexual dysfunction and by extension what is and isn’t a valid disability. Bear in mind that to be considered a sexual dysfunction clinically, there must be acute personal distress accompanied by a sexual problem. That means if you have low or zero sexual desire but you’re not dealing with serious stress and problems due to that, then you do not meet the clinical definition of sexual dysfunction. (However if you were to say to me “I think I have FSD even though I don’t meet the clinical definition,” I would be disinclined to boot you out and say you can’t party over here. You know yourself better than I do, and by the same token I have no business diagnosing anyone.)

Most blogs allow comments to continue discussing the original post beyond its end, but as you are probably already aware, comment features are a dual-edged sword. (As if we needed a timely reminder of this, one need only look at recent guest posts on Feministe.) On the one hand, blog comments allow discourse and debate to take place, and participants may learn something new about a topic or about themselves. On the other hand, comment sections carry the potential to backfire and turn into cesspools of troll waste and rampant privilege. Try as it may, the feminist blogosphere (alas, including this blog) can never be truly “Safe space” for everyone.

It’s been a few weeks since the flibanserin hearings, and and things have settled down a bit with regards to sexual dysfunction in the blogosphere. It’s quieter now… the trend has come and gone, but this won’t be the last we’ll hear of it. With some distance between me and the discussions now, I’ve been able to slog through comment threads on some of these flibanserin posts with only feelings of numbness instead of white-hot rage. Today we’re going to take a look at some comments on one of the flibanserin threads, because I believe the comments posted in relation to flibanserin, FSD and HSDD reveal problematic attitudes about FSD and towards women who have it, and especially who seek to address it. I’m not very interested right now in talking in detail about whether or not flibanserin should or should not have received FDA approval – I’m interested in talking about what people are talking about. I believe these attitudes, which include ablism and sexism, further stigmatize female sexual dysfunction and the women who have it. Some of you visiting here now need to examine what some people are saying about FSD, because perhaps you yourself have harbored such problematic attitudes, or else maybe you never thought about it this way. Others reading this blog are already familiar with the ugly things people say about FSD. If you or your partner have sexual dysfunction, you may want to bypass the rest of this post, or at least be in a position to return to a good state of mind after reading.

You may notice that the format of this installation in our hopefully not continuing series on what people are saying about female sexual dysfunction has changed since the first time around. Instead of pulling some of the best of the worst comments from various sites around the feminist blogosphere, I’m going to focus on one post from Feministe, FDA Wants YOU! to Have Sexual Satisfaction, which eventually turned into a privilege goldmine. We’re going to touch upon many areas but I cannot go into detail on all of them because if I hang around the comments too much I’ll burn out.

The setup: On Feministe, Frau Sally Benz posted a brief note about how the FDA hearings on flibanserin were about to take place. Not much else to it really; just a heads-up, no critical analysis in the body of the original post. From the flippant way it’s written, it’s hard for me to make out what Frau Sally Benz’s position, if any, is on flibanserin and female sexual dysfunction.
Anyway discussion ensues in comments, following a pattern that is becoming familiar to me.

Early on, the social construction arguments critical of FSD and the medicalization of sex were stated,

The problem with “female Viagra” is that there are so many reasons why women might have a poor sexual experience that are not biological.

More,

My understanding is women experience loss of interest in sex because of stress, tiredness, hormonal fluctuations due to pregnancy and menopause, past abuse, repeated unsatisfying encounters, and being unable to name and explore what gives them sexual pleasure.

Often when I see someone talking about the social construction of FSD and social construction approaches to dealing with it, it’s as if social construction is a brand-new revolutionary way to think about sex and sexual dysfunction – to the person talking about it. Social construction isn’t all bad, but one of the reasons I’m unwilling to unquestioningly stand behind it is because it just doesn’t work for me. Based on what I’ve seen in some comments on this blog, a purely social construction approach is not a panacea for everyone. These social and relationship tweaks work well for some couples and individuals, and they may be significantly cheaper than going to a doctor and using medication! When it works, that’s just fine. Better communication, studying sex and technique, etc. Lovely.
But what happens when it doesn’t work?

Basically, what I want to know and still have not figured out is, what is the next step when ardent social construction proponents encounter responses like this:

I personally WOULD really like a drug to treat my crappy libido, and not wanting sex feels bad to me both physically and emotionally. Low libido CAN be a physical problem for many women, and I suspect it may be so for me.

