Did you miss Pleasurists 165? Read it all here. Do you have a review for Pleasurists 167? Be sure to read the submission guidelines and then use the submission form to submit before Sunday February 5th @ 11:59pm Pacific.

*Pleasurists recently started accepting photo submissions for the art at the top of editions! For more information click here.

Want a shiny new toy? All you’ve got to do is enter.

• Shiny twisty swanky glass dildo giveaway! Deadline: February 1st @ 11:59pm Eastern.
• Dildo Giveaway! Deadline: February 1st.
• Eden Fantasys $25 Giveaway! Deadline: February 2nd.
• Giveaway Contest – The Heeldo Deadline: February 2nd.
• FunWares Valentine’s Giveaway Deadline: February 4th.
• Anniversary Giveaway Deadline: February 6th @ 12:01am Eastern.
• Giveaway: Onye Gallerie Petite Deadline: February 8th.
• Heart Wand Glass Dildo Giveaway Deadline: February 8th.
• DreamGirl Mesh Panty Giveaway Deadline: February 14th.
• Love is in the Air! Deadline: February 15th.

Editor

Scarlet Lotus

On to the reviews:

Vibrators

• Leaf Touch by Mistress Kay
• Leaf Fresh by Kira
• Leaf Vitality by Mistress Kay
• G-Twist by Karen Blue
• L’Amour Petite Indulgence by Sammi
• L’Amour Petite Indulgence by Belle
• LELO Elise by Juliettia
• Doc Johnson Black Magic Ribbed by Girl Deviante
• Pure Skin Bendie by Nymphomaniac Ness
• Pure Skin Bendie by DIY Orgasms
• Silky G by buzzvibe
• Hitachi Magic Wand by Penny
• Vibrating Pleasure Panties by Sammi
• Climax Twist Massager by Mistress Kay
• PicoBong Honi by Diabolical Kitty
• PicoBong Kiki by Smokebelly
• Couture Collection Pink Inspire by Lucid Obsession
• Couture Collection Pink Inspire by Naughty Snow White
• Blush Oui by Lucid Obsession
• Tuyo Vibromasseur by Mistress Kay
• Fun Factory Capricorn Astrovibe by Delilah Captor
• Onye Galerie Petite by Karen Blue
• Mini Wahl Rechargeable Massager by Mistress Kay
• Tantus Mini Rebel by Smokebelly
• Silky Vibrations Tingle Me by Naughty Snow White
• We-Vibe 3 by DIY Orgasms
• Extase Zenith by Smokebelly

Dildos

• Simply Blown Shiver by Bzzingbee
• SSA Glass Cyclone Wand by Kira
• Fleshlight Drac by Beanfiddler
• Tantus Throb by Blacksilk
• Jollies Jollet by Kira
• Tantus Luke O2 by True Pleasures
• Fleshlight Freaks Cyborg by HotMoviesForHer Sex Toy Crew
• Tantus Alumina Flow by Kira

Anal Toys

• Crystal Twist Mini Plug by True Pleasures

Sleeves, Rings, & etc.

• Tenga 3D Spiral by LucyLemonade

Lube, Massage Oil, Bath Stuff, & etc.

• Edible Glow Massage & Body Oil by Lucid Obsession
• Earthly Body Massage Candles by Kit OConnell
• Tasty Trio Holiday Cheer Edition by Lucid Obsession
• Oral Sex Candy Spray by buzzvibe

BDSM/Fetish

• Kinklab Butt Plug Harness with Cock Ring by Mistress Kay
• Wartenberg Pinwheel by Willow Wand
• Bound by Diamonds Leash and Collar by Belle
• Kinklab Vampire Gloves by Jnuts

Adult Books/Games

• Male Playing Cards by Mistress Kay
• Enchanted: Erotic Fairy Tales by BashfulBabe
• Teasing the Devil by BashfulBabe
• The Adventurous Couple’s Guide to Strap-On Sex by K__

Adult DVDs & Porn

• Tight Places (A Drop of Color) by Pixel
• Eat Me Out by J.D. Bauchery
• Cabaret Desire – Scene 1 by Ginger Leigh
• The Secretary 2 by J.D. Bauchery
• Cosmic Re-Entry by Ginger Leigh
• Lily Cade’s Live Nerd Girls by J.D. Bauchery
• Fallen by Pixel

Lingerie

• Tiger Print Mini Dress by Red Vinyl Kitty
• Coquette Petticoat by Red Vinyl Kitty
• Sheer Chemise Set by Lucid Obsession
• Darque Nurse Costume by Mystress Lady Evyl

Miscellaneous

• Blow Job Expert Kit by True Pleasures
• Bend Over Beginner Kit by Smokebelly

Why are we reviewing a book about pegging on a blog about sexual dysfunction? For much the same reason cited last time we read a book by Violet Blue: Personal reasons + it was in the book queue. Besides, I’ve said it before and I’ll say it again: Sometimes when you have sexual dysfunction, you gotta get real creative, real quick.

The short version of the review is…
Well… I liked the Ultimate Guide to Fellatio better…

The Adventurous Couple’s Guide to Strap-On Sex – let’s call it TACG from here on out – the book is short. I was able to burn through the book start to finish within just a few hours. The Kindle edition I read has 1568 locations (sentences, I think,) which translates to about 160 pages in paperback format. There aren’t any pictures in the Kindle version – there’s not even one of those cut-away academic diagrams of male pelvic anatomy. All of the descriptions of anatomy and how-to are written out in paragraph form.

TACG‘s target audience is cis, heterosexual couples interested in pegging – and pegging, by definition, takes place between cis, het partners. But strap-ons are used in LGBTIQA communities too – so to me, it was weird to see so little coverage of strap-on use outside of straight sex. There was a lot of reassuring the reader that an interest in pegging does not necessarily mean you or your partner is gay. Definitely a book aimed at cis, het couples primarily.

The book includes just about everything you will need to know about strap-on sex and maybe some stuff you hadn’t thought about – anatomy, history, myth debunking, what gear to look for, how to go warm your partner up and then go through with pegging, and safe sex. Actually, I would have preferred to see the section on making strap-on sex safer close to the beginning of the book, instead of at the very end, but there is precedent for saving the best for last – Sex Toys 101 did it that way too. Remember that anal penetration is a risky sex act in terms of passing along infectious agents between partners, because the tissue is delicate, and there’s a lot of bacteria behind the anus. Blue includes a table detailing your risk of infection from anal sex, pegging and related activities and describes tools like condoms & dental dams you can use to reduce the risks.
Remember also that if you’re inserting objects anally, they really need to be designed specifically for that. If you just grab whatever’s handy, you or your partner could wind up with a toy lost inside the body and/or a serious injury – either scenario requires a trip to the emergency room. Blue addresses what kind of butt-friendly toys to look for. Shape, size, and materials all matter, so shop smart. Don’t forget the lubricant, since the anus can’t produce its own secretions the way a vagina can.

Where TACG really shines is when Blue talks about the importance of communication. Pegging isn’t something you can just spring on your partner, and a desire to engage in it isn’t something you can just pantomime out using secret code gestures (no matter what Cosmopolitan tells you.) If you’ve been slacking off in the sexual communication department, Blue lists a few suggestions for how to bring strap-on sex up in conversation – most of these suggestions can easily be applied to other various sex acts as well. Blue also reminds the reader to think about their partner’s perspective, since talking about sex can be (but doesn’t have to be) nerve-wracking. Blue suggets a few areas for exploration if one partner or another is reluctant – what are you the most uncomfortable with, the potential for pain? Insecurity with flipping around gender norms? Cleanliness/messiness/poop? You don’t even know where to start or what else there is to do during? There’s ways to address these concerns.

I liked the section about the history of the terminology of strap-on sex and why you may have noticed a glimpse of pegging here and there in mainstream sex shops, films and discussions. I was also pleasantly surprised by the inclusion of a chapter on how to have strap-on sex with a third party. Opening up a relationship is a little too advanced for me but the book is clearly polyamory friendly. There’s a lot of coverage about various reasons couples might want to try strap-ons during sex in the first place – some reasons include (but are not limited to) the potential for prostate stimulation, aesthetics, and/or fantasy fulfillment.

TACG contains a little information about strap-on sex and disability. Author Blue suggests using a double-ended dildo if you have a wrist injury or mobility problems (location 1188,) and she suggests a vendor from which to procure a harness designed for cis men. (Specific item is here; NSFW; similar products may be available elsewhere.) Why would someone who already has a penis want a harness for a dildo when their equipment is already present? The idea is double penetration of a cis female partner, but in my mind I’m imagining something like it might actually come in handy for couples dealing with erectile dysfunction – especially since Blue states that an erection is not required to use a double harness. TACG describes other harnesses as well; there’s one kind that the wearer can strap onto their thigh or even their head.

A couple of considerations for folks with pelvic pain issues who might be interested in harnesses:

Blue writes that “If you worry about [your pubic bone] getting sore from thrusting, you can buy a specially made pad of thin foam to cushion your pubic bone” (location 1159,) though where exactly one might buy such a pad is not explicitly stated. If this type of pad has a specific name, I don’t know it.
One of the double-ended dildos described in TACG is the Feeldoe, a double-dildo with one bulbous end. It’s designed to have the bulbous end inserted vaginally, leaving the phallic part exposed, for your partner’s enjoyment. However I don’t know how accessible this toy is to folks with pelvic floor dysfunction and/or pain – It looks like something I would find uncomfortable, if not outright painful, to the point of impossible to use as intended. Supposedly it can be used with certain harnesses with some adjustments, but it’s designed to be inserted in the wearer’s vagina.

In general, I would recommend some of the other dildos from Tantus, because I own one I’ll vouch for, they’re silicone & many have a flared base suitable for a harness and anal stimulation – including a few smaller models and plugs.
If you’re a pelvic pain patient interested in a harness, I strongly recommend  sticking to two-strap harnesses only. Or harnesses that are worn over some other body part, like the thigh. The problem is that single-strap pelvic harnesses have to be worn between your legs like a thong and thus cover up more of the vulvar area. Two-strap harnesses go around your thighs and butt instead, leaving more area exposed. The distinction between single and two-strap harnesses is described in further detail in TCAG.
Also, Blue doesn’t mention this part, but beware of harnesses with a pouch for a vibrator… Harnesses with a bullet vibrator are supposed to make the experience more pleasurable for the wearer, but depending on how the vibe rests against you, it might just feel like a foreign, hard something digging uncomfortably into your pelvis. It’s like something out of the Princess and the Pea. I personally find it more comfortable to use a vibrator separately either before or after wearing the harness.
If you’re worried about causing your partner pain, then remember that anal stimulation doesn’t have to – and if you’re doing it carefully, shouldn’t – hurt. You might be tempted to share your prescription lidocaine or OTC novelty numbing gel with your receptive partner but that’s actually a bad idea: numbing gels dull everything, which makes deriving pleasure more difficult… and if you can’t feel what’s going on, then you won’t know if you’re getting injured. The book will tell you how to adjust your techniques to minimize discomfort & maximize pleasure.
Remember also that you are by no means obligated to peg if you’re thinking about getting a harness. After talking with your partner, you may decide instead to just wear it around for awhile or to engage in some other non-penetrative activities with a dildo equipped, just for show.

