The (slightly late) 2011 retrospective post

01/19/2012 at 9:22 pm | Posted in Uncategorized | Leave a comment
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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.

Slowpoke with top hat

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

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

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

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

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

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

The 2009 retrospective
The 2010 retrospective

Don’t miss the guest posts from 2011: 

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

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

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

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

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

A series of posts!:

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

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

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

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

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

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

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

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

Aren’t tax returns *Fun*?

01/01/2012 at 6:47 pm | Posted in Uncategorized | 6 Comments
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Is everybody excited for tax season?! January 15 to April 15, woo-hoo…!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Doctors debate dyspareunia part 4: The debate continues

09/19/2011 at 10:51 pm | Posted in Uncategorized | 3 Comments
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“The sad truth is that at our current state of knowledge, sexual dysfunction is whatever sexologists or others say it is” – Yitzchak M. Binik, Ph.D.

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

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

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

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

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

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

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

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

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

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

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

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

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

Facepalm Carl Pictures, Images and Photos

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Doctors debate dyspareunia part 3: Pain’s validity, con’t

08/24/2011 at 9:44 pm | Posted in Uncategorized | 2 Comments
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[We're picking up this post directly where the last one left off, because it was getting too long. If you're just joining us, we're in the middle of a conversation about whether doctors think painful sex is best looked at as a pain problem or as a sex problem. Read part 1 here, and part 2 there. Stay tuned for the thrilling conclusion!]

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

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

*record scratch sound*

The heart of feminist critique of patriarchal sexual relations?

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

But…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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…

Shorties II

03/21/2011 at 2:10 pm | Posted in Uncategorized | 4 Comments
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In the same spirit as the original Shorties, I bring you: A series of posts which were each too small to constitute blog entries on their own. Divided we are weak, but together, we are strong!

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The National Vulvodynia Association’s newsletter for 2010 is posted on their website, here. It includes updates on research and funding, and profiles of researchers who have received NVA-related grants. There are also profiles of medical professionals working towards a more comprehensive understanding of vulvodynia. There’s also updates on educational materials and programs provided by the NVA.

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There’s a couple of reasons I like to post book reviews on this blog. I may post product (vibrator, dilator etc.) reviews in the future; I haven’t decided yet. Again, a reminder: Any reviews I posted here so far, I had to pay for the product in question & I haven’t gotten any compensation for my services.

It’s a blog about sexual dysfunction, especially that greatest bone of consternation, female sexual dysfunction. One of the common themes I read in feminist analysis of FSD is that a lot of it is actually sexual insecurity which stems from ignorance and lack of education. The idea goes something like, men & women are socialized differently and grow up with different expectations & pressures when it comes to sexual behavior. (In other words, differences in sexual behavior between men & women aren’t necessarily inborn.) Women are discouraged from learning about sex & pleasure. Combine this with shitty sex education and you have a pretty good chance of not understanding the influence of gender roles and how your own body works. This in turn is misinterpreted by the individual as “There must be something wrong with me” when experiencing a normal, understandable reaction to sexual stimulation. And the cure for this is better sex education instead of medication. Go read a goddamn book or something!

Improved sex education is great, so that’s one reason to post reviews of sexual guides and products. So every one in awhile you’ll find such a review here – it’s my way of saying, “Hey, here’s something that’s good and worth your time,” or, “Hey, here’s an overrated product that isn’t worth the packaging it came in. Save your money.” Or I’ll post something more nuanced –  “This is good, this is bad, and this part I don’t understand at all.”

However there’s another reason I post the reviews here…
Sometimes all the sex education in the world cannot fix a sexual problem.
Because it doesn’t all come from sexual ignorance.
Many of the sexual guides I’ve read, some of which come highly recommended, do not do a good job of addressing my problem in particular – pain. Maybe it’s because they’re not medical advice books so they can’t recommend treatments. Liability issues, maybe.

I’m doing what I’ve been told to do. I’m getting better sex education. I read the blogs. I buy the sex toys from the feminist sex shops. I have explored my sexual fantasies and will continue to do so. I masturbate to orgasm. I am in love with a supportive partner (the feeling, I understand, is mutual.)

The lady with sexual dysfunction is reading a goddamn book or something.

So why do I still experience dyspareunia?
Why do I still have vaginismus?
Why does my vagina still take so long to recover from vaginitis?
Why is medical intervention the treatment that best addressed the sexual and chronic pain?

Hey wait a second, this isn’t working. I still want to have some penis-in-vagina sex over here and that’s still like, really hard to do. Maybe I’m just not reading books and trying to learn hard enough.

The sex education helps – it’s definitely worth something. But it’s not comprehensive enough for me.

Now we could say here that I am the special snowflake exception to the general rule that FSD is a fake invention designed by Big Pharma and evil doctors; Dr. Leonore Tiefer, organizer of the New View Campaign, said as much when she wrote, “Dyspareunia is the only valid sexual dysfunction and certainly the only important one,” in response to the suggestion that dyspareunia might be better considered a pain condition rather than a sexual problem.