My partner is competent as hell and places no demands on me. I’m healthy, I don’t have emotional problems with sex. I would just like to be able to come in less than half an hour. It’s also not diet, exercise, or any of the other blah blah blah things I’ve been told I should change about myself to fix a problem that is not my fault or under my control. So, commenters, please don’t belittle the experiences of women who have libido issues. I don’t want to see drugs given to women to substitute for their partners giving a fuck about their pleasure, no, but if a woman has libido problems that are distressing her, yeah, a little help might be useful. Drugs are not the enemy. There is nothing superior about a person who does not take or does not need to take drugs.

I really wish we’d see more comments like this when talking about FSD and flibanserin, since these are the voices of women who would be most directly effected by advances (and setbacks) in sexual medicine. But so often in discussions of sexual dysfunction, the conversation becomes dominated by people who do not have it, (statistically no matter how I look at it, the majority of women do not have sexual dysfunction,) perhaps who don’t even believe in its validity, and/or who are unfamiliar with what it’s like to live with. Which probably wards off women with FSD who might otherwise speak up. I’ve seen some women with sexual dysfunction, or at the very least sexual problems, have problems in their lives that social construction might do a good job addressing. But I’ve also heard from women with sexual dysfunction for whom a pure social construction approach does not and has not worked. It is as sex therapist Dr. Marty Klein says,

Flibanserin is proposed for women whose reduced desire can’t be explained by a dozen other factors, including well-known desire killers such as ambivalence about the relationship, sexual trauma, and husbands who don’t bathe.

Furthermore it seems there is very little room in social construction to acknowledge that there can be social forces and biology, or even, once in awhile mostly biology, at work when people develop sexual dysfunctions. What social forces caused me to develop vulvodynia? I’m uncomfortable with the way that social construction and medicine are separated, as though it is impossible to use both medicine and a social construction approach at the same time. It is as though the two are mutually exclusive, and if you choose one, you can’t have any of the other. On paper, the New View Campaign leaves a little wiggle room for medical factors to cause sexual problems but in practice the New View does not appear 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 medicine, even if FSD patients were dealing with complications from vulvar surgery. I’m very surprised that one of the early comments acknowledged the possible role of hormones in sexual dysfunction, because Dr. Tiefer included “Defining a [condition] as a deficiency disease or disease of hormonal imbalance” as a sign of disease-mongering (Payer in Tiefer, 2006).

Here’s an example of what I’m talking about on the Feministe thread with the resistance to sexual medicine:

I’m a bit concerned about the drive behind this drug. If you look at current information about women experiencing low arousal/desire, it’s full of sensible ideas like “talk to the woman about how she is feeling” and “maybe ur doin it rong”.

I so hate assigning blame for sexual dysfunction. What if your partner has been doing everything right? What if you already have good communication? What if your’re single? What if there really is something physical going on?
When my libido crashed because it was looking like I’d never be able to have sex again anyway, how sensible would it have been to say that was all my partner’s fault because he was doing something “rong? This was no one’s fault – and I remain grateful that my libido rebounded after getting medical treatment for the pain.

Seriously, I get it. I get the concern behind the drive for the drug. But I don’t get why there’s no concern about denying treatment, including medicine, to women who genuinely need it. The social construction approach is that since FSD isn’t a valid disease and isn’t recognized as a disability, it needs no medical intervention – there’s nothing to treat almost all of the time. I hear very little support for those rare cases in which someone does need sexual medicine.

Moving on, there’s also the ubiquitous women’s sexuality is complicated argument,

Will a pill fix a woman’s loss of libido? I think it’s unlikely, given that sexual arousal in women is complex, and that drugs do not affect one specific part of the brain and body.

Returning to Dr. Marty Klein, it’s more accurate to acknowledge that sexuality in general is complicated regardless of gender:

* Reinforcing the myth that women’s sexuality, especially desire, is more complicated than men’s.

No, no, no. Eroticism in adults is complicated, and it insults both genders to suggest that only women have emotions around sexuality. Professionals don’t understand why men don’t desire women they love any more than we understand why women don’t desire men they love.

Most men are not heartless machines eager to screw anything with a heartbeat, any more than most women are frigid creatures who only acquiesce to sex out of duty.

Another of my concerns is that the “Women’s sexuality is complicated” argument may be used to quash investigation into biology and sexual functioning. Sexuality may be complex but should that complexity stop further research into sexual medicine? Is there any room for sexual medicine at all?

