Guest Post: Interview with Elizabeth on Asexuality

11/01/2010 at 10:17 pm | Posted in Uncategorized | 2 Comments
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[Dear internet, we have a guest poster today! This is a follow-up post that picks up where Guest Post: Interview with K on Female Sexual Dysfunction over at Shades of Gray left off. Our guest poster, Elizabeth, had some questions for me about FSD and HSDD in particular, which I addressed over on her blog. And I had some questions about HSDD and asexuality which I was hoping she would be able to clarify.

To refresh your memory: In summer of June 2010, hearings were scheduled to determine whether the antidepressant-turned-potential-libido booster, flibanserin, should receive FDA approval. The possibility of this drug of questionable value going to market in the near future was met with resistance, especially from certain feminist organizations and activists. There were also some concerns about flibanserin and the type of sexual dysfunction it was supposed to address (Hypoactive Sexual Desire Disorer) from within the asexual community. Elizabeth and I first made contact when we bumped into each other on a thread about the drug over at Ily’s blog; there was some delay between then and the posts you see before you now.

I suggest that if you would like to participate in the discussion here, please check your privilege so as not to step on anyone’s toes. Don’t forget about the intersectionality; it’s possible that we’ve got some folks with sexual problems & dysfunctions lurking in the wings here who put the “Questioning” or “asexual” in LGBTIQQAA. Flibanserin will no longer be pursued by Boehringer Ingelheim so we don’t need to debate it today. As Elizabeth said in the preface to my interview, let’s focus on making each other more aware, understanding & accepting of asexuality and sexual dysfunction.]


My name is Elizabeth, though many in the asexual community know me by my online moniker, the Gray Lady. I am a twenty-something cisgendered female blogger. I am both asexual and a feminist, and I blog about both subjects and how they interrelate. I identify myself as panromantic asexual, and am currently in a committed polyamorous relationship with a trans woman. Although the original subject of my blog is about being in the gray area between sexuality and asexuality and my own questioning where I fit on that spectrum, I now simply identify myself as being a sex-positive asexual. I take an intersectional approach to feminism, and always strive to identify where I have privilege and confront it, though of course from time to time I will fail to see it, as anyone does. I think it should be noted here that not all asexuals are feminists or any of the other things that I listed, and certainly not every asexual agrees with me. I represent only myself, though I try to do my part to help the community. In my leisure time, I can often be found reading, learning foreign languages, or playing Pokemon.

I understand that there is a lot to think about in a definition of asexuality. What are some important points you would like to see people understand about asexuality?

Most importantly, I want people to try to understand the word as we actually use it before trying to enter into a conversation with us. Too often, people make the mistake of inferring a meaning from the word’s component morphemes–that is, they think it simply means “not sexual”–which is very vague and could have a whole range of meanings, depending on how each person defines “sexual.” Some people have such a broad definition of sexuality that from their perspective, it encompasses the entirety of human existence. So at first glance, to some people it seems to be impossible. Others may think that we are referring to celibacy (lack of sexual behavior), an inability to have normal sexual function, or even think we’re saying that we don’t have genitals.

Generally speaking, however, we’re ONLY addressing sexual attraction. What that means is that, while we may be attracted to people in other ways (we might think they’re pretty, or like their personality), and while we are certainly capable of love, that (by itself) just doesn’t translate into a desire to have sex. If we do get “crushes,” they’re not sexualized; for me, if I like someone, the things I want to do with them are things like having deep intellectual discussions, cuddling, sometimes making out (though at other times I find myself grossed out by the thought of doing so), and literally sleeping in the same bed. Or sometimes, when my attraction to a person is purely aesthetic, just looking for a while. For this reason, some of us will use the word “squish” to describe a non-sexualized crush, so that hopefully there will be fewer misunderstandings.

That’s not to say that none of us ever want to have sex for other reasons, but the attraction itself just isn’t it. I never look at people and think anything like, “Wow, that person is so hot, I would so do her/him!” It doesn’t typically occur to me to think about sex on my own without some sort of external reminder, except as some sort of intellectual puzzle. I’ve found that I can have desire for sex, even enthusiastic desire for sex, without experiencing attraction, however. I never really feel this desire as I’m going about my day-to-day life; it only really arises when I’m in a situation where I’m comfortable with my partner and okay with the idea of having sex, and she begins to physically arouse me. That doesn’t mean that when I’m not in that situation I never think, “Oh, that might be nice,” but that kind of thought is usually pretty detached and apathetic, not so much a true desire. My partner and I will still often go months without realizing how long it’s been since we last had sex, even though she is sexual. I think one thing that helps me be comfortable with her is that she is not really sexually attracted to me either, because she mostly prefers guys for sex.

So asexuality doesn’t necessarily mean that we dislike sex, although there are certainly some asexuals who do. There’s tons of variety in the asexual community. There are some asexuals who would prefer to be celibate for life themselves, but are totally fine with sex otherwise. There are other asexuals who are disgusted by even the idea of sex, and don’t want to talk about it or see it in movies, books, etc. Just as there are many different sentiments within the asexual community about sex itself, there are also many different preferences on romance and intimacy. I’ve had people assume that just because I’m asexual, that means that I don’t experience love, or don’t experience romantic love. That’s confusing what we in the asexual community call romantic/affectional orientation (which, just like sexual orientation, describe what gender(s) a person tends to attach romantically to; e.g. hetero-romantic, homo-romantic, etc. And on that note, just to clear this up, it’s not a contradiction to identify as, for example, an asexual lesbian, because lesbianism can refer to either sexual or affectional orientation.) with sexual orientation at best, or assuming a lack of basic human emotions at worst. I think it should be the default assumption that asexuals of ALL stripes, even aromantic asexuals, experience love, even if it is platonic or non-romantic love. There is a wide variety of ways to form close connections with others; some rely on a close group of friends, some get intimacy through their communities, some have intimate relationships that aren’t categorized as strictly friendship or as romantic. What does “romantic” actually mean, anyway? There is no clear definition, and some of us struggle with deciding whether we are romantic or aromantic because of that, or don’t believe there is a distinction at all.

There’s so much variety that really, it’s reasonably safe to say that the only thing that unites us is a lack of sexual attraction significant enough for us to embrace this label. Of course, there are some gray areas as well which I’ve devoted much of my blog to, but that’s a little outside the scope of this.