So hypothetically I suppose I could say, “Fuck you all; I got mine.”

Hypothetically. I have no desire to actually do that and in fact I feel dirty for having spelled such a phrase out in text. Excuse me while I swish some mouthwash and/or wash my hands. Is that what I’m supposed to say? Is that the way I’m supposed to feel? Is this the signal that, as someone with dyspareunia, I’m supposed to shut my pie hole when I see folks with other dysfunctions belittled for it?
I maintain that elevating one or some forms of sexual dysfunction as more real than others creates and crystalizes an artificial hierarchy. And it throws folks with sexual dysfunctions other than or in addition to pain under the bus.

And if, for me, all the sex education in the world fell short of actual medical help from professionals, then why should I believe that it would be any different for all of my friends who have sexual dysfunctions that are not painful?
Not that sex education has been completely useless; far from it. I have taken advantage of the information I found useful. (I also tripped over the parts that were counter-productive.) But to deny medical options to women with sexual dysfunction is to remove an important potential treatment, which for some folks may very well be necessary to find sexual satisfaction. And I find it highly disturbing when such options are removed through means of threats & intimidation, shaming, or ableist comments.

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Speaking of dyspaerunia being “The only valid sexual dysfunction and certainly the only important one,” I made this Privelege Denying Dudette meme just for you:

[Picture: Background: 6 piece pie style color split with pink and blue alternating. Foreground: White girl wearing a green t-shirt, featuring an African-American Sesame Street muppet with nine different hairstyles, subtitled, “I Love My Hair.” Has a smug, arrogant facial expression and plays with her long, brown hair. Top text: “ [SEXUAL DYSFUNCTION ISN'T REAL, YOU DON'T NEED MEDICAL INTERVENTION IN YOUR SEX LIFE] ” Bottom text: “ [WAIT, YOU HAVE DYSPAREUNIA? YOU BETTER GO SEE A DOCTOR.] ”]

What? Wait, what’s it going to be, do I trust my doctors or not? Do they know enough about sex to help me or is it an exercise in futilty to even bring up a sex problem? Am I allowed to go to one of the heavily-marketed sexual dysfunction clinics Dr. Tiefer mentioned in Sex is Not a Natural Act when my regular gynecologist gets stumped and refers me to such a clinic? If I take a prescription for sexual pain, am I just feeding the Big Bad Phama Beast and looking for an easy, quick fix? If I get treatment for dyspareunia, does that count as medicalizing sexuality?

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I recently came to a revolutinary conclusion. If your definition of sex positive does not include sexual dysfunction, then your definition isn’t positive enough.

I want to go out of my way to explicitly include sexual dysfunction in sex-positive discussions. Because ignoring it, outright denying its existence, or claiming that looking at sexual dysfunction = focusing on the negative, will not make it go away. Insisting that sexual dysfunction is a lie erases people who actually have sexual dysfunction. As a result, people with sexual dysfunction are excluded from sex-positivity – and I hate that. There is push-back against excluding people with a history of STIs from the sex-positive community by means of negative, stigmatizing language – why not push back for people with dysfunction?

You know what? I have sexual dysfunction. I exist. This is a long- term thing for me that I do not foresee changing any time soon. It will not go away just because you are uncomfortable with dysfunction (and, by extension, disability. These two phobias tend to go tovether, possibly because dysfunction may be viewed as a sub-type of disability.)

Yet even with the dysfunction, somehow, in spite of everything, I am sex-positive. I have made peace with it – or, at the very least, I have made a truce with myself until I can figure something better out.

Insisting that sexual dysfunction isn’t real or that medical options are unwarranted is just going to make it harder to get the care that I and my friends need. It’s true that most people will never experience sexual dysfunction, and so will not require medical options to address it. Nonetheless, inevitably, some people are going to develop sexual dysfunction. Isn’t there a way we can focus on getting support to such folk, instead of trying to sweep ‘em under the rug?

Sexual dysfunction and sex-positivity do not need to be mutually exclusive.

——————————————

Sometimes, I worry a little bit about my reliance on a vibrator for orgasm. I think that, with enough practice, I probably could masturbate to orgasm using only my (or my partner’s) hands. But until then, I orgasm easily enough with a battery-powered vibrator.

I’m not worried about spending money on vibrators and thus supporting a capitalist system. I’m not worried about using my vibrators during sexual activity with my partner. I’m not worried that he’ll feel inadequate compared to my vibrator. I’m not worried about becoming addicted to masturbation. I’m not worried that I’m supporting the tyranny of orgasm.

The real reason I sometimes worry about using my vibrator is…
…I have this paranoid fear that some day space aliens or a freak accident or a Hollywood movie-esque disaster will unleash an electromagnetic pulse over the USA (home) and all elecronics will lose functionality.
Including my vibrators.
And then I’ll have to find a techno wizard to SteamPunk some kind of hand-cranked or steam-powered vibe for me. Possbily incorporating or inspired by one of the old-time antiques like those found in the Museum of Sex. And it’s just going to be really awkward and frustrating and I’ll probably have a lot of other important things to worry about post-EMP.

