What is this war on women you speak of, and why should I care?

02/16/2012 at 6:02 pm | Posted in Uncategorized | Leave a comment
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You may have noticed that there is a war on women being waged in the United States. It’s not a war (always) fought with weapons and explicit acts of violence (although violence against women is very much alive and well.) It’s not (always) a war confined to a physical area in space (although genuinely terroristic activities can target certain facilities used by women more than others.) It is very much a Cold War, one fought via politics and policies, threats and fears. And like all wars, this one has casualties – women, most obviously, though women are not the only ones to feel the shocks. You don’t have to be a lady to express femininity, and thus to be perceived as womanly – and therefore in need of “Correction.”

So what exactly is this war on women, and what does it mean?

The war on women is big enough so that you have to step far back to really take in its overwhelming scale. The war on women means that in the US, social services used by a whole lot of women are getting scaled and cut back. The war on women means that services related to sexual and reproductive rights in particular are the target of vitriol and budget cuts. Social services broadly include social safety net features like Title X and prenatal care, food assistance, and more.

The most talked about targets in the war on women’s sexual and reproductive healthcare (this week) are Planned Parenthood and contraception in general. When anti-abortion politicians infiltrate women’s health care organizations and then deliberately divert cancer screening funding away from other healthcare services – precisely because that targeted organization provides abortion among other thingsthat’s the war on women in action. When a bunch of old guys get together to whine to Congress about how much they hate contraception and don’t let the people who actually use contraception talk – that’s the war on women in action. When politicians create barriers to care – like when they design & then try to ram through “Personhood” laws and/or laws that require needless medical procedures or waiting periods to obtain legal medical servicesthat’s part of the war on women. It goes on.

Maybe you don’t want to call it the “War on women.” Maybe you are not a woman and so believe this does not apply to you – you’d be surprised. Sexologist Marty Klein and historian Dagmar Herzog address overlapping subjects when they talk about “America’s war on sex.” (In fact, Dr. Klein calls the PP/Komen debacle part of the war on sex here.) I am increasingly convinced that the “War on women” and the “war on sex” are two sides of the same coin. You can’t go after one without simultaneously demonizing the other, and I think resolution will require looking at both.

This war on women (or war on sex, if you prefer,) is basically one part of the exact thing feminist sexologist Dr. Leonore Tiefer is talking about in her work when she says we need to examine the social & cultural forces that negatively impact women’s sexuality and thus lead to sexual problems. There’s a lot more to the social construction model of women’s sexuality (you had to have been there,) but the war on women is part of it.

Remember: The social construction model of sex means that what we “Know” about sex isn’t set in stone – our understanding of sex & sexuality is shaped by our social contexts. Sex doesn’t have an inherent meaning so much as it has whatever meaning you, me, and our peers say it has. Get enough people saying the same thing about sex, women, whatever, and you get a big feedback loop that just feeds itself. By the way – there’s already a feedback loop.
I tend to criticize Dr. Tiefer’s work in particular since she’s recognized as a feminist leader in the social construction model of women’s sexuality and sexual dysfunction, yet her work still can’t be a panacea for all the sexual problems.

You don’t ingest the war on women – an idea, a description, a series of events – like a poison from a tangible cup. It’s a cumulative process, where the little things pile up and subtly alter your opinions & perceptions. In other words, you internalize the negative beliefs you’re constantly exposed to. So credit where credit is due – we’re seeing the social construction model of sex in motion before our very eyes. The war makes it harder to express & find what you want, to the point where if your desires don’t match up with what enough other people say is right, you can be subjected to violence (TRIGGER WARNING).

Social construction has limits and problems of its own. It cannot explain away and treat all the sexual problems. My vulvodynia & vaginismus didn’t spring up in response to any particular slight. Even if this war on women ended tomorrow, I’d still have physical problems lurking in my body. Medical science would still be confounded by my case. Kyriarchy would still be alive & well so we’d still be dealing with other kinds of prejudices & phobias. But it’s there.

I wish I could say that “No one wins when there’s a war against women going on,” but obviously someone’s coming out ahead or else this whole mess would never have happened. Someone out there – a few, elite powerful leaders maybe – must be gaining power and/or money off of it. There are a lot of casualties in this cold war; patriarchy hurts men, too. But from where I’m sitting, it looks like the deck is stacked against the ladies in particular.

I think the war on women goes something like this:

  • There’s cultural pressure for women to remain “Pure,” sexually,
  • So if you have sexual experience, if you have been raped, or are merely perceived as “Impure,” you have to take shit from surprisingly angry people about the fact that you may or may not have had sexual activity (Slut shaming.)
  • Simultaneously, there’s cultural pressure for men to have sex with women – the more, the better.
  • Yet paradoxically, this pressure to have sex with women exists even though there’s misogyny in the first place!

It gets worse: that’s not just pressure to perform sexually… Some folks think they are genuinely entitled to have sex with the very women they loathe so much. This is what social justice advocates are referring to when they use the term, “Rape culture.” Rape culture supports and even encourages ideas like: Violence and sex go together naturally. Women aren’t supposed to want sex and if a woman is raped, she must have done something to provoke it. Men can’t be raped and it’s funny when they are. I’m sorry to say, there are literally countless examples of Rape Culture. It is a culture in which rape is allowed to happen – in where it’s justified, or it must be made-up, or not that big of a deal, or what did you expect? Rape culture is the culture in which even I cannot distinguish between statements made by rapists and statements published in a lad magazine. I don’t know what the bigger backdrop is; the war on women, the war on sex, or rape culture, but they’re all going on at the same time in the same spaces, and I think it goes something like this:

  • Meanwhile, for the most part culture doesn’t know what to do with folks who don’t fit well in a gender binary – leading to unnecessary & malicious policing.
  • “Sex” means, “Penis-in-vagina,” = Intercourse.
  • “Penis-in-vagina” = 2 cisgender, heterosexual partners, so that pretty much wipes out queer relationships.
  • PIV intercourse has its own risks – notably, infections and potentially fatal diseases and pregnancy.
  • The responsibility for pregnancy prevention tends to fall on women in cis, het relationships – after all there are still only 2 kinds of birth control available to sexually active men (condoms & vasectomy.)