Up to this point, the comments I’m pointing out are pretty typical and to be expected when talking about FSD. But right about now is the point where the comment thread started to get really weird. I’m familiar with the social construction arguments regarding HSDD, FSD and sexual medicine and while I’m tired of it and feel like I’m just being able-‘splained to, (“Here’s what’s REALLY going on with you,”) at least I understand where it’s coming from. But then the conversation took a new, unexpected turn. Here’s where problematic attitudes about FSD become obvious and things start to turn ugly.

Here’s another quote from the Feministe comments section, which demonstrates at least three problematic things at once: Heterocentrism, what FigLeaf describes as the “Two rules of desire/No sex class” and the slippery slope,

It occurs to me that a rather depressing dystopian story could be written about this. Woman doesn’t want to have sex with man. Man sends her to doctor. Woman suddenly wants to have sex physically, but is mentally unready. Emotional health is effed up. Welcome to the new slavery. Fin.

Huh? Well that’s a new one to me.

To Sarah’s credit, you probably could write a very depressing story about a Stepfordian society in which women are minus all sexual desire and have absolutely no sexual agency! Or any other agency, for that matter, since it sounds like the women characters in this story are subject to Man’s orders to go to the doctor and then become slaves. However that dystopian story would probably not be about “This,” the topic of interest right now being real-world flibanserin with all its inherent limitations: should the FDA approve it? The dystopian story requires a gross exaggeration of flibanserin or any other sexual medicine for women to the point where it becomes a magic, mind-controlling sex pill, and it requires a world without lesbians, bi-, a- and pansexuals. Right now, in this physical plane we call home, such a magic mind-controlling sex pill doesn’t exist. Might make an interesting, depressing story but it moves us farther away from real-world women with sexual dysfunction, and further up into the ivory tower of theory.

The Feministe comment thread continues, with demonstration of a fundamental misunderstanding about how flibanserin works,

To end the sarcasm and speak seriously, I have a question that I hope one of you can answer. Would the drug work only through penetration. Or does clitoral stiumlation “activate” this drug too?

To find out how flibanserin “Activates,” let’s visit Neuroskeptic, who has a scientific descriptions of how it works.  Neuroskeptic says,

How is flibanserin supposed to work? According to a paper on the Pharmacology of Flibanserin, it’s a serotonin receptor 5HT1A agonist and a 5HT2A antagonist. This makes it a kind of cross between the antidepressants nefazadone and buspirone. Neither of these are widely used as antidepressants because they’re not considered highly effective. Flibanserin is also a weak dopamine D4 receptor partial agonist. This might underlie its aphrodisiac properties, because drugs which increase dopamine levels are known to enhance motivation and libido (or indeed cause problematic hypersexuality.) In rats and mice, flibanserin has sedative effects and enhances the effects of other sedatives. It also has antidepressant-like effects in some tests but not all. Drug geeks can click the image on the left for more details.

The short version is: the description does not say anything about flibanserin requiring penetration or clitoral stimulation to work. I don’t think that mattters… or it would depend on what the person using flibanserin likes.

Back over to Feministe again. Some combination of both heterocentrism and misunderstanding the application of sexual medicine,

The drug is an antidepressant.

In short, if a woman doesn’t want a penis in her vagina it MUST be because she has an undiagnosed mental illness.

Well, no, not exactly… flibanserin doesn’t work well as an antidepressant. And what this commenter and many readers visiting this post for the first time are probably unaware of is the fact that tricyclic antidepressants are sometimes used by women with the vulvar pain condition vulvodynia. That does not mean that vulvodynia is in and of itself a mental illness. In this case there’s something physical going on inside the body. The low dose of tricyclic antidepressants are thought to calm overactive nerve endings down for some patients.
However it is worth noting here that FSD is listed in the DSM-IV and soon-to-be-V. Pain may be included as a sexual dysfunction. That’s interesting, but today as I write this post, instead of questioning validity of this categorization, I’m inclined to save that conversation for another day. No matter how I slice it, I keep coming back to recognizing FSD as disability…

Furthermore, this is an intercourse-centric quote that treats PIV intercourse as the default sex. There’s no room for a woman who wants to want a vibrator on her clitoris sans the involvement of a penis.

So far, pretty typical stuff for a discussion of female sexual dysfunction and sexual medicine. I’ve seen comments like this before and I’ll see them all again.

Then things started to get really weird.

But you’ll have to stay tuned until our next installment of Ugly Things to find out what comments were so shocking to me that they constitute their own post! …Plus this is getting way too long.

17 Comments »

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  1. Ok.
    I didn’t follow these blogs, and I’m kind of glad I didn’t because some of the comments that you highlighted in your post are aggravating.