Overall, The Adventurous Couple’s Guide to Strap-On Sex is an okay book. It will be most useful for straight folks – especially cis women – just starting to consider strap-on sex, who don’t know what’s involved. Likewise, it will be useful for straight men who want to be on the receiving end, but never tried it before.
TACG becomes less useful if you’ve already had exposure to strap-on sex, either through experience or though some of the free how-to guides available on sexuality websites. The trick is, if you’re thinking about trying strap-on sex, then chances are you’ve already looked at those free how-to guides before picking up the book.
I wouldn’t recommend TACG be your first book purchase by Violet Blue. My overall impression is that IMHO I think she put more effort into some of her other stuff. There’s nothing wrong with the book; It contains good factual information & encouragement! I just liked some of her other sex guides more. Franky I thought that some parts of the book were drawn out longer than necessary – I basically skimmed through the chapter about male anatomy because I’ve seen it all before… And I skimmed over the erotic vignettes. The short stories are fine; I have no problems with the writing, though they are several pages too long. They’re just not my taste. Obviously, YMMV!

In summation: the $10-$15 retail price investment will be best for newcomers, with less bang for buck the more experience & knowledge you already have about strap-on harnesses & how to use them. More experienced readers may find it useful as a reference from time to time.

Disclaimer: As with all products reviewed on Feminists with Female Sexual Dysfunction to date, I had to pay for this book out of pocket with my own money, and I don’t get any compensation for writing this review.

[Image description: Slowpoke from the Pokemon franchise. Quadraped pink critter with its mouth open and big, dead eyes, and a blue top hat that says "HAPPY NEW YEAR!" Found via Know your meme.]

If I could give 2011 a theme as it relates to my personal life, the theme was Change, con’t. I made a big life-changing switch at the very end of 2010 and spent much of the rest of the year re-adjusting & getting back on my feet. Most of the changes involved in my personal life were positive, but there’s still one area that’s acutely lacking. I’m working on fixing the weakest link. Unfortunately for the blog, my attempts to further improve my personal situation continue to impede my ability to write on a regular basis. This trend will continue until such time as I get everything worked out to my satisfaction.

More broadly – politically and economically – 2011 was… more of the same shit from 2010… Pretty lousy. Unemployment in the US is still high, both the US and Europe had debt problems, the US continues to see record numbers of laws restricting reproductive rights, etc. Man-made and natural disasters did enough damage on their own and combined into some long-term destructive forces. But you already knew all that, and other bloggers have done a superior job delving into 2011′s news.

I didn’t see quite so much buzz re: sexual dysfunction in 2011 as I did in 2009 and 2010 though – probably because the flibanserin fiasco is done, with no change for ladies. You still don’t have an oral medication option to address a low sex drive. There are still activists who will do everything in their power to combat any such drug from entering the US market. I didn’t hear any news bits about vulvodynia or vaginismus coverage on the television or radio either, but if I missed something, let me know in comments.

One story I did miss re: vulvar pain is that, another study just confirmed what we here already knew: That vulvar pain is still ~uncommon, in the sense that less than a majority of vulva-possessing people experience it… but ~common enough so that you’d be surprised at just how many people do deal with it – up to 25% of women experience it at some point during their lives. Wow. Based on survey results, researches concluded that somewheres around 8% of women  (cis in this study, I presume?) have it now, and a lot of them aren’t able to get effective treatment. I wish I could say I’m surprised by the findings, but I’m not. Here’s an abstract to the official study.

My blogging schedule is reduced, but we’re still able to crank out some original content here. Let’s review some previous noteworthy content first.

The 2009 retrospective
The 2010 retrospective

Don’t miss the guest posts from 2011: 

Guest post – update from a guest poster – the return of Rhiannon, who provided readers with a follow up to her original 2009 guest post.
Guest post – the sexual subject – about pleasure and vaginismus, in a culture that works to impede women’s enjoyment of sex in the first place.
Guest post – on sexual pain, consent and treatment – an anonymous post from someone with PFD/vaginismus, addressing important topics. It’s still rare for me to see perspectives on these topics from someone whose sex life is made more complex due to sexual dysfunction(s.)

Top 10 don’t-miss posts I wrote in 2011: 

1. Feminists with FSD does Orgasm, Inc. – If you read just one 2011 post by me at Feminists with FSD, make it this one. This is the post that finally addresses the film that everyone’s talking about. You know – the sexual dysfunction documentary that didn’t talk about sexual pain, which Dr. Leonore Tiefer herself is surprisingly quick to pathologize as the One True sexual dysfunction. You know – the film that I’m not even sure if it took the perspective of women with sexual dysfunction, considering the one woman interviewed who talked about experiencing it, we’re supposed to question whether she really had it and even then at the end, she decided she was normal all along after all. Great for her, not so great for me, since I had another solid year of sexual dysfunction and stigma.
These cartoonish slaps the face somehow aren’t working to snap me out of it – they just annoy me.

2. Vulvar pain in women of color – This blog desperately needs perspectives of vular pain and other sexual dysfunctions from women of color. If you are a woman of color who would like to submit something, please leave a comment somewhere on this blog (this post is fine,) and I’ll get back to you with contact  details.

3. Conceptualizing the FSD hierarchy - So if dyspareunia is the one true sexual dysfunction, then what about every other kind of sexual problem? I cobble up graphics to show the relative importance placed upon a few different broad categories. I don’t like that there’s a hierarchy at all and I think it sucks.

A series of posts!:

4. Doctors debate dyspareunia (painful sex) – Starting off an in-depth look at the weird way painful sex is treated by sexual health professionals. It occupies a unique place in that it’s a hot potato no one knows wtf to do with.
5. Doctors debate dyspareunia part 2: is pain the only valid FSD?: Start of a 2-part series within a bigger series in which I take a more detailed look at that journal article/editorial/reply by Dr. Tiefer I’m always linking to.
6. Doctors debate dyspareunia part 3: Pain’s validity, con’t: We finish looking at Dr. Tiefer’s response in the debate about wtf to do with sexual pain.
7. Doctors debate dyspareunia part 4: The debate continues: My conclusion upon completion of our multi-part series is that, no one knows wtf to do with sexual pain; everybody has a different opinion and a basis for for their opinion and oh my god it’s a fucking mess out there. Ya’ll on ya’own. The fact that doctors are talking to each other without soliciting the feedback of patients contributes to the problem. Hey. Hey. We’re over here. *Waves arms* Hey. Can someone send up a flare signal over here or something?

8. For (belated) Lady Porn Day: What are the experts saying?: In which I feel like I’m in the middle of a tornado and the tornado is made up of different sex therapists’ opinions about pornography’s place in relationships and sexuality. Who do I believe and why should I trust you, but not this other person with likewise admirable credentials, who came to an opposite conclusion after years of practice?

9. Happy 3rd birthday, Feminists with FSD: I can’t believe I blogged that much… also, ponies.

10. Where are all the good advice columnists?: Yeah good luck finding one of those when it’s all just more of the same. Well, maybe not always – there’s a few good eggs out there I guess.

What’s next? We still have a lot of work left to do, if my previous retrospectives are any indication. There’s still a lot of topics we haven’t covered, and new areas to explore develop with every passing year. Those posts aren’t going to write themselves, people.

One painful topic I’m brainstorming on is sex or the lack thereof within marriages and unconsummated marriages. Why think about this now? Because I am so completely disgusted by some recent conversations about “Cutting off sex” – because there’s a very real possibility that that could be me everyone’s gossiping about someday and how could she do that to him etc marriage is a contract with certain expectations etc terms of the relationship etc disclosure etc no one is saying he’s entitled etc physical intimacy etc x number of weeks/months/years is far too long etc (why is marriage between asexual partners not coming to everyone else’s minds?) etc at least open the marriage up etc unreasonable demands etc…
Has everybody forgotten about the post, “Painful vagina? Your poor husband!” Cuz I didn’t.
So if’n anybody reading knows about sexless marriages/unconsummated marriages and divorce – comment and let’s see what you can give me to work with here. (Poking around on google, it looks like there’s no legal precedent for lack of sex to be a viable grounds for divorce in and of itself.) Yes I want to explore the very language used in these conversations, ie how exactly are we defining “Sexless,” “sex,” “unconsummated,” etc. I don’t mean to use these terms uncritically.

Alas, my time and energy levels are limited for the vague reasons outlined above – I only just now finished reading like 1 book for pleasure within the past year, so I couldn’t even crank out a book review.

But we’re still here… going at whatever pace I can manage. Stay tuned…

I’m dreading it. My tax return is the opposite of fun; I bet yours isn’t much better. Certainly filling out tax returns can be headache-inducing, to the point where some folks hire out the service to a third party. But sometimes, examining financial statements and tax returns can reveal useful – if dry – information.

I don’t mean to get paranoid here, but since Jezebel pointed to a fascinating critique of anti-gay marriage group NOW’s tax records carried out by American Independent, and Feminist Whore pointed out the high salaries received by higher-ups at the Police Executive Research Forum (timely in light of their alleged involvement in suppressing OWS,) I figure it’s fair for me to point you in the direction of some feminist & health nonprofit organizations tax returns – if only to use them as examples of some interesting features to look for when choosing where to donate your hard-earned tax deductible donations. It’s a way for the public to hold charities accountable and a way for the charities to maintain transparency.

Caution: Among many other things, I am not a tax professional. There’s a limit to my interpretations of the following tax returns. I know enough to find public returns mildly interesting, but please address serious inquiries to a real pro. (Good luck with that – I knew a tax professional who replied to all questions about taxes from laypersons (including his friends and family) with, “Sure, I can help you with that, I’ll do some research – if you pay me!”) Nonetheless, nonprofit tax returns are publicly available information you have a right to review. All we’re doing today is stating the obvious. One additional caveat: This post is US-centric, since we’re dealing with US tax laws.

If you want to evaluate charities, there’s some decent guides available online. According to CharityGuide, excellent organizations put about 80 cents out of every donated dollar towards their stated purpose – and you’ll find that purpose explicitly stated within a tax return. In general, fundraiser, salary reimbursement and administrative costs should be relatively low. Good luck with that, since some charities classify fundraiser activities as something else. A shortcut to some strong charities is compiled here and here. I recommend this easy-to-understand 990 guide by Ronald Campbell, but it’s in Word .doc format – Google Docs can open it though.

Of course the financial criteria do not address the subjective, ideological importance a charity to you. That means organizations with high administrative costs may in your eyes still be “Worth it.” Or not – for example, the Salvation Army has an excellent financial rating, but it has been subject to criticism from sex workers and LGBT advocates. So there’s more to think about than money.

Protip: Usually you can use the IRS’s search pages, to confirm that donations to organizations are in fact tax-deductible by using the Search for Charities tool. Alternate searches for financial records can be conducted at Guidestar and Foundation Center. However, according to the IRS’s site, small tax-exempt organizations with revenues below a minimum thresh hold (Between $50,000 or $25,000, depending on the year,) don’t need to file a regular tax return. Such small organizations can report in using an e-postcard instead. And the IRS search function to look for 990-N e-postcard organizations is located here.
It can be a little tricky to find some organizations since the DBA (“Doing business as” – how you know an organization) names might be different from the name on their official tax return. Bitch Media’s official name is “B Word Worldwide.” And to make matters more complicated, some nonprofit orgs accept tax-deductible contributions through a loophole via a pass-through.  In order to make a tax-deductible donation to sex education site Scarleteen, you have to go through the Center for Sex and Culture. (You can donate any amount at any time – but you can’t necessarily deduct the amount at year end unless you do it a specific way.) UPDATE 1/3/11: Heather Corinna stopped by (*excited gasp*) and pointed out that you can make tax-deductible donations to Scarleteen through the NetworkforGood nonprofit organization.