That’s about where the war on women steps in. Women are expected to be the ones to prevent pregnancy, and when women do have children, childrearing responsibilities still disproportionately fall on women. That makes it hard to bring up a baby and improve your career at the same time (and savings, and thus later on, your social security/retirement income.) The war makes it even harder to obtain contraception and family planning services.

I could just leave it at that, but this is a sexual dysfunction blog and there’s additional stuff that pertains to people with sexual dysfunctions.

  • Sex – that is, intercourse as defined above – isn’t so easy to pull off if you’ve got some form of sexual dysfunction.
  • If that’s the case, then you get to take on the additional pressure of not conforming to the problematic gender dynamics culture set up for you to adhere to in the first place!
  • You can’t perform your role as “Nature” (not necessarily) intended.
  • Not to mention the part where folks who aren’t het can also develop sexual dysfunctions.

This is the environment in which the medical model of sex thrives. Dr. Tiefer wrote extensively about this – how, in a setting where there’s so much sexual pressure and cultural rigidity around sex, marketers for drug companies can easily exploit people with sexual problems & insecurities. (I think the US’s lack of public healthcare contributes as well.) She’s explicitly anti-medical model though, whereas I recognize that some people still have a need for medical assistance even when there’s social forces whirling around. The marketing may make it look like medicine is easy to obtain, easy to use, and easy to get results – but in reality, it’s not so easy.

Anyway, the war on women sounds very limiting, right? But enough people just don’t see it that way, and are willing to serve as foot soldiers. There’s enough folks within the US who (Publicly) are so heavily invested in holding up this “One true way” of sexuality that they grew up with, so that it fucks up life for all the rest of us. So the war goes on:

  • We weren’t raised in a vacuum. You might have been able to buck some of the cultural pressure and expand your definition of sex as you grew up. But pretty much everyone has been stewing in it for a long time…
  • …Some people are just more heavily invested in upholding the dominant cultural sexual narratives than others.

So I’m seeing a lot of sexual double standards in place that make it a lot harder to enjoy sex and to, you know, live. For me, anyway; maybe you’re still totally cool… But the war on women creates a hostile environment in which to discuss and engage in sex. If I get hurt or in trouble, I may not be able to get help – something I’m sure some of you already experienced first-hand.

The almighty glass of wine

02/07/2012 at 12:28 am | Posted in Uncategorized | 9 Comments
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How many readers here have heard a variation of the following statements, with regards to their sex lives?

“Have a glass of wine and relax.”
“Sex life is lacking? May I suggest some red wine to go with dinner.”
“A pill for sexual dysfunction is dangerous and ineffective! After all, it’s not like a glass of wine.”

*Raises hand* Heard it? I’ll keep on hearing it till the day I die! There’s a reason I included the ol’ wine glass advice on our FSD Discussion Bingo card, version 1.0. I’ve heard it from doctors, I’ve read about it in advice columns, and I’ve heard it from my own family members.

Follow up question… …Does this advice ever work???

I’m so sick and tired of hearing this! And I know for certain that I’m not the only one frustrated with getting the same generic, useless advice. From a commenter on Jezebel:

I suffer, on and off, from severe pain during intercourse (diagnosed as Vulvodynia), and the worse part for me, is the lack of researched treatments and even the lack of knowledge among doctors about the condition (three doctors told me to “try to relax more” when I had sex. Another told me to “try drinking a glass of wine.”

Even feminist sexologist Dr. Leonore Tiefer, organizer of the New View Campaign, suggests alcohol can improve women’s sex lives:

“I mean there are a lot of inexpensive products like a glass of wine or a massage.” - June 11 2010, related to the Flibanserin controversy.

(After what I’ve been through, I figure if you actually have a sex problem troublesome enough to merit drug use then chances are you’ve already tried a lot of other, inexpensive solutions without satisfactory results.)

This isn’t the first time I’ve heard Dr. Tiefer mention alcohol in the context of sexual medicine; In 2004 when testifying to the FDA about the potential risks of a testosterone patch for women as a treatment for low libido, Dr. Leonore Tiefer stated:

Intrinsia is not a glass of Chardonnay, and yet we have already seen that it may well be promoted with a giggle and a wink as “the female Viagra.” Not so – this is a steroid hormone women must continuously take for weeks before getting an effect.

Dr. Tiefer is absolutely right that the Intrinsia patch requires continued use before seeing any effects, so you can’t just slap it on one night and expect to get horny. And it’s absolutely true that the FDA did not approve it for use in the USA due to concerns about health risks. But what I’m really interested in is Dr. Tiefer’s dropping wine in the context of women’s sexual health. What do you suppose she meant by that comparison, anyway?