Is there a difference between asexuality and HSDD, and if so, what is it? What about sexual dysfunction more broadly defined?

Well, as I mentioned earlier, asexuality has to do with sexual attraction, and HSDD has to do with sexual desire or sexual interest. These are not the same thing; it’s very possible to have either one without the other. For example, I’m not sexually attracted to anyone, but with an understanding partner and a different approach to sex, I’ve found it enjoyable and desirable, even though I don’t really have an intense level of interest in it. I’ve found that I tend to fall into a pattern of responsive desire as mentioned above, wherein I don’t really think about sex too often or get “in the mood” for sex without having had any kind of physical stimulation, but being in a safe space with a partner I’m willing to have sex with does allow me to enthusiastically consent, and generally speaking I find that I have no trouble on the physical side.

Of course, I used to have a lot of pain with PIV intercourse, to the extent that my first sexual partner condescendingly explained to me that I have a sexual disability, but that situation was coercive at best, and the real problem there was that I wasn’t able to become aroused enough in a situation that I wasn’t entirely comfortable with, with a person who didn’t seem to really care how I was doing and never bothered asking my permission before touching me. He essentially was writing off any responsibility he had for the way I felt (both physically and emotionally) by claiming that I was just “defective.” Initially, even in a situation where I am completely comfortable with having sex, I do sometimes have pain with intercourse for a variety of reasons, but it’s not very much pain, and it’s mostly due to not being used to the size, not enough lubrication, perhaps a bad angle, something like that. As far as I understand, this kind of pain is relatively common and normal for a person who has intercourse as infrequently as I do. I don’t have any pain with outercourse or any other form of sex. It’s not something that typically inhibits my ability to even have PIV intercourse on the same occasion that I have that sort of pain; most of the time, it is temporary. I’m not distressed about it at all. So I don’t define this as a disability or dysfunction of any sort, though if I did, it wouldn’t be HSDD.

One other thing I wanted to mention is that there was a study that recently came out recently called “Physiological and Subjective Sexual Arousal in Self-Identified Asexual Women” (by Brotto and Yule)” which I want to quote from here. This is just from the abstract, so you don’t have to actually read the full article to see where the quote came from:

“Asexuals showed significantly less positive affect, sensuality-sexual attraction, and self-reported autonomic arousal to the erotic film compared to the other groups; however, there were no group differences in negative affect or anxiety. Genital-subjective sexual arousal concordance was significantly positive for the asexual women and non-significant for the other three groups, suggesting higher levels of interoceptive awareness among asexuals. Taken together, the findings suggest normal subjective and physiological sexual arousal capacity in asexual women and challenge the view that asexuality should be characterized as a sexual dysfunction.”

So at least we do have some scientific evidence that asexuality is not a sexual dysfunction of arousal, in addition to much anecdotal evidence that asexuals are perfectly capable of normal sexual function. However, I also want to note that asexuality and sexual dysfunction can and do sometimes overlap. I know of at least one asexual woman who also has vaginismus, although I have not been in contact with her for a long time now. I’d love to hear from anyone in this overlap who would be comfortable talking about this, because I’m curious how these issues intersect, and how people within that intersection deal with attitudes from both sides.

What are some of the key concerns about HSDD in the asexual community and what (if any) are some ways these concerns might be addressed?

The main concern is that it might be used to delegitimize asexuality–which, quite frankly, a lot of times it is, however erroneously. There’s still a widespread view that asexuality is not a sexual orientation, but instead a disorder, a disability, a dysfunction, or the result of sexual trauma. The DSM-IV specifies that in order for it to qualify as a disorder, it must “result in significant distress for the individual,” however I’m not sure that is specific enough. What kind of distress? There are a lot of people who feel distress about being asexual because they have been taught to feel that it isn’t normal, it’s a defect, and that it’s a huge burden to their romantic partners, who will eventually leave them because of it, or that they’ll never find any romantic partners at all, and that not having a romantic partner and not having sex means they will never lead a fulfilling life. Basically, if asexuality is a sexual orientation, then it is not chosen and we cannot expect asexuals to be happy with it all the time, so simply saying there must be distress as a qualifier, while somewhat of a step in the right direction, doesn’t really work in my view and to be honest, it seems like it was just tacked on without much thought. If we assume that only people who are distressed about their lack of interest in sex have HSDD, and that asexuals don’t qualify because they lack that distress, isn’t the assumption that asexuals are all happy about being asexual? I’ve seen many threads where asexuals (with much embarrassment to admit it) discuss their distress due to being asexual, and I think this mindset only disempowers those people by encouraging them to hide how they feel. Plus, in that study that I quoted from earlier, anyone who felt distress about their lack of sexual interest or level of attraction would have been disqualified from the study, so this leads to issues with gathering representative samples as well. Of course, no one who volunteered did feel that sort of distress, and most likely no one who did would volunteer for anything like that, because of the pressure to present asexuals to the rest of the world as being happy and distress-free, so as not to make it easier for other people to dismiss us all as just disordered.

Now, technically asexuality is not about a lack of desire or a lack of sexual fantasies at all, and in fact it’s possible to be asexual and have either some form of sexual desire* or sexual fantasies, or both. But that distinction is very fine, and not often understood. In practice the two are often confused, and this may lead to a situation where an asexual person who has not yet realized they are asexual will be pressured into seeking treatment for HSDD, further internalizing the message that there is something wrong with them. Asexuality is not yet well known enough that we can expect people to realize that it’s a possibility, in this kind of situation. Sometimes it takes many years before people will come to understand themselves as asexual. I think it would help to have asexuality specified explicitly as something that should be considered. That would go a long way towards helping asexuality gain visibility as well.

* Since it’s been pointed out to me that this term isn’t all that clear itself, I’ll clarify that when I use it I’m not just talking about libido or “sex drive”–which I interpret as a physical urge for release–but also non-physically based desire as well. In other words, I tend to use it more in the sense of having any kind of interest in having sex, aside from altruistic partner-pleasing or coercive situations. Not an interest in the social consequences of having sex, but a desire to have sex itself, even when unaccompanied by a physical urge.