    I’m not getting why there appears to be an assumption that “all” women with low libido will be required (or will immediately want) to take this? Maybe I’m reading it wrong. It’s like any other medication out there. If you want it and actually need it, take it. If you don’t want it and want to go another route, don’t take it.

    I think it’s a tool. Talk therapy is a tool. Biofeedback is a tool. Topical creams, low dose antidepressants, partner communication, injections, surgery…all tools.
    As someone who has a healthy loving relationship, has her thyroid problem under control, is for the most part healthy, sees a pain specialist for vestibulitis and is progressing well with those treatments, AND has been in therapy for low libido for two years now, I personally would REALLY like something else to help this along. It’s a long frustrating process. If there is something biological going on that medical professionals just stumbled across that will speed this up, send it my way.

    I don’t think it should be the first line of treatment. I think other biological causes should be explored/ruled out. I think some therapy to explore any possible issues for the individual and/or the couple is beneficial. But for those of us out there who are going by the book in dealing with this and taking two steps forward and one step back all the time, it’s just an extra bit of help along the way.

    • Exactly.

      I don’t think you’re reading it wrong. The assumption goes something like, if Big Pharma can make a pill that will address HSDD, that’s the most common form of FSD. Simultaneously doctors have an incentive to prescribe medication. So doctors and Big Pharma have a vested interest in getting flibanserin or a similar drug into as many patients as possible, in order to make serious bank. So Big Pharma will market the drug aggressively on TV and in print thus creating sexual insecurity in women who will feel like “Well am I getting enough action? I better talk to my doctor!” who will then instantly without reservations prescribe flibanserin or similar drug.
      Too bad they’re not as quick to prescribe medication that addresses pain eh? Not even boned up on conditions that cause sexual pain. (You see what I did there?)

      I see flibanserin similarly. It’s a tool – or at least, it would be if it had been approved. Flibanserin itself might not even be all that great of a medication since the effects it had were pretty weak.

      But in more general terms, such a drug is not going to work for everyone, it’s not right for everyone, not everyone wants it, some people would probably go off of it due to side effects or not even be willing to go on it due to the stigma that FSD carries. But for other people… sometimes folks genuinely need their meds. Sometimes those alternative routes don’t go far enough.

  2. Can I just say that I love your righteous indignation? ^_^

  3. Oh man.

    I’m starting to feel like this stuff would be easier to deal with if someone could come up with a FSD Discussion Bingo.

    (If no one else volunteers to make one, maybe I can.)

    • You think this is bad just wait till the next installment. It’s probably going need trigger warnings.

      As a matter of fact I have such a bingo board in the works. If you’re volunteering, would you like me to email you the list of 31 possible squares for review?

      • Oh my God, that is awesome!

        I made a “women in math” bingo after one too many frustrating conversations with my fellow participants at a summer research program, and it was incredibly cathartic.

        Can we have a square for “just relax”? PLEASE???

      • Sure, go right ahead. I might be able to use Corel Draw to make it look fancy, while I’m at it…

  4. This is my first comment, and I am very new to this whole thing, but I want to let you know I liked this post. I’m not even sure in my own case whether I have HSDD/FSD, am sort of asexual, or what, but I like to explore the matter from all sides. Biology should not be overlooked, and the Big Pharma outcries are usually exaggerated

  5. [...] Last week, I re-opened an old wound, the ugly things people say about FSD, the women who have it, and what treatments (if any) should be acceptable for it. I directed your attention to the comments section of a Feministe post, FDA Wants YOU! to Have Sexual Satisfaction. That’s a brief heads-up that the FDA was about to have hearings on whether or not to approve the drug flibanserin, which in early testing had an ever-so-slight positive impact on women’s sexual satisfaction, but with the cost of a small payout and potential side effects. In the end, the FDA did not approve the drug and it’s back to the drawing board for Big Pharma and for women with HSDD (hypoactive sexual desire disorder.) [...]

  6. [...] 1.2 presented here – I have incorporated elements and feedback from boards we came up with.) You asked, and we [...]

  7. [...] warped) in feminist arguments against sexual medicine. And let me show you, it can get real ugly real fast. Leaving sexual pain as a sexual dysfunction might lend medical and social legitimacy, [...]

  8. [...] be able to talk about it, because someone more enlightened will refuse to believe her – and will instead ‘splain why she is so deluded and gullible and brainwashed. I have this fear, because that’s exactly how I feel when I try to talk about FSD on any blog [...]


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