Where are all the good advice columnists?

12/16/2011 at 11:31 am | Posted in Uncategorized | 7 Comments
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I can’t find an advice columnist I like.

I’ve been searching for the right agony aunt for years. It shouldn’t be too hard, since advice columnists are a staple feature of most major news outlets and magazines. Even smaller media outlets and blogs recruit advice columnists to generate new content.
Besides, sooner or later, just about everyone goes through a period where they believe they are equipped to start giving advice, so some folks take the “Dear so-and-so,” mantle upon themselves, without solicitation.

Perhaps I should put an ad in the paper – “Single (not really) white female seeks competent sex, relationship and general life advice columnist. Must maintain a predictable schedule, be open minded, patient yet firm, and be knowledgable on every topic addressed… Must never screw up.”

Part of my problem is timing and schedules. I liked the Feministing.com column, Ask Professor Foxy when it was still active, but the eponymous Prof. Foxy hasn’t written a new Q&A column for the site in about a year. Good Vibrations Magazine occasionally answers reader submitted questions in the feature, GV Housecalls, but this feature is irregular. There can be weeks or months between new columns.

I believe that folks gravitate towards the advice they want to hear. So how open-minded your agony aunt is, is likely a function of how open-minded the advice seeker is. In other words, if you value spiritual guidance, you probably wouldn’t reach out to a secular agony aunt for relationship advice. You’d probably look for an advice columnist with a spiritual bent instead. “Dr.” Laura Schlessinger is one such spiritual agony aunt, but for multiple reasons her programs, which include racist rants, repulse me.
With regard to advice columnists in general though, that desire for certain types of advice means different agony aunts will attract certain types of audiences. I’m sure that agony aunts figure out their target demographics. Advice columnists then hone their responses to better meet their readers’ expectations.

Advice columnists specialize in certain areas too. Although one agony aunt responded to every submitted query, I think this is an absolutely terrible idea. The sheer amount of research required to give yourself a crash course before answering curveball questions would draw time away from more relevant queries. I wouldn’t ask a self-described expert on cooking about when it’s appropriate to move out-of-state. (I might ask a financial advice columnist though.)

And so much advice-giving is really permission granting. I notice that the way questions are written offer clues as to what the the submitter already perceives to be true – submitters want confirmation from someone perceived as an authority figure. I remember reading an article about the real Erin Brockovich a number of years ago, in which she described talking to herself when facing dilemmas. (An Amazon review of her book provides backup that Brockovich does indeed describe talking to herself.) I think a lot of advice seekers could similarly find the answer they seek by looking within and confronting themselves.

Frankly I’m not even fond of the direct question-and-answer format of advice columns. With Q&A columns, there’s no way to get all the relevant information required to make an informed decision on behalf of the submitter. Printed letters have to be edited for space, too, which can be even more confusing for readers.
An example of a format I especially want to avoid though, can be found in Wayne & Tamara’s column. The authors usually respond to questions with unrelated stories, with the advice buried in parables. I love it and I hate it all at the same time – the responses can be so cryptic it’s funny.
I prefer blogs, since bloggers frequently follow the “Show, don’t tell” principle – though there’s still some telling involved with blogging. Even then, personal stories & experience work well as examples to illustrate a larger point – the personal is political, after all.
But not all bloggers are agony aunts.

So there’s still plenty of popular advice columnists left to consider, right? Maybe not. My last criteria may be unfair, since everybody makes mistakes sooner or later. And what I view as an error, someone else may perceive as a positive feature. (The social justice blogosphere frequently critiques examples of ignorant “Advice.” Feminist & social justice readers probably recognize the problems in this recent gaffe, but if you’ve been swimming in privilege, you may be all like “I don’t get it.”) But when an advice columnist is recommended and has a strong reputation, I expect more. I’ve been disappointed and disgusted by popular columnists, and once I’m disappointed enough I just stop reading. From that point on I’ll be more reluctant to trust the agony aunt and whatever advice zie have to offer. Sometimes advice-givers apologize after getting called out for obvious screwups, but it may be too little, too late… Doubling down on privilege doesn’t help either. For example:

I stopped reading Dear Abby on June 27, 2007 when I saw this Q&A posted. In her response to a 33-year old virgin woman with anxiety over the prospect of her first gynecological exam, Abby wrote in part:

DEAR SCARED: A woman should be seen by a gynecologist if she is sexually active, or if she has reached the age of 18. She should DEFINITELY see one if her regular doctor tells her to — so please start acting like the 33-year-old adult you are and stop listening to “horror stories” from friends. Pap smears are not painful, and women do not normally bleed after having one.