So that’s the practical concern. The other big concerns I’ve seen being raised are primarily ideological. I’ve seen asexuals and feminists alike raise these kinds of concerns. What is “normal,” and who gets to define it? In the case of HSDD, the task of defining such a disorder is essentially the same as authoritatively declaring what level of sexual interest–and by “sexual desire” they do seem to also mean “sexual interest,” as the DSM-V’s proposed revisions make clear (it may be renamed to Sexual Interest/Aversion Disorder)–constitutes a normal level of interest, what constitutes a disordered level of interest. This of course has a significant impact on laypersons’ ideas as well, because it is coming from people who presumably know what they are talking about (although I’ve seen some spectacularly bad… uh, “science” used by those in charge of rewriting the gender and sexuality disorders to justify their claims, so that assumption is not always a good one). If not being interested in sex continues to be considered a huge problem (disorder/defect) by and large by society as a whole, unqualified, then how can we reasonably expect stigmatization of asexuality to decrease? Without any explicit expression that asexuality, while uncommon, is still just a normal human variance, asexuals will still get lumped in with people with HSDD and the current cultural ideology (that all humans are sexual and so a lack of interest in sex is unnatural) will remain the same. Likewise, I think we also should be concerned about potentially having the wrong focus in cases where incompatibilities with one’s partner, relationship problems, or abusive situations may be the cause of the disinterest. Sometimes a lack of interest in or aversion to sex is actually very healthy and adaptive, and this needs to be taken into consideration as well.

Andrew Hinderliter of Asexual Explorations, our go-to guy for information about the DSM, posted an article on the Sociological Imagination which addresses this, and helped me to articulate some of my own views on the subject. As he points out, HSDD describes a symptom rather than a syndrome, and encompasses a wide variety of people in many different life contexts. As context is essentially the determiner for whether or not a low or non-existent level of sexual interest/desire is a disorder rather than a natural human variance or positive adaptation to a coercive situation, I have wondered at times whether this is particularly useful as a diagnosis by itself, or whether it might not be better as a symptom of other diagnoses. However, I also realized that the cause of such a problem may either not be obvious at first, or as with asexuality, just plain unknown. Thus, I think it can serve a purpose as a stand-alone diagnosis, but lots of careful thought needs to go into crafting it.

I’m well aware that careful attention needs to be paid to how this diagnosis works as a barrier for women with FSD from getting the help they need, or how any diagnosis might. If it is a symptom of another problem, that might not be immediately obvious, and so for those people, this diagnosis might be useful to get things started, and can change as more information surfaces. That’s a big if. But I also think that this can be a useful diagnosis in and of itself. Asexuals tend not to realize that you can have sexual attraction or interest in having sex without feeling desire for it. Because it’s a realm outside of our own experiences, we don’t necessarily tend to think about the possibility of this kind of disparity that deeply inhibits a person’s self-expression, this emotional pain that actually does come from an internal source. Although I wouldn’t compare these two experiences, I imagine it might be like a cisgendered person trying to understand what it’s like to feel a mismatch between one’s internal gender and one’s physical, wrongly-sexed body. That mismatch doesn’t exist for us, so we don’t tend to think about the possibility that it might exist for others, or the deep distress that it might cause. That distress alone should be sufficient to qualify for calling it a disorder or disability. I don’t think it’s right to minimalize the way it affects a person’s life by calling it a sexual “problem” instead, though at the same time I do think we ought to be careful not to make “distress or no distress” the sole distinction between people who have HSDD and people who don’t. I think that’s reducing it to an on/off, yes/no type distinction, when it’s really more complicated than that.

Another big concern I’ve seen raised, particularly among feminists and certainly by New View, is whether what is expected of women sexually speaking is centered around a male-centric norm. The argument, as I understand it, is that female sexual desire is very context-dependent, and that “sexual desire” may for many women mean having a sort of desire that is triggered more by physical arousal (in a safe and consensual context) rather than initial interest or attraction. From my own personal experiences, I know that this can be true, but other than knowing that responsive desire is perfectly possible without experiencing sexual attraction, I don’t know what to think about it. Does the HSDD diagnosis itself indeed put women in a position where they are expected to respond the same way as men, or is that more of a cultural assumption? Will the proposed split between male and female SIAD correct that? I don’t know those answers, but more pointedly, is that even the reason why women seek treatment for HSDD? That’s a pretty big assumption, I think. It’s certainly possible that some women do seek treatment for it because they apply a model of desire that’s more appropriate for men, but does that mean that all women who seek (or would seek) treatment for HSDD are doing this? I doubt it. What about women who don’t even have responsive desire? And why assume that no women who might seek treatment are aware of this tendency to view women’s sexuality through a male lens? I do think this cultural tendency ought to be addressed, but I don’t think it’s grounds to dismiss the entire diagnosis.

Switching gears… I want to return to something I mentioned briefly above: the issue of relationship incompatibilities. I feel this needs just a little bit more explanation before I move on to the next part of the question. I’ve noticed that the vast majority of the time, within a relationship where one partner has a much higher level of desire for sex than the other, the partner with the low level of interest gets all the blame for the problems that arise out of that. Rather than viewing this as just another incompatibility with both partners working towards a solution, often it is assumed that only the person with low desire must change, because there must be something wrong with them. A person who is told this over and over again might internalize this and begin to believe it themselves, and in this case might begin to feel distress over this aspect of themselves and want to seek treatment for it. I think many asexuals know this sense of believing oneself to be broken just because it’s what they’ve been told over and over and over again, because it is how they felt before understanding asexuality. I myself have been told many, many times that I must have a sexual disorder or disability, and while I never believed that, to some extent in the past I have considered asexuality to be a shortcoming in sexual scenarios because of it. I would say that this very emotional, touchy subject is what drives many asexuals to discount the possibility that HSDD/SIAD might be a legitimate disorder, and I think we saw that come out in the comments to K’s interview on my blog. But we do need to keep our emotional reactions under control, and realize that we have the privilege of not dealing with this internal pressure that inhibits our self expression.

So, with all that said, how might our concerns about the HSDD/SIAD diagnosis be dealt with, aside from all of us trying to take a level-headed view that acknowledges our own privilege? I’m not sure on how the diagnosis should be worded. I do think we need something that distinguishes between different kinds of distress, not so much as something that delineates specific definitions (being too specific would be exclusionary), but something that at least directs therapists and medical professionals to try to locate the origins of it. It seems to me like no matter how it’s worded, a short list of diagnostic criteria is still going to fail to acknowledge the complexity of all the different things that might be going on, and so I think perhaps having educational materials on asexuality available to be presented at the time of consultation might be a good option. (This of course with the acknowledgment that it might not apply, but is just being presented as a way to empower people with the knowledge that it exists, and ability to decide for themselves. I think it should be handled very carefully so as not to be coercive.) I don’t foresee that happening in the near future though, just because it’s such a tremendous task to get such materials distributed to every therapist’s office, not to mention getting them to understand and accept asexuality. If not that, then at least I think that all therapists and medical professionals should be made aware of both asexuality and the instances where low sexual interest or desire would be adaptive, and of the concerns of women who have FSD. They should be educated on the importance of balancing those concerns, and not assuming that the whole diagnosis is bunk just because it might be somewhat too vague in its description. I don’t foresee this happening soon, but we’re taking baby steps towards that goal, and it’s something that I’m hopeful for in the future.