Obviously I don’t really know how EMPs work and I don’t really care. Everything I learned about them, I learned from movies.

I think about this with about the same frequency that I think about the Zombie Apocalypse as a real thing. Which is to say, not very often except for maybe after watching a movie about a zombie apocalypse or a post-apocalyptic setting.

Vulvar pain in women of color

02/01/2011 at 1:59 pm | Posted in Uncategorized | 2 Comments
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This was cross-posted to Womanist Musings.

For the purposes of this post today, I will be focusing on vulvodynia; however keep in mind that there are other causes of chronic pelvic and sexual pain; likewise there are serious sexual problems besides pain which also deserve attention.

Vulvodynia is a syndrome, a collection of symptoms, centered around chronic vulvar pain, lasting longer than 3 to 6 months. Pain (commonly described as burning, stinging, stabbing, rawness and/or irritation,) may occur in the vulvar vestibule, mons, urethral opening, labia, clitoris, or elsewhere in the vulvar area. Not all instances of vulvar pain are vulvodynia, and for some women vulvar pain may resolve on its own.

Vulvodynia does not have one universal cause; some possible causes include injury, sensitivity to vulvar microorganisms (like yeast,) hormonal changes, muscular problems, etc., though for some folks the cause will remain unknown. For some women, vulvar pain is caused by pudendal neuralgia or pudendal nerve entrapment. Everyone is different, so some women experience pain all the time without provocation while others experience pain only when attempting to insert something vaginally. Likewise, for some women, it is still possible to enjoy sexual activity even with vulvodynia, while for others sex will become too painful to engage in. There are a number of treatments available for vulvodynia, but no single cure, so women with vulvar pain may have to burn through multiple doctors and treatments before finding the right one.

Who develops vulvar pain? I have seen several sources which present similar estimates as to how many women experience vulvar pain at some point during their life – at least, in the United States. According to one 1991 study, about 15% of 210 patients attending a gynecology clinic met the criteria for a diagnosis of vulvar vestibulitis. According to a 2002 release from the National Institutes of Health, about 16% of over 3,000 survey respondents reported chronic vulvar pain. (More on this figure in a bit.) The raw numbers seem to vary more; this same NIH release estimates that up to 14 million US women will experience vulvodynia at some point during their lives, whereas media coverage such as the Dr. Oz show estimate that there’s about 6 million US women currently living with vulvodynia. One thing all these studies agree on is that chronic vulvar pain, while not experienced by a majority of women, certainly isn’t rare either.

However, for a long time, I thought that women of color developed vulvar pain like vulvodynia less frequently than white women. I believed this, because I saw such statements in books, I saw it in studies, I saw it in the media and I went along with it. I realize now that I was completely and totally wrong. Vulvar and sexual pain does NOT just effect white women and in fact the rates of pelvic pain in white and nonwhite women is similar. But how many people still don’t know about vulvar pain in women of color? How many doctors and gynecologists are, like I was, under the impression that their nonwhite patients rarely experience nameable vulvar pain conditions which have treatment options available?

Here’s why I was wrong and why you too should care about women of color and chronic pelvic pain:

One of the first resources I picked up when I started looking for treatments was Dr. Howard Glazer’s The Vulvodynia Survival Guide, which is all about vulvodynia. Here’s what Glazer’s book said about vulvar pain and women of color…

“For unknown reasons, African-American women as a group are the least likely to report vulvar dysesthesia, or any other type of vulvodynia” (Glazer, 19). And “Again, Caucasian women have vestibultis [a specific, localized type of vulvar pain -K] more than any other racial group (Marinoff and Turner, 1992).” (Glazer, 23).

It goes on. In the late 1990s, early 2000s, Glazer organized a survey of women with vulvodynia though his website, vulvodynia.com, and in his book he reported that 90% of the survey respondents were Caucasian; “Less than 1 percent were of African origin” (33.) Additionally, it’s worth noting here that according to this same survey, participants’ “Socioeconomic status was higher than average; 62% reported incomes greater than $50,000″ (33,) and the majority also held “professional, managerial occupations,” and “59% had completed college” (33.) Glazer cautions, “The higher levels of socioeconomic, education, and occupation status is consistent with previous studies. Why? Unfortunately, it’s probably because educated women with access to money for medical care are the most likely to pursue the best, most sophisticated medical treatments (or at least to use the Internet” (33.)

But who is also the most likely group to be in the higher socioeconomic class and have a high level of education, and be in a better financial position to use technology and seek medical care? White people, in the US. Because of this, the design of Glazer’s study itself most likely skewed the results to exclude women of color. However, he went on to state,

Caucasian women reported more vulvar pain than any other ethnic group. African-American wome rarely report these conditions. Researchers aren’t sure why this is true, though it has been commonly observed by many of our colleagues in the International Society for the Study of Vulvovaginal Disease, who practice and teach in various medical settings where women of various races and incomes are seen. Other dark-skinned ethnic groups, such as Indians, do report chronic vulvar pain syndromes (33).