Sounds spot-on, right? Wrong. Pap smears can be painful for some women – Abby’s response makes it sound like anyone who says otherwise must be a drama queen or a liar – instead of someone who may have a treatable medical problem that any competent gyno could make accommodations for.

Abby doubles down and adds insult to injury with the snide implication that “Scared” is acting like an immature child, just like a childish woman who can’t suck it up and deal with it at the gyno’s.

I never got into Dan Savage’s advice series because by the time I found out about him, it was because his reputation had been recently marred – and not for the first time. I know he’s done good things for the gay & lesbian community in particular, notably the “It gets better” project and comically redefining “Santorum,” but I can’t get over his history.

I’m certainly not going to read Dear Prudence, who recently gave some fucked up “Advice” to a gentleman regarding his wife’s prolonged therapy and the lack of sex after marriage… because she had just started therapy to cope with the abuse her father committed on her.
Do I really need to delve into why Prudence’s advice terrifies me? To make matters worse, Prudence’s answer was heard ’round the tubes, so hundreds of folks saw fit to comment on this couple’s sex life. As always, things got real ugly, real fast.The myriad terrible answers to this particular question, unfortunately, are how I know looking for any better advice is ultimately an exercise in futility.

I used to read Carolyn Hax’s advice column (When it was still called Tell me about it,) until I got bored with it. I decided that much of her romantic relationship advice boiled down to “DTMFA,” because it looked to me like relationship problems, minor or major, could be solved with a breakup. In fairness, that is always an option. But her recent advice is pretty good, so maybe I should give Hax another chance.

Then there’s the self-described agony aunts of the Internet – they’re not featured in mainstream media, but they’re still popular (On the internet!) Some of these advisors have qualifications that lend credence to their advice – Ph.D. Degrees, M.S.W. degrees, certificates reflecting formal training, etc. Others are bloggers with no formal training, yet have a wealth of experience to reflect upon. And for a lot of readers, I’m sure the advice in Internet agony columns works out well.

The problem is that when the advice I want or need is sexual in nature, I can’t turn to a lot of agony aunts, even the popular ones. I saw some professors and sex educators recommended by commenters in blog posts on places like Jezebel or Feministe, so I read and have since screened out a few recommended agony aunts who write general observation stuff.

Sometimes the posts are great and well-researched. Other times, they’re as airy & fluffy as cotton – and personally, I would rather not post anything, then inflate my post count with fluff. (Everyone reading this now is thinking to themselves, “Yes, K, we’d all prefer it if you didn’t post too.” Haha.) That quality variation is pretty typical of any writing though, so no big deal.

But when it comes to problems most near & dear to my heart, sexual dysfunction specifically, the recommended agony aunts let me down. Some just vomit up yet another uncritical iteration of the New View’s rhetoric: The problem you describe isn’t an actual problem you are experiencing; it’s just part of being a woman. You can’t take medicine for sexual problems today because in the past women didn’t get a choice and you dishonor their memory. Doctors and Big Pharma are in cahoots to fleece potential patients so you can’t trust the sexual health research out there co-authored by medical doctors and certainly you should never visit one for a sex problem. Wait, you have pain with sex? Go see a doctor.

To be fair, I’ve seen this very blog you are reading get plugged by commenters offsite too. I’m flattered. So what’s the difference between me and professional or amateur agony aunts?
The difference is I have never described myself as an agony aunt. I’ve repeatedly stated, I am not here to give you advice. I prefer to be a general nuisance, presenting evidence in contrast to conventional advice, since the usual advice backfires on me anyway. I may on occasion, when pressed directly, offer up some link or sound byte, but ultimately, I believe that individuals are the only ones who know what’s best for themselves when it comes to personal & health decisions.

That said, there are some bloggers I still look to for advice, though they aren’t necessarily in the business of answering questions. Keep in mind even you may find the following bloggers repulsive, for the same reasons I’ve outlined above! They aren’t always perfect, and I’ve seen some of the below make mistakes too.

People I still find credible most of the time:
Holly of the Pervocracy, Violet Blue, Corey Silverberg, Heather Corinna, the archive of Go Ask Alice!, Matt Kailey

Tier 2 (Generally like but with some reservations,)
Greta Christina, Carol Queen, the Sexademic, Marty Klein.

