Statistics and FSD (part 2 of 2)

06/14/2010 at 9:55 pm | Posted in Uncategorized | 5 Comments
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Last week I shared with you my interpretation of Sexual Dysfunction in the United States, a peer-reviewed journal article about sexual dysfunction that appeared in the Journal of the American Medical Association in 1999. The study is widely cited to this day, though it remains a source of consternation in discussions of sexual dysfunction due to some major problems the study had. To refresh your memory, one of the researchers involved with the article had financial ties to Pfizer (the maker of Viagra) and the statistics on the prevalence of sexual dysfunction (43% for women) may have been overstated, because the study did not take participants’ personal distress or lack thereof into consideration. This is not the only research paper on sexual dysfunction but it’s notable because it’s got the backing of the AMA and because of its scale, both in terms of sample size and how big of an impact it had on sexual dysfunction treatments.

But time flows like a river… and history repeats…

Almost 10 years later, another big research study on sexual dysfunction was published in the American College of Obstetricians and Gynecologists journal, Obstetrics and Gynecology. The article, Sexual Problems and Distress in United States Women: Prevalence and Correlates, is another one that’s free and available to all who have an internet connection. This study deals exculsively with female sexual dysfunction, and revises the prevalence of FSD to a much lower rate within the US – in the end, the prevalence rate is estimated to be about 12%. We’re going to be feeling reverberations from this study for quite awhile longer, although I have not seen as much criticism of this study as I did with the JAMA one. Still, like the JAMA article, there are a few potential problems with Sexual Problems and Distress in united States Women we should take a good hard look at.

First, the study was sponsored by Boehringer Ingelheim International GmbH – that’s the same company that is working on producing Flibanserin, a highly controversial drug that may increase women’s libido, and thus address one of the more common types of female sexual dysfunctions. You may have seen some hoopla about Flibanserin on the blogosphere starting around late 2009, and it hasn’t let up. In fact, I’m sure there’ll be more media hype and handwringing as the FDA considers approving Flibanserin. In fact, I know for certain that there’s more hoopla going on right now, because the New View Campaign has organized an online petition to the FDA to block approval of Flibanserin… Well-intentioned as this may be, it’s something that I cannot get on board with and I do not support.
But what Boehringer’s involvement with this study means is that, almost 10 years after the JAMA article, there’s still a conflict of interest in studying FSD! Additionally, all five researchers in this study had financial ties to pharmaceutical companies, as disclosed on p. 970.

Ultimately those conflicts of interest described above and in the JAMA article wind up hurting women with FSD, since such conflicts are taken as a sign that FSD simply must be fake and a source of E-Z money for big pharma. From there, you’ll get pundits, doctors & journalists seizing upon those conflicts of interest and dismissing what women with FSD say.
Unfortunately in this day and age, I am pessimistic that we will see many studies on sexual health that are completely free of commercial taint. Dr. Tiefer in Sex is not a Natural Act looked to academia as a safe haven for research to continue without conflicts of interest. Educators and professors can still apply for research grants, and generous donors still donate, but I have lost access to many scientific journal databases that I was able to get into while I was still in school – because there wasn’t room for all the databases in the school’s annual budget. Raises, new hirings, budgets, and promotions at my alma mater were frozen last year. Plus, academia brings its own set of institutionalized problems. So as far as academia being the alternative solution – well I guess I’m jaded because I’m not entirely convinced about that, either.

For a contemporary real world example of conflicts of interest in the world of women’s health, just check out this About page for the Overlapping Conditions Alliance. At the bottom, we can see that it’s sponsored in part by Pfizer. As someone who stands to benefit from this campaign, I like that this organization went to Washington D.C. to bring attention to women’s chronic pain conditions. But I can’t ignore the little Pfizer logo. I’m not sure we’re going to be able to be completely free & clear of private funding in producing research that impacts public health, and I don’t have a solution to that. I know to take research papers with private ties with a grain of salt, but that’s all I know what to do right now.

