Tags: blogging, female sexual dysfunction, Feminism, FSD, news, sexual dysfunction, vulvodynia
2011 has come and finally gone, as have most of the retrospective posts around the rest of the blogosphere. As my time has been worn thin due to real life concerns, I’m only just now able to catch up to everyone else.
[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.
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…
Tags: academia, communication, disability, experts, female sexual dysfunction, FSD, health, language, medicine, pain, psychology, sex, sexual dysfunction, sexual health, vulvar vestibulitis
No one knows what to do with sexual pain.
If you have experienced long term sexual and/or genital pain, you’ve probably seen multiple doctors about it. You may have started with a general practitioner, who referred you to a gynecologist or urologist, who referred you to a sex therapist, who referred you to a pain specialist. There may have even been a dermatologist or psychatrist in there somewhere. And you may have noticed that each of these professions have their own ideas (or lack thereof) about how to best handle the situation. When getting refered to yet another doctor, you’re getting clued into who your current caregiver thinks is likely to have the most knowledge about treatments. (Of course, this assumes you have the health insurance and cash to cover medical treatments.)
But having been through the doctor shuffle already, I have come to the conclusion that no one really knows what to do with sexual pain.
Part of the reason chronic pelvic pain patients get bounced around so much is that, behind the scenes, doctors themselves are still debating how best to handle sexual and genital pain. Are we dealing with a chronic pain syndrome akin to something like back or neck pain? Or are we dealing with something purely sexual? A gynecologist may feel inadequately prepared to deal with long-term genital pain that doesn’t resolve following standard operating procedures. But when the pain takes place mostly during, or most acutely, during sexual activity, a pain specialist may think the problem is purely sexual – and some pain specialists may feel uncomfortable addressing unwanted pain during sex. Sexual dysfunction as we in the US know it is a relatively new and highly controversial area of study. And it will take time for doctors, scientists and philosophers to sort out the defining characteristics and treatments of dysfunction – if indeed such standards can ever be decided. It is the nature of science and medicine to go through revisions and changes.
I just wish these doctors and professionals would make up their minds already about which one of them I’m supposed to go to for treatment.
One such behind-the-scenes debate about the appropriate way to address sexual pain took place in early 2005, when Dr. Yitzchak M. Binik, Ph.D. wrote in to the peer-reviewed journal, Archives of Sexual Behavior. You can view an abstract of Dr. Binik’s piece, Should dyspareunia be retained as a sexual dysfunction in DSM-V? A painful classification decision here. If you want to learn more, you can view the full text on Dr. Binik’s website. (I can’t determine if what we’re going to look at today is considered an editorial piece, a study or a research review.)
So who is this guy? Dr. Binik is the director of Sex & Couple Therapy Service up at McGill University Hospital in Canada. He was one of the contributors to the textbook, Female Sexual Pain Disorders, (wrote the foreword) and he has written many articles about dyspareunia. According to his website, he’s also been involved with research on painful sex – there are three grant-funded projects listed as of 2011. But wait, there’s more – his whole resume is up for perusal.
At the time of Dr. Binik’s submission to the Archives of Sexual Behavior, dyspareunia (painful sex – usually when professionals say it, they mean “Cis-heterosexual intercourse,”) was classified as one of the four female sexual dysfunctions then-recognized by the DSM-IV. (The DSM-IV is the Diagnostic and Statistical Manual of Mental Disorders – basically it establishes guidelines for recognizing and treating various mental illnesses and disabilities. Professionals that rely on the DSM include psychologists and medical doctors. As of today a fifth revision to the manual is pending.) The other three sexual dysfunctions recognized by the text are arousal, libido and orgasm problems. Until then, there was not much debate among professionals who deal with dyspareunia about how appropriate its classification as a sexual dysfunction is.
Dr. Binik set out to challenge the classification of dyspareunia, with the goal of shifting it out of the sexual dysfunctions and into the pain category of mental disorders in the DSM. Reclassification of dyspareunia as a pain disorder instead of a sexual dysfunction would not remove it from the DSM completely – it would just move the problem around and give it a different name, grouping dyspareunia with any other pain while recognizing non-sexual pain in the crotch – such as the pain of a gynecological exam or attempted tampon insertion.
In Binik’s discussion of the history behind the term, “Dyspareunia,” he makes it sound like sexual pain was pretty much just thrown in with the other dysfunctions for lack of any better ideas at the time. But painful sex presents some unique problems compared to the other three sexual dysfunctions – after all, sexual pain frequently bleeds out into non-sexual areas of life. He talks about the differences between pain during sex (an act) vs. arousal or desire dysfunctions (physiological reactions,) and how dyspareunia is a broad term – to Binik, its breadth is a weakness instead of a strength.