Readers, have you found a decent agony aunt that might fit the bill for what I’m looking for? Now I want your advice as to who’s good & why.

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Quick link – a dating site for folks with sexual problems

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

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

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

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

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

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

Guest Post: On sexual pain, consent & treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Guest post: The Sexual Subject

03/09/2011 at 4:46 pm | Posted in Uncategorized | 3 Comments
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[Dear internet, we have a guest poster today! The following was written by Elaine F. Bayless:

Elaine F. Bayless is an author and pastor who lives in Raleigh, NC. She is currently working on a memoir about her experience with pelvic floor dysfunction. After choosing to have surgery to correct her issues, she is happy to report that most of the dysfunction is resolved. She and her husband are expecting their first child in July of this year. For more information about Elaine’s published work and her writing process, visit her blog http://elainefbayless.blogspot.com]

I am one of the lucky ones. I only saw three gynecologists who ignored my vaginismus. I only wasted 9 months of my marriage in therapy, convinced that my pain was psychological. My husband never forced me into sex, never punished me for my condition. It only took me six years of treatment to finally find resolution in the form of penetration concomitant with orgasm – MY orgasm.

In November 2010, Discover magazine’s column, Vital Signs, discussed an intern who missed the symptom of painful intercourse. When the doctor asked him about this symptom, he admitted that he thought all women found sex painful. This doctor was shocked to discover this attitude in an “educated” person. I’m not shocked.

Women just don’t enjoy sex that much. That’s the pervasive belief in our society. And women who do enjoy sex are often penalized. We aren’t supposed to enjoy it, after all. We are supposed to be enjoyed. We are objects, not subjects. I still remember vividly an encounter in my recent past, when I had multiple orgasms and my husband had none. I was apologetic! But he had no regrets. He simply smiled and said he was glad I enjoyed myself. He’s a true man, someone who understands that sex is a two-way activity, an encounter between two participants, not between a subject and object. How does this belief play into the diagnosis and treatment of dyspareunia? In every way. My own story serves to illustrate it.

I had my first Pap smear at age 18. I was a virgin, but irregular periods plagued me and so I wanted to go on the Pill. The exam was torture, but every year I went back. My gynecologist was unconcerned, blaming me for not relaxing. She never gave me any tips on how to relax, never suggested anything to try to make things less painful, even when I almost passed out from the pain. My gynecological history post college was sporadic. Still a virgin, I went on and off the Pill, only getting a couple of Pap smears. Each time it was excruciating. I didn’t use tampons – too painful. But I kept that a secret. My doctors assumed that I didn’t enjoy insertion because I wouldn’t relax – that it was my fault, not something beyond my control. After all, women don’t enjoy sex, why would they enjoy an exam?

Prior to my marriage, I went to a friend’s gynecologist, highly recommended. I shared with her my pain issues. I asked her specifically to determine whether there were any reason why sex would hurt (I was still a virgin). This was her chance – her opening to discuss dyspareunia with me, to talk about different causes for pain in the vagina. Surely my medical history, my fear of tampons, and my simple reaction to the exam should have clued her in. She told me to relax because there was nothing wrong with me.

Why did this doctor not even mention the possibility of actual physical conditions that could cause pain during intercourse? Why did she assume that after 11 years of pain during vaginal exams I would be able to relax? I guess she figured I would learn how to grin and bear it, like many women do.

Because of her bad advice, I went to see a therapist immediately after my honeymoon, convinced I was mentally screwed up. After all, physically I was fine, right? When my prescription for the Pill ran out, I went to see a new doctor, a nurse-practitioner who specialized in seeing rape victims. I knew she would be sympathetic. She gave me a tranquilizer to take prior to the exam. It did nothing – my blood pressure was through the roof and I winced at the moment of first contact. And that wonderful woman sat back and told me I needed to see a physical therapist.

The discovery that there actually was something physically wrong with me – that I was incapable of relaxing – that was a turning point in my entire life. I had never heard of vaginismus, vulvar vestibulitis, dysparaunia, etc. I didn’t know that walking around with a constant Kegel was abnormal. (To this day I still catch myself in “locked and loaded” position). Finally I was able to clear the self-blame and self-doubt that was tormenting me and my marriage. I had a physical problem!

I still listen to women who have bought into the lie that we don’t enjoy sex. They say that their vaginas are too small. They say that they don’t enjoy orgasm. They continue to engage in sex that is unfulfilling. I was teaching a group of high schoolers about sex and counseled them to stop having intercourse if it hurt. They all looked at me blankly and then asked why. I was horrified.