Speadking of Bitch Media! Let’s start off with this feminist organization as an example. You’ll find that there’s a lot of jumping around to do when you look at a tax return.

The most recent tax return is from 2009. Here’s some highlights about how Bitch did that year: I’m seeing negative income (loss, so their expenses were greater than income) for the year – which can happen when you run a non-profit – and negative assets. Non-profits place a higher priority on goals other than making “Profit,” so losses can happen from time to time. But according to the tax professional I quoted earlier in this post, ultimately nonprofits still have to run like a business… I’ve seen nonprofits collapse for financial reasons.

Next up are some yes/no disclosure questions. When I do a quick rundown of this part of the return, I look for check marks that don’t line up with everything else – a “Yes” where most other answers are “No.” For Bitch’s return, I find most of the answers to yes/no questions in the return to be mundane, except for one indicating that a loan to a major stakeholder was outstanding at year end. We can learn more about this loan by jumping to Schedule L, which indicates about $5k remained to be paid back by Lisa Jervis – she’s the founding editor of Bitch.

Parts VIII, IX, and X break out the yearly revenue, expenses & balance sheet by category. Basically, most of the 2009 revenue came from “Other sources” and sales of inventory (magazines?) The revenues in Part VIII Column B & C add up to the $117,386 listed back in Section III as revenue toward Bitch’s goal – analyzing pop culture from a feminist perspective. The biggest expenses (Part IX) were labor related, and about half of their expenses (Column B) went most directly towards Bitch’s mission statement (for tax purposes anyway.)
(FYI I’m not using shorthand for ‘section,’ ‘part,’ or ‘schedule’ – these all have unique meanings and locations so don’t mix ‘em up.)

Turning towards women’s health, here’s a copy of the Boston Women’s Health Book Collective’s (AKA Our Bodies, Ourselves) 990 for 2009.

What I find most interesting about this return is that, between 2008 and 2009, the amount of net income this non-profit earned netted to almost zero. There was a loss one year and a profit the next. The net income between the two years was ever so slightly negative – something like a loss of -$1660+ total. Interestingly, OBOS lobbied for political activity, as described in Schedule C, $1400 worth of lobbying. Most of their revenue came from “Other sources” and royalties (books?) Most of their expenses were program-related and again, labor-related costs made up the biggest chunk of expenses. If we jump down to Schedule A, we can drill down farther and see that the revenue from “Other sources” came from the public. Schedule F is included, and it lists the value of activities outside of the US.

Readers with vulvar pain problems may be interested in the National Vulvodynia Association’s tax return for 2009. Here’s some highlights of how the NVA did:

The organization had net income (“Profit,” if we were talking about a business,) of a little over $100k for 2009. One interesting response to a yes or no question is that, we see that under part VI (page 6) that there’s a familial or business relationship between at least two of the key stakeholders. A disclosure like that can indicate a potential conflict of interest, so it’s something to keep in mind as a donor. If we drill down to schedule O, we can see that the board president & treasurer are married. Part VII lists out compensation to officers & directors – with this return, we can see that executive director Christin Veasley (you may recognize her name from the website and from interviews, etc.) received about $50k for the year for her work with the NVA.

The NVA generated most of its revenue (almost $300k) from “Other sources,” which means the public at large – and over $50k from investment income, with another $20k from selling assets. The balance sheet shows that the organization holds over $1 million in investments. The NVA’s 2009 tax return lists limited fundraiser expenses. The NVA funds grants for research & treatment of vulvar pain. Labor and grant allocation were the largest expenses – the NVA distributed about $75k worth of grants. Schedule F & I break out where the research grants went – about $50k (doled out over 6 grants to medical and educational facilities) stayed within the US, and $25k (2 grants) went abroad. There are printing, internet, mailing and publishing related expenses broken out as well – keep in mind the NVA maintains a website and produces pamphlets & guides, etc. for patients & doctors. So per Column B of Part IX, most of their operational expenses were related to the NVA’s mission statement.

At this point, I would like very much to show you all the tax records for the New View Campaign, a feminist nonprofit organization dedicated to spreading the social construction view of sexual dysfunction and combatting the medicalization of sex. After all, Dr. Petra Boynton has recommended directing donations to the organization for the last two years. However I can’t find their records on Foundation Center, GuideStar, or on in New York’s state’s registry of corporations (including nonprofits) and businesses. I can’t find the group listed in the IRS charity database. I’m both fascinated and frustrated that I’m having difficulty confirming the organization’s tax-exempt status. It’s not just that I can’t see the 990 document – nonprofits are not obligated to make the forms available online - it’s that I can’t confirm the group’s exemption using the IRS’s publication 78 database.

I’m stumped, however the lack of confirmation doesn’t necessarily mean anything. The New View Campaign could be operating under a different DBA name. The most likely scenario is that the tax stuff isn’t readily available because the revenues are small (I’m comfortable estimating under $25k/year,) and that if I just ask politely, a representative from the group would be happy to send me the New View Campaign’s public tax records. I may yet do something like that – we can always swing back around to analyze the records later.

In conclusion, I hope I have provided readers with some tools about how to follow the money trail at non profit organizations, how much cash you’re willing and able to provide to charities, and what charities make the most efficient use of funds. Keep in mind that there’s limits to the information though, and it can be hard to find this information in the first place if you don’t know where or how to look. Understanding nonprofit finance isn’t easy, and the tax froms can’t tell you everything, but sometimes you can quickly find interesting answers to burning questions.

As for other blogging news – every blog and their grandmother is posting 2011 retrospectives in light of the new year! Expect to see mine, listing 2011′s don’t-miss posts from this blog, later this month.

I’ve been searching for the right agony aunt for years. It shouldn’t be too hard, since advice columnists are a staple feature of most major news outlets and magazines. Even smaller media outlets and blogs recruit advice columnists to generate new content.
Besides, sooner or later, just about everyone goes through a period where they believe they are equipped to start giving advice, so some folks take the “Dear so-and-so,” mantle upon themselves, without solicitation.

Perhaps I should put an ad in the paper – “Single (not really) white female seeks competent sex, relationship and general life advice columnist. Must maintain a predictable schedule, be open minded, patient yet firm, and be knowledgable on every topic addressed… Must never screw up.”

Part of my problem is timing and schedules. I liked the Feministing.com column, Ask Professor Foxy when it was still active, but the eponymous Prof. Foxy hasn’t written a new Q&A column for the site in about a year. Good Vibrations Magazine occasionally answers reader submitted questions in the feature, GV Housecalls, but this feature is irregular. There can be weeks or months between new columns.

I believe that folks gravitate towards the advice they want to hear. So how open-minded your agony aunt is, is likely a function of how open-minded the advice seeker is. In other words, if you value spiritual guidance, you probably wouldn’t reach out to a secular agony aunt for relationship advice. You’d probably look for an advice columnist with a spiritual bent instead. “Dr.” Laura Schlessinger is one such spiritual agony aunt, but for multiple reasons her programs, which include racist rants, repulse me.
With regard to advice columnists in general though, that desire for certain types of advice means different agony aunts will attract certain types of audiences. I’m sure that agony aunts figure out their target demographics. Advice columnists then hone their responses to better meet their readers’ expectations.

Advice columnists specialize in certain areas too. Although one agony aunt responded to every submitted query, I think this is an absolutely terrible idea. The sheer amount of research required to give yourself a crash course before answering curveball questions would draw time away from more relevant queries. I wouldn’t ask a self-described expert on cooking about when it’s appropriate to move out-of-state. (I might ask a financial advice columnist though.)

And so much advice-giving is really permission granting. I notice that the way questions are written offer clues as to what the the submitter already perceives to be true – submitters want confirmation from someone perceived as an authority figure. I remember reading an article about the real Erin Brockovich a number of years ago, in which she described talking to herself when facing dilemmas. (An Amazon review of her book provides backup that Brockovich does indeed describe talking to herself.) I think a lot of advice seekers could similarly find the answer they seek by looking within and confronting themselves.

Frankly I’m not even fond of the direct question-and-answer format of advice columns. With Q&A columns, there’s no way to get all the relevant information required to make an informed decision on behalf of the submitter. Printed letters have to be edited for space, too, which can be even more confusing for readers.
An example of a format I especially want to avoid though, can be found in Wayne & Tamara’s column. The authors usually respond to questions with unrelated stories, with the advice buried in parables. I love it and I hate it all at the same time – the responses can be so cryptic it’s funny.
I prefer blogs, since bloggers frequently follow the “Show, don’t tell” principle – though there’s still some telling involved with blogging. Even then, personal stories & experience work well as examples to illustrate a larger point – the personal is political, after all.
But not all bloggers are agony aunts.

So there’s still plenty of popular advice columnists left to consider, right? Maybe not. My last criteria may be unfair, since everybody makes mistakes sooner or later. And what I view as an error, someone else may perceive as a positive feature. (The social justice blogosphere frequently critiques examples of ignorant “Advice.” Feminist & social justice readers probably recognize the problems in this recent gaffe, but if you’ve been swimming in privilege, you may be all like “I don’t get it.”) But when an advice columnist is recommended and has a strong reputation, I expect more. I’ve been disappointed and disgusted by popular columnists, and once I’m disappointed enough I just stop reading. From that point on I’ll be more reluctant to trust the agony aunt and whatever advice zie have to offer. Sometimes advice-givers apologize after getting called out for obvious screwups, but it may be too little, too late… Doubling down on privilege doesn’t help either. For example:

I stopped reading Dear Abby on June 27, 2007 when I saw this Q&A posted. In her response to a 33-year old virgin woman with anxiety over the prospect of her first gynecological exam, Abby wrote in part:

DEAR SCARED: A woman should be seen by a gynecologist if she is sexually active, or if she has reached the age of 18. She should DEFINITELY see one if her regular doctor tells her to — so please start acting like the 33-year-old adult you are and stop listening to “horror stories” from friends. Pap smears are not painful, and women do not normally bleed after having one.

Sounds spot-on, right? Wrong. Pap smears can be painful for some women – Abby’s response makes it sound like anyone who says otherwise must be a drama queen or a liar – instead of someone who may have a treatable medical problem that any competent gyno could make accommodations for.

Abby doubles down and adds insult to injury with the snide implication that “Scared” is acting like an immature child, just like a childish woman who can’t suck it up and deal with it at the gyno’s.

I never got into Dan Savage’s advice series because by the time I found out about him, it was because his reputation had been recently marred – and not for the first time. I know he’s done good things for the gay & lesbian community in particular, notably the “It gets better” project and comically redefining “Santorum,” but I can’t get over his history.

I’m certainly not going to read Dear Prudence, who recently gave some fucked up “Advice” to a gentleman regarding his wife’s prolonged therapy and the lack of sex after marriage… because she had just started therapy to cope with the abuse her father committed on her.
Do I really need to delve into why Prudence’s advice terrifies me? To make matters worse, Prudence’s answer was heard ’round the tubes, so hundreds of folks saw fit to comment on this couple’s sex life. As always, things got real ugly, real fast.The myriad terrible answers to this particular question, unfortunately, are how I know looking for any better advice is ultimately an exercise in futility.

