Different reactions to different articles

12/05/2009 at 4:20 pm | Posted in Uncategorized | 1 Comment
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Everyone experiences sexuality differently…

It seems everyone also experiences reading & writing about sexuality & sexual dysfunction differently. Before we go on with the weekly blog link roundup, there were two interesting reactions to two different articles on female sexual dysfunction this week. I was going to include these in the regular link round-up but it got too long.

First we have Women getting it up over at Vagina Dentata, a feminist & science blog. Naomi MC wrote a response to news about Flibanserin, an antidepressant drug that may increase women’s libidos, and so may be useful for some women with low sex drives.

MC raises some concerns about Flibanserin and links to two other pretty good resources on the topic, but I’ve got some concerns about the way her concerns are worded.

She says, “But here’s the news we’ve all be waiting for – female Viagra has been invented,” but that’s not really accurate. Viagra doesn’t create sexual desire in and of itself, it just makes a physical response to arousal more noticeable by increasing blood flow to the genitals. The thing is it’s easy to confuse actual sexual desire with signs of sexual arousal. It’s not clear to me if MC already knew that and was just playing up on this misconception for rhetorical purposes.

It’s also not clear to me if, in the next line, where MC says, “In sum, this was a preapproved drug being aggressively marketed for a likely manufactured ‘disorder’, and may be no better than a couple of glasses of wine,” which ‘disorder’ we’re talking about – are we talking about the broad blanket term of female sexual dysfunction in general or are we talking about the specific, more controversial diagnosis of hypoactive sexual desire disorder? Because female sexual dysfunction is a broad blanket term. Under the usual definition, it usually encompasses problems with libido, arousal, orgasm, or sexual pain. There are alternate models of sexual problems, and the percentage of people who have a genuine dysfunction depends on what study we’re looking at, and who’s asking. But, since FSD encompasses pain – the one valid & important dysfunction, according to Dr. Leonore Tiefer – (I’m definitely not okay with minimizing the impact of other sexual health problems for other women,) and because I’m personally distressed by what I’m living with here, I have it. What I’m going through is real. Which is why I’m concerned when I see words like, “manufactured,” used when talking about FSD. But if we’re talking about the specific diagnosis of hypoactive sexual desire disorder, then I have a better understanding why that’s more controversial.
I’m still don’t agree that it’s entirely a made-up disorder though.

There’s some other paragraphs in the post of interest about sexual violence and a historical view of female sexual dysfunction, & then comes, “So if you’re lacking sexual desire, chill out, have a glass of wine and think about it for a bit, considering what factors might be feeding the problem.

Emphasis mine, because this…
Is probably one of the worst things you could say to someone like me.
I can only speak for myself of course, as a pelvic pain patient. What I’ve gone through is, people have said this to me. Bad gynecologists have said this to me upon becoming frustrated with my repeat visits without problem resolution. When the usual medical treatments don’t work, the gynos defaulted to “It must be in her head. If it’s in her head, she should just get a little tipsy and loosen up.” Of course it turned out that my problems did have names and could be treated medically, so the “Relax and have a glass of wine” advice always raises red flags to me. It suggests that whoever I’m talking to is not familiar with the less common gynecologic conditions, and so is not prepared to help me. Time to find a new gyno.

There is another way I interpret the “Relax, have a glass of wine” thing:
Do you really think I haven’t sat down and thought about it?
Do you really think that other women who have serious sexual problems, maybe not pain but problems with arousal or libido or orgasm, don’t think about it, and ruminate on it, possibly night after night with a glass or three of wine in hand?
After considering what other factors might be feeding the problem – what then, when no factors can be identified, or when they can but there is little that can be done about it? What happens when identifying stress and modifying lifestyle to reduce stress doesn’t improve quality of life?

(The last problem I have with this statement is mostly a personal preference. Except for a few times a year, and a few sips at a time then, I don’t drink.)

The last line MC concludes with is, “Or maybe talk to someone; ideally someone who won’t financially benefit from selling you a pill.”

The thing is I have absolutely no idea who this “someone” would be. There are no suggestions listed…
A doctor or gynecologist? There’s a risk there that a doctor or gynecologist could have a vested interest in prescribing a pill to a patient complaining of low libido. (Although in my personal experience, the risk of having sexual complaints taken seriously is slim-to-none, and the patient may have to press hard for a medical treatment.)
Should someone with low libido talk to a sex therapist? Theoretically a sex therapist also has a vested interest in drawing out treatment for an extended period of time, although I would expect a good, ethical sex therapist would want to keep costs as low for a patient as possible. But then if the therapist is able to write prescriptions, then they may also suggest a medical option. That may be reserved as a last resort, but when it comes down to that last resort, does that mean the sex therapist is untrustworthy because they have recommended a medical option?
Should a patient with low libido talk to her sex partner? Probably if she even has a sex partner; what about singles? Between the taboos against frankly talking openly about sex and sexual health problems, and ignorance about female sexual dysfunctions it may be a bit tricky to determine if a friend or family member is trustworthy and knowledgeable enough to talk to. My own family is fairly supportive of me now, but when I first tried to explain to them (multiple times) what was happening to my body and why that was important, they didn’t believe me.
Well I suppose online support groups are always an option… If you have a computer.