We are not sexual objects. We are sexual subjects. I am currently pregnant with my first child, a little girl. A girl conceived during pretty fantastic, orgasmic sex. (Sure, it took 6 years, 3 physical therapists, and surgery, but it was WORTH it). And one of the most important things I hope to teach her is that sex feels good. And if it doesn’t feel good, she will have to be her own advocate and work tirelessly to find the cause and the solution. I hope that the world will have changed somewhat by then – that the medical establishment will have a better understanding of sex as something that is designed to be enjoyable. For anyone.

Book review: A New View of Women’s Sexual Problems

11/16/2010 at 10:14 pm | Posted in Uncategorized | 5 Comments
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Several months ago, over the course of a five-part series, I reviewed sexologist and feminist activist Dr. Leonore Tiefer’s nonfiction anthology, Sex is Not a Natural Act and Other Essays. It presents her critique of contemporary discussions of sex, sexuality and sexual dysfunction, from a social construction perspective. (Basically that means that Dr. Tiefer gives significantly more weight to cultural influences on the formation and expression of sexuality than to biology.) While reading it was certainly an informative experience for me, it was also rough – at several points I tripped over apparent contradictions between what Dr. Tiefer had written in one chapter vs. another and multiple instances of disablist language. Overall, while I learned a lot about social construction and criticism of female sexual dysfunction as a diagnosis, the book left me feeling isolated and unsatisfied since biology and the availability of medical options have a strong impact on how I have sex.

So for awhile I and guest posters wrote about other stuff in the wide world of female sexual dysfunction. And then I had to take a hiatus from blogging so I could deal with real-life chaos. After settling into a new routine, I felt motivated to read something… Now seems as good a time as any to pick up A New View of Women’s Sexual Problems, another nonfiction essay collection detailing an alternate model for looking at women’s sexuality and dysfunctions. A New View doubles as an in-depth manifesto for the New View Campaign, complete with examples of how the New View model can be applied to real-world women’s sexual complaints. Let’s see what it’s all about.

Overall Impressions:

A New View is and feels significantly shorter than Sex is Not a Natural Act – it’s about 218 single-spaced pages, divided into three parts. Each chapter is short, ranging from just a few bite-sized pages up to around thirty, so it’s easy to digest. Each chapter was published simultaneously in the journal Women in Therapy, volume 24, issues 1 & 2, so you’re actually reading academic journal articles. Except for a few essays towards the end of the book, most of the time it’s generally not heavy on academic jargon.
Downsides unrelated to the writing: A New View is not available in e-book format and at about $30 on Amazon (new) it’s a little outside my sweet spot price range for something sans illustrations. I went in to the book hoping for a list that would explicitly spell out which biological problems get the green light for medical treatment but I’m still not clear on exactly when sexual medicine is appropriate (and why.)

On paper, the New View looks good. Overall, the book is nuanced and presents the perspectives of many professional women familiar with sexology, sexuality, women’s studies, feminism, psychology, health, and related fields. The responses to the New View manifesto illustrate its merits and practical application…
On paper.

In practice, I’m still wary of the manifesto and the eponymous organization. Reading the entire body of work has not sufficiently addressed my apprehensions.
Because in practice, I’ve seen the New View’s positions and activities turn into another prescriptive theory, one that creates new complications and restrictions for women even as it attempts to free them. For example, in practice, the strong emphasis on relationship problems can also oversimplify women’s sexual problems and turn into partner blaming. The New View’s insistence on referring to “Female/Pink Viagra” further obfuscates understanding the difference between arousal and desire, even when drugs like flibanserin do not work like Viagra. I was horrified to see New View organized petition to stop FDA approval of flibanserin, since I felt like the petition organizers overlooked whatever small number of women might actually benefit from such a drug, questionable though it is. Anti-Big Pharma arguments can easily turn into anti-medicine rants and rampant disablism. Looking for the deeper meaning behind sexual problems can turn into so much ‘splainin and Freudian analysis. And I think that by questioning the very existence of such a thing as female sexual dysfunction, the New View contributes to the further stigmatization of FSD. Basically, when used irresponsibly, the New View lends itself to Bingo Board fodder.

But on paper, the ideas are great. There’s even wiggle room for medical problems and biological factors as causes of women’s sexual problems (though the contributors are less interested in examining biological and health problems.)

In practice, the New View raises new questions and creates potential problems that warrant further examination.