I used to read Carolyn Hax’s advice column (When it was still called Tell me about it,) until I got bored with it. I decided that much of her romantic relationship advice boiled down to “DTMFA,” because it looked to me like relationship problems, minor or major, could be solved with a breakup. In fairness, that is always an option. But her recent advice is pretty good, so maybe I should give Hax another chance.

Then there’s the self-described agony aunts of the Internet – they’re not featured in mainstream media, but they’re still popular (On the internet!) Some of these advisors have qualifications that lend credence to their advice – Ph.D. Degrees, M.S.W. degrees, certificates reflecting formal training, etc. Others are bloggers with no formal training, yet have a wealth of experience to reflect upon. And for a lot of readers, I’m sure the advice in Internet agony columns works out well.

The problem is that when the advice I want or need is sexual in nature, I can’t turn to a lot of agony aunts, even the popular ones. I saw some professors and sex educators recommended by commenters in blog posts on places like Jezebel or Feministe, so I read and have since screened out a few recommended agony aunts who write general observation stuff.

Sometimes the posts are great and well-researched. Other times, they’re as airy & fluffy as cotton – and personally, I would rather not post anything, then inflate my post count with fluff. (Everyone reading this now is thinking to themselves, “Yes, K, we’d all prefer it if you didn’t post too.” Haha.) That quality variation is pretty typical of any writing though, so no big deal.

But when it comes to problems most near & dear to my heart, sexual dysfunction specifically, the recommended agony aunts let me down. Some just vomit up yet another uncritical iteration of the New View’s rhetoric: The problem you describe isn’t an actual problem you are experiencing; it’s just part of being a woman. You can’t take medicine for sexual problems today because in the past women didn’t get a choice and you dishonor their memory. Doctors and Big Pharma are in cahoots to fleece potential patients so you can’t trust the sexual health research out there co-authored by medical doctors and certainly you should never visit one for a sex problem. Wait, you have pain with sex? Go see a doctor.

To be fair, I’ve seen this very blog you are reading get plugged by commenters offsite too. I’m flattered. So what’s the difference between me and professional or amateur agony aunts?
The difference is I have never described myself as an agony aunt. I’ve repeatedly stated, I am not here to give you advice. I prefer to be a general nuisance, presenting evidence in contrast to conventional advice, since the usual advice backfires on me anyway. I may on occasion, when pressed directly, offer up some link or sound byte, but ultimately, I believe that individuals are the only ones who know what’s best for themselves when it comes to personal & health decisions.

That said, there are some bloggers I still look to for advice, though they aren’t necessarily in the business of answering questions. Keep in mind even you may find the following bloggers repulsive, for the same reasons I’ve outlined above! They aren’t always perfect, and I’ve seen some of the below make mistakes too.

People I still find credible most of the time:
Holly of the Pervocracy, Violet Blue, Corey Silverberg, Heather Corinna, the archive of Go Ask Alice!, Matt Kailey

Tier 2 (Generally like but with some reservations,)
Greta Christina, Carol Queen, the Sexademic, Marty Klein.

Readers, have you found a decent agony aunt that might fit the bill for what I’m looking for? Now I want your advice as to who’s good & why.

This nationwide protest is visible activism as part of their recent Vulvanomics media blitz. The clinics in question have not been publicly named to my knowledge – the group communicates on a listserv instead. I haven’t joined it, due to a clause on the New View website that states joining the listserv means you endorse the group’s philosophy & actions. The New View Campaign does not represent my views and does not speak for me.

It is not the first time the group has publicly protested against vulvar modification. The intentions are good – draw attention to unnecessary asthetic procedures, which target women, are expensive and carry health risks. In spite of this, I wasn’t comfortable with it the first time around. And I remain uneasy, because I fear that their activism has the potetial for some unintended negative consequences.

Full disclosure: I may be a bit biased, seeing as I’m someone who actually knows what it’s like to undergo genital surgery, and as someone who actually has FSD.

As the campaign gets underway, I want to contribute to the hard conversation by raising a few questions about this planned event.

- I understand vulvar and general cosmetic surgeries to be a symptom of a larger problem – body snarking & policing, fatphobia, misogyny and racism – rather than THE problem. Take away cosmetic surgeries, and there will still be these underlying problems remaining. An example of this would be Austrailia’s practice of censoring naturally large labia in softcore pornography.
What steps is this current campaign taking to address the systemic, more intangible problems that may motivate permanent surgical changes in the first place?

- One goal of this round of activism is to get the FDA to monitor cosmetic and laser surgeries and require more rigorous research, to be made available to end users (clients.) That way, women can do better research and make informed decisions about what they do with their bodies.
However, I doubt this type of activism will end there. I got a feeling I can answer my own question above: Even if the New View gets exactly what it wants – which would be beneficial to women – the anti-surgery and anti-medicine activism is likely to move on to new targets. Perhaps then the New View will shift its focus to censorship vs. idealized & unrealistic body representations in pornography, etc. All of which is certainly eligible for a social construction critique.
However, since these systemic problems will still remain, and are likely to be the next area for activism, that means even if you read the material and wanted to go through with surgery, you’ll probably still have your decision questioned. It will never stop and there is no way to do a cosmetic surgery correctly, so you’re just going to have to deal with the stigma and shame of doing it wrong anyway.
So, the question is – are there any conditions in which it is socially acceptable for a woman to undergo cosmetic or sexual surgery on the genitals? If so, what are these conditons?

- One approach to address women’s insecurity about the appearance is to embrace vulvar diversity. But what do we mean by vulva diversity? In galleries of what normal vulvas look like, how often do we see vulvas with visible (if subtle) health problems? Does vulva diversity, a celebration of the wide range of normal, include vulvas like mine which, pretty much everyone including Dr. Tiefer, agrees, is in fact not normal? (Remember, when vulvodynia acts up, a lot of gentle and sexual touches will register to the vulva owner as pain.) And does the movement to celebrate vulvar and body diversify embrace those women who have already undergone modification?

- I notice that this campaign refers to cosmetic genital surgeries as FGCS – it’s not explicitly defined on the petition but I’m pretty sure the acronym translates to “Female genital cutting surgery,” with the intent of invoking FGC, aka FGM – female genital mutilation.
Recall that the film Orgasm, Inc. did not hesitate to use the term FGM, even though it carries a degree of stigma – the implication is that, if you’ve undergone FGM, then you are a mutilated mutant. FGC is more sensitive term.
But how does the New View respond to critics who claim there is a difference between FGC and vulvar cosmetic surgeries? Some critics here, for example, claim there is a difference between damaging girls’ genitals against their will & without their consent, vs. trained surgeons operating on women who seek such procedures out.

- During a recent Feministe shitstorm, (not actually that recent in blog-time but still to soon for me,) (Google “Feministe ‘don’t do this’ just because I’d prefer to avoid trackback trolls for awhile longer,) several commenters deflected questions about medically necessary genital surgeries. The idea seems to be that medically necessary procedures are exempt from critique. That’s different – and I still don’t understand why.
- So how are we defining medically necessary vs. purely asthetic? What criteria is necessary to justify a surgical procedure to a vulva? How do we quantify the amount of discomfort and danger required? How shall we address the intersection of medical, sexual and cosmetic concerns, for example in reconstructive surgery? To that end, were the current surgical facilities subject to the protest screened to ensure that medical patients will not receive unwanted attention?

- Relatedly, some of the New View’s criticisms, and general feminist critique, of cosmetic surgeries include the fact that surgeries hurt, come with health risks, and cost a lot of money. Genital surgeries carry sexual health risks in particular, and the price tag can reach thousands of dollars – just like my medical surgery, which my insurance dicked around about & didn’t reimburse what they were supposed to.
But these concerns – pain, side effects, and cost – are present with medical surgeries as well. So, again, why are medical surgeries, which carry the same risks, not subject to the same critique? (Basically, if cosmetic surgeries are bad because x, y, and z… and I did a surgery that also involved the same x, y, and z… then what makes my situation any more forgivable? Intent? I thought the intent doesn’t matter.)

- During the same recent Feministe shitstorm, I saw a commenter raise concerns about the impact that anti-cosmetic surgery sentiment and activism might have on trans* individuals. Some transsexual women and men undergo top and/or bottom surgery.
Has the New View taken any steps to clarify the difference between GRS and cosmetic surgery? (Of course I suppose transphobes will look for any excuse to be transphobic – and if that means invoking the spectre of cosmetic surgery with all it’s negative implications, – then we’re gonna need a lot more activism to get that to stop.)

In fairness, most of the problematic comments about cosmetic surgery, including genital surgery, is derived from the New View’s work, rather than explicitly stated by representatives of the group. I’ve noticed that in her writing, Dr. Tiefer by and large is very thoughtful about what she puts in print. In contrast on the Feministe post I’m referring to, Jill & co addressed cosmeric surgery as largely an individual provlem, imploring indivduals not to go through with it. Buried in the comments, there was some effort made to address social problems contributing to the spread of this type of surgery… But I had to wade through a whole lot of crap to find it, to the point where I found the thread exhausting. I give up; you win; I disengaged.

The New View has been around for over a decade, stirring up uncomfortable but necessary conversations – and that, in and of itself, isn’t necessarily a bad thing. But its still largely the same organization it was ten years ago, and it really should take some time to examine & reevaluate some areas for improvement, especially with regard to its internalized ableism re: FSD and mental illness.

So, I just hope that on Friday, I don’t run into a protest group outside of an outpatient cosmetic surgery facility just like the one where my medical surgery took place. As much as I’d like to be a punk and counter-protest, (I’d be the one holding the sign that says, “New View doesn’t speak for me / Ask me about my surgically altered vagina”) I know myself well enough to recognize that a group of women protesting vulvar surgeries – by using props of tools like the ones used on me – will probably just set off a massive anxiety attack.

Gather ’round readers and gender studies students (because I know that you’re going to watch this sooner or later for class,) and behold an opposing view of the sexual dysfunction documentary from someone who actually has female sexual dysfunction.

I’m not doing a chapter-by-chapter breakdown of what happens during the film; you can find that elsewhere. Today we’re going to look at problems and places for improvement in the film. Some problematic elements with the fim are intrinsic to the philosophy the director embraced, others are problems of omission: Viewpoints left out, intersectionality not explored, things that should be investigated further.

- Orgasm, Inc.’s alternate title could be, “Sex is not a Natural Act, abridged version.“ If you’re short on time and want to learn about the feminist social construction perspective of sexual dysfunction, then the film will be a time-efficient crash course. To most uninitiated viewers, the film will entertain and present new information. I’ve already heard Orgasm, Inc’s. arguments regarding the history and validity of sexual dysfunction elsewhere, so I spent most of the 80-minute film bored to tears.

What’s the social construction perspective of sexual dysfunction? Basically, everyone’s sexuality is shaped by culture, and sexuality is varied with a wide range of normal. But the deck is stacked against the ladies, due to gender roles, restrictions on reproductive rights and misogyny. Under social construction, what might be called sexual dysfunctions are better identified as sexual problems – understandable, if annoying, responses to crappy circumstances. Most women’s sexual problems are social in origin, (stress) and can be addressed with broad changes – and some individual lifestyle changes. This is all well & good for most women.
Contrast this with the medical model of sex, which sees sexuality as a natural phenomenon, acted out in a fairly rigid series of steps (arousal, plateau, orgasm, resolution.) Problems expressing sex (performance) are viewed as dysfunctions from the norm, stemming from organic imbalances that can be addressed at the individual level – using medicine. But even under the medical model, most people are generally healthy and can perform sex.
No matter how you slice it, most women don’t have sexual dysfunction.