Now you may be thinking, “K, the chardonnay was just an example. Dr. Tiefer could have used anything in her comparison of sexual medicine.” But wait — I keep finding examples of alcohol specifically in discussions of sexual health. That’s two comparisons of drugs for sexual dysfunction vs. booze by Dr. Tiefer. I’m noticing a pattern…

Between Dr. Tiefer’s comments and repeated comments about booze and sex found elsewhere -

There may be cheaper and faster ways to reduce inhibition—like a glass of wine and a more attentive partner.The Daily Beast

Agree with your partner that you will devote every Wednesday night or whenever to talking, sharing a glass of wine, a video, relaxing together… At least once a week try to think of some little extra to add a touch of glamour or luxury to your love life – a bottle of sparkling wine, a scented oil, a flower.Dear Deidre

Plan a date that you can both really enjoy, with a movie or dinner beforehand, or perhaps a walk or a glass of wine by candlelight. walk, have a glass of wine by candlelight, whatever the couple likes to do as a couple.Sex Therapy Online

- Why, it’s almost as if booze is being held out as a magical panacea to all sexual problems! Even if it’s not an appropriate course of action for everyone’s sex problems!

(Note also that much of this sex life advice is directed at couples – does wine still work on single people? I wonder what folks with religious restrictions or recovering alcoholics with sexual problems think of this advice. Is this advice regularly given to young folks with sexual problems but still below the drinking age?)

Yet somehow the wine recommendation is supposed to be more complicated and nuanced than considering medication to address some sexual problems. I don’t get it; the medical model simplifies women’s sexuality, but the social construction model recognizes the complexity. By the way, have you heard that wine is good for your sex life…?

It sounds like a large part of the push for alcohol instead of medication has something to do with the idea that drinking is cheaper than prescription medicine, but then I keep thinking of that old adage, “Life is too short to drink cheap wine.” I’d really have to run the numbers some time – if a decent bottle of wine costs $20+, maybe $40? split between 2 people and a one-time use of Viagra costs about $10 split between … 1 or more people… Or we have some top-shelf vodka at what, $35? $40? which will last for more than 1 evening vs. about a month’s worth of a prescription gel… But then wine aficionados will point to decent wine under $10 per bottle… or will Box Wine bought in bulk suffice?

Anyway, let me confirm your suspicions so far and this admission is probably going to make me very unpopular:

I hate booze.

I hate all booze everywhere.

I hate wine.
I hate beer.
I hate liquor.
I don’t even like Champagne.
I hate alcohol!

Hate all the booze!

[Description: Bug-eyed stick-figure type white lady in a pink dress. 1 arm raised triumphantly, the other arm holding a broom. Mouth wide open, big teeth. Caption: HATE ALL THE BOOZE! Original picture by Allie Brosh @ Hyperbole and a half.]

I’m one of those people who throws out good booze instead of drinking it, because I get tired of looking at the bottle take up space that could be used up by tasty snacks instead.

hate all the booze?

[Description: Bug-eyed stick-figure type white lady in a pink dress. Not quite so triumphant anymore. Mouth frowny face, tears in eyes. Caption: Hate all the booze? Original picture by Allie Brosh @ Hyperbole and a half.]

Now before we go any further, let me assure you: I don’t hate your booze. I have no interest in taking your booze away from you and I accept that drinking is a socially acceptable way of – being socially acceptable. If anything, I’m the weird one. Almost everyone drinks and does so responsibly. I just ask that you extend courtesy to me and please stop pressuring me to drink. No thanks, I’m fine; I’ll be your designated driver or whatever.

Now let me tell you why booze + I don’t get along:

It all tastes the same to me and the taste is Bad; I’m almost 30 and I’ve heard enough iterations of “You just haven’t found the one you like” to know that I’m never going to find the one I like.

If I drink enough to get tipsy or drunk, then I act out of character – I get giggly. This is not conductive to relaxation, as I must then consciously self-monitor myself to prevent saying something foolish. I can’t keep up with conversations or movies. I lose my wits. The room spins.

Alcohol can cause dehydration, which can then lead to feelings of vaginal dryness. The sugar content can tip some sensitive folks over into yeast infection territory, or at least make it harder to recover from yeast infections. Since my yeast infections last up to six months and tend to be complicated with simultaneous bacterial vaginosis, this is a concern that’s always on the back of my mind when I drink, even more then when I eat junk food.

I hate the smell. I associate booze-breath stench with alcoholic family members and the feelings of powerlessness I endured when I had to put up with them.

Alcohol makes my pelvis feel funny, like my vulva is swollen with blood, yet it decreases my feelings of physical sensitivity, making it harder to orgasm.

Annoyingly, there seems to be a direct correlation between amount I drink and my desire to go to sleep. Unfortunately I wake up multiple times per night on a good night, due to bladder problems. Having to get up & go pee makes it hard to fall asleep in the first place.

The absolute worst part is that alcohol tears the fuck out of my bladder and makes me piss approximately every 5 minutes – not conductive to a satisfying sexual encounter. This is the part I hate the most. Ohh, getting up to go pee every 5 minutes – that’s so sexy. Having to pause, stumble over to the bathroom and pee only to do it allover again a few minutes later. (This goes on for hours when I drink…) Hot.

So far alcohol & sex don’t combine well for my partner either. A single shot is enough to impair his ability to maintain an erection. He can still get one – but not for long. 2+ drinks and it’s just not happening – he’ll be too distracted & uncoordinated to give me the attention I need, and he becomes incapable of maintaining an erection & having an orgasm. Since we can’t enjoy each other sexually after drinking, I feel like if he drinks instead of fooling around with me, he chosen booze over me.
Worryingly, I think my boyfriend is more sensitive to alcohol than he acknowledges. Sometimes, booze will just knock him out even after 2 drinks. One time we split a small bottle of wine over steak and immediately afterward, he blacked out for awhile. He was conscious – or so it appeared – but he had no memory of playing a video game (and he accused me of taking his turn!)
That’s scary! I thought blackouts required more alcohol than that! So was he pulling my leg or is he really that sensitive…? I think we better not fool around after drinking. Nope, not gonna do it.