Hmmm, Glazer sure spent a lot of time driving home his point that black women don’t report vulvar pain frequently and that white women do.

But wait, there’s more. The results of an oft-cited but highly controversial, hotly contested study of sexual dysfunction in the US, Sexual Dysfunction in the United States, also stated that black and hispanic women were less likely to report dyspareunia,

The association between race and ethnicity and sexual problems is more variable. Black women tend to have higher rates of low sexual desire and experience less pleasure compared with white women, who are more likely to have sexual pain than black women. Hispanic women, in contrast, consistently report lower rates of sexual problems. (Laumann et al, online).

Additionally, media coverage of vulvar pain frequently reinforces the idea that it’s mostly white women who experience vulvar pain. Stock photos and illustrations that accompany books and articles about vulvar and sexual pain overwhelmingly feature white women. (See for examples, here, here and here – I could easily go on!) The erasure of women of color with pelvic pain and dyspareunia happens on television too, with a few exceptions; for example in 2008 the television show Oprah explicitly reached out to women of color in an e-mail requesting participants willing to talk about vulvar pain. Alas, to this day, although filming has been completed, that episode has not aired on tv. Another exception took place in 2010 on the Dr. Oz program, which ran a segment on vulvodynia. The original 8-minute segment included a guest woman of color who briefly commented on life with the pain condition (unfortunately the second half of this segment has been excised from the online video.)

However, the prevalence of vulvar pain among women of color may have been understated. The study which the NIH release above references is, A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? The abstract contains this critical line: “Contrary to earlier clinical assessments, white and African American women reported similar lifetime prevalences. However, Hispanic women were 80% more likely to experience chronic vulvar pain than were white and African American women” (Harlow and Stewart). Harlow & Stewart’s survey is no fluke; the WebMD article Vulvar Pain isn’t so Rare refers to a University of Michigan study published in the 2004 Journal of Lower Genital Tract Disease, “Although previous reports show the condition is rare among black women, the responses indicated that this is not the case. Black women had similar rates of vulvar pain as women of other races.” (Reed, online).

And as for Dr. Glazer’s claim that women of African descent rarely report pain outside of US settings? Even that has been challenged! In 2005, a study in the Journal of Reproductive Medicine revealed that 22.8% of women attending a general medical clinic in Ghana reported vulvar pain, which was linked to sexual dissatisfaction.

I am certain that effect of emphasizing white women’s reported rates of vulvar pain over that of women of color is silencing to this day. So what’s being done to address this revision in what caregivers should know about vulvodynia?  The NVA’s fact sheet on vulvodynia now reflects that nonwhite women are just as likely as white women to develop vulvodynia. The language explicitly shows a change of perspective, from vulvodynia being thought of as primarily a Caucasian women’s issue to much broader. An NVA newsletter, Faces of Vulvodynia, included identifiable women of color like Karen, Yamalis, Amanda, Michele and Emily, who are willing to be interviewed by the media.

Unfortunately vulvodynia remains difficult to diagnose and it doesn’t help that some doctors remain ignorant of its very existence. Even doctors who do know about vulvar pain conditions may not be up do date with all the research. And doctors who are well-trained to address chronic pelvic and genital pain may be too far out of reach for many patients, both in terms of money and geographical distance. Genital and sexual pain received some media attention in 2010 but it still remains very much a taboo subject, and it is the butt of crude jokes surprisingly often. Society, guided by the long tendrils of patriarchy, pushes women to learn how to please men sexually, and so there is also pressure to perform sexual activity – even if it hurts. It shouldn’t have to be that way. And the quality of sex education is highly variable – I recall my own sex education lacked any mention of pain other than what happens when the hymen is broken.

If you or someone you love is experiencing chronic vulvar and/or sexual pain, some resources available online include the NVA in the US or the ISSVD internationally. A short list of some available treatments is available from the Mayo Clinic’s site.

Guest post – Update from a guest poster

01/27/2011 at 11:11 pm | Posted in Uncategorized | 3 Comments
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[Dear internet, we have a guest poster today! Rhiannon was the first guest poster we ever had here on Feminists with Female Sexual Dysfunction. It's been a little over a year since her first post with us, and she has volunteered to share a follow-up of what's been happening with her vulvar pain since then. The following account comes with a trigger warning though, for invasive medical procedures and brief mention of self-harm.]

The wisdom – or not – of pursuing medical options

A lot has happened since my last post. I spent most of the year celibate, trying to embrace that as a queer identify, and not really getting there; in September, I began a triad relationship with a man and a woman who were a couple. It has all fallen apart now, but my relationship with the man folded first, and a big part of that was that we couldn’t have sex.

When I told my GP this, she asked whether I was in treatment for the vulvodynia. I said I wasn’t, and explained how grim the treatment options had seemed before. She suggested that I could get a second opinion.

“Can’t hurt,” I said. I was wrong.