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The ugly things people say about FSD Part 3: The Redeadening

08/11/2010 at 7:47 pm | Posted in Uncategorized | 8 Comments
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Trigger warnings for ablism and rape.

Previously in our hopefully never-continuing series about what people online are saying about female sexual dysfunction…

Last week, I re-opened an old wound, the ugly things people say about FSD, the women who have it, and what treatments (if any) should be acceptable for it. I directed your attention to the comments section of a Feministe post, FDA Wants YOU! to Have Sexual Satisfaction. That’s a brief heads-up that the FDA was about to have hearings on whether or not to approve the drug flibanserin, which in early testing had an ever-so-slight positive impact on women’s sexual satisfaction, but with the cost of a small payout and potential side effects. In the end, the FDA did not approve the drug and it’s back to the drawing board for Big Pharma and for women with HSDD (hypoactive sexual desire disorder.)

But I’m not here to talk about flibanserin today. I need to show you something else – I need you to see what was going on in the comments section and why what was being said there is harmful to women with sexual dysfunctions.

I already addressed some of the comments, like the comments that stated some of the key social construction perspective points of female sexual dysfunction. Those points may be of some use for folks with sexual dysfunction. Social construction isn’t all bad, but it grates on my nerves every time I hear it, because when I see it presented as though it’s something new, it’s actually the millionth time I’ve heard it. But you can’t really have a discussion about female sexual dysfunction without bringing up the social construction perspective so that’s out of the way.

Then, I went into some of the stranger comments. Comments where the social construction model of FSD decayed away and revealed widespread problematic attitudes underneath. Comments that presented entirely new-to-me and far-out arguments about FSD. Comments that started developing serious problems.

Since I already presented the context of the discussion last week, we’re going to pick right up where we left off, where things started to get weird:

I agree that lack of interest/arousal/orgasm is distressing. But terrifying? Is it healthy to have so much invested in our sexual identity? How much of that thinking is behind this pill?

What? If you have sexual dysfunction, you had too much invested into your sexual identity. If you find yourself experiencing a strong emotional reaction due to sexual problems, perhaps even grieving over the loss of your sex life as you knew it (or hoped for), you have no one to blame but yourself. There are many other important things to attend to in life and you should have imposed an arbitrary artificial limit on your sexual self, putting more of yourself into other hobbies instead. Like macramé. Moderation in all things and such.

It goes on with a hard-line stance against medicalization:

I’m in the ‘this is not a really good idea’ camp. The problem ISN’T physical as a rule- it’s that we live in a shitty society with shitty prospective/ current partners and far too many rapists around.

See, this is what I was talking about earlier, when I said that on paper, the social construction model of FSD leaves a little wiggle room for physical problems… but in practice, there’s very little interest in exploring and addressing what some of these physical problems are and how to address them. Now, low libido, as a rule, is not physical. The rule is (who set the rule?) low libido is due to “Shitty partners” and rapists. It sounds like a very rigid rule – is there any wiggle room at all for rare exceptions? Any room for hormonal changes? I wonder what the penalty is when you break the rule.

Someone anonymously spoke up about having sexual problems and about the possibility of a physical cause, and zie mentioned some of the problems in the thread up to that point.

Look, you just can’t ignore that sometimes women can’t get their rocks off due to purely physical causes. And that they would like to get that fixed. And that doing so may require drugs.

Please don’t fall into that godawful trap of assuming that scientists and drug companies are all evil woman-hating pushers. It’s anti-science, in practice it’s often anti-woman (HPV vaccine paranoia, anyone?) and it’s just plain ignorant.

It’s obnoxious to have otherwise reasonable people go off on wild tangents about the evil FDA taking cruel advantage of undersexed lasses, and it’s not helpful to the undersexed lasses either. (The right to self-define and all that: I’m “undersexed” because I would like more sex. Simple.)

This is the response that the anonymous commenter received:

ADTMI: Do you really think that pharmaceutical companies have our best interests at heart? Because, yeah, vaccines are great, and I’ve taken anti-depressants and have a friend that might not be alive without them, but let’s not pretend that there aren’t such things as side effects. Most of them are survivable, but there’s always gonna be someone who really suffers.

Anything that can be used, can be abused. Like the actual Viagra, there’s more demand for this drug then there is a need for it.

I am not seeing the point in which the anonymous commenter said anything at all resembling “Boy howdy I sure am glad Big Pharma’s got my back!”

Around this point, I decided to speak up in the Feministe thread again.

…Ok hold the phone. Are you suggesting then, that women who have HSDD believe that Big Pharma really is watching out for their own best interests? Are you operating under the impression that women with HSDD believe medicine is always best and never hurts anybody? Are you suggesting that women with HSDD have exclusively that one problem and have no experience with other chronic conditions, and so have never run the gauntlet of modern medicine before and so are blissfully ignorant of the abuses of big pharma? Are you suggesting that the real suffering of women with sexual problems is unimportant compared to the suffering of women who have side effects from drugs?

You say you have used antidepressants, and yet in the next paragraph you say that in this case you’re worried about side effects broadly. Do you have the same worries about the antidepressants you were given? Why is it okay for antidepressants to be used but not a drug to treat sexual problems?

The drug isn’t the root of the problem in that case, it’s medicine & abusive doctors & partners at large. The drug would be used as a tool, by bad people. Just as with any other drug. Like antidepressants.

Yet some people still really need the tool. And would benefit from it.

I am continually frustrated with conversations about HSDD and FSD in general that do not center women who have the experience of interest.

Let’s look at some components of the response I got:

K:In this particular case, the women who have HSDD and FSD seem to be saying ‘Full speed ahead and d*mn the side effects.’ Secondly, yes, I have experienced a wide range of side effects from anti-depressants. And from other meds, to, so you can be sure that with any med I’m taking, I will ask about the side effects, and raise my concerns about them.