Yet I’m noticing a theme in the social construction arguments against sexual dysfunction: Women don’t need sexual medicine, because they already have booze. Wine can solve all your sexual problems. You’re just too uptight and need to loosen up, girl!

I don’t want to have to drink when I want to feel sexy. If I want to get drunk, then I’ll drink. If I want to have sex, then I’ll go work on that. The two things have, in my experience, combined very poorly.

So why sex therapists and sexologists suggest alcohol, which has known side effects on sexual health to patients with sex problems, I’ll never know. Perhaps the unofficial prescriptions had something to do with the common sense advice that red wine is good for you, except one reason why may need re-evaluation now, since a researcher’s data is in question. The effects of alcohol and sex are paradoxical: in some ways it might be good for you, but at the same time it can impair sexual health and enjoyment short term. This measurable negative effect has been researched mostly in alcoholics; yet almost half report positive effects.
However, in sexologists’ favor, there may be a link between drinking and higher levels of sexual satisfaction! So maybe there’s something to this advice after all in certain contexts – IF you live in Italy, where there are no doubt cultural differences to take into account, and IF you drink wine every day.

So when someone says about sexual medicine, “It’s not like a glass of wine,” I say…

Good!

I’m glad that sexual medicine isn’t like a glass of wine! Booze gives me more trouble than it’s worth. I say, “Not booze” is a benefit of our hypothetical sexual medication!

So please, reconsider that advice that I add a bottle of wine to my bedroom, and stop telling me it’s what I really need to solve all my sex problems.

Pleasurists edition 166

01/31/2012 at 1:16 am | Posted in Uncategorized | Leave a comment
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Welcome to Pleasurists, a round-up of the adult product and sex toy reviews that came out in the last seven days. If you like what you see and want more of it be sure to follow the RSS Feed and Twitter for updates.

Continue Reading Pleasurists edition 166…

Doctors debate dyspareunia part 2: Is pain the only valid FSD?

08/17/2011 at 9:51 am | Posted in Uncategorized | 3 Comments
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Previously on Feminists with Female Sexual Dysfunction…

Many folks who experience sexual and/or genital pain share the experience of getting bounced around from doctor to doctor when seeking satisfactory resolution to their problems. In a recent post on this blog, I explored one of the many reasons the doctor shuffle occurs: there’s no definitive class of doctor designated to handle sexual & genital pain. And behind the scenes, doctors themselves are debating what medical specialty is best prepared to address this type of problem.

In 2005, a peer-reviewed journal published an article by Dr. Yitzchak M. Binik, Ph.D. His idea was to start a serious debate on how best to handle dyspareunia (painful sex.) Currently, under the DSM-IV, dyspareunia is classified as a sexual dysfunction. When the DSM-V revision comes out, it is likely to be kept there (though under a different name, genito-pelvic pain/penetration disorder.)

Dr. Binik made some compelling arguments in favor of of changing the classification of sexual and genital pain from a DSM-recognized sexual dysfunction to a pain disorder. But his position was controversial, and generated many professional responses against making the switch.

One such published response came from Dr. Leonore Tiefer, a feminist sexologist, author, college professor and organizer behind the New View Campaign, an organization opposed to the medicalization of sex, with a particular focus on the role of Big Pharma. I have read and reviewed some of Dr. Tiefer’s previous work on this blog, bringing to it my own unique perspective as someone who actually has FSD.

Unfortunately this time I won’t be able share the full ~2 page text of Dr. Tiefer’s response, Dyspareunia is the only valid sexual dysfunction and certainly the only important one, because it’s locked down behind an academic firewall. I think I can share a summary of what’s in it (with my own commentary,) but unless you’re enrolled at a school with journal access, you’ll have to take my word on good faith.

Dr. Tiefer’s disagreement with Binik’s reclassification argument focused exclusively on one argument: Nomenclature; the power of names. It’s a familiar theme in Tiefer’s earlier work – language is a powerful tool capable not only of reflecting reality, but of shaping it. And Dr. Tiefer has serious concerns about the language used to describe sexual problems in particular. In light of this, I was surprised to find that in her response to Dr. Binik’s article, Dr. Tiefer argued in favor of keeping dyspareunia classified as a sexual dysfunction instead of a treating it as a pain problem – At least, so long as such terminology is used by the American Psychiatric Association.

Dr. Tiefer starts her article by describing the origins and goals of the New View Campaign. One of Tiefer’s criticisms of female sexual dysfunction is that it’s based on the idea of deviations from a “Normal,” universal sexuality, but normal is arbitrarily defined and doesn’t account for all of the human population. In this case, the “Normal” sexual response cycle was defined by Masters & Johnsons’ work – the four-phase model that goes, excitement, arousal, orgasm and resolution. Sex doesn’t work that way for everyone, and so over the last few years – decades at this point – she has challenged the medicalization of sex, with a particular interest in libido and orgasm.

“My criticisms have, however, focused on the universalized notions of desire, arousal and orgasm in dysfunction nomenclature, and not on the inclusion of dyspareunia and sexual pain. Immersed in the feminist literature on women’s health, I was more than aware of the disgraceful history of neglect and mishandling of women’s complaints of pelvic pain and thus it seemed that dyspareunia was the only sexual dysfunction with validity in women’s lives (50, emphasis mine.)

(And that’s where the title of the article comes from. I don’t know whether Dr. Tiefer picked the name out herself, or if some editor arbitrarily decided it, but we have the same sentiment reflected in the body of the text.)