There are several sexual dysfunction issues that Binik didn’t explore, and these omissions mean something. He did not challenge or question the existence or appropriateness of the term “Dysfunction” for any other sexual problem. He excluded a discussion of vaginismus, though this may be because vaginismus isn’t technically a dyspaerunia issue in the current DSM for some reason. (I’m not yet 100% clear on what the reason is for vaginismus to sit on it’s own tier of dysfunction; I think the folks behind the DSM fixated on how it prevents vaginal insertion of objects as the main feature, instead of the pain associated with attempts at insertion. This distinction is likely to change with the DSM-V.)
As examples to bolster his reclassification argument, Binik focuses almost exclusively on vulvar vestibulitis (VVS) patients – so he’s talking about people like me. Binik did not talk about dyspaerunia and endometriosis, or dyspareunia and interstitial cystitis, or dyspareunia and cancer. For this discussion, dyspareunia and VVS are used almost interchangeably… even though VVS is not the only cause and kind of painful sex.
I summarize Binik’s main agruments to move dyspareunia out of the sexual dysfuctions and into pain as:
1. Dyspareunia is similar to any other pain in self reports. Genital pain is similar to other pain conditions when visualized using brain scans (pages 14, 16.)
2. There’s more research on pain. “By contrast, there is a relatively large literature onhow pain is represented in the brain (Casey & Bushnell,2000; Talbot et al., 1991).” (page 16.) So there’s more material to work with.
3. Treatment plans for sexual dysfunction don’t usually include pain management. If professionals take a pain perspective of dyspareunia, it opens up more complementary treatment options. That means potentially better outcomes for patients (page 18.)
(Unfortunately, Dr. Binik doesn’t address this – it also means more anxiety about seeking treatment in the first place, since pain management can include oral medications – and certain feminist anti-FSD activists in particular and bootstrapists in general dedicate extensive resources to opposing medication for sexual and health problems. Just think of all those sensationalist news stories about celebrities becoming addicted to pain pills.)
4. Socially, pain is a more dignified, less controversial subject than sex – “Finally, as a seeker of research funding, I have noted that there have been several recent new governmental funding initiatives for pain related to dyspareunia (see National Institute of ChildHealth and Development, 2000). As far as I know, this is not being matched in the sexuality area where funding is constantly under attack” (page 19.) This is an unfortunate reflection of how sexual issues are downplayed and sneered at by the public. It’s just easier to get funding, research and respect if you’re exploring pain than it is if you’re exploring sex.
Judging from the passionate responses included with the same issue of Archives of Sexual Behavior, Binik’s article was quite controversial at the time. There were at least 21 responses, plus however many other e-mails and memos were written up and sent around but didn’t get published. Eventually Binik wrote a follow-up statement in response to professional criticism, which I’d like to look at with you later.
My biggest schtick with Binik’s article and the responses is: I honestly don’t get why this has to be an either/or question.
I’m saying this as a patient: This isn’t a simple either-or issue. Dyspareunia isn’t something that fits neatly into a single box. Try to stick it in the sex box, and the pain stuff will still leak out into every day life. Try to place it exclusively in the pain box, and sexual problems will jump in. You can have pain AND another sexual dysfunction, like problems with arousal or orgasm.
If you ask me, pain in the genitals should be recognized as both a pain and sexual problem. For some patients, it may very well fit neatly into only one category. But whatever professional field is assigned as having the final say on the best way to treat dyspareunia – you need to be prepared to go outside of your own comfort zone, in order to bring me the comfort I need.
Unfortunately my perspective as a patient isn’t given much value. Just the location of publication presents a problem – the insular nature of being part of a peer-reviewed journal itself acts like a firewall to keep out non-professionals and non-academics. Which means ordinary folks probably don’t even get a chance to find out when debates like this happen, and we probably won’t be solicited for feedback. These debates excluded most women with FSD from participating.
It’s a bummer, too, since I got more to say about this article, which I’ll spell out here instead.
A major weakness of Binik’s argument and one that Binik had to address in a later, separate response, is that he did not really consider the sexual part of sexual pain.