Now, going to the gynaecologist to have your vulvodynia examined is always going to be at least a little painful, because the chief symptom is pain and they have to cause a little in order to see where it is. The classic way of doing this is the cotton-bud test – a controlled and relatively gentle touch to the painful area to confirm its location. I know because I’ve had it done several times in the past.

Apparently this consultant hadn’t heard of it.

I had my history taken by a relatively nice registrar, and I thought that if she examined me it would be okay. Once she’d taken my history, though, she said she had to fetch the consultant because she’d never seen this before – fair enough, nobody can know everything – and I should get ready and wait on the bed. A nurse came in and talked me through the need to take my knickers off and pull my skirt up (and cover the tops of my thighs with that silly little piece of paper they always use… what purpose is that supposed to serve?).

The consultant appeared. He was a big black man who didn’t speak directly to me, just found his gloves and went to have a peer and a poke. I am aware that my prejudices could be showing here; I think that I would have found the behaviour rude in a white doctor or a female doctor, or indeed a shorter doctor, but I might not have been as frightened by it.

My Bartholin’s glands are visibly inflamed, and most doctors see that. I don’t think he noticed them, although I had mentioned that specifically when my history was taken by the registrar; he certainly didn’t try and avoid touching them. I have been examined many times, and it’s never comfortable, but this was very painful. It was as painful as penetrative sex is, in fact.

I gasped and cried out, I nearly screamed, and it must have been obvious because the nurse felt the need to hold my hand.

Afterwards, I was shaking and in tears. I was left alone to get dressed again – I managed to calm down by one of my milder self-harming methods. After what seemed like a long wait, the consultant and registrar returned with what appears to be a hurried print-out of some basic information (I suspect I know which website they used).

“I’ve never seen anything like this before,” the consultant told me. “I’m going to have to ask around and see who I can refer you to.” They said that; the referral letter hasn’t arrived a month later, and if the new consultant will be anything like this one I shall have to think twice about going.

They left me alone with the nurse, who checked I was okay and had one last piece of final ironic advice: “Don’t go looking at the internet and scaring yourself.”

I was too shaken to tell her that the internet is the only place I’ve found comfort in facing vulvodynia.

2010 a retrospective

01/01/2011 at 1:27 pm | Posted in Uncategorized | 3 Comments
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So long, 2010! Don’t let the door hit you on your way out, ‘cuz I don’t want ass prints on my new door!

2010 is finally over. It was a difficult year for me filled with many changes and much instability. Ten people that I personally knew died in 2010; I was close with three of them; one of them was only my age (still under 30.) The political climate in the US (where I live) continued to shift towards the right-wing, particularly the extreme right-wing towards the end of the year. The US economy continues to be shit even though I have heard economists proclaim the recession to be officially over. In the last quarter of the year, I went through two major life transitions, much needed and long overdue, which culminated in the largest change I have ever gone through. Since I’m still trying to maintain a level of anonymity, I can’t explicitly state what the big change was. It’s sufficient to say that  I can never return to the old normal I once had, but at this point I wouldn’t want to anyway. Still, my life remains in a state of flux. Phase 3 of my major life change starts today, though phase 3 will be intangible, long and drawn out, and less major… basically consisting of adjusting to all the newness I am surrounded by.

With phase 2 of my life upheaval over, I can now turn my attention back to other areas, such as this blog. Sexual dysfunction is still real, it’s okay to have sexual dysfunction, it’s okay to want and/or need help with your sex life, and it’s okay to be a feminist yet still have sexual dysfunction. We may not see female sexual dysfunction covered in mainstream news for awhile, but that doesn’t mean FSD is going to disappear into the ether. (At least, not for me it sure isn’t; yours, if you have any at all, may resolve, but I still face a long road ahead.)

We got a lot done in 2010 – we here talked about a lot of different topics and explored some different perspectives on FSD. I would like to extend a special thank-you to all guest posters and contributors who participated in this blog over 2010 and 2009. Did you see the following 2010 guest posts and contributions?

Guest Post – On the social construction of sex
Guest Post – 10+ years with vaginismus
Guest post – Heteronormativity and FSD
Guest Post – On dealing with doctors
Guest post – On the FSD hierarchy and why it hurts all of us
Guest post: GUILT, FAILURE AND A PRE-ORGASMIC FEMINIST
Guest Post: Interview with Elizabeth on Asexuality
Feedback reconciling BDSM and painful sex
Feedback understanding the difference between BDSM and painful sex
BADD 2k10 – sexual dysfunction as disability
Female sexual dysfunction discussion Bingo!
Guest blogging: Reaching out to the asexual community (I did some guest posting too.)