However, when criticizing female sexual dysfunction, Dr. Tiefer has in the past included pain. It’s true that she doesn’t talk about it much, relative to her body of work on orgasm and desire. But in the past she has let pain stay under the broad umbrella of the term, “Sexual dysfunction,” complete with scare quotes:

We believe that a fundamental barrier to understanding women’s sexuality is the medical classification scheme in current use, developed by the American Psychiatric Association (APA) for its Diagnostic and Statistical Manual of Disorders (DSM) in 1980, and revised in 1987 and 1994. It divides (both men’s and) women’s sexual problems into four categories of sexual “dysfunction”: sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders. These “dysfunctions” are disturbances in an assumed universal physiological sexual response pattern (“normal function”) originally described by Masters and Johnson in the 1960s.

In the New View manifesto, Dr. Tiefer kept sexual pain disorders lumped with all the other dysfunctions that merit feminist skepticism and critique. Feminist critique, such as the perspective that DSM criteria for dysfunctions (including pain) are excessively genitally, and therefore reproductively, focused (Sex is not a Natural Act, location 737.) However in 2005 we see support for leaving dyspareunia behind, as the only valid sexual dysfunction.

Dr. Tiefer’s quote about the importance of dyspareunia as dysfunction is problematic for additional reasons: The implication here is that no other sexual dysfunctions recognized in the DSM have any merit as a health problem. That’s a key point of the New View Campaign: Desire, arousal, and orgasm problems may not be problems at all, and when they are, the problems can be addressed with lifestyle and social change instead of medicine. But here I interpret the idea that pain is a sexual dysfunction, and the only valid one, as maintaining a sexual dysfunction hierarchy. It elevates physical pain above all others. My problem matters; yours doesn’t. My physical pain is real, your emotional or psychological pain isn’t.

So what does this mean for folks who have one of the less-important, invalid dysfunctions? To whom can they turn when they have exhausted virtually all of the non-medical interventions for long-term sex problems?

Dr. Tiefer then briefly expands on some implications of Masters and Johnson’s work. In the next section of her response, she describes an alternate, benevolent way of looking at the inclusion of sexual dysfunction in the DSM: Recognizingsexual problems as health and medical problems legitimizes such problems in the public’s eye. Suddenly, sexual problems are no longer just about sex, which (according to vocal conservatives anyway) is dirty and wrong and immoral – sexual problems are now about the body and health, which is (relatively) socially and politically acceptable to talk about. “Looked at from this perspective, the inclusion of women’s problems with sexual pain in the sexual dysfunction classification system was a positive step” (50,) because then the ISSVD and NVA can harness that legitimacy for raising awareness and research funding.

It strikes me as odd that Dr. Tiefer mentions the NVA and ISSVD by name as working for the benefit of patients with pelvic pain problems. Not because I have any question that both organizations do good for the public, but because in Sex is not a Natural Act, Dr. Tiefer had this to say about patient advocacy organizations:

These advocates for medicalization include self-help group and newsletter promoters who have created a market by portraying themselves as something between consumers and professionals. The formation of Impotents Anonymous (IA), which is both a urologists’ advocacy group and a self-help group, was announced in the New York Times in an article including cost and availability information on penile implants. (Organization helps couples with impotence as problem 1984.) … The advocates for medicalization portray sexuality in a rational, technical, mechanical, cheerful way. Sexuality as an area for the imagination, for political struggle, or for the expression of diverse human motives or as a sensual, intimate, or spiritual rather than performative experience is absent (locations 2277-2282.)

Basically, according to Dr. Tiefer, patient advocacy groups – at least those for erectile dysfunction – existed partly in order to sell sexual health problems, to promote a select few doctors qualified to treat the problems, and then to sell medical treatments for big bucks. In these earlier statements, Dr. Tiefer made it sound like patient advocacy groups were just part of the packaging that came with so-called selling sexual dysfunction. In fact, the formation of patient advocacy groups is one piece of what motivated Dr. Tiefer to organize the New View Campaign in the first place:

This backlash dovetails with the analysis and critique of “medicalization” over the past several decades within sociology, the women’s health movement, the “anti-psychiatry” movement, and newly, from cultural historians examining the social construction of illness and disease. All these scholars argue that the medical model, with its hallmark elements of mind-body dualism, universalism, individualism, and biological reduction, is not well suited to many of the challenges of contemporary life and suffering.

Yet, at the same time, patient advocacy groups are clamoring for medical legitimacy, increased funding and research, and, above all, new drug treatments. And the drug industry continues to expand.

Allying with the backlash, I convened a “Campaign for a new view fo women’s sexual problems” in 2000 to provide a feminist anti-medicalization perspective in the debate about “female sexual dysfunction” (location 3550.)

Given these prior statements on patient advoacy groups, I’m surprised that Dr. Tiefer didn’t skewer genital & sexual pelvic pain advocacy groups in her 2005 response to Dr. Binik.

Furthermore, by classifying dyspareunia as a sexual dysfunction, isn’t dyspareunia and its treatment subject to the same criticisms that Dr. Tiefer has previously made about sexual dysfunction and Big Pharma broadly? I’ve seen the rhetoric used by the New View used (and unfortunately warped) in feminist arguments against sexual medicine. And let me show you, it can get real ugly real fast. Leaving sexual pain as a sexual dysfunction might lend medical and social legitimacy, but not when you do everything you can to undermine the legitimacy of sexual dysfunction broadly and stigmatize those who experience it.

This post is getting way too long, so we’re going to stop abruptly here and come back after you’ve had a few days to digest our story so far. To be continued…

Quick link – a dating site for folks with sexual problems

08/16/2011 at 10:07 pm | Posted in Uncategorized | Leave a comment
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Found via Jezebel today, here is a link* to a new dating site, 2date4love.com. The site’s own description explicitly says,

2date4love℠ is a dating site that enables people who cannot engage in sexual intercourse to meet and experience love, companionship and intimacy at its deepest level.