Wow…

Where is the commenter getting this information from? Did zie speak with any women with HSDD and FSD? Did zie listen to any of the responses from the few women who spoke up in the comment thread?
Is that the impression of women with HSDD that the commenter has?
This is what people are really saying about women with FSD: Broad, sweeping generalizations, without listening to them. It’s archetypes and stereotypes allover again.

Perhaps we can rectify this situation, starting with small steps. Shall I introduce myself?

Hi! I’m K and I’m a blogger on Feminists with FSD, and I have female sexual dysfunction! Specifically, my crotch hurts! I sought medical intervention for this and I think it’s totally unfair to say that my physical pain is any more or less real and important than someone else’s distress from non-painful sexual problems! I am capable of independent thought and I think about side effects all treatments that I use even if I’m supposed to use something as mundane as an antifungal! Sometimes, the risk of side effects or the side effects themselves are worth it! Other times, they’re not! This one time, I had to go off of The Pill due to side effects!

(I don’t think anyone is listening…)

There’s no room to recognize intersectionality in this comment. There’s no room to recognize that women with HSDD and FSD more broadly have quite probably thought about, and have been distressed by, life with a low libido for a very long time. There’s an assumption that women with HSDD are unfamiliar with side effects from other medications and that women with HSDD and other forms of FSD will not think about side effects to new medication.

The same comment goes on:

And the reason I favor anti-depressant over libido enhancements is simple: anti-depressants keep people from killing themselves, libido enhancers just add an extra thrill to life.

This is a clear ableist statement that prioritizes one type of disability over another. The distress from living with HSDD (remember we’re talking about a sexual dysfunction here, not just a low libido) is unimportant compared to other chronic problems that sometimes warrant medical intervention. But hey, it’s not like women’s sexual pleasure matters or anything. After all, it’s not like you’re going to die or something.

“An extra thrill?” That’s what a satisfactory sex life means now? It’s true that individuals do not need sex to live, but for many people – not everyone, but for a lot of folks – a satisfying sex life is an integral part of a good quality of life. I have no problem with consensual sex for thrills, but we should recognize that for many folks, it’s about more than the sheer excitement – a satisfying sex life can be a way to let off steam, express comfort, intimacy, playfulness and love.

There’s more to this comment:

Just out of curiousity how the h*ll can anti-depressants be abused? I’ve never heard of a black market in prozac, although I’ve heard of black markets in ritalin and other ADHD drugs.

Wait a moment – let’s backtrack. Am I seeing things? I thought that just a few minutes ago, the same commenter explicitly said (emphasis added,)

Anything that can be used, can be abused.

It seems that antidepressants are the one exception ot the rule that anything that can be used, can be abused.
However even this is not true. Antidepressants can be abused by caretakers or spouses pushing ther partner to go on medication – much the same way some commenters in this thread fear filbanserin will be abused. Doctors may over prescribe antidepressants, or prescribe the wrong type for an individual. But here, in this comment, there is no protest to keep antidepressants out of the hands of the mentally ill due to the risk of medication being forced upon people who do not need or want it.
(There is, however, backlash against antidepressants and other medication in other blogs and books elsewhere. Depression and mental illness are also subject to a social construction critique.)

With regards to abuse and the black market, I also once had a dear friend who became dangerously sick after overdosing on prescription antidepressants following a bad break-up. And every once in awhile I’ll get spam e-mail offering to sell me Prozac and other antidepressants on what might be considered a black market.

Things may get triggery from here on out, if they haven’t gotten there already:

One last thing: Is the wide-spead abuse of a libido enhancer an acceptable risk if this drug goes on the market? ‘Cause the way I’m seeing it, this is the next date-rape drug.

This is a new-to-me claim in discussions of FSD. Just when I thought I’d seen it all. Date rape drug?

Widespread abuse of a libido enhancer means that someone somewhere has to be distributing this medication, maybe a doctor, or else folks are getting this medication through the same black market I could potentially obtain antidepressants through. But again and again when it comes to sexual dysfunctions, especially pain (which is something most people readily acknowledge as “Real,”) I’m hearing from women who struggle to find doctors who take their sexual complaints seriously. Based on what I’ve been through and on what I’ve heard, I believe that even if flibanserin made it to market, I speculate that most doctors would still be reluctant to prescribe it to women.

But this misunderstanding about flibanserin used as a date rape drug appears to be widespread:

If a man slips a drug in a woman’s drink that makes her so aroused she has sex with him when she otherwise wouldn’t, you’re talking about rape.

A drug that would, shortly after consumption, instill an irresistible impetus for sexual activity would raise serious ethical problems! But flibanserin won’t work like that. Times like this I’m glad that women’s sexuality is complicated, and can’t be instantly turned on or off with the flick of a button – or consumption of a pill. (Furthermore would such a hypothetical drug instill a desire for partnered sex? Why not masturbation?)

To begin with, this comment demonstrates a misunderstanding of the difference between desire and arousal. This misunderstanding is probably only exacerbated by the media and the New View Campaign’s insistence on calling flibanserin “Female Viagra,” which it isn’t. Desire and arousal are closely related, and hopefully the two match up when you’re looking for consensual sexual activity. But you can have conscious sexual desire but low or absent arousal (physical response, like lubrication or erection) or you can be physiologically aroused but lacking in desire. You do not have to act on either. From About.com:

Libido refers to a baseline interest in sex and might be redefined as sexual appetite. Arousal refers to the physiological response to sexual stimuli. Women with higher libidos generally have a greater response to sexual stimuli, or greater arousal. Physical manifestations of sexual arousal include vaginal lubrication and increased blood flow to the labia, clitoris and vagina.

But framing flibanserin as a date rape drug, again, seems to come from a fundamental misunderstanding of how the drug works. It’s not an instant aphrodisiac, and it won’t work on bloodflow like Viagra does – it takes several weeks for the ever-so-slight effect on sexual satisfaction to kick in. That means slipping it into someone’s drink won’t do anything to someone’s sexual desire and will not make someone consent to sex (but it would still be  predatory.) According to Dr. Petra Boynton,

Early trials claim the drug boosts sexual desire, but (as with other SSRIs) this drug must be taken every day for 3-6 weeks before any effects will be noticed and continuously thereafter.