- Who is Orgasm, Inc. for? Who did Canner choose to interview? What audience did Canner have in mind? Whose care is prioritized?

Prominent interviewees include sex educators Kim Airs and Carol Queen, and neuroendocrinology professor Kim Wallen. Most of the interviewees included in the film represented members of the medical industry. On the flip side, Canner spoke with journalist Roy Moynihan and representatives of the New View Campaign, an activist organization which takes a social construction perspective of sexual dysfunction.

Orgasm, Inc. is for most women; the ones without sexual dysfunction. Liz Canner is deeply worried about the well-being of normal, healthy TAB women. Unfortunately the film left me feeling isolated, as one who actually does have and sought treatment for sexual dysfunction. Interviewee Moynihan states, “There’s a lot of money to be made telling healthy people they’re sick,” as recently recognized (if still contentious) diagnoses such as restless leg syndrome and social anxiety disorder scroll across the screen. The concern is that if Big Pharma can create the perception of a disease (that must be addressed,) and develop treatments, then there’s potentially billions of dollars worth of sales to be made. This quote prioritizes protecting the majority from Big Pharma, rather than prioritizing care for the largest minority, especially if we pause to recognize that many medicalized conditions are real – just invisible, and poorly understood.

# of interviews with someone who identifies as having female sexual dysfunction: Unknown. Liz Canner interviewed four non-professional women about their experiences with sexual problems. Of these, only one, Charletta, identified as having “A disease,” referring to FSD. Upon learning that most women require clitoral stimulation to reach orgasm during intercourse, she changed her mind and decided she was normal after all.
The film juxtaposes Charletta’s interviews with commentary about how most women reach orgasm, with the implication that Charletta never had FSD to begin with. Canner comments, “Charletta was enrolled in a study for women with FSD, despite the fact that she was healthy.” Yet clearly, Charletta identified as having FSD at one point and was upset about it – after all, no one wants to be considered diseased, right? Disease and mental illness and disability are bad things to have!
And then, she dropped it from her identity.
I won’t speculate as to her status. Rather, it is my firm belief that a valid alternative way to address the stigma & distress Charletta felt from identifying as having sexual dysfunction, is to recognize that it’s okay to have sexual dysfunction. Stigma need not be intrinsic to sexual dysfunction, it comes from outside sources. From where? Well, I’m not the only one who notices that there’s quite a lot of limp and small dick jokes in the media – a social force rather than medical.

It may be worth noting that during an interview with the founder of the pharmaceutical company Vivus, Virgil Place said he created the company after developing erectile dysfunction after undergoing a radical prostatectomy for cancer. This may be the only other person included in the film who openly identified as having sexual dysfunction – of the male variety.

So, why choose Charletta? Critically, she was one of 11 patients in a test of Dr. Stuart Meloy’s sensationally-(and un-originally)-named Orgasmatron. It’s surgically installed hardware that sends sends electricity through the body, with the goal of inducing orgasm. It reminds me of a TENS machine for pain management, though more invasive. This makes sense, because the device was originally designed for chronic pain patients and sexual stimulation was a side effect. Furthermore, the risks associated with surgical implantation of the Orgasmatron are derived from the Safety Information sheet about using Neurostimulation Systems for pain management. (The director makes no comment as to what decisions chronic pain patients should make when considering electronic stimulation for pain management.) Since installing the Orgasmatron involves surgery and potentially serious side effects, it’s an extreme measure. Nonetheless I can still see a potential application for some interested patients.

It took surgeons twice as long to install the Orgasmatron into Charletta’s spine as it did with other patients, and then it did not work as intended. She had to have it removed.

So what happened to the other 10 patients?
According to Dr. Meloy, the device stimulated 8 of 9 patients, or 10 of 11 patients (I don’t know why two figures are cited.) 6 of the women in the study kept the electrodes in. And “It worked” (Meaning it induced orgasm?) in 4 of those 6 patients.
So why don’t we get to hear the first-person accounts of these women? What’s going on with them? Unfortunately we’re not likely to find out any time soon, as I have yet to find Meloy’s peer-reviewed primary source journal study.

- # of times we learn about dyspareunia/sexual pain/chronic pelvic pain: 0.
Even though Dr. Leonore Tiefer has stated that dyspareunia is the only valid & important female sexual dysfunction, (a problematic statement with which I disagree,) Orgasm, Inc. doesn’t talk about it. How painful sex fits in with the critique of sexual dysfunction and pharmacological treatments (often off-label) broadly remains unknown. The film addresses pleasure, orgasm and arousal, but not pain, and certainly not other overlooked sexual problems. It’s another cop-out.

- Orgasm, Inc. criticizes the famous and questionable statistic that 43% of US (cis, I presume) women have some form of female sexual dysfunction. Even I agree that number is overestimated. But there was a subsequent 2009 study that included “Personal distress” as a criteria for sexual dysfunction, and using this modifier, the statistic revised downward, to some 12% of the US female population having a form of sexual dysfunction. And that’s only if we completely exclude dyspareunia from the definition of FSD! I still wonder whether the raw numbers really matter – if only 12% of the population experiences FSD, is that small enough to make it real?
In fairness, Canner did most of her filming prior to 2009. The new study came out too late for the filming, but could have been included with the DVD extras, which include documents through 2010.

The film’s coverage of genital surgeries is brief, but that 5-10 minutes encapsulates serious feminist critique. I never know how to address this topic, because I went through vulvovaginal surgery. And although I’m ambivalent about cosmetic surgeries, I hate the way almost all discussions about it go – including Orgasm Inc’s. 
The film makes no commentary on genital surgeries done for health reasons (cancer, vulvodynia, burns & injuries, etc.) or for bottom surgery for trans* people. Feminist discussions of genital surgeries usually exempt from critique genital surgery done for “Medical reasons,” whatever that means — medical needs are rarely defined. What scares me is there’s this binary, where surgery for medical reasons is “Okay,” and for asthetic reasons is “Not okay.” So what happens if someone undergoes genital surgery for reasons of both looks (or insecurity) and physical well-being – that person is likely to have to prove to an outsider’s satisfaction, that their procedure was in fact medically mandated. Canner focuses exclusively on non-medical surgeries, as a husky voice whispers, “Sex surgeries.”

“Sex surgeries,” eh? Maybe it’s not as medical and acceptable as I thought it was after all. This phrasing presents me with a unique problem, because the vulvar vestibulectomy allows me to have sex – theoretically, anyway; in practice, it’s a bit more complicated. Since I experienced pain, we can probably consider this a “Medical” surgery, but my life was never in any direct danger. VVS was not going to kill me, though it did depress me and send me into a dark place Idon’treallywanttotalkaboutrightnow. Theoretically, if I never attempted vaginal insertion of objects ever again until the day I die, then I might have been able to go my whole life with minimal discomfort. So since I could have made some lifestyle modifications instead, were my reasons for surgery still medical enough? Or is what I had just another sensational “Sex surgery,” yet another form of FGC?

Canner cites an editorial in the BMJ comparing cosmetic genital surgeries to female genital mutilation, and like many peer-reviewed articles & editorials, it generated critical responses. Responses brought up the difference between genital cutting forced upon young girls without their consent, whereas plastic surgeries are actively sought out by consenting clients. Other responses raised concerns that the comparison draws attention away from FGC globally.

That’s all I’ll say about the film’s coverage of genital surgeries for now. Although I’d like to talk more about surgery, I don’t even feel comfortable getting into my own experience on this blog.

- The critiques of sexual medicine apply to the medical industry broadly. Of course a movie about medicine and sexual dysfunction focused only on sexual medicine. However, most of the critiques about Big Pharma’s involvement in shaping medicine apply to the field broadly.
Canner et al address problems inherent in the growth of modern medicine, including a for-profit motivation, direct-to-consumer marketing, defining what it means to be sick and well, and financial conflicts of interest between doctors/researchers & pharmaceutical companies. I noticed that Vivus staff talked about the influence of stock market speculation as a driving force behind drug development, which in light of the current US recession & Occupy Wall Street protests and who is most likely to actually have stock in the first place, makes me go “Hmmm.” These are systemic problems, inherent in Big Medicine itself. As such, it’s going to take systemic changes to the healthcare industry in order to rein in corporate greed and improve patient health.
It becomes a delicate balancing act though, when we recognize that these systemic changes have to occur in such a way as to minimize harm to current and future patients who need and benefit from medical interventions. We can’t outright kill Big Pharma without there being casualties at the individual level. Canner’s DVD extras link to a few organizations that viewers can get involved with in order to critique Big Pharma, however, I myself am not comfortable with the tactics employed by one of the most vocal activist groups.

- Orgasm, Inc. does not address the stigmatization of sexual dysfunction, a stigmatization which regrettably the film contributes to.
I am constantly dismayed when I see arguments against the validity of sexual dysfunction broadly get used at the individual level to invalidate women’s experiences with sexual problems – to jeer, to crack jokes, to partner-blame. I fear that a woman who identifies as having sexual dysfunction won’t 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 other than my own. This already happens.

If you seek medical treatment for sexual or other health problems, then you are doing something bad and wrong. This is made abundantly clear with Orgasm, Inc’s. theme song lyrics, “Sex Pill! I need those poisons baby!” and when interviewee Kim Airs explicitly states, “The whole thing with taking drugs, for this or that, my belief is, living for [or 'we live in?' Didn't quite catch that - K] a drug-free America. I mean, don’t take drugs!”

Is this really the ideal America to strive for? The US war on illegal drugs reveals that enforcement disproportionately targets people of color. It also holds back potential treatments for some disabilities, leading a few states to legalize marjiuana. Patients with prescription drugs can get legally and medically busted, too. Legal use of prescription drugs for this (depression?) or for that (chronic pain?) is already sneered at by many (including some folks in my own family) with dangerous consequences to those who need the meds. (She didn’t say what this or that is.) So now we have people with chronic pain conditons who have to jump through hoops & present themselves “Correctly,” in order to not appear as a junkie. So some folks have to live in a drug-free America whether that’s what they need or not.

Some interesting areas for discussion were not explored; perhaps a budding documentarian is reading this and will run with it. The film does not talk about sexual dysfunction treatments + insurance. In the United States, there is an ongoing healthcare financial crisis. Millions of Americans – the figures range between 44 million to almost 60 million – are without health insurance, or spent at least part of the last year doing without. Recent news tells us that those who do have health insurance face increased out-of-pocket costs. Meanwhile, government safety nets for the poor are seeing their budgets cut. So there’s no word on folks who may consider themselves to have sexual dysfunction, but who cannot afford to seek treatment. This is something I’m facing right now, as I need to go get physical therapy again and can’t afford to pay for the deductible.

So if you can’t afford medical treatment, then that’s good, right? Now you must focus on non-medical interventions, which have fewer side effects. Hold that thought – remember that it is possible to seek non-medical intervention for sexual dysfunctions, such as talk therapy with a licensed sex therapist or psychologist, and to have such costs be partly covered by insurance. The blogger Minority Report has written about taking this route, and she’s done some math. Talk therapy can become pricey, and even sex therapists themselves express disappointment with the outcomes. I have no doubt that there’s a connection between deregulation and the privatization of healthcare (insurance,) but I do doubt that I can explain it here. (That hasn’t stopped me from trying, though.)