Some other posts I wrote and am particularly proud of in 2010 on Feminists with FSD in 2010, as arbitrarily chosen by me (Not in any particular order):
Statistics and FSD – Part 1 of 2 – In which we examine that famous study that said something like 43% of all women in the US have some form of FSD.
Statistics and FSD – Part 2 of 2 – Don’t miss part 2! I think of it as a follow up to that 43% study. For some reason this follow up never generated the same number of views as the original, which bums me out.
Picture post – Antique prophylactics [NSFW] - People really liked this funny picture post! Someone even offered to buy the antiques off of me but they’re not truly mine to sell.
A 5-part series in which I read all of Sex is not a Natural Act and Other Essays by Leonore Tiefer, which came highly recommended and presents a social construction critique of sex and female sexual dysfunction. My opinion remains unchanged: The book was not enough to convince me to take an exclusively social construction perspective; it’s filled with disabilist statements (It’s not a bug, it’s a feature!) and it creates unique problems of its own which merit further examination.
Edit 1/7/11 – Oh what the heck, throw this one up there too: Book review: A New View of Women’s Sexual Problems – because if anybody suggests that I read this in 2011, I beat you to it. We did that already. Same conclusion as the above book review.
Symbolism, archetypes and stereotypes: What experts have said about vaginismus – You want to talk about the symbolism behind sex fine let’s go and do exactly that.
Book review – The Camera My Mother Gave Me – I thought it was a good review.

Television programs that addressed vulvovaginal pain conditions in 2010:
Dr. Oz – Vulvodynia
Dr. Oz – Vaginismus
Strange Sex on TLC – Vulvodynia – I can’t find a video of the segment so here is a transcript instead!
Chelsea Handler responds to Dr. Oz winning a television award (Warning: you’re probably not going to like this one. Proceed with caution… But on the bright side, there’s 3 serious videos on that same page, right after the Chelsea Handler one, which are more comprehensive and informative about vulvodynia. You might like those.)
Action News – Vulvodynia
MTV – True Life: I Can’t Have Sex - Vaginismus, vulvar vestibulitis, pelvic floor dysfunction; did not explore overlapping conditions.

Wow. I’m impressed with the quantity of media coverage (though not always impressed with the quality,) and that’s just what I know of. I can’t decide which one I like best, the Dr. Oz coverage or the MTV coverage. The weird part of the Dr. Oz video for vulvodynia was using a traffic light analogy. I would have gone with one of those plush vulva puppets instead.
Drop links if’n you saw more about pelvic & vulvovaginal pain conditions in 2010!
Strange Sex also covered restless genital syndrome, aka RGS aka PSAS (persistent sexual arousal syndrome) or PGAD (persistent genital arousal disorder.) The video was here in 2010 but I’m not sure if it’s still up. And you still have to register to get that far.

Biggest FSD controversey topic of 2010: Flibanserin and hypoactive sexual desire disorder (HSDD.)
In 2010, pharmaceutical company Boehringer Ingelheim moved forward with plans to gain FDA approval on flibanserin, a drug that started out as an antidepressant but that, in drug trials, showed a small but significant change not on mood but on women’s sexual satisfaction. As the FDA hearing date approached, media and blog coverage of this topic increased. However what the great flibanserin debacle of 2010 reveals the most about FSD, isn’t the drug or its development or the long arm of big pharma. There’s that, yes, and I have no doubt that much of the media coverage we saw was yet another form of marketing. What was revealed but went unexamined in most mainstream media coverage can be found in the comments about HSDD, FSD and flibanserin. In comments and sometimes in the articles themselves, negative, patronizing attitudes towards women with FSD are made clear. I mean, look at these piles of bullshit people say and think (Trigger warnings):
The ugly things people say about FSD Part 2: Electric Boogaloo
The ugly things people say about FSD Part 3: The Redeadening
Good grief. And it just went on like that in some fashion on other blogs and news outlets, resulting in the FSD Bingo Board (linked to above.) But misogyny and disabilism isn’t limited to HSDD. Trigger warning re: [Trigger warning] all the troll comments that Chloe’s article in response to MTV’s True Life: I Can’t Have Sex received on Salon.com. There is something going on with, I think all forms of FSD, where it isn’t acknowledged as a valid experience and diagnosis. When it comes to FSD, it doesn’t matter what kind of FSD we’re talking about; everyone is an expert except for the women who live with it.

Speaking of trolls, heads up: as of the end of 2010, there is still some guy going around targeting V-blogs, YouTube Videos, articles about dyspareunia, etc., and spamming them up with troll comments – Usually the same exact troll spam copied word-for-word, or slightly modified. If you’re maintaining a V-blog and get a weird, deliberately ignorant comment about vaginismus from an IP address that traces back to the Philippines, then that’s the guy. See, this is the crap you have to deal with when you write frankly about life with FSD! Here are some short entries with links to other entries about dealing with trolls, from a feminist perspective: GeekFeminism and FF101.

Reminder: things Feminists with FSD is not:

  • A medical advice blog: It’s possible that some commenters and/or guest posters have medical qualificatons, but I don’t. Do not ask me for medical advice because I probably don’t have any new information for you and god forbid I give you the wrong information, and just make things worse.
  • An agony aunt blog: I am not here to give you dating, relationship or general life advice for the same reasons listed above.
  • A news blog: I make an attempt to keep abreast of FSD news but I have a life outside of blogging and I’m not a journalist.
  • Making any money. I haven’t figured out a way to fairly monetize the blog. Full disclosure: to this day I have earned exactly $0 from blogging about the intersections of feminism and sexual dysfunction.
  • The final authority on FSD – I’m a feminist blogger who has sexual dysfunction. I have my own opinions which may not match your own. Although I certainly hope that as someone who actually lives with the topic of interest, you would give some extra consideration to what it is I say. I’ve been through quite a bit already. I hope you would also question anybody who claims to be the final boss of FSD.