And even when reading Sex is Not a Natural Act, I didn’t see the specter of “Female Viagra” raised as a date rape drug. I haven’t gotten around to reading the New View book yet, but rape isn’t even listed in the index to the book. In Sex is Not a Natural Act, Dr. Tiefer examined several angles of the medicalization of sex, for better or worse – and from what I’ve seen so far, sexual medicine used as date rape drug isn’t even on her mind. Furthermore I did not see Dr. Petra’s blog talk about using flibanserin as a date rape drug either, nor did I see Dr. Klein say anything about that. Credit where credit is due: critics of sexual medicine do their homework, and examine the issues from multiple sides (just not all sides, and different experts weigh their pet arguments differently.) I think that it means something then professionals who put their reputations on the line writing about sexual dysfunction do not give any credibility to this possibility.

The other part of this argument about flibanserin as date rape drug moves away from a critical fact: Rapists are predators. Someone who is a rapist will use whatever tools are available at their disposal to rape. That may mean alcohol, GHB, force, coercion, abuse, threats, drugs – anything. What you wear, or what you do, or who you’re with, won’t change that. Flibanserin won’t change that. The difference in whether or not you are raped is the presence of a rapist.

This argument, as with many others made on the Feministe comment page, de-centers women with HSDD. Based on what what I’ve just described, I think it’s safe to say that flibanserin as date rape drug is a red herring. We’re moving farther away from women who actually have sexual dysfunction and instead we’re sacrificing their concerns, supposedly for the greater good.

Enough.

That’s enough. I certainly hope you’re starting to get the picture.

So, what did we learn about sexual dysfunction from the comments thread at Feministe? To summarize, I saw the following:

  • Social construction arguments against medicalization – not completely irredeemable but can become just as prescriptive and corrupted as medicine is supposed to be
  • Misunderstandings about the way flibanserin would work
  • Misunderstandings about the difference between arousal and desire
  • Dismissal of sexual pleasure as important
  • Disregard for what women with sexual problems were saying
  • Ablism
  • Partner blaming
  • Sexual medicine as date rape drug
  • The further stigmatization of sexual dysfunction

Ouch. And all of this took place within an explicitly feminist space – a place where, of all places, I should have felt relatively safe talking about my point of view of sexual dysfunction. Now are you starting to understand why I was motivated to start this very blog? Is anybody listening?

So I think we should turn our attentions back to the women who filbanserin and other sexual medicine would most effect – women with sexual dysfunction. Women with low libido who are disturbed by their low libido, to the point where they actively seek out help for it.

There will probably not be a new post by me for next week. You’ve drained all that I am out of me for now, feminist blogosphere. I hope I never have to do this again.

The ugly things people say about FSD Part 2: Electric Boogaloo

08/04/2010 at 8:12 pm | Posted in Uncategorized | 17 Comments
Tags: , , , , , , , , , , , , ,

Part two in our hopefully never-continuing series on what people are saying about female sexual dysfunction, the women who have it, and how to address it. I hate writing these posts so much. Feeling masochistic? Click here to visit part one.

Around June 2010, the feminist blogosphere went all a-twitter with news and rumblings about the upcoming FDA hearings regarding the potential libido-boosting drug flibanserin. Flibanserin is a drug that was originally intended for use as an antidepressant. In drug trials, it did not perform well as intended. However, it had an interesting side effect: flibanserin was found to have a small but statistically significant effect on women’s sex lives. Flibanserin was found to increase the number of satisfactory sexual encounters ever-so-slightly, moreso than the placebo effect. Although it’s been called “Female Viagra,” it’s worth noting here that flibanserin does not operate the same wasy as Viagra. Viagra works on bloodflow, whereas flibanserin has an effect on brain chemistry – it’s thought that flibanserin has an effect on women’s libido. Naturally, the drugmaker Boehringer Ingelheim took an interest in this result. There is to this day no FDA-approved female equivalent of Viagra in the USA (although some women use it off-label nonetheless, and the hormone-based Intrinsa patch is available in Europe.) However, in the end, the FDA did not approve Flibanserin. There were concerns about the study design and more testing is needed. Boehringer Ingelheim remains interested in getting flibanserin approved and the FDA did not outright reject the condition flibanserin may address as something that may sometimes warrant medical intervention.

This is controversial stuff here, and it raises ethical questions. Some feminists (and one major feminist organization in particular, the New View Campaign,) charge that the very existence of flibanserin (or any other “Female Viagra” drug) is inherently problematic. Potential risks include the possibility that pharmaceutical companies will market such a drug aggressively, creating demand from otherwise healthy but sexually insecure women. There is also concern from the asexual community that such a drug would be used to “Treat” asexuality, which, being a sexual orientation rather than a dysfunction, needs no intervention.
On the other hand some women like myself recognize potential for good in such a drug in managing female sexual dysfunction, even though its application would be limited. Flibanserin would not have any discernable application for sexual pain that I am aware of, for example, and the effects of the drug were small in trials. Nonetheless, for women who’ve felt anguish over a decreased or absent libido  and have been unable to restore their sex drives to a personally satisfactory level, such a drug could be of some use, whether used alone or in conjunction with another treatment. I also have concerns about the way in which FSD broadly is handled in most feminist discussions of women’s sexuality and I believe that even if flibanserin were more effective than it is, there would still be resistance against it.

During this time, some feminist bloggers stayed on top of the flibanserin hearings and criticism of female sexual dysfunction broadly – of particular interest in these discussions of flibanserin was a specific sub-type of FSD: hypoactive sexual desire disorder (HSDD.) One popular feminist critique is that low sexual desire is not a disease and not a valid form of sexual dysfunction. However I do not feel comfortable creating a hierarchy of what and isn’t a valid sexual dysfunction and by extension what is and isn’t a valid disability. Bear in mind that to be considered a sexual dysfunction clinically, there must be acute personal distress accompanied by a sexual problem. That means if you have low or zero sexual desire but you’re not dealing with serious stress and problems due to that, then you do not meet the clinical definition of sexual dysfunction. (However if you were to say to me “I think I have FSD even though I don’t meet the clinical definition,” I would be disinclined to boot you out and say you can’t party over here. You know yourself better than I do, and by the same token I have no business diagnosing anyone.)