The second major problem I can see with this new study is that, this study on FSD deliberately excluded pain!

WTF?! It’s a study about FSD, how can you exclude pain from any definition of FSD? How and why would you do that? Here’s the stated reason why: “Sexual pain problems were not assessed, because a physical examination is required for evaluation of dyspareunia (Shifren et al, 2008).

WTF is this?! Wtf. What, you can’t listen to women who tell you that sex hurts? Why can’t you take their word at face value? If I tell you, “It hurts when I go to have sex,” I mean exactly that! Wtf, I need a doctor’s note to verify that my fucking crotch hurts?! Why won’t you listen to me?!?! Why doesn’t anyone believe me?! News flash: Not all women with dyspareunia can afford to go to a doctor, and often enough when they can afford to see one, the doctor dismisses any and all sexual complaints as “All in your head!” I’m not making it up, this is real! Why don’t you care about this?!

So yeah that’s… if you ask me, that’s a big, huge, major problem with the study. Reading that line threw me into rage-rage-rage mode. The researchers cite some earlier study, Assessment and management of women’s sexual dysfunctions: problematic desire and arousal when they make that dismissive claim, but of course I can’t access the full text of that study to see if that’s what Basson, Brotto et al really say. Why would you say that? I’m seeing the study cited only looked at arousal, desire and orgasm as well, so what, did they just decide not to look at pain too because it was too hard or something? The cynic in me thinks to myself that the current researchers have no interest in sexual pain because Flibanserin, the drug Boehringer was working on, will probably not address pain. Pain will not be looked at due to lack of profit, or something.

This makes no sense. The problematic JAMA study said that 7% of women had sexual dysfunction under the pain category, the Goetsch study found that something 15% of women going to a gynecology clinic met the criteria for vulvar vestibulitis. It’s not exactly a majority of women, but why would you ignore a significant chunk of the population like that? Like, why is pain irrelevant for this discussion of FSD? Seriously. You think pain never influences other areas of sexuality, like desire and orgasm?

ANYWAY, there’s two potential problems with the study right off the bat. So what does the the research say, anyway? What, if anything, can we learn from Sexual Problems and Distress in United States Women: Prevalence and Correlates?

There were some improvements defining FSD since the JAMA study was done all those years ago. Sexual Problems and Distress in United States Women: Prevalence and Correlates looked at how often sexual problems occurred, and took participants personal distress into account. Under current guidelines by the American Psychiatric Association and FDA, personal distress must be present in order to make a diagnosis of sexual dysfunction. Not everyone feels distressed when they experience sexual problems. This is one of the reasons that the rate of FSD was found to be much lower in this study (about 12% in the end) compared to the JAMA study (about 43%.) Is this revised, lower statistic satisfactory to those who have registered complaints about the 43% number? Is that sufficiently low enough to acknowledge as Real?

The way the research was conducted was by survey. Researchers mailed out surveys to over 50,000 households and got responses back from 31,581 women. (I know, and the researchers were also aware of, there are some concerns about asking participants to self-screen themselves in this way.) Unlike the JAMA study, this one did not exclude women who did not have recent partnered sexual activity. The survey included 14 items about problems with desire, arousal and orgasm, which you could answer on a 5-point scale for frequency. Personal distress was measured with 12 items about the participant’s feelings, like guilt, worry, frustration, unhappiness, etc. You could have a personal distress score ranging from a low of 0 to a high of 48. If your score was 15 or above, you were considered to have sexual distress, and if you reported a sexual problem AND scored a 15 or higher on the distress scale, then you were considered to have FSD. (Shifren et al, 2008). That means it was possible to report distress sans problems, and if that was the case, you did not have FSD according to these researchers. You needed to have both distress AND a problem at the same time. One possible alternative to this classification I can think of would have been to simply ask participants whether or not they considered themselves to have sexual dysfunction. I don’t know if this alternative would have yielded better results, but I like leaving room for self-identification.