Is Feminists with FSD a sex blog? I don’t know; I’ve said elsewhere that I consider myself to be more of a lack-of-sex blogger. We talk about sex and sexuality! I’m even open to reviewing sex toys in the future. But it doesn’t come easily and my experiences are fairly limited (though many sex bloggers likewise strive and struggle to put out good quality posts, so it’s not like sex blogging is easy, either.) And then there’s times where sexual problems aren’t elusively sexual problems. Problems bleed out and overlap. They stain. If this is a sex blog at all, then certainly it’s a different kind of sex blog.

And so, as 2011 begins, I see that there is still much work left to do. We’re not done here. I have not yet begun to fight so it’s a good thing I’m still not burned out.

I’ll be catching up with my RSS feeder and working on new posts over the next couple of days. Won’t you join me on this journey? I cannot do it alone.

Notes on MTV’s True Life: I Can’t Have Sex

12/07/2010 at 9:42 pm | Posted in Uncategorized | 3 Comments
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Last night, December 6, 2010, at 10pm EST, MTV aired the season premiere of the television show, True Life. The episode was titled, “I Can’t Have Sex.” To produce this program, the show crew followed three women around over the course of several months and presented the impact of chronic pelvic pain conditions on their sex lives.

I watched the episode on television and I took notes. There’s a lot of things going on with and around this episode!

First, in case you missed it, MTV.com has the full episode available for viewing, now! This is what you’re looking for! I do not know if it will remain online indefinitely or if it will be removed in the future, but if you missed the episode here is a chance to catch up to it. It’s 42 minutes long. No subtitles available on the online version. Here is a brief summary with a link to the video. MTV has posted this follow up feature: True Life Check-ins. The follow-up article contains links to helpful resources.

Full disclosure: I sort of “Know” two of the women who were featured in this episode, because Tamra and Tali both maintain blogs. I do not know if Tess maintains a blog. Tamra’s blog is Living with Vulvar Vestibulitis. Tali’s blog is The Rambling’s of an IC Patient. I have not met anyone in person (that I know of) who was involved in filming this episode. But still, I feel a little weird posting about the episode at all, since I can apply a name, a face and a blog archive to two of the women who were on TV. It’s also weird because I have some of the conditions which were examined on the show.

Here is some of my notes taken during this episode, fleshed out a bit:

This is the first episode of MTV True Life that I have ever seen, so I went in not knowing what to expect. I rarely watch MTV and I tried to ignore the commercials that aired between segments. I was anxious about how the show would be edited and whether there would be any commentary provided by a third party. I’m still anxious about how the episode was received by a general audience. The sound to my TV was cutting out for a second at a time here & there so I was having a hard time hearing at some points.

The episode features three 20-something year old white women over the course of several months – Tess (self-diagnosed with vaginismus,) Tali (the episode focused on pelvic floor dysfunction but she has overlapping conditions which were not all given screen time,) and Tamra (diagnosed with vulvar vestibulitis and, later, orthopedic issues.) Chronic pelvic pain is an invisible condition. You would probably never guess from a first impression that these three women were dealing with chronic health problems unless they chose to disclose such information to you. Tamra, Tess and Tali are currently in, have previously been involved in, or are interested in heterosexual relationships. They are all unmarried and do not have children. We saw Tess and Tali’s boyfriends (at the time of filming) on this episode and MTV followed Tamra around on a date and to a social event. All three live in the USA. Except for the introduction to the episode, there was no narrator. That means that everything you heard, was spoken by the women or those close to them. Of course I’m sure MTV did some creative cutting and editing of the material collected. Filming wrapped up awhile ago, so there have been updates and changes in the womens’s lives in the interim between filming and the airdate.

Actual, proper terminology was used throughout the show. Chronic pelvic pain conditions were named, but some conditions that overlap were not mentioned at all (interstitial cystitis, for example, was not explored in this episode. This is a shame – interstitial cystitis is another misunderstood condition which would benefit from careful media coverage.) This episode focused on the impact of chronic pelvic pain on the women’s sex lives. And that means that while you could learn a little about life with chronic pelvic pain from this episode, for a clinical discussion and details on specific conditions and available treatments, you’ll need to look elsewhere.

We see some of the treatments that Tess, Tali and Tamra tried. A dilator kit on television, a TENS unit, a visit to a sex toy shop (Babeland) to pick out a comfortable lubricant. Psychological therapy, and pelvic floor and intra-vaginal physical therapy. (Several scenes where Tali received physical therapy with Isa Herrera looked familiar to me and Herrera talked about muscle tightness which was and remains a problem for me. It was just weird seeing someone else in the same position I had to spend so much time in.) Injections of anesthetic to the pelvic area and oral painkillers. Ice packs as needed. But I didn’t see anything about diet modification or alternative therapies like acupuncture.