Like it or not, pain in the genitals takes on a different meaning than pain in the arm or neck. And no it’s not fair, I think it sucks that it is socially unacceptable to say, “My vulva/penis/clitoris hurts today.” Not that its easy to talk about chronic pain to begin with though! Non-sexual, non-genital pain still gets heaps of stigma and able-bodied folks going, “Deal with it.” But right now, in the US at least, genitals are all tied up with issues of gender, identity and performance. So looking at dyspareunia exclusively as a pain problem won’t address the ways in which pain can impact sexuality. Even if the pain resolves satisfactorily, dyspareunia patients may still have to deal with long-term insecurity and body memories. If other dysfunctions like difficulty or loss of orgasm have gotten tied in with the pain, then those non-painful problems may not resolve at the same time as pain. To ignore the sexual component of genital pain, to the extent that it is present, is inadequate.
ON THE OTHER HAND, for some folks, skipping the sex part and addressing the pain is exactly what’s needed. This was actually more the case for me – what I needed the most when I went through the most intense period of genital pain and treatment wasn’t sex therapy or a better understanding of social construction. Gender roles and patriarchy, as much as they do hinder me in many other ways, did not reach inside of my body and cause my cells to rebel. What I needed most was something to address the physical pain and discomfort.
That urgent need is lessened now, but it’s not completely gone and it will probably never go away completely. So I remain open to medicine in my sex life now and in the future.
Now, of all the people who wrote in, who do you think would have been the most likely to agree that dyspareunia should not be classified as a sexual dysfunction? I’ll give you a hint: After all, sexual dysfunction is a controversial term – part of the resistance against it stems from concern that the medical industry will throw around the term to convince able-bodied women that they have physical problems, thus increasing sales of medications and devices to address it. Who’s to say whether a libido is low in the first place, and how exactly are we supposed to measure such a subjective experience?
So I was shocked, absolutely shocked, to see Dr. Leonore Tiefer, Ph.D., organizer behind The New View Campaign, sex therapist, educator, author and editor, write a negative response to Dr. Binik’s proposition. You may remember Dr. Tiefer from such posts as a 5-part series on Sex is not a Natural Act and A Review of A New View of Women’s Sexuality. You may also recognize her name from prolific writing on feminism, social construction and female sexual dysfunction. Dr. Tiefer is a critic of female sexual dysfunction, particularly the way it is handled by organizers of the DSM and its end-users (the end users being doctors and other professionals.)
So if, in other cases, Dr. Tiefer supports the view that female sexual dysfunction is a myth manufactured by medicine (even if she herself is careful to avoid using that exact phrasing,) then what’s she doing getting involved with the reality of dyspareunia?
To be continued…
Tags: blogging, experts, female sexual dysfunction, Feminism, FSD, introspective, sex education, sexual dysfunction, TMI
It has been far too long since the last post here.
So it seems that the blog took a bit of an unexpected hiatus. Being a feminist/social justice type of blog, I chalk it up to the inevitable, and figure it was bound to happen eventually. Lots of feminist blogs go on breaks for awhile, or disappear entirely, for various reasons. Only a fortunate few can afford to write full time, and even those who can must still attend to the non-financial matters.
I finally got a little burned out, frustrated with speaking out but seemingly never being listened to. In looking over materials for a few recent conferences on sexual dysfunction, and noting who was selected to speak about what topics, I cannot help but feel a bit hopeless.
Yet another variation on a theme, yet another news article with a title like, “Is female sexual dysfunction real? You vote and decide!” “Is sexual dysfunction a made up hoax? News at 11.”
Why is my life up for debate?
More then that though, as I’ve been saying for awhile now, a lot of shit went down in my offline life within the last six months or so. Lots of changes, and the last two or three months were particularly intense, requiring more energy than I originally anticipated. There isn’t always much left of me by the end of a work day.
But some of what I’ve been up to has been worthwhile. Here’s some of the more interesting and relevant activities I’ve been up to while hiding from the internets:
- Got a new computer to work on. There was an adjustment period with the new system.
- Went to a sex education workshop.
– Participated in one of the US Slutwalks.
I’d love to talk about what I saw at both events and my opinions on the execution, however I fear that doing so will give enough details away to narrow down my geographic location(s). Suffice it to say that with Slutwalk in particular, there was some good stuff and some areas that sorely needed improvement; nonetheless I am glad to have participated in such a Walk – if only for the social aspects of it, because I need to get out more.
- I have attempted multiple times to have PIV intercourse with my partner…
…However, in spite of this hands-on experience with sexuality and attending a workshop, and in spite of exposure to sexually educational materials, I still somehow have sexual dysfunction. The additional education did not cure me. I still haven’t been able to have pain-free intercourse in about two and a half years.