Overall Women getting it up is a bit contradictory to me too, since, in an earlier post, MC explicitly said,

It is a concentration on “doing sex right” which leads to the medicalisation of male and female sexual ‘dysfunction’. I don’t deny that sometimes drugs and treatments for sexual dysfunction are necessary and beneficial to individuals but often, and certainly historically, we are being told that there is a right and wrong way to have sex and if you’re not doing it right then you have to be corrected.”

I’m definitely aware of the pressure to do sex right vs. doing it wrong, but, here we have a drug treatment for something that for a few women is probably a very real sexual dysfunction and so might find beneficial… I still think we can re-frame sex to reduce pressure to perform AND explore medical options at the same time. At least, I sure hope we can do both at the same time because that’ s what I need the most. To explore only the social & historical construction of sex, or only medical explanations for sex, backfires against patients like me who need both.

Then we have an interesting post at Asexy Beast, a blog written from the perspective of an asexual woman.
The thought that keeps popping into my mind is with regard to this particularly interesting post is, “So an asexual woman and a woman with sexual dysfunction walk into a bar…
What I mean by that is, I can’t figure out what the next line in that setup is but there’s something going on there…

Background information: A few days ago, an article was featured in New York Times Magazine, Women Who Want to Want. It’s an article about female sexual dysfunction as it relates to low or absent sexual desire, specifically the controversial diagnosis of hypoactive sexual desire disorder (HSDD.) The article does not examine sexual pain or orgasm.

I briefly touched upon this article when I did the weekly blog link roundup for the week of 11/28/09. My opinion at this time is about the same as it was at time of reading. That is, I found the article to be interesting, well-researched, and sensitive in dealing with female sexual dysfunction and the women who have it – at least, definitely sensitive compared to other recent articles about female sexual dysfunction, which I’ve blogged about here before. Women Who Want to Want includes my first exposure to Lori Brotto, who researches sexual desire and will have a direct influence over the next DSM revision regarding female sexual dysfunction.

Ily’s reaction to Women Who Want to Want is very different from my own. From what I’m reading, the article was a lot harder for Ily to handle than it was for me. I thought the article was relatively sensitive to women with FSD, but Daniel Bergner and Brotto steamrollered over asexuality and asexuals. Ily says,

It made me cringe to read that women in Brotto’s support group were told to repeat, “‘My body is alive and sexual,’ no matter if they believe it.” Maybe some of those people could really identify as asexual, and could be helped by knowing there is a community of people who are very much alive, and yet aren’t sexual. Even the women with low/no desire who would never call themselves asexual, or obviously are not ace, would probably have a lot in common with us anyway. What is Brotto thinking?

And what comes to my mind here is that, yes certainly the body can be alive and asexual at the same time. It does sound vaguely Freudian to me, to say, “Alive and sexual.” Is equating the two the same as eros, a drive to live & love? I’m asking because although I have read some of Freud’s work and am somewhat familiar with it, I’m definitely no expert & I could use some help here. I’m still struggling to figure out exactly what eros is.

Ily and I both recognized names that appeared in Women Who Want to Want, but we recognize different names. I recognized Dr. Leonore Tiefer’s name towards the end of the article because she is such a prolific writer on FSD – and because I disagree with her a lot of the time. Ily had not heard of Tiefer before, but she had heard of Brotto. Brotto has been involved in researching asexuality, and Ily noted how odd it was to not even mention asexuality in an article about low or absent sexual desire.

Not mentioning the possibility of asexuality when talking about various sexualities and libidos, is probably an omission on my own part too.

Ily and I interacted a bit in the comments (I was a tired that night so I wasn’t at my best over there.) I know I’m probably doing a very bad job of including asexuality in my thoughts when I write about FSD. But on the other hand, I don’t want to slap a label of dysfunction onto someone who identifies as asexual, especially if that someone is perfectly comfortable with who they are. No distress, no problem.

But one complication when talking about low libido and asexuality is that, if you actually live with female sexual dysfunction and talk about it, there’s a pretty good chance that someone may have flippantly said to you, or will say to you, “Well maybe you’re just asexual. I’ve run into that myself. It’s not accurate, and it wasn’t said in good faith by someone who was actually familiar with the asexual community. Asexuality is a real possibility for some women who have absent sexual desire, yes, but used by or on the wrong person, what could be a comfortable identity, is an insult instead. Possibly an intentional insult, a dismissal, a denial of an individual’s stated sexuality.

At the same time, despite popular belief, nonheterosexual orientation is not a cure or prevention against developing sexual dysfunctions. Online, I have met heterosexuals, lesbians, bisexuals and pansexuals with vulvodynia. (I’ve only met one other woman in flesh & blood who confided to me that she has vulvodynia, so if I know anyone else in real life with this problem, I don’t know it.) I haven’t met anyone who disclosed to me that they are asexual and are living with vulvodynia, but I can see no reason that asexuals would be immune to it, or other sexual health problems. (I’m thinking I probably haven’t run into asexuals with vulvodynia because the spaces I hang out at do spend at least some time talking about sex, so those spaces may feel less welcoming to an asexual.) But if an asexual does develop what is usually considered a sexual health problem, is it still a sexual problem or is it purely a health problem?

So Ily’s post was particularly interesting to me because raises a lot of new issues to me that I hadn’t considered before, but probably should try to in the future.

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  1. […] quite differently from me. We interacted a little in comments at her blog, and I fleshed out some more ideas here, re: FSD and […]

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