Orgasm, Inc. final thoughts:

- Do you still want me to do a play-by-play review?
- Do any regular readers here want to write a review as well? Maybe you saw it and just <3 it idk
- So basically, we have a movie here about FSD, with either minimal or zero representation of folks who actually have FSD (depending on how we look at Charletta.) We have an old guy with ED and one lady who decided she’s totally fine in the end.
- I’m hearing people talk for me, but not using an accurate reflection of my own voice.
- How much unchecked privilege do you have, that you can protest the very existence of a health problem, with no room for any exceptions, when there are people going, “Hey, I think something is going on over here I need medical help with”???
- I am still not convinced that FSD is an invention created by Big Pharma, nor that there is no place for pharmacological options for sexual problems.
- I am still wary of the social construction model of sexual problems.
- I am still wary, because it’s supposed to address weaknesses in the medical model, but it has its own fucked up weaknesses and all it does is fuck up in new ways. Like it tries to address blanket statements in the medical model, but then it just creates new blanket statements.
- I am certain that viewers will approach this blog to ‘splain to me how the film opened their eyes and how I still don’t know what I’m talking about, because I’m not looking at this ~objectively or something.

It wasn’t all bad. It’s definitely a movie. And I agree with some points in the film, and there’s parts that I appreciate Canner including, like the part where we hear an anonymous woman talk about negative side effects she experienced after her genital surgery. (What, am I supposed to say it’s totally risk-free and problems never happen and la-de-dah? If anything I know full well complicatons can result.) I know sex education matters, I know an equitable division of labor matters in couples (though where that leaves the single ladies who just miss masturbating remains unclear to me,) I know Big Pharma is motivated by profits. I know most women never have to deal with this shit, I know drugs cost money and have side effects, etc. etc. etc., Reganomics. I am fully aware of all this. But a lot of people love this film unconditionally – so why I am I still seeing some flaws. Was it overrated? Yes, at least I thought so. It still wasn’t enough to convince me to go over to the other side.

The above quote comes from the person responsible for setting off the 2005 sexology debate about how doctors should address dyspareunia (painful sex,) and it succinctly reflects my own frustration with the field of sexology.

Recently, I have directed reader attention to a debate that took place amongst doctors and other professionals tasked with treating sexual pain problems. The debate started when Dr. Yitzchak M. Binik wrote in to the peer-reviewed journal of the International Academy of Sex Research, Archives of Sexual Behavior, on whether dyspareunia should be viewed primarily as a pain problem or as a sex problem. To catch up with this blog’s review of the debate, read part 1 here, part 2 there, and part 3 last.

Dr. Binik’s original article outlined his position that sexual pain is best classified as a pain condition under the DSM-IV-TR criteria. Currently it remains classified as a sexual dysfunction, though the soon-to-be-released DSM-V will likely change the name and the definition.

Dr. Binik’s publication in the Archives received 20 responses, expressing varying levels of support. I did not read all 20 of the responses he received. In parts 2 and 3 of this blog’s dyspareunia-as-pain series, I zeroed in on Dr. Leonore Tiefer’s fascinating and contradictory response, because I’m already familiar with the rest of her work with regards to sexual dysfunction.

Dr. Binik reviewed each response to his original article, and finally addressed them in a sequel, Dyspareunia Looks Sexy on First But How Much Pain Will It Take for It to Score? A Reply to My Critics Concerning the DSM Classification of Dyspareunia as a Sexual Dysfunction. Now this is another article behind an academic firewall, so most readers can’t see the full text. In the interests of spreading knowledge about sexual dysfunction, I can only provide an executive summary.

The first thing that jumps out at me in reading Dr. Binik’s final answer is that, this article is almost intolerable.
Basically, Dr. Binik says that he was late in getting back to everyone who replied to his original article because he was distracted by baseball season. I find it ironic that, in light of the continuing debate among sexologists about the appropriate use of the term “Sex addiction,” here Dr. Binik flippantly refers to his interest as “my baseball addiction” (63.) My amusement eventually gave way to groans of annoyance with all the sports metaphors and puns strung throughout the rest of the article. Clearly, Dr. Binik still had baseball on the brain when he penned this reply. That in no way diminishes the validity of his arguments; it just annoyed me on a personal level.
Remember, there is already a baseball metaphor used in casual conversations about sex – “Bases.” Each base represents an arbitrary milestone in heterosexual sex, where running through all 4 bases means you’ve progressed to hetero, PIV intercourse.
Fortunately, the article is short – about 4 pages, as opposed to the original 10+, so I didn’t have to put up with the sports jargon for long.

Dr. Binik acknowledges that his original article met with mixed reviews from his colleagues & peers. For the most part, Dr. Binik’s assertion that sexual pain should be reclassified as a DSM-approved pain condition did not go over well. Three respondents endorsed Dr. Binik’s original position that sexual dysfunction should be reclassified as a DSM-approved pain problem. Five vehemently opposed the change. Nine responses agreed with part of what Dr. Binik said, but not everything. And three didn’t really address the question at all (63). You can find publication details about the 20 responses here. PubMed does not provide full text or abstracts for any of them, but I have GOOD NEWS, everyone! Today I found a compilation of all of the responses to Binik’s article on Ohio State University’s website! If you’ve got hours of free time, you can read and analyze each individual response, spanning some 40 pages! Except for the response we’re looking at today.

Dr. Binik interprets the disagreements as stemming from four basic positions:

(1) I overgeneralized from one typ eof dyspareunia – vulvar vestibulitis syndrome (VVS); (2) my reclassification strategy for dyspareunia was of dubious clinical utility; (3) I did not recognize that dyspareunia really is a sexual dysfunction; and (4) I confused symptom and mechanism in my discussion of classification (63).

Dr. Binik did not deny focusing exclusively on VVS, even though it is not the only type of pain one can experience during sexual activity (63). It is, however, the best researched type of sexual pain, and the research on it provided the most support to Dr. Binik’s position (64). He talks about how post-menopausal dryness & vaginal atrophy may be another sexual pain – except for the part where, due to lack of systemic research on the topic, he isn’t convinced that these problems can account for dyspareunia (64).

To the criticisms that reclassification (moving dyspareunia from sexual dysfunction to pain condition,) wouldn’t solve any problems, Binik responds that the outcome results couldn’t possibly worse than they are now. Some critics pointed out that both the sexual dysfunction and pain condition categories in the DSM-IV-TR both have problematic elements (64). What those problematic elements are, is not discussed in this particular article; we need to examine the primary source responses in question for supporting details. Dr. Binik, however, contends (perhaps somewhat blithely,) that if professionals fix the problems inherent with the DSM pain classification, then sexual pain would fit in with that category (64). And with regards to concerns that pain clinics may not be prepared to handle sexual complaints, Dr. Binik says,

Several commentators (e.g., Carpenter and Anderson, Strassberg) implied that the sexual concerns of women with dyspareunia might get ignored if they go to pain clinics. I think they underestimate clinicians/researchers, such as Masheb and Richman, who work at such multidisciplinary clincs and are very sensitive to sexual issues. It is no more difficult for professionals at a pain clinic to learn about sex than for sexologists to learn about pain (65, emphasis mine.)

In that case, my fellow folks with sexual pain, we are fucked! And not in the good, clean fun way; I mean, I am so completely frustrated with how poorly some notable sexologists handle sexual pain! If I have to look to sexologists as an example of how professional disciplines handle overlapping issues, then I am hopeless that pain professionals could possibly do any better with sex! I have seen sexologists and popular sex bloggers online who write about dyspareunia, and the extent of their writing is, “Refer to your doctor.” That’s it; that’s the extent of their learning, to this day in 2011. Since there are still sexologists who can’t be bothered to learn about the intricacies of sexual pain, I remain unimpressed. So given sexology’s poor track record of handling dyspareunia, why should I believe a pain doctor could do any better at handling sexual problems?

[Description: Carl - a heavy, hairy white guy from Aqua Teen Hunger Force - looking exasperated and doing a Facepalm. Wearing a white tank top and tacky gold chain.]

Moving on, other commentators maintained that sexual pain is and should continue to be recognized as a sexual dysfunction. This was Dr. Tiefer’s surprising, contradictory argument. However, when Dr. Binik explicitly addressed Dr. Tiefer’s response directly, he clearly missed her point.
See, Dr. Tiefer’s whole schtick is that sexual dysfunction is an artificial construct designed to benefit the medical industry, Big Pharma in particular. The New View Campaign’s social construction perspective dictates that most sexual problems stem from social problems and can be addressed through broad, non-medical interventions. But Dr. Binik clearly is not familiar with The New View or with Dr. Tiefer’s work, because he said,

For example, Tiefer argued that “dyspareunia is the only true sexual dysfunction,” because “…sexual problems [are best defined] as discontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience.” (p. XX). While I have some sympathy for this definition, it is too broad since everything that intereferes with sex (e.g., watching too many baseball games?) becomes a sexual dysfunction (65).

Wait, what the f—?! Gaaah!!! That’s not what she said! She never said that! That’s the opposite of what Dr. Tiefer’s been saying for ten years!!! I cannot believe — I can’t deal with this shit! The right hand doesn’t know what the left is doing!

[Description: Captain Jean Luc-Picard, a bald white guy from Star Trek, doing the Facepalm.jpg thing. From Know Your Meme.]

One area where Dr. Binik and Dr. Tiefer agree, is that the current classification of sexual dysfunction in the DSM-IV-TR is so problematic that it probably needs to be scrapped entirely and done over – and this is, apparently, one of the reasons why Dr. Binik wants dyspareunia moved out in the first place (65).

The last main argument against Dr. Binik’s reclassification scheme is the one I’m having the most difficulty understanding. Some commentators questioned whether Dr. Binik was endorsing a classification scheme based on symptoms or one based on mechanisms (the underlying causes of pain, like inflammation.) Dr. Binik clarifies that he doesn’t like symptom-based classification schemes, but we’re pretty much stuck with that until researchers figure out what the mechanisms behind sexual pain actually are (66).

Dr. Binik then responded briefly to a few additional criticisms of his original article, like the fact that he left vaginismus out of the discussion (an oversight he didn’t want to make but felt obligated to do since vaginismus is treated differently in the DSM for some reason) (66). Binik actually retracts one of his arguments in favor of moving dyspareunia over from sex to pain. Initially, Binik suggested research funding as one of the reasons he supported making the switch, thinking that pain research is easier to fund since it’s less controversial than sex research. He was called out for this claim by Black and Grazziotin (66).

In the end, Dr. Binik was not convinced by the respondents that sexual pain is best left as a sexual dysfunction. He is glad to have started the conversation though, and it’s possible that this discussion did play a role in the changes to dyspareunia as described by the DSM-V. Unfortunately, Dr. Binik uses a baseball metaphor with a double-entendre to conclude his article with an expression of gratitude with participants in the conversation,

“It is clear that my article did not hit a home run; however, dyspareunia is looking sexy enough to have finally gotten to first base. I think it will finally score in the major leagues” (66.)

He means his article wasn’t met with the adulation and acceptance he was expecting. This is an awkward way to put it though, considering that dyspareunia, in my experience, is the opposite of sexy and here again all I can think of is the sexual double entendre of baseball metaphors. Either I have a dirty mind or else Dr. Binik overlooked the phrase and how it might interfere with a serious discussion of sexual pain.