And this bit posted in the New York Daily News expands on that idea, saying,

The website is also for men and women who can’t have sex because of other injuries or disabilities, or who are simply uninterested in being physical with their partners.

We may swing back around to take a more in-depth analytical look at this later, but until then I thought this might be relevant to some readers’ interests right now. Since it’s a new site, and a little different, I expect to see more written about it through other channels as well. (If you will be reading the links provided on their media page, I suggest in advance avoiding comment sections.) There is a FAQ page but it doesn’t address the kinds of questions we here on this feminist-type blog might be interested in. What I do know is that it was founded by a stage 4 cervical cancer survivor who would otherwise now experience painful sex. Laura Brashier talks a little more about her experience with cancer treatment and her desire for sexual intimacy on the Good Morning America website.

*Probably don’t need to state it, but just in case: This post should not be interpreted as an endorsement or an approval of 2date4love. Always use safety precautions when doing stuff online.

Guest Post: On sexual pain, consent & treatment

08/09/2011 at 10:51 pm | Posted in Uncategorized | 10 Comments
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[Dear internet, we have a guest poster today! The following was written by someone who prefers to remain anonymous. A trigger warning applies, for questions of sexual consent and rape.]

I offered about two years ago to make a guest post on this blog, then tried to actually write it, and vanished into thin air because I was so uncomfortable with the issues it was dragging up. I was trying to write something hilarious, and political, and historically enlightened. But it turns out that the only important thing I need to share right now is what happened to me.

This is a post about feminism, sexual pain, and consent.

Here’s what’s wrong with me: I have a pelvic floor dysfunction. It’s originally a muscular problem: it means that somewhere along the line, I got the habit of carrying tension in my pelvic floor the way other people carry it in their shoulders. I get vaginal muscle spasms the way other people get neck cramps. They could get set off by any kind of anxiety, such as direct stimulation of an already-painful spasm, leading to a godawful feedback loop called “secondary vaginismus”—a conditioned psychological response of increased painful spasms, and aversion to sex, due to the association of vaginal penetration with intolerable pain. The happy ending is that my primary dysfunction was treated by physical therapy, which gave me strategies for combating the muscular issues; and the secondary aversion went away because the association was broken. The physical therapy process took about 3 months. I wasn’t able to find it for 9 years.

The horrible thing about getting to the correct therapy for vaginismus was that even reasonably well-educated doctors seem to routinely believe that the only way a woman gets a conditioned aversion to sex is rape, or a fundamentalist upbringing that teaches that sex is dirty. I have had fruitless arguments with puzzled GPs who, I believe, left the encounter convinced that I had somehow buried sexual abuse trauma somewhere in my brain—when in actuality, the genuine traumatic moments of my life had been occurring on their own gynecological exam tables. And all in the name of getting my poor, long-suffering boyfriend laid.

To say that this sort of thing breeds resentment is just a little bit of an understatement.

Here’s the thing of it. Since I had my first orgasm (clitoral, manual), I never really saw the big deal with getting my twat all stretched out into fighting shape. I liked sex, I was fully capable of climax, I could make my partner climax, and as the pain mounted, I was increasingly convinced that there was no logical need for vaginal intercourse specifically. The boyfriend didn’t share this analysis. At his urging, and my initial gameness to experiment, we tried, and failed, and tried, and failed.

Maybe it’s really bad for all girls, but they put up with it better than me. I’m a spoiled, privileged elite wimp. I need to grit and bear it before I can get the good stuff. “Our Bodies, Ourselves” taught me sex was supposed to be fun for me. Was that just rose-tinted glasses?

The more we tried, the less it worked, and the less I wanted to have sex at all. I went to the gynecologist. I grit my teeth around the speculum, was told I was “small” and needed to stretch, was handed a plastic dilator and sent home. I couldn’t look at it. I put it under the bed.

I am lazy. I am a coward. I am frigid. Did feminism make me frigid?

(Years later, on vaginismus support groups, I would encounter all these women who described their boyfriends as saints. Soooo patient, soooo understanding. Here’s the thing, ladies: he’s not the one suffering dysfunction and pain. That’s you. Him? He’s horny. It’s not a martyrdom. Last resort solution: he whacks off.)

I am denying sex to my boyfriend. Every day we are together is an archetypical punishment for him. If other people knew, they would think he was crazy to stay with me. I can’t tell anyone this is going on.

He stopped requesting that we try, but everything had already turned into guilt. Without really knowing why, I no longer wanted to have sex with him. He would ask, and because I felt like it was ungenerous not to, I would whack him off. I let him touch me only when I wanted it, because that’s what a good feminist does, and that was less and less often. I was frigid when he was home, and I masturbated when he went away. This went on gradually for about six years. It was some kind of screwed up, semi-coerced, semi-consentual sex; nobody made me do what I didn’t want to, but I didn’t want to. The logic goes something like this:

1) Who would ever date someone who can’t have intercourse? Such a person isn’t a functional woman. Such a person isn’t a whole woman at all.
2) Therefore, this is my only option for a life partner. I have to make it work.
3) He wants consentual sex with me. So we will have (unwanted) consentual sex.

(All the while I’m angry as hell, on some level, and undermining the situation like mad.) I sought treatment again, and was referred twice to a psychiatrist for vaginismus, which was described as a mental condition caused by the aforementioned rape or ignorance. I threw the pamphlet away in disgust. St. Boyfriend became depressed, I was pretty sick of it too, and he broke up with me. In the desperation of feeling like I was defective—which I felt very deeply and very abstractly and clinically—I finally went to a psychologist, who confirmed that the problem was physical and not psychological, and referred me to a specialist in pelvic pain, who referred me to a physical therapy specialist in pelvic floor dysfunction. Three months later I was having intercourse.