Most blogs allow comments to continue discussing the original post beyond its end, but as you are probably already aware, comment features are a dual-edged sword. (As if we needed a timely reminder of this, one need only look at recent guest posts on Feministe.) On the one hand, blog comments allow discourse and debate to take place, and participants may learn something new about a topic or about themselves. On the other hand, comment sections carry the potential to backfire and turn into cesspools of troll waste and rampant privilege. Try as it may, the feminist blogosphere (alas, including this blog) can never be truly “Safe space” for everyone.

It’s been a few weeks since the flibanserin hearings, and and things have settled down a bit with regards to sexual dysfunction in the blogosphere. It’s quieter now… the trend has come and gone, but this won’t be the last we’ll hear of it. With some distance between me and the discussions now, I’ve been able to slog through comment threads on some of these flibanserin posts with only feelings of numbness instead of white-hot rage. Today we’re going to take a look at some comments on one of the flibanserin threads, because I believe the comments posted in relation to flibanserin, FSD and HSDD reveal problematic attitudes about FSD and towards women who have it, and especially who seek to address it. I’m not very interested right now in talking in detail about whether or not flibanserin should or should not have received FDA approval – I’m interested in talking about what people are talking about. I believe these attitudes, which include ablism and sexism, further stigmatize female sexual dysfunction and the women who have it. Some of you visiting here now need to examine what some people are saying about FSD, because perhaps you yourself have harbored such problematic attitudes, or else maybe you never thought about it this way. Others reading this blog are already familiar with the ugly things people say about FSD. If you or your partner have sexual dysfunction, you may want to bypass the rest of this post, or at least be in a position to return to a good state of mind after reading.

You may notice that the format of this installation in our hopefully not continuing series on what people are saying about female sexual dysfunction has changed since the first time around. Instead of pulling some of the best of the worst comments from various sites around the feminist blogosphere, I’m going to focus on one post from Feministe, FDA Wants YOU! to Have Sexual Satisfaction, which eventually turned into a privilege goldmine. We’re going to touch upon many areas but I cannot go into detail on all of them because if I hang around the comments too much I’ll burn out.

The setup: On Feministe, Frau Sally Benz posted a brief note about how the FDA hearings on flibanserin were about to take place. Not much else to it really; just a heads-up, no critical analysis in the body of the original post. From the flippant way it’s written, it’s hard for me to make out what Frau Sally Benz’s position, if any, is on flibanserin and female sexual dysfunction.
Anyway discussion ensues in comments, following a pattern that is becoming familiar to me.

Early on, the social construction arguments critical of FSD and the medicalization of sex were stated,

The problem with “female Viagra” is that there are so many reasons why women might have a poor sexual experience that are not biological.

More,

My understanding is women experience loss of interest in sex because of stress, tiredness, hormonal fluctuations due to pregnancy and menopause, past abuse, repeated unsatisfying encounters, and being unable to name and explore what gives them sexual pleasure.

Often when I see someone talking about the social construction of FSD and social construction approaches to dealing with it, it’s as if social construction is a brand-new revolutionary way to think about sex and sexual dysfunction – to the person talking about it. Social construction isn’t all bad, but one of the reasons I’m unwilling to unquestioningly stand behind it is because it just doesn’t work for me. Based on what I’ve seen in some comments on this blog, a purely social construction approach is not a panacea for everyone. These social and relationship tweaks work well for some couples and individuals, and they may be significantly cheaper than going to a doctor and using medication! When it works, that’s just fine. Better communication, studying sex and technique, etc. Lovely.
But what happens when it doesn’t work?

Basically, what I want to know and still have not figured out is, what is the next step when ardent social construction proponents encounter responses like this:

I personally WOULD really like a drug to treat my crappy libido, and not wanting sex feels bad to me both physically and emotionally. Low libido CAN be a physical problem for many women, and I suspect it may be so for me.

My partner is competent as hell and places no demands on me. I’m healthy, I don’t have emotional problems with sex. I would just like to be able to come in less than half an hour. It’s also not diet, exercise, or any of the other blah blah blah things I’ve been told I should change about myself to fix a problem that is not my fault or under my control. So, commenters, please don’t belittle the experiences of women who have libido issues. I don’t want to see drugs given to women to substitute for their partners giving a fuck about their pleasure, no, but if a woman has libido problems that are distressing her, yeah, a little help might be useful. Drugs are not the enemy. There is nothing superior about a person who does not take or does not need to take drugs.

I really wish we’d see more comments like this when talking about FSD and flibanserin, since these are the voices of women who would be most directly effected by advances (and setbacks) in sexual medicine. But so often in discussions of sexual dysfunction, the conversation becomes dominated by people who do not have it, (statistically no matter how I look at it, the majority of women do not have sexual dysfunction,) perhaps who don’t even believe in its validity, and/or who are unfamiliar with what it’s like to live with. Which probably wards off women with FSD who might otherwise speak up. I’ve seen some women with sexual dysfunction, or at the very least sexual problems, have problems in their lives that social construction might do a good job addressing. But I’ve also heard from women with sexual dysfunction for whom a pure social construction approach does not and has not worked. It is as sex therapist Dr. Marty Klein says,

Flibanserin is proposed for women whose reduced desire can’t be explained by a dozen other factors, including well-known desire killers such as ambivalence about the relationship, sexual trauma, and husbands who don’t bathe.

Furthermore it seems there is very little room in social construction to acknowledge that there can be social forces and biology, or even, once in awhile mostly biology, at work when people develop sexual dysfunctions. What social forces caused me to develop vulvodynia? I’m uncomfortable with the way that social construction and medicine are separated, as though it is impossible to use both medicine and a social construction approach at the same time. It is as though the two are mutually exclusive, and if you choose one, you can’t have any of the other. On paper, the New View Campaign leaves a little wiggle room for medical factors to cause sexual problems but in practice the New View does not appear to be heavily invested in investigating and addressing biology and sexual problems. Reading through Sex is Not a Natural Act, author Dr. Leonore Tiefer, who is affiliated with the New View, she came down pretty hard on sexual medicine, even if FSD patients were dealing with complications from vulvar surgery. I’m very surprised that one of the early comments acknowledged the possible role of hormones in sexual dysfunction, because Dr. Tiefer included “Defining a [condition] as a deficiency disease or disease of hormonal imbalance” as a sign of disease-mongering (Payer in Tiefer, 2006).

Here’s an example of what I’m talking about on the Feministe thread with the resistance to sexual medicine:

I’m a bit concerned about the drive behind this drug. If you look at current information about women experiencing low arousal/desire, it’s full of sensible ideas like “talk to the woman about how she is feeling” and “maybe ur doin it rong”.