Reading between the lines, you may notice some elements missing…

The New View Manifesto which guides the campaign was written from the perspective of professional women – psychologists, anthropologists, sexologists and related fields; however none of the original twelve named contributors to the succinct document had qualifications in medicine. There were no physicians, gynecologists or obstetricians involved in drafting the original manifesto. However, the document has subsequently received endorsement from several medical doctors and many therapists.
None of the contributors to the New View book disclose whether or not they have personal experience dealing with sexual dysfunction. The only clue we have as to whether an author with sexual dysfunction was included in this anthology may be found in Gina Ogden’s essay, which said, “I have been able to relieve much personal relationship angst by understanding sexual dysfunction as a manifestation of cultural dysfunction” (19). So there’s an “I” statement that touches upon sexual dysfunction and Ogden probably meets the New View’s definition of having had “Sexual problems,” but it’s not clear to me whether she ever considered herself to have a dysfunction. However even this statement ultimately rejects sexual dysfunction as an actual bodily phenomenon that women experience in and of itself. The rest of the book is likewise resistant to the very idea of sexual dysfunction as a valid medical problem.

There’s an expression in business, “Management sets the tone,” which means upper management, through actions and words, dictate the general atmosphere of an organization. It was Dr. Tiefer who pushed for the New View Campaign to come together, and throughout Dr. Tiefer’s essay, she consistently keeps the words female sexual dysfunction in “Scare quotes.” A footnote details the reason why: “4. I will put “FSD” (female sexual dysfunction) in quotations in this paper to indicate its questionable legitimacy” (92). Based on this, it seems highly unlikely to me that the contributors to this book would have actively reached out for feedback directly from women with sexual dysfunction. After all, if a condition is not legitimate and real, then who has it? There isn’t anyone with it to recruit.
Women who definitely had relationship and sexual problems and/or dysfunctions are presented as case studies in support of the New View model. Sometimes these women are quoted briefly, other times a contributor presents a summary of what brought a client in. Our words are presented through the filter of professionalism.
The omission of responses by women with sexual dysfunctions is a problem since such women are critical stakeholders in the New View model of sexuality and sexual problems. The New View is meant to be applied to women who experience sexual obstacles. But did anybody run the New View by the women who it most deeply effects before going to print? Based on one of Dr. Tiefer’s essays, it looks like the answer is No – the New View was drafted by about a dozen North American professional women based on their interactions with clients and with feminism (87); women with sexual dysfunction were not explicitly solicited for feedback. This is especially ironic in light of Peggy J. Kleinplatz’s essay, On the Outside Looking In: In Search of Women’s Sexual Experience in which she says, “Women’s sexual experience is conspicuously lacking from popular and sexological discourses of female sexuality” (124) and,

“Alternative models of female sexuality are called for which embrace the entire range of female sexuality from the vantage point of lived experience… A new epistemological stance is required which features women’s subjectivity at the center of inquiry. Female sexuality is best understood by listening to women’s own voices rather than attempting to peer from a safe distance and have our views filtered through the distorting lenses of conventional and sexological images of sexuality and female sexuality” (130).

Without follow through, calling out for the voices of women is little more than lip service. Nothing about us without us. (This is a continuing problem in the wide world of feminist writing, and writing in general.)
On the other hand, even if women with sexual dysfunction had been consulted when the New View document was first drafted ten years ago, I doubt it would have raised many objections or concerns. It looks fine on paper; it’s when and how you use the document to guide your activism that problems become are either solved or manifest.

I was surprised to see some criticism of the New View contained within the book’s pages: according to Gina Ogden, it may not have much to offer women who are extroverted in their sexuality. Jaclyn Friedman comes to mind, because Ogden says such women are labeled “Sluts” (19) and Friedman self-identifies as a slut, in the best way possible. So what does the New View, which focuses on negative sexual outcomes, have to offer her if she experiences sexual dissatisfaction? Good question.

The New View does a better job looking at causes for sexual problems than it does at offering guidance for what anyone should to do about it. I suppose that’s true of the DSM too though. One thing that’s clear in the New View is that medicine should generally be avoided, since medicine won’t address social forces, and it has been hijacked by for-profit entities.

And unfortunately the book doesn’t say anything about the grieving process you may go through (I went through it…) when it turns out that your sex life is not, and may never be, anything like what you had expected.