Here’s the kicker, though. I went through the therapy process because I felt defective without the capacity for PIV intercourse—even though I thought, all the while (and I still think) that this is a nauseatingly offensive and wrongheaded idea, and that all those quiet thoughts I had between the lines of what happened were horrible and wrong and poisonous, untrue things. And I got desperate enough to fight my fear and pride and begin the therapy process because I believed that no matter how poisonous I knew they were, precious few men would be enlightened enough to date someone incapable of intercourse. I might even be right about that. But I don’t think I’m ever going to be quite reconciled to the fact that even though a streak of self-destructive pride kept me from seeking treatment in time to quench the lust of my own St. Boyfriend, I did finally seek it for the sake of the hypothetical St. Boyfriend of my future—not for my own sexual needs. Now every time I give consent, no matter how willing, it’s always going to be tainted by that history. And that strikes me as very unfortunate.

Doctors debate dyspareunia (painful sex)

08/01/2011 at 1:26 pm | Posted in Uncategorized | 7 Comments
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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…

Pleasurists edition 139

07/24/2011 at 8:06 pm | Posted in Uncategorized | Leave a comment
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[Dear internet, I submitted my Afterglow candle review to Pleasurists, and what I wrote was included in their roundup! As part of the rules & regulations of Pleasurists, I am to re-post the edition in which my post was included - behind a cut is permitted. You'll have to click through from the main page to view the Pleasurists materials, although everything should still appear in your RSS feeder. All links should below the fold should be considered potentially NSFW.]

Continue Reading Pleasurists edition 139…

Pleasurists Edition 138

07/12/2011 at 9:58 pm | Posted in Uncategorized | Leave a comment
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[Dear internet, I submitted my Pinwheel review to Pleasurists, and what I wrote was included in their roundup! As part of the rules & regulations of Pleasurists, I am to re-post the edition in which my post was included - behind a cut is permitted. You'll have to click through from the main page to view the Pleasurists materials, although everything should still appear in your RSS feeder. All links should below the fold should be considered potentially NSFW.]

Welcome to Pleasurists, a round-up of the adult product and sex toy reviews that came out in the last seven days. If you like what you see and want more of it be sure to follow our RSS Feed and Twitter.

Did you miss Pleasurists 137? Read it all here. Do you have a review for Pleasurists 139? Be sure to read the submission guidelines and then use the submission form to submit before Sunday July 17th @ 11:59pm Pacific.

Continue Reading Pleasurists Edition 138…

Book review: The Ultimate Guide to Fellatio

04/07/2011 at 9:53 pm | Posted in Uncategorized | 4 Comments
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Case in point from the recent Shorties II post: Presenting a book review for the purposes of sex education + product evaluation. The book in question at this time is, The Ultimate Guide to Fellatio: How to go down on a man and give him mind-blowing pleasure, by Violet Blue. Now in case you’re wondering, “K, why is there a book review regarding fellatio on a blog about female sexual dysfunction?” The answer is, “I decided to read & review this book now, mostly for personal reasons. Also I need to clear away some stuff in the book backlog before I can justify making any new literature purchases.” I read the Kindle version, second edition, which tops out at about 2,400 locations or 256 pages. Here’s a Google Books preview to get you started if you want to look at it.

The Ultimate Guide to Fellatio covers a lot of ground. It’s not just a book of tips written just for people who perform oral sex; it’s for the recipient of oral sex as well. For both the giver and receiver, there’s a lot to think about – what to do, what’s happening to you and your partner, and ways to make sure both parties feel physically & mentally comfortable during the act.

The book provides a detailed anatomical explanation of the relevant body parts – mouth, tongue, throat, penis, testicles, and yes the anus, prostate and pubes. Body fluids are described in frank terms. Blue does present some bullet point lists of tips, but she also provides detailed, how-to instructions that wouldn’t have fit in a short list. She also addresses the cultural baggage and negative attitudes around fellatio – sexuality, especially men’s sexuality, tends to get oversimplified (“Insert tab A into slot B…”) and fellatio in particular is often associated with dominant & submissive gender roles. It doesn’t have to be that way. On the other hand, for some folks, D/S gender roles are a turn-on, and Blue acknowledges this flipside as well in the discussion of BDSM and fellatio towards the end of the book.

The Ultimate Guide to Fellatio is particularly helpful when it comes to safe sex. There’s a chapter talking about ways to make oral sex safe between partners (the pros and cons of various barrier methods are discussed at length,) and the safe sex chapter even includes charts detailing the probability of contracting STI’s from giving or receiving oral sex. One interesting feature about the charts was the inclusion of the probability of contracting vaginitis (a vaginal infection not necessarily caused by STI pathogens,) from giving or receiving fellatio – the risk, according to the chart is, “N/A,” (location 661) or not applicable. Still I thought that was neat to remember it at all. I guess a chart including the risk of contracting vaginitis would be more relevant in the related Ultimate Guide to Cunnilingus book. Which I should probably also read and review.