Interestingly, the results found that the rate of self-reported problems regardless of distress was around 44.2% (Schifren et al, 2008.) That’s not too far off from the 43% found in the JAMA study. This is what I was referring to towards the end of my last post, when I said we’d see a similar number again. Problems with low desire were reported most frequently, then low arousal and problems with orgasm. Another interesting note, the survey asked women about how satisfied they were with their orgasms – check out the little footnote under table 2 on page 974. However, not all of the participants were distressed by a problem, and so they did not all have FSD. They just had problems. Which maybe weren’t even all that big of a deal or considered a problem at all to the individuals – just to the researchers for the purposes of this study. Sometimes stuff happens. Sexual distress was found in 22.8% of participants, but not all of those participants experienced a sexual problem. And sexual problems + distress, the combination required to come to a conclusion of FSD, was found in 12% of the respondents. (Schifren et al, 2008). These are the overall results; the results are more specific if you break it out by age.

The researchers went on to break out the results by demographics like age, education and health. Women with good self-assessed health were less likely to experience distressing sexual problems. Some health problems that were more likely to be associated with FSD were depression, thyroid problems, anxiety and urinary incontinence. (Schifren et al, 2008). I’m wondering if use of antidepressants influenced the response, since sometimes antidepressants can cause sexual side effects, but then, so too can depression.With urinary incontinence, I’m wondering if the pelvic floor muscles were weaker in women who experienced this? In evaluating sexual problems across race, shown on table 4, white women were the default against which other races were measured. I think there may be something problematic with that.

The likelihood of feeling distressed by more than one of the three sexual problems in question was low, which surprises me. Distress + low desire + either low arousal OR problems orgasming only happened to 5% of respondents, and distress + problems happening in all 3 areas of interest only happened to 2.3% of women. (Schifren et al, 2008) I was shocked to read that; honestly I was expecting there to be more overlap. I’m probably thinking of the overlap sometimes seen between vulvodynia and other chronic health problems like IBS, IC, fibromyalgia, etc. So then I’m wondering of course, what percentage of women would report feeling distress accompanied by all four problems – the fourth being pain? I wonder, how did sexual pain influence the rates with which women reported low libido, arousal, and orgasm… these things can overlap too, you know. If only the researchers had asked about it…

Furthermore, if theoretically a woman reported having sexual pain plus some other problem like low desire, but low desire is in and of itself not acknowledged as a genuine problem by doctors and experts, then what is a patient’s course of action? Address the pain only by whatever means necessary without touching the desire? Or is it then acceptable to extend a medical option to address desire (or orgasm, or self-lubrication) as well? Is the expectation that the woman’s sex drive will naturally increase with non-medical intervention? What if it doesn’t, but she wants it to?

Unfortunately this study does not tell me the % of women who sought medical assistance for their sexual concerns. Recall from the JAMA study, that about 20% of women had sought medical assistance for sexual problems. I’m very curious to know which 20%. If 20% of women in the JAMA article sought medical assistance, and 22% of respondents to this survey reported feeling sexual distress (which may or may not have been accompanied by a complication,)… how much overlap is there? How many of those 20% who sought help for their problems in the JAMA article would meet the criteria for FSD described here?

So there you are… That’s another big study on FSD, and more recent to boot. But don’t just take my word for it, it’s available online so you can see for yourself. But again – no pain. The researchers had zero interest in sexual pain for this study so I have no idea how the results would have changed, if at all, if pain were taken into consideration. And again, unfortunately, conflicts of interest.