Yeah it’s still not happening, the vaginismus is acting up. At least, I *think* it’s mostly vaginismus right now. I’ve been learning how to enjoy digital insertion of small-to-medium objects & fingers into my vagina, but I’m struggling again with anything I consider “Large” – it gets stuck and can feel painful. I can’t quite tell if the pain is muscular or if it’s closer to the surface.
- I am still having bladder problems to the point where I’m starting to worry about repercussions at work. One of my co-workers already asked me, when I got up to use the restroom for the nth time, “Are you okay?” Frankly the answer is “No, not exactly; it’s a long story.” Sooner or later someone is going to pin me down about my bathroom habits and it’s going to be really awkward.
So since I’ve been out of commission for awhile, I missed a lot of stuff in the news and blogosphere, and I cannot hope to ever catch up. We missed out on our chance to make timely commentary on stuff including but not limited to:
Blogging against disablism day!
All of Masturbation month! (May)
Most of Pride month! (June)
Gay marriage in New York state!
US and global politics and media scandals, including but not limited to Anthony Weiner’s weiner! (For better or worse, there’ll be no shortage of political news all the way through 2012.)
On a more serious note, multiple attacks on reproductive rights in the US!
Hearings in California over whether or not pornographic film actors & actresses should have to use barrier protection!
Multiple well-covered internet security breaches!
A slime The DSM-V’s revision draws near!
The Orgasm, Inc. DVD should be available on Netflix now!
But before we get into any of that, my intention remains to write one or two sex product reviews first before getting into much detail with politics & sexual dysfunction related news – if only because after such a long break, I need to flex my writing muscles. And I should try to get a review of Orgasm, Inc. up before September, because you know that it’s going to become a staple of all sexuality and gender study courses.
Unfortunately I need to stretch and flex my writing muscles, because clearly there is still a need for a hands-on perspective of sexual dysfunction.
That there is still a need for such self-advocacy is a disappointment to me.
For you see, there are still some credible professionals, academics and feminist advocates who do not themselves have sexual dysfunction, yet who continue to participate in programs which declare that female sexual dysfunction is an utter fabrication and any efforts to legitimize it as a diagnosis meriting medical intervention (and social acceptance) must be stopped at all costs. Which I interpret as a direct threat, because if sexual dysfunction does not exist, then people with sexual dysfunction – female sexual dysfunction in particular – must not exist.
I am a woman with sexual dysfunction.
The goal is usually something along the lines of stopping the long arm of Big Pharma from tapping into people’s sexual insecurity in order to capitalize on sexual insecurity. Sexual insecurity being a pretty common thing that a lot of people have, short of dysfunction.
The unfortunate consequence, deliberate or not, is that to hear for the millionth time that sexual dysfunction is not real is the millionth erasure of my existence and the validity of my experiences. And I know I’m not the only one who feels this way.
When I read such impassioned speeches rallying against recognition of sexual dysfunction as a health problem, a disorder, a label, it’s like hearing, “Everything you went through and continue to go through is invalid. She doesn’t really have sexual dysfunction, because sexual dysfunction isn’t real. What an utterly useless description for an experience.” Hence me writing a snarky April Fool’s Day post about mythical Unicorns – because apparently I am a mythical beast as well. I don’t exist, and as such clearly I can not speak for myself, because there is no one to speak for.
Do I really have to sit back quietly and let people talk “For” me, even when what they say causes me to feel endless anguish? Do I really have to sit back and not say something back?
So some things changed in the last few months, but others remain the same. The feminist perspective that female sexual dysfunction isn’t a valid thing continues to frustrate me. Remember, my problem is that I have dyspareunia, which has been described by Dr. Tiefer as “The only valid sexual dysfunction and certainly the only important one.” That article continues to disturb me because it throws my friends with non-painful sexual problems under the bus – what they have isn’t valid and therefore it certainly isn’t important. And the contradiction that sexual dysfunction simultaneously does not exist and yet selectively does exist, confounds me to no end.
Thus motivating me to write again.
Now how fast I’ll be able to crank out posts with actual content and not just this fluffy stuff remains to be seen. There’s enough distractions around me so that I’m often doing stuff offline and nowhere near a keyboard. Once again I would like to put out a reminder that I am open to Guest Posts. Check out some of these previous guest posts for examples. (You need to leave a comment with a valid e-mail address to contact me about guest posting, or with any other questions.)