Throughout the book, Blue addresses erectile dysfunction and disabilities - not just limited to physical disabilities; she explicitly wrote a paragraph on Attention Deficit Disorder, for example. I appreciated the inclusion of these topics. Blue makes it clear that, even if you or your partner are dealing with erectile dysfunction, chances are that fellatio will probably still feel good. (If you’re not certain, ask – the book emphasizes over and over again that communication is important.) Interestingly, Blue points out that certain disabilities may make sexual stimulation painful, even when there’s a penis involved rather than a vulva – she focused on Multiple Sclerosis in particular as a potential cause of sexual pain. With disabilities, erection, orgasm and/or ejaculation may be impaired, but that does not necessarily mean that the penis is non-responsive and that the owner of it does not feel and react to sexual stimulation. For people with disabilities such as spinal cord injuries, she also mentions “Phantom orgasms,” something I’ve seen talked about elsewhere – orgasm isn’t just a body reaction; the body is a shortcut to the brain. There’s still some parts about disability we can push for improvement on though; for example she uses the term “ADD sufferers” (location 1445) which implies that ADD equates with suffering, and at one point she says “You should never consider a disabled man asexual” (location 1432,) by which she probably means that it isn’t fair to de-sexualize people with disabilities… but then again with this quote, you get the whole asexual erasure thing going on. So it’s probably better to not make assumptions about the sexual orientation of people in the first place.

The last part of the book covers resources for learning more about fellatio, and these resources often coincide with learning more about sexuality in general. For example, the contact information for sex-positive retailers is printed (some of it may be outdated at this point though, because the book was originally printed in the early 2000s – you may have to Google some information to confirm if its still current.) There are some suggestions for pornographic yet educational films and how to enjoy them.

For the most part, I felt the book was written with a cis-gender heterosexual audience in mind. The book does talk about how to give and receive fellatio when performed on a strap-on dildo and how the act of fellatio can be subverted into a means to bend gender roles, but for the most part, penis = man = cis man. Most of the illustrative vignettes sound like they were provided from the point of view of opposite-sex couples, although I did see some gay and lesbian content as well. Speaking of which, there are some illustrative sexual fantasies described between chapters – these erotic short stories did nothing for me, but I am certain that is a personal thing. Your mileage with the written sexual fantasies will vary.

One thing I did not like about the book at all was the drawings. The illustrations are just terrible: The line art is shaky and near the end there’s an illustration of a guy receiving oral sex on the beach and one of his eyes is all like 0.- and it just looks weird. Technically speaking, Amazon isn’t supposed to sell pornography, (enforcement is another issue,) so I think the drawings maybe had to be below optimal in order to get the book past the censors.

So who might be interested in pursuing the pages of The Ultimate Guide to Fellatio? Who would gain the most benefit from reading a how-to on how to give or receive “Mind-blowing pleasure?”
Well for starters I’m actually becoming skeptical & jaded when it comes to any guide that promises such a claim. I know that book sellers gotta be able to move stuff off the shelves, but there’s so much human variation that it’s too hard to guarantee that anything can create that kind of sexual pleasure.

This would be a very good book for people who have not yet had any experience with oral sex, or who have had only limited exposure to it, yet who nonetheless have an interest in being the recipient or provider of such an act in the future. Because it covers such a wide berth of content, from Anatomy to X-rated films, (I couldn’t think of anything that starts with a Z – unzipping pants, maybe?)  the book will provide plenty of  information with which to brace yourself. I would suggest reading the book start-to-finish if you’re on the newer side. If you do not yet have a partner but expect to find one later, Blue makes some suggestions for practicing fellatio in a solo setting. (You won’t get the body language feedback but you’ll be under no pressure while tweaking your own techniques.)

One potential problem newbies may have with the book though, is that since it’s so detailed, it can seem overwhelming at times. As I was reading through some of the how-to suggestions, I found myself asking at points, “How is anyone supposed to remember all this?!” So if it’s too much to take in all at once, you may have to go back and skim parts of the text again later.

It would be an okay book for people who have some experience with fellatio and expect to continue participating in it, but do not yet consider themselves to be experts. If you are such a reader, then you can probably skip around to whatever parts you’re most interested in.
So for these two kinds of audience members, the book is most worth it.

I think the book would be less useful (and thus less worthwhile) for people who already have a lot of experience with oral sex. So if you think of yourself as “Advanced” in fellatio, (even theoretically!) then The Ultimate Guide might not be worth it. At that point, chances are you’ve already seen & heard most of what Violet Blue talks about. It’s still worth something; because it’s so dedicated to its topic, there may still be a few things you can pick up here and there… However, I think you’ll eventually pick up on those few things that you didn’t know about, by reading sexuality & sex education blogs, for free. Just hang around a few favorite blogs long enough (try some of the ones listed on my blogroll) and you’re bound to see the same subjects pop up, eventually.
For example, since I have read a lot of related sexuality material elsewhere, I found myself anxious to speed through the stuff that I already knew. I felt obligated to read everything for the purposes of this review but there was a lot of stuff I could have just passed over without a look back.

The Ultimate Guide to Fellatio may or may not be of use to people who do not expect to give or receieve fellatio in the near future. This is because if you have decided that it’s an act with no appeal to you, then the book may still provide you with insight into what’s on the minds of folks who do engage in it and why such folks will often defend it. But if you’ve already made up your mind that fellatio is off the table, then chances are no book will be able to change your mind and in some cases it will just be a waste of time. It could be irrelevant to you in this case.

I am not sure if this would be a good bet for sexual abuse survivors, because there is only a very brief mention of fellatio and past abuse.

So if price is a factor, then I think the $10 for the e-book version or ~$15 for the printed copy is worth the investment if you are new-to-medium in fellatio. If you feel that you’re advanced, then I think the $10 for an electronic copy is cost-effecient only if you are already heavily interested in sexuality books. Otherwise, if you know what you’re doing, then save your money and read some blogs instead. And if you know that fellatio isn’t going to happen then whether you would benefit from the book depends on your political or philosophical inclinations.

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