Ultimately, women with FSD will be directly effected by research and statistics, as well as by subsequent handling of research findings, say by the media or pharmeceutical research companies. There is also overwhelming concern that women without FSD will be impacted by these journal articles. These concerns are not invalid either – concerns about disease mongering, pathologizing natural fluctuations in libido, abuse at the hands of overzealous doctors and cruel partners. One thing that worries me to this day though, is that in these sorts of conversations, I’ve frequently seen women who would genuinely benefit and who maybe genuinely need medical intervention to address problems in their sex lives, become invisible or dismissed, either due to a relatively small proportion of the population meeting stricter criteria for FSD (and thus not be worth worrying about,) or because these women have bought into the media hype.

I believe that women with FSD have the potential to gain improved treatment through well controlled studies, but when the methodology or numbers are skewed or questionable, problems ensue. It’s not just problems with the numbers themselves, though that certainly is worth looking into. Media response matters, too.

Interesting posts, weekend of 6/5/10

06/05/2010 at 9:35 pm | Posted in Uncategorized | Leave a comment
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Dear internet, what a week. It’s starting to get super-busy at work, which is normal, and good. But I’ve got my work cut out for me for the next few days. Looks like I’ll be earning some overtime pay this summer. And I’ve been having the most irresistible craving to play Super Mario RPG… I’m reluctant to start a new game because of that one part where you have to scale a cliff face by jumping from flying turtle to flying turtle. Remember that part? Wasn’t that the worst part in the game? Oh that’ll be fun on a keyboard. Loads of fun… it’ll take me like a week to get past that one part.

I hope you have enjoyed the last few weeks of BDSM-themed posts on this blog. It is a topic I would like to explore and practice in the future. But if you did not enjoy it, don’t give up – we shall return to our regularly scheduled academic/critical analysis posts shortly. Since my computer access is going to be iffy for a little while, if you have a guest post ready to go, now would be a good time to submit so I don’t have to worry about skipping a week.

Oh yeah, about that… For the next week or two I will have only sporadic access to a computer and the internet. I’ll have periodic access to a computer and my mobile device, but I’ll probably be having too much fun doing other things to spend much time using either 🙂 That means that posts may be late or absent until I get back to my regular work station. On the other hand I already wrote up two posts that are almost ready to go live anyway, so I may be able to stick to the new content schedule after all. If you’ve been following the Twitter account, you may already be aware that I plan on talking about statistics and journal articles next. But I’m probably going to have to skip the blog link roundup for awhile until I can catch up from lack of access to my favorite work station.
Luckily where I’ll be and who I’ll be with means that when I return to our regularly scheduled vagina blogging, I’ll probably have lots of new & interesting experiences to blog about. The new content practically writes itself!

Don’t forget, I’m also on Twitter now. Anybody want to follow me? I follow people. Sometimes I post idle thoughts & sometimes I post what I’m working on as sneak peaks.

Did you all get to see the semi-guest post with feedback from SnowDrop Explodes this week? He followed up with a similar post at his own blog this week.

Friendly reminder: I am looking for Guest Posters. I want to hear more perspectives on the themes dealt with here at Feminists with Female Sexual Dysfunction. Because I am dealing with such a sensitive topic, I don’t think I can actively recruit new posters, since if I went onto someone else’s blog and said something like, “Hey u wanna write a post about your sexual health and/or feminism on a public forum?!” that would probably be very invasive. For this reason, Guest Posters requesting to remain anonymous will also be taken seriously.
At this time, criteria for inclusion is, “If you think you would fit in here, you probably would.” This may be subject to change but for now we’ll try that & see how it goes.
In an attempt to preemptively fight spam and rude comments, this blog’s email is private. Please leave a comment on this post if you want to write something. I’ll screen comments so you can remain anonymous if you want. That way I’ll have your email and we can collaborate.
Have something you’ve been working on? Send it my way.
Comments made by new e-mail addresses here are auto-screened before going live, so if you want to stay anon use an e-mail address that you haven’t used here before.

Now then, on with the weekly blog link roundup. Posts I found interesting for one reason or another over the last week. Share links if’n you got’em.