I so hate assigning blame for sexual dysfunction. What if your partner has been doing everything right? What if you already have good communication? What if your’re single? What if there really is something physical going on?
When my libido crashed because it was looking like I’d never be able to have sex again anyway, how sensible would it have been to say that was all my partner’s fault because he was doing something “rong? This was no one’s fault – and I remain grateful that my libido rebounded after getting medical treatment for the pain.

Seriously, I get it. I get the concern behind the drive for the drug. But I don’t get why there’s no concern about denying treatment, including medicine, to women who genuinely need it. The social construction approach is that since FSD isn’t a valid disease and isn’t recognized as a disability, it needs no medical intervention – there’s nothing to treat almost all of the time. I hear very little support for those rare cases in which someone does need sexual medicine.

Moving on, there’s also the ubiquitous women’s sexuality is complicated argument,

Will a pill fix a woman’s loss of libido? I think it’s unlikely, given that sexual arousal in women is complex, and that drugs do not affect one specific part of the brain and body.

Returning to Dr. Marty Klein, it’s more accurate to acknowledge that sexuality in general is complicated regardless of gender:

* Reinforcing the myth that women’s sexuality, especially desire, is more complicated than men’s.

No, no, no. Eroticism in adults is complicated, and it insults both genders to suggest that only women have emotions around sexuality. Professionals don’t understand why men don’t desire women they love any more than we understand why women don’t desire men they love.

Most men are not heartless machines eager to screw anything with a heartbeat, any more than most women are frigid creatures who only acquiesce to sex out of duty.

Another of my concerns is that the “Women’s sexuality is complicated” argument may be used to quash investigation into biology and sexual functioning. Sexuality may be complex but should that complexity stop further research into sexual medicine? Is there any room for sexual medicine at all?

Up to this point, the comments I’m pointing out are pretty typical and to be expected when talking about FSD. But right about now is the point where the comment thread started to get really weird. I’m familiar with the social construction arguments regarding HSDD, FSD and sexual medicine and while I’m tired of it and feel like I’m just being able-‘splained to, (“Here’s what’s REALLY going on with you,”) at least I understand where it’s coming from. But then the conversation took a new, unexpected turn. Here’s where problematic attitudes about FSD become obvious and things start to turn ugly.

Here’s another quote from the Feministe comments section, which demonstrates at least three problematic things at once: Heterocentrism, what FigLeaf describes as the “Two rules of desire/No sex class” and the slippery slope,

It occurs to me that a rather depressing dystopian story could be written about this. Woman doesn’t want to have sex with man. Man sends her to doctor. Woman suddenly wants to have sex physically, but is mentally unready. Emotional health is effed up. Welcome to the new slavery. Fin.

Huh? Well that’s a new one to me.

To Sarah’s credit, you probably could write a very depressing story about a Stepfordian society in which women are minus all sexual desire and have absolutely no sexual agency! Or any other agency, for that matter, since it sounds like the women characters in this story are subject to Man’s orders to go to the doctor and then become slaves. However that dystopian story would probably not be about “This,” the topic of interest right now being real-world flibanserin with all its inherent limitations: should the FDA approve it? The dystopian story requires a gross exaggeration of flibanserin or any other sexual medicine for women to the point where it becomes a magic, mind-controlling sex pill, and it requires a world without lesbians, bi-, a- and pansexuals. Right now, in this physical plane we call home, such a magic mind-controlling sex pill doesn’t exist. Might make an interesting, depressing story but it moves us farther away from real-world women with sexual dysfunction, and further up into the ivory tower of theory.

The Feministe comment thread continues, with demonstration of a fundamental misunderstanding about how flibanserin works,

To end the sarcasm and speak seriously, I have a question that I hope one of you can answer. Would the drug work only through penetration. Or does clitoral stiumlation “activate” this drug too?

To find out how flibanserin “Activates,” let’s visit Neuroskeptic, who has a scientific descriptions of how it works.  Neuroskeptic says,

How is flibanserin supposed to work? According to a paper on the Pharmacology of Flibanserin, it’s a serotonin receptor 5HT1A agonist and a 5HT2A antagonist. This makes it a kind of cross between the antidepressants nefazadone and buspirone. Neither of these are widely used as antidepressants because they’re not considered highly effective. Flibanserin is also a weak dopamine D4 receptor partial agonist. This might underlie its aphrodisiac properties, because drugs which increase dopamine levels are known to enhance motivation and libido (or indeed cause problematic hypersexuality.) In rats and mice, flibanserin has sedative effects and enhances the effects of other sedatives. It also has antidepressant-like effects in some tests but not all. Drug geeks can click the image on the left for more details.

The short version is: the description does not say anything about flibanserin requiring penetration or clitoral stimulation to work. I don’t think that mattters… or it would depend on what the person using flibanserin likes.

Back over to Feministe again. Some combination of both heterocentrism and misunderstanding the application of sexual medicine,

The drug is an antidepressant.

In short, if a woman doesn’t want a penis in her vagina it MUST be because she has an undiagnosed mental illness.

Well, no, not exactly… flibanserin doesn’t work well as an antidepressant. And what this commenter and many readers visiting this post for the first time are probably unaware of is the fact that tricyclic antidepressants are sometimes used by women with the vulvar pain condition vulvodynia. That does not mean that vulvodynia is in and of itself a mental illness. In this case there’s something physical going on inside the body. The low dose of tricyclic antidepressants are thought to calm overactive nerve endings down for some patients.
However it is worth noting here that FSD is listed in the DSM-IV and soon-to-be-V. Pain may be included as a sexual dysfunction. That’s interesting, but today as I write this post, instead of questioning validity of this categorization, I’m inclined to save that conversation for another day. No matter how I slice it, I keep coming back to recognizing FSD as disability…

Furthermore, this is an intercourse-centric quote that treats PIV intercourse as the default sex. There’s no room for a woman who wants to want a vibrator on her clitoris sans the involvement of a penis.

So far, pretty typical stuff for a discussion of female sexual dysfunction and sexual medicine. I’ve seen comments like this before and I’ll see them all again.

Then things started to get really weird.

But you’ll have to stay tuned until our next installment of Ugly Things to find out what comments were so shocking to me that they constitute their own post! …Plus this is getting way too long.


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