So what did we learn from this debate? Here’s what I learned:

If there’s only one lesson I want readers to take home, it is encapsulated in the opening quote to this post. Getting professionals involved in sexual research and medicine to agree on a definition of sexual dysfunction is like trying to herd cats. (Not to mention the fact that many professionals have neglected to involve their own patients’ feedback in the discussion – hint, hint!) We have an arbitrary definition spelled out by the well-known APA’s DSM, but in practice it’s more of a guideline than a hard set of rules, and there’s much it overlooks.

Different professionals may not agree with the DSM classification of sexual dysfunction for various reasons, and will come up with independent working definitions instead. These fractured definitons will reflect whatever agenda the professional(s) who developed it wish to spread and capitalize on. Different agendas may make some good points and thus be defensible, even when in direct conflict with one another.

I’ve seen examples of these contradictions illustrated before; One Ph.D. says porn addiction is a real thing that must be stopped, while another Ph.D. says there’s no such thing as sexual addiction, only sexual impulses. If both start sexual counseling clinics that reflect their views, then whose therapy the most appropriate? So in the end, sexual dysfunction remains a white-hot conflagration of controversy and disagreement – Looking at it pragmatically, to rephrase Dr. Binik, sexual dysfunction is whatever anyone wants it to be. You want it to be pain only? Boom, done. Wait, this other person wants sexual dysfunction to include lack of sexual arousal? Bam, here’s a phone number for a clinic you can call for that. Wait, this other person says all sexual dysfunction isn’t real at all? Boosh, here’s a whole lesson plan you can integrate into your gender studies program supporting that position. Even if some professionals manage to come to a stalemate and agree with each other on certain points, on others there will inevitably be disagreement.

I suppose this is the way science is supposed to work. Doctors and researchers are supposed to go back and forth at each other in order to find the correct answers to life’s big questions. It’s all part of the process.

But sometimes when I see these contradictory perspectives of sexual dysfunction, I get so frustrated! Then all I can do is think of the sexologists involved as chasing each other around, re-enacting the Yakety Sax scene from Benny Hill. Then I feel better:

(I couldn’t find the original Benny Hill chase scene in YouTube. Deal with it.)
[Description: Black-and-white chase scenes from Charlie Chaplin silent film, "The Tramp," set to the fast-paced & wacky music, "Yakety Sax." Charlie and co. generally cause mischief and misery to a team of cops trying to catch him and another character. Features running into some kind of fun-house boat with a hall of mirrors; Charlie and another character pretending to be animatronics in order to hide in plain sight from police, messing up a spinney Coney Island-era ride inside of a circus setting and general mayhem.] 

One interesting part of this debate is how it contrasts with the history of sexual dysfunction as presented by Dr. Tiefer in the chapter, “‘Female Sexual Dysfunction’: A New Disorder Invented for Women,” (quotations are hers not mine,) included in the anthology Sex is not a Natural Act. When she reported on sexual dysfunction conferences attended by medical professionals, she made it sound like a bunch of rich doctors all went in, bullshitted with each other, slept in the fanciest hotel suites, maybe bathed in goats milk and children’s tears, had a few drinks, and all agreed unanimously about a common definiton of FSD – a definition conveniently designed to line their own pockets. But instead, here, we’re seeing a much more lively & varied debate unfold.

Meanwhile, patients with sexual problems find varying levels of treatment and in some cases may be blocked from having sexual dysfunction treatments made available to them in the first place, whether that’s for safety reasons or purely political & idealogical ones. But its all in our best interests, right? …Right…?

On the other hand, I’m somewhat relieved that there isn’t a universal accord on sexual pain, precisely because that means there’s still a chance for patients to influence doctors along and get them to listen. But it’s a very slim chance – A notable omission in this debate is the involvement and perspective of patients. It’s possible that some participants in the debate themselves had experience with sexual pain, but judging from the credentials provided by the respondents, they were not answering as lay patients. These doctors talk to each other, but not to us; they talk about us, and that’s something disability advocates in particular have long recognized as a problem. Furthermore, the academic firewall helps reinforce doctors’ various levels of power over patients – I didn’t even know this debate happened until relatively recently. Then, I had difficulty researching it as someone no longer affiliated with an academic institution.

Other lessons include: Although sexual pain does not effect only women, it is still looked at as primarily a women’s issue. The most common reason I’ve seen cited for this is that sexual pain disproportionately impacts women. However, by focusing on women exclusively, professionals are probably hurting men and folks who do not fit onto a gender binary.

But as far as the original question goes: Should dyspareunia be classified as a pain or sex problem? Whether painful sex is best classified as a pain condition or as a sexual dysfunction, there is no final answer. Jury’s still out deliberating. Dr. Binik and commentators made good points defending their opinions, but no one budged from their original positions. There was no argument so logically perfect, it had the power to change minds.
Sorry gang, I don’t have an answer to this question.

I think this calls for some small celebration and a few more pictures on this mostly-text operation. (We especially need some filler right now because I am still working on part 4 Ina blog post series about doctor’s views of sexual pain.) We already have pictures of cupcakes and unicorns here, but there is one very special type of unicorn I neglected to include during my little April Fool’s prank:

[Description: Unicorn pony Rarity leaning into also-unicorn pony Twilight Sparkle. From the MLP:FIM wiki. You can't actually see Rarity's horn in this picture, but it's there.]

Yes that’s right: It’s a Pony post! Deal with it. This blog needs about 20% more Ponies in order to be cool. (Don’t tell me you didn’t see it coming.) Now let’s get this pony stuff out of our systems pronto.

See more on Know Your Meme

[Description: Animated .gif of Twilight Sparkle jumping mid-air and black glasses landing on her face. She talks and text appears saying, "Deal with it."]

As is tradition, let’s take a break from usual serious posting to do some retrospective navel-gazing. (See the first-year anniversary here and last year’s post here.)

2011 has been a quieter year for Feminists with FSD than in previous years, because I didn’t write anything during the summer. We lost some time we could have spent blogging. On the other hand, taking time off gave me a chance to recharge and shed some burnout. I may have to do that again next year.

But even with that break, things are likely to remain quieter around here than they have been in the past – you may have noticed the lack of weekly blog link roundups. My excuse for this is that I still work full-time in a completely unrelated field and receive zero compensation for putting anything up on this blog. I cannot offer compensation to guest posters, because I have nothing to give. And since my commute got a lot worse this year than it has been in the past, I don’t have as much time to blog as I used to. But I keep trying to chug along and plug along as much as I can.

There’s still a lot of stuff left to talk about with regards to the intersection of feminism & female sexual dysfunction. I’ve addressed only a few of the outstanding issues I brought up in last year’s anniversary post. Your undying patience with my snail’s pace at getting new content posted is appreciated.

On the other hand, there are new topics posted now that I hadn’t thought of last year – such as our still-continuing series on how doctors think sexual pain should be addressed – as a pain problem, or as a sex problem? Hmm. So much work left to do… and it needs to be done.

I am 100% confident that there is still a need to present these first-person perspectives on feminism & sexual dysfunction. I’m still finding posts online and in articles written by people who present themselves as experts on sexuality – yet articles about sexual dysfunction still fail to speak for me, or even, to me. So many articles by folks who have never experienced sexual dysfunction firsthand, yet claim to know more about it than I and my friends do. The authors don’t talk to me as an equal deserving of respect and with a mind of my own, capable of making thoughtful decisions on what to do about my health and sex life. Instead, what I’m seeing as someone who actually has sexual dysfunction, is condescension and stereotypes presented as helpful “Advice.”

I don’t know about the rest of you, but most of the advice offered in these contemporary articles about and critical of sexual dysfunction do not address my problems. Instead, the advice presented just adds bullshit onto my growing pile of crap I gotta deal with – and makes it harder for me to slog along way to a satisfactory resolution. I’m thinking to myself right now, Oh look, another so-called “Sexpert” just implied that anyone who even considers using medication to manage a sex problem must be a pill-popping shill incapable of critical thought re: the pharmaceutical industry and potential side effects. What do these journalists think we do? I think they think we all go to a big city with fistfulls of cash and bang on the door of the first corporation we can find, saying, “BIG PHARMA TAKE MY MONEEEEY!!!”

[Description: Stylized unicorn with a gold tiara and rainbow wavy hair Princess Celestia shrugging with this look on her face: >:/]

I think to myself, And look over there, another journalist just explicitly stated that women who don’t have orgasms are holding themselves back because of peer pressure brainwashing by the patriarchy. I can’t believe this is still a thing.

Remember, I am not an Agony Aunt. Most of the time I hate giving out advice, because I can never have a complete story of what’s going on in your life, what you’ve already tried, where you want to be in the future, etc. I don’t want to be the one to give you the wrong advice that winds up causing more problems in the end.
And please, for the love of god, no one ever refer to me as a “Sexpert.”

I will proceed to make one exception to my general guideline about not giving advice though. Here’s something that the sexual dysfunction writers to which I am referring need to know:

Protip: if you yourself do not know what daily life with sexual dysfunction is like, yet you still want to write about female sexual dysfunction, maybe find some women who actually have sexual dysfunction ask for their opinions and experiences first. Having trouble finding women who identify as having sexual dysfunction and who are willing to open up to you about it? Then maybe you should read the archives on this blog for examples of why it’s risky to come out as having a sexual dysfunction in the first place. There is still tremendous stigma attached to it as a diagnosis, whether you’ve got a low libido, pain, or any other seriously distressing sexual problem. Is your blog post or magazine excerpt going to be yet another one of these problematic articles?

So instead of copying the way I see most articles about sexual dysfunction, here’s what I prefer to think when I write stuff for this blog. I start off from these general points of view to serve as guidelines:

People with sexual dysfunction are smart.
People with sexual dysfunctions are capable of making rational decisions about what to do about their health and sex lives.
People with sexual dysfunction have probably already sought advice, are currently seeking advice, or will seek advice in the future. That means that whatever advice you as an individual have for someone with a sex problem, it probably isn’t that new or revolutionary. Whoever you’re writing for has probably seen some iteration of your advice, or will see it again in the future. So that’s why I like to take things in a different direction here – I like to show off stuff that I haven’t seen before, or stuff that I’ve only rarely seen.

It’s a different starting point from how I usually see sexual dysfunction patients handled. Most articles and essays about sexual dysfunction start off from a position where the patients are ignorant, gullible and easily manipulated.

Hmm… No, sir, I don’t like it.

What th— wait a minute! This was supposed to be a pony post! Who let Mr. Horse in here?! Get out of here, Mr. Horse. You’re from a different show.

[Description: Mr. Horse from the Ren & Stimpy show standing on two legs and wearing a gentlemen's coat and tie. Standing in front of an abstract yellow & gray background with a sour look on his expressive face.]

A problem holding me back is that since I am not an Agony Aunt, Sexpert, Ph.D., M.D., M.S.W., or anything other than an ordinary lady with an extraordinary crotch, I still lack something critically important: Credibility. Who is going to listen to a young lady’s views of sex and feminism when she herself has not actually even had any penis-in-vagina activity in over two years, despite being in a long-term heterosexual relationship? Who is going to take seriously a critique of peer-reviewed journal articles, as written by someone with no relevant academic credentials? What publisher would ever take an essay about sex by someone like me seriously? There’s no two-or-three letter acronym before or after my real name, other than the generic “MS.” So although This blog has a decent number of readers – as many as some college classes – I remain painfully insecure about my own perceived illegitimacy. I feel like it doesn’t matter how much research I do or if I do a good job of pointing out flaws in the way people present sexual dysfunction; without something to make me look like I’m important, no one will ever listen.