So now there’s a petition to block FDA approval of the drug Flibanserin… that’s the antidepressant turned potential libido booster. It works differently from Viagra, but some folks still call it “Viagra for women” anyway. FDA hearings on Flibanserin are set to take place later this month, so we’re probably going to see a lot more chatter about it over the next few weeks. I cannot stop your actions, but I am not signing that petition. Nope. Can’t get on board with it. Not convinced yet. Wondering if the folks who organized the petition (The New View Campaign… Dr. Tiefer is affiliated with this group, she speaks out on behalf of it, and I already wrote a series of posts critiquing one of her books… believe it or not, it’s not perfect. Another one of her books is in my to-be-read queue but that series of posts drained almost everything I am out of me and I am not looking forward to having to do it all over again…) asked women with FSD how they feel about using medication to treat it. I’m thinkin’ that this petition is just making my own distress about having FSD even worse. Because now I have to worry about women being actively denied potential treatments for it. This is not making me calmer & more ready to explore my own sexuality without drugs. As should be clear by now, I’m already doing that. Although this drug would probably not be the most appropriate for me at this time. Honestly I still think Viagra would work better on me since so many of my problems are downstairs. But Dr. Teifer has spoken out against that too.
You know what I can’t deal with this right now. How much longer until I can be away from a computer… Moving on.

If, in fact, you did enjoy the last few weeks of BDSM-themed posts at Feminists with Female Sexual Dysfunction, you may also enjoy some kinky blog posts that coincidentally went up elsewhere. These posts may be triggering due to the subject in question. Crap that irritates me about kinky bloggers. Not necessarily all kinky bloggers. I don’t think I’m reading these irritating kinky blogs. There was a response to that particular post at SM-Feminist, Irritating Crap! 😉 Two via HaT, The Nature of Consent, Part One: SSC vs. RACK (SSC = “safe, sane, consensual” model of BDSM; RACK = “risk aware consensual kink.”) The Nature of Consent, Part Two: The Importance of Safe Signals – safe signals going beyond safe words because they allow for non-verbal communication. And if, in fact, you did not enjoy those posts, then read on for some posts not about BDSM. (It just kind of worked out that way this roundup.)

Our Porn, Our Selves and the sex-positive, pro-porn campaign – [NSFW] A response to anti-pornography activist groups.
But what’s this?! A challenger appears! Here’s a critique of Our Porn, Our Selves – and from an unexpected angle! This isn’t coming from the anti-porn side at all, it’s same-side examination. So here’s a critique of Our Porn, Our Selves from the Blog of Pro-Porn Activism. Still NSFW though. “Our Porn, Our Selves”: The Beginning Of The Pro-Porn Pushback To “Stop Porn Culture”…Or Is It??

Tips for Men Who Want to be Allies to Women – Short & sweet, delivers what it promises.
Possibly related:  Defensiveness as a Signpost of Privilege – Same as above. Think about it.

Injuries to mobility-impaired kids: researchers suggest “consider avoiding stairs” – Thus missing the point of improving accessibility.
Also posted at FWD: Military Docs Treat Pain in New Ways and Shame in All the Old Ways – About chronic pain in the military, and how the military responds to servicepersons who have it.

Edit 6/6/10 – I don’t want to forget about this and I probably won’t be around next weekend to include it then, so, also, First Edition is here! – First edition of the Carnival of Kinky Feminists. With lots of kinky posts around the topic of “Introductions!”

Sarah Palin is a feminist, actually – because she works against women. – What this means is that, Sarah Palin is upholding the time honored tradition, which is better described as a long-term problem in feminism, of relatively privileged feminists marginalizing and steamrollering over vulnerable, oppressed groups. One of the reasons that some people & bloggers who express pro-feminist sentiment do not actively identify as such.

Anti-Choice Ultrasound Laws Don’t Change Abortion Rates, But Continue Getting Tougher – Some patients chose to view the ultrasounds even when not required by law, but doing so does not frequently change minds. Sometimes the ultrasounds backfire because it assures the patient that the fetus has not yet developed recognizable features.