Although sex and sexuality were the focus of this episode, MTV did show how chronic pain and anxiety can bleed out into other, non-sexual areas of life. Sometimes, like in Tamra’s case, pelvic and vulvovaginal pain is not limited to sexual activity. This was downplayed compared to the sexual aspects of pelvic pain, however. Because this is a blog about sexual dysfunction, I was okay with the sexual aspects of life with chronic pain for the episode – especially since I’ve been on this kick lately where I want to hear women talk about their own experiences with sexual problems. But keep in mind that if you do have chronic pelvic pain, there may be a lot of issues going on at the same time besides sexual problems. Or it may all be connected.

For example, there was one point in the episode where Tamra was speaking with a therapist. It was an emotional scene. But I thought that the therapist was misinterpreting Tamra’s concerns. Maybe it was just the way the editing was put together but during this scene, I thought that Tamra’s concerns included sex, yes… but they also went beyond relationships and sexual pleasure. However that that is what the therapist seemed more interested in. In this scene, I thought the therapist’s priorities did not match Tamra’s.

Tess was in a 5-month relationship with her boyfriend at the time filming began. She had not been able to have intercourse with him and was upfront with him. She picked out a dilator kit that came with an educational booklet and talked to a therapist to help address her anxiety.

Tali experienced the onset of her symptoms at age 17 and has seen 24 doctors. She was in a relationship with a young black man, Boom, at the time of filming (they have since broken up.) Remember, Tali’s blog is titled, “The Rambling’s of an IC patient” – yet this episode did not talk about IC at all.

Tamra was a student and the episode featured her giving a speech about vulvar vestibulitis in front of a whole bunch of people, as part of a women’s & gender studies class. Hmmm. Tamra had been in a sexually active relationship before developing what would be diagnosed as vulvar vestibulitis (her condition has since been re-examined.) She talked openly about how pain was making it hard for her to date and enter relationships – and pain made hard to enjoy other activities, like dance.

Viewers saw some of the relationship tension that Tali and Tess had, at least as far as their sexual problems went. If there were other problems in their relationships beyond sexual problems and anxiety, that was downplayed for this episode. Tess mentioned to her therapist though, that a previous boyfriend had said abusive comments to her. I thought it was interesting how Tess and her therapist involved Tess’s partner, Antonio, in her treatment for anxiety. Tali’s physical therapist also demonstrated some therapeutic techniques to Boom. (I wish I had had this opportunity to do the same with my partner; however we were in a LDR at the time of my physical therapy.)

Tess and Tali showe improvement with their favored treatments. For Tess and Tali the episode ended on an optimistic note. By the end of the episode, the two couples, Tess and her boyfriend, and Tali and Boom, were having sexual intercourse following the therapies they chose. But for Tamra, she was still dealing with a lot of pain in the end, and with a new diagnosis and the possibility of surgery. She had a labral hip tear and this may account for a lot of her pain. (She has been writing about this on her blog for some time now.)

Overall, I liked the episode. I thought it was good and I am shocked with the amount of time that these topics received. A whole hour-long television show, which works out to over 40 minutes?! Here I was scrabbling around for 2 to 7 minute clips! But there’s always room for improvement. This episode could have given much more airtime to Tali’s related conditions. Any airtime, really, for IC and lichens sclerosus. Just name them, even. In the future, a television program or other media outlet could do a whole episode or article about life with chronic pelvic pain and focus on areas besides sexual activity, because there is so much to life with pelvic pain. But there is that sexual aspect too… Was sexual pain sensationalized in this episode? Hmm… No, I don’t think so, I thought it was pretty frank. It was focused on sex, yes, but realistic to me. The editors certainly took the show in a certain direction. But it definitely wasn’t sensationalized like a recent segment on vulvodynia that aired on a local news channel. And pelvic and vulvovaginal pain was not treated like a huge joke (although Tess and her friends did laugh nervously when discussing vaginsimus.) There was no narrator for this episode and it did not feature an interview with say, a gynecologist, so no one was able to go into great detail about what causes pelvic pain and what treatments there are.
Future programs like this could also take steps to be less hetero-centric, and could actively reach out to more nonwhite women. (For example, years ago producers of the television show Oprah reached out to women of color for an episode about pelvic pain – an episode which has never aired.) And I’m surprised that the episode didn’t list some resources or URLs to information about chronic pelvic pain during the follow up with each of the interviewees. Resources such as the National Vulvodynia Association, The Interstitial Cystitis Association, and The Interstitial Cystitis Network.

So so far, in 2010, there have been a few depictions of vulvovaginal, sexual and pelvic pain, and each of these depictions have been different. There have been strengths and weaknesses with almost all of them. And I’d like to see more topics like this covered going into 2011 and beyond.

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