And that makes me sad.

[Description: Light purple winged unicorn Princess Luna crouching on the ground. She is looking up at something off-screen.]

I suppose the solution to this dilemma is to go back to school to get a two-or-three letter acronym to put in front of or behind my name. Except I already have a Bachelor’s degree in another field, and school costs money. Money and time, which I am also short on. It is a conundrum… Plus, in principle, you shouldn’t need to have professionally recognized credentials in order to talk about what’s going on in your life.

So for some reason I keep on blogging anyway. It’s one of those things where you do it because you have to do it. Not that I’m being compelled by any outside force; just something inside pushing for more. So more comes out – and hopefully, will continue to pour out for the foreseeable future.

Thanks for reading, we shall return to our regularly scheduled non-pony blogging shortly.

In her response to Dr. Binik’s original article, Dr. Tiefer then goes on to acknowledge that dyspareunia is a surprisingly common experience. Dr. Tiefer says that sexual pain is deeply important to the feminist community: 

Beyond womens’ lack of sexual satisfaction or lack of orgasms, the common experience of pain during intercourse or vaginal penetration lies at the heart of the feminist critique of patriarchal sexual relations (e.g., Boston Women’s Health Collective, 1998, pp. 256-257) (51.)

*record scratch sound*

The heart of feminist critique of patriarchal sexual relations?

I think in her citation, Dr. Tiefer is referring to an old version of Our Bodies, Ourselves. That’s The-capital-T Feminist Health Text Book put out every few years by the Boston Women’s Health Collective. It comes in different flavors, like one version for menopause and another for pregnancy, so I’m not certain which OBOS she’s referring to.

But…

Let me put it to you this way: I don’t know what’s on those two pages cited by Dr. Tiefer, because I no longer have a copy of OBOS. During my major life upheaval, I left it behind because it didn’t have anywhere near enough information on sexual pain. I remember about one page on vulvodynia, and there was a little bit about FSD in general - citing Dr. Tiefer’s work, in fact.
I was so disappointed at seeing little about sexual pain relative to chapters about pregnancy, sexuality, abortion, and other human rights issues, that I dumped OBOS. The Boston Women’s Health Collective let me down. I turned to other books, not specifically feminist ones, for more comprehensive information.

I don’t think there’s much support to the claim that vaginal or sexual pain lies at the heart of feminist critiques of patriarchal sex. Perhaps it’s just that feminist perspectives of patriarchial sex are a tiny niche, and so small that I miss them when scanning with my naked eye. After all, I often see feminist critiques of sex and sexuality generally, or I see critiques of patriarchal sex and rape culture that do not explicitly address the existence of unwanted physical pain.

But feminist perspectives on painful sex specifically are hard to find. I seek essays about vaginismus & vulvodynia in feminist-oriented traditional printed media on purpose. I have only just barely scratched the surface of a large feminist library, but it’s still pretty rare for me to find much about dyspareunia.
Online, I recall Twisty Faster’s post about vaginismus from a few years ago as a feminist perspective on patriarchial sex and a painful sexual problem – and even then, her post was more about treatment than about the experience of vaginismus itself. Every once in awhile I’ll find posts about sexual and genital pain on popular feminist sites, and I am eternally grateful when I receive guest posts that address the subject here. But big social justice & feminist sites have to keep up with all the other social-justice news too, and the pain posts get buried after awhile.

So to say that pain with sex or vaginal insertion lies at the heart of feminist critique of patriarchal sex is an exaggeration at best and bullshit at worst. It’s not there, not at the heart. It’s off to the side, maybe; on a good day you can see it poking out. Then it sees its shadow and bolts for another few months before making another appearance.

Anyway, back to the article. Dr. Tiefer then talks about how feminist sexologists have emphasized downplaying the centrality of penis-in-vagina intercourse as the end-all, beat-all form of sex – Dr. Marty Klein wrote an entire book about this, in fact. And then there’s a mention that sexual pain is implicitly (but for some reason not explicitly) covered by the World Association of Sexology’s Declaration of Sexual Rights (51.) For the record, I think the declaration document linked to in Dr. Tiefer’s original response has been updated since 2005. The URL changed to something else sometime in the last few years and the phrase “Sexual pain” does in fact appear in the body of the text (once.)

Towards the end of her response, Dr. Tiefer states that dyspareunia falls under the New View’s definition of a “Sexual problem,” whereas Dr. Binik’s view is that there is no special type of pain that applies only to sexual situations. (For example, in Dr. Binik’s view, vulvar vestibulitis is a primarily a pain problem rather than a sex problem, because you get the same pain during sex as you get during a routine gynecological exam.) According to Dr. Tiefer, even if sexual dysfunction as we know it were to be redefined or dropped from the DSM classification system altogether, pain during sex would still remain primarily a sexual problem that can be looked at from a social construction perspective -

We recommend that professional nomenclature dispense with the idea of norms and deviance… and move to a model wherein sexuality was viewed as a cultural construct and individuals could have various subjective or performance problems. Thus, sexual pain would be like swimming pain or swimming phobia, a problem that a person had with a desired behavior, not with some universal capacity (51, emphasis mine.)

Wait, what? “Swimming pain?” “Swimming phobia?”

Ironically I think comparing sexual pain to swimming pain strengthens Dr. Binik’s argument in favor of reclassifying dyspareunia as a pain condition – is there a special type of pain that kicks in only when swimming? Seriously, I’m asking because I’m not a doctor and I don’t know.

Swimming pain a vague term – are we referring to the pain of a muscle cramp, a broken limb, skin irritation from an over chlorinated pool, or swimmer’s ear? Plus, swimming doesn’t carry around the same gender, consent and relationship issues that sex does. (We could make an argument that swimming does carry performance issues, I suppose, especially when done professionally or in athletic competitions – but even then, I don’t think I’ve ever seen swimming activity stigmatized the same way I’ve seen sexual activity get turned into a problem in and of itself.)

I find the comparison of sexual pain to swimming phobia to be the more problematic half of Dr. Tiefer’s statement. I’ve come a long way from the time when I had a lot of fears and anxiety about sex. Somewhere along the line while puzzling sex out (and maybe while blogging about it,) some of the old fears started to slough & flake off. And at this point, It is no longer the act of sex that I fear. It’s the pain that I have come to expect if I try to engage in sex. So some folks who have experienced painful sex do have, or go on to develop, fear of sexual activity in and of itself. But now, years later, I’m still dealing with dyspareunia over here, not erotophobia or genophobia. I’m concerned that conflating sexual pain with sexual phobia will only complicate getting pain patients the comprehensive treatments they need the most.

Dr. Tiefer’s choice of words here was probably deliberate. This isn’t the first time she has compared avoiding sex and avoiding swimming:

Who’s to say, for example, that absence of interest in sex is abnormal according to the clinical definition? What sickness befalls the person who avoids sex? What disability? Clearly, such a person misses a life experience that some people value very highly and most value at least somewhat, but is avoiding sex “unhealthy” in the same way that avoiding protein is? Avoiding sex seems more akin to avoiding travel or avoiding swimming or avoiding invsetments in anything riskier than savings accounts – it’s not trendy, but it’s not sick, is it? (Sex is not a Natural Act, location 243).

Yet if a patient avoids sex due to dyspareunia, in that case it seems to be acceptable to view the avoidance as part of the sexual dysfunction that is painful sex. This is all very contradictory and confusing to me.

Dr. Tiefer ends her response to Dr. Binik by summarizing her position on the reclassification of dyspareunia: “As long as there are expert-based listings of sexual dysfunctions, we do women a disservice by failing to include pain as one of them,” but ideally she’d prefer to see classifications based on arbitrary norms dropped altogether (51.)

And that’s the way Dr. Tiefer’s response to Dr. Binik ends.

I find it disturbing that in spite of the New View’s probing explorations about how sexual dysfunction is arbitrarily defined in the DSM, in this response Dr. Tiefer felt it appropriate to make an artibrary decision about how to look at dyspareunia. Whereas in the past she has questioned whether or not disorders of desire and orgasm are truly a form of illness or disability, here, she made the unequivocal decision that sexual pain is in fact a sexual dysfunction.

I don’t know what to make of this contrast between Dr. Tiefer’s previous work and this article. Low sexual desire is not a disease… but feeling sexual pain is.
You are not sick if you can’t have an orgasm… but if your crotch hurts, then of course there’s something wrong with you. It’s normal and acceptable to go through periods of low sexual interest, especially if you’re tired… but if sex hurts, then that is not normal.

On the one hand, it makes some sense to me. Statistically, most people do not experience sexual pain – at least, not chronically, and not without some reason. In terms of raw numbers, it certainly is unusual to feel pain with most or every sexual encounter. And for me, personally, after careful consideration I view the pain I have as a sexual dysfunction.

But on the other hand, here I see a one-sided judgement about how normal my experience is, and by extension, how normal I may or may not be. If dyspareunia is recognized as a sexual dysfunction, then that’s an abnormality, isn’t it? So then, am I abnormal too? If so, what exactly am I supposed to do about it? Do I even have to do anything? What does it mean to have a feminist organization ask questions like, “Where are the women” in discussions of sexual dysfunction – and then have one leader of the organization declare what’s going on with women who have a certain type of sexual problem, without their feedback first? Where are the women, indeed – where are the women with sexual dysfunction when the doctors debate back and forth with each other?

When do the women with sexual dysfunction get a say? Dr. Tiefer does not speak for me; and I represent no one but myself.

By focusing on language, there are several dyspareunia issues Dr. Tiefer didn’t address. Practical questions like, if dyspareunia remains a sexual dysfunction, what treatments are appropriate to address it? Given the her criticism of the role of Big Pharma in marketing brand-name medications for other sexual problems, is it acceptable to offer oral pain medication as a treatment for this sexual problem? Or are pain medications and devices for sexual problems to be viewed as yet another tendril of dangerous, Big Bad Pharma? Is it appropriate to look at sexual pain as a relationship problem that exists only when trying to engage in partnered sexual activity, or is it a health problem in and of itself that exists independently of relationship status?

And it’s still not entirely clear to me which class of doctor Dr. Tiefer feels is best suited to handle complaints of sexual pain – If sexual pain is in the DSM, which various health professionals use, then does that make sexual pain a medical problem? Who should address it, medical doctors? Sexologists? Psychologists?

I don’t have the answers to these questions. I’m interested in the answers though, because in the end, I am someone directly effected by the decision makers. Ultimately it’s my health at stake in this debate. The decision of who is best equipped to address sexual pain will impact who I must seek out for assistance, what kind of help I can expect to receive, and how soon I can expect to see results, and how satisfactory results will be measured. It’s not an understatement to say that my future lies in their hands.

The debate about sexual pain didn’t end with Dr. Tiefer’s response, nor did it end with the other 20 or so articles generated by Dr. Binik’s 2005 discussion. Eventually Dr. Binik wrote up a conclusion in which he acknowledged & evaluated each reply. But an evaluation of his final answer on what to do about dyspareunia will have to wait until next time.