Welcome! To the Menaissance Festival! – Some kind of reniassance faire if it were done by dudebro culture. Funny to me because I know a guy who actually performed one of these events (The “I can totally jump off this roof!” event. It did not end well.
I also enjoyed, SEXIST BEATDOWN: The Retrosexual Trend-Piece Writing Code Edition – because it talks about gender role policing & backlash.

Rape Victims Tell of Mistreatment by the NYPD – [Trigger warning] Police officers mistreating and asking the wrong questions when interviewing rape victims, and not going far enough to address shortcomings. Sometimes rape victims do not go to the authorities or press charges and if you ask why that is, this post might answer your question. This really happens.

International Whore’s Day 2010 – Also called International Sex Worker Day. Hexy’s post talks about the history behind the origins of this day.

friday nibbles – [NSFW] I just thought there was a bunch of interesting links in this post this week. Some of it has been addressed previously elsewhere.

The Lady Is a Tramp: What isn’t feminism saying about masturbation? – Kind of a neat post at Bitch, via Feministing. Includes lots of quotes and tweets from feminists on masturbation.

I’m sure there’s more…

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.

Back for more

11/18/2009 at 8:42 pm | Posted in Uncategorized | 1 Comment
Tags: , , , , , , , , , ,

Dear internet, I have returned from some scheduled downtime. During my off-time, I had many adventures with my boyfriend, and did not check my e-mail or blog on a regular basis. As a result of this break, I returned home feeling refreshed, renewed & restored…

…and buried by work that piled up in my absence, and new content in my RSS feeder online!

Needless to say, I’ve got quite a bit of catching up to do. We’ll get to that in a few moments. First, to bring interested readers (all what, 8 or 9 of you,) up to speed with what’s been going on with me,

I picked a very good time to take a break in terms of not letting too much work pile up on the job or at home. The weather where I went was pleasant, the crowd levels minimal, lots of things to see and do, and my boyfriend and I had some private time together. We had plenty of activities to keep us busy and amused, and we ate so much good food… I really could not have asked for a more perfect vacation.
Well, actually, there is one thing that could have made our time together even better. A certain piece of jewelry presented to me with a certain flourish would have made my year… but apparently it is not time for that yet. So be it then.

This time around, although we’ve done it before and have very few opportunities to try this, we did not attempt to have intercourse. Nope. Did not even try it. We both wanted a pressure-free, totally relaxing time together. Intercourse is this whole big production for me and we’re both so new at this. Attempting intercourse can be nerve wracking. It’s definitely worth it when it happens, but it’s not too far off the mark for me to say that for us, the act of intercourse is about as intricate & requires about as much rehearsal as a Broadway musical.

That’s not to say that we didn’t have sex though – we had enough quality sex & intimacy to keep both of us satisfied. No pain on my end, however it looks like that Bartholin’s gland cyst is going to keep coming back whenever I spend a lot of time aroused (as I often do when I’m with my boyfriend.) The cyst is already starting to decrease in size and firmness on its own, so I’m not worried about it right now. But I know that sooner or later I’m going to need to have that gland looked at. Some day it will likely require a more complex and permanent intervention than warm compresses & sitz baths.
One thing at a time. Worry about that later when the time comes.

While my boyfriend and I are comfortable with the quality & quantity of sex we enjoyed while on break, unfortunately the rest of the world is not satisfied with it.

Upon my return home my family started in on me about whether we’d had sex – by which they mean intercourse. On one hand, it’s great that I have their support – they want me to have a happy, healthy sex life. My mother & sister especially supported me when I was recovering from vulvovaginal surgery. On the other hand, it’s not great that their support can often turn into invasive nagging & pressure to perform. “Did you do it? How was it? That’s all?! Aw K, you gotta put that vag of yours to good use while you can!”

Even my boyfriend had some family pressure regarding sex, or rather pressure to not perform. Even though he is an adult, and even though we’ve been together for years, his family still does not approve of our relationship. His family certainly does not want him sleeping with me, and so he returns home to a different kind of nagging.

Why is sex so heavily policed by peers & family?

Anyway, now that I’m back online, I mean to return to regular blogging about feminism & sex & female sexual dysfunction – and all the work I left behind before my break remains to be done. Those draft posts don’t write themselves. Even the “Fluff” needs more tweaking.

It’s probably going to be a few days yet before I’m all caught up with my RSS feeder, and even longer before I find time to pick up & read some books on my shelves. Unfortunately for me (fortunate for the interested & patient reader though,) more articles & editorials & blog posts were written about FSD in my absence. I must have picked a bad week to take off in terms of blogging. I won’t be able to put together a weekly blog-link roundup for awhile longer, yet I still want to bring attention to a few pieces you may have missed:

For instance, that Nation article I had such a big problem with a few weeks ago – it’s been joined by yet another anti-FSD cohort. So someone (probably me) is going to need to sit down and analyze this article & see if it contains any troublesome (even if well-meaning) implications and dismissive language (hint: it does.)

Meanwhile, there’s a new drug for female sexual dysfunction on the horizon, and I’m sure it will set the feminist blogosphere abuzz once word spreads – so far Violet Blue is on the ball, a sex therapist sees the potential benefit for patients, and a sex educator takes a comprehensive look at it, including the history of FSD. This drug, Flibanserin, is a type of antidepressant – it’s an SSRI rather than a tricyclic. (Tricyclic antidrepessants, in low doses, are sometimes used to treat pelvic pain, including sexual pain.) It won’t work like Viagra, which increases physical response but doesn’t necessarily instill a craving for sex in and of itself. Flibanserin is designed to increase libido.
This drug actually sounds like it would be less appropriate for me than Viagra, as I am comfortable with my current libido. My main problems in sex are with this physical body of mine.
So I may need to talk about Flibanserin, Viagra, et al soon.

Regarding vulvovaginal surgery (labiaplasty in particular – always with the labiaplasty to the exclusion of other genital surgeries and/or surgeries done without aesthetics in mind,) we have some Fightin’ Words:

Angelica Kavouni, a cosmetic surgeon who carries out labioplasty, said it was wrong to “terrorise patients” with suggestions of long-term consequences.

Them’s fightin’ words! Strong, unequivocal language – you may be wondering what sort of anti-surgery/surgery awareness tactics could possibly terrorize a patient about to undergo vulvovaginal surgery, whether the surgery is for purely cosmetic reasons or not. I may be inclined at a later date to tell you some examples of tactics which yes, even I would consider over the top and counter-productive.
Also, if Kavouni is a surgeon, I wonder why the editor did not include “Dr.” or “Ph.D.” in the title of her name… she does have a medical degree, yes?

Brie is keeping up with Private Practice, the ABC television show which a few years ago aired an episode about a patient diagnosed with vaginismus and vulvodynia. The show now includes a recurrent theme of a female sexual dysfunction clinic, but it is not doing a very good job of actually talking about FSD.

There’s a LOT of news going on outside the realm of FSD that I’m trying to stay abreast of. One of most frequently-spotted topic in my RSS feeder is about US health care reform, including discussion of the Stupak amendment. I’m also overwhelmed & appalled by the amendment itself – this is bad news for women’s health. Health insurance reform, but at a very high price. One particularly good post on the topic I’ve seen is over at Female Impersonator. I, too, speak legalese (although possibly not as fluently as Jenn.) This isn’t the only news topic going on; I’ve seen posts about the Carrie Prejean slut-shaming scandal, the Ft. Hood shooting, and more. Then there are the posts that are not necessarily political in nature, but are interesting invitations into bloggers’ personal insights.

And that’s just for starters. Stay tuned – we’ve got a lot of work left to do.

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