The book itself:

The first part of the book is the shortest – it’s the New View Manifesto document itself, which you can find online if you know where to look. It has been re-published on the Our Bodies, Our Selves blog supplement. (A later chapter goes into more detail about Dr. Tiefer’s connection with the Boston Women’s Health Book Collective, which I was curious about.) The document itself, not so bad. It does not use the label “Sexual dysfunction,” instead using the term “Sexual problem,” which is defined as, “discontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience, may arise in one or more of the following interrelated aspects of women’s sexual lives,” and then there’s the whole bulleted point list of stuff that makes sex hard for women to enjoy. This alternative definition is similar to the DSM’s criteria of “Personal distress” in sexual dysfunction since it acknowledges the importance of personal dissatisfaction, but it’s more flexible in acknowledging what causes dissatisfaction, and the language is supposed to be less hurtful. It’s meant to acknowledge social influences and reassure women that there’s nothing wrong with them if they experience sexual problems. To the best of my knowledge the document has remained unchanged since the final draft was put together in 2000 (88).

The second part of the book consists of 10 contemporary responses to the New View. Professionals read it and wrote in about how it could be applied to their practices and/or demonstrating ways in which women’s sexuality is shaped by local culture – often with negative outcomes for the women, since culture is frequently patriarchal. Throughout this section, there is a strong emphasis on relationship factors as being the main culprit for women’s sexual problems. So what about all the single ladies who are not in a romantic/sexual relationship? Well, you still got a relationship with your friends right? Or your parental figures, or if you’re reading this blog then surely you have some kind of relationship with the media. Relationships! You can’t get away from ’em.

The essays have merits, yes. But there’s flaws too. Here’s some examples of what I mean…

In the first essay response to the New View model, Dr. Lucy M. Candib presents a case study of a patient with sexual problems and lists elements of her problems that fall under all four of the main areas of the New View classification. It’s a compelling case. Yay! But then Dr. Candib says,

Practitioners may attempt to address the anger that women hold about both the division of labor and the experiences of abuse, but such anger is usually chronic, and many women develop symptoms in relation to it – headaches, chronic pain, fatigue, or depression – especailly when the relationship appears to be an inescapable trap (13).

Emphasis mine…Wait, what am I looking at here? I don’t think I like where this is going… didn’t DW user beautyofgrey talk about looking at “Unresolved anger” as a way to explain away what was actually a chronic, invisible illness? And didn’t she talk about how people interfere with her treatment decisions out of fear of Big Pharma?

Beth A. Firestein’s essay, Beyond STD Prevention: Implications of the New View of Women’s Sexual Problems talks about how a strong focus on sexually transmitted infection prevention fails to address the concerns of people who have or have had a STI. Prevention is great, but what happens if it isn’t enough? What happens when prevention fails and you catch a sexually transmitted infection? This chapter explicitly mentions the role of STI (or the fear of them) s in developing vaginismus, and this is the only chapter that explicitly mentions vulvodynia. Yay! However, this is the context:

3. Women who have partners that suffer from recurring outbreaks of a viral STD, such as veneral warts and herpes, or neurological pain disorders, such as vulvodynia, that cause pain with sexual activity or penetration, need to be helped to seperate fear from fact and to determine a personal range of safe and pleasurable sexual behaviors – behaviors that allow for sexual satisfaction of both partners while decreasing the risk of exposure to their partner’s disease. Such women could also benefit from coaching in ways to deal with a partner’s STD that protects the woman without eroding their partner’s sexual self-esteem or healthy sense of sexual self-expression (30).

I’m actually not put off about talking about vulvodynia in the same chapter as STIs, because Firestein’s view is meant to go beyond STIs and take away some of the stigma associated with them. This paragraph is somewhat awkward though, since vulvodynia is not actually an STI and it is not contagious, my partner does not need to worry about being exposed to it. A simple grammar tweak would likely strengthen this passage. I’m more concerned that this passage does not provide guidance with what to do if you are someone who has a chronic condition or infection… and you still want to go beyond your current safe range of activities. I already know facts about vulvodynia, probably more than the average sex therapist or general practitioner. My fear does not come from ignorance about my own health. Some women with vulvodynia still want to, or do, have sex even if it is painful, and this paragraph does not address what steps might be taken in those situations.

Dr. Lisa Aronson Fontes’ essay on Latina sexuality, The New View and Latina Sexualities: Pero no soy una maquina! compares the New View vs. the DSM classification of sexual problems and where each classification schema centers the causes of women’s problems: Within the individual vs. with external forces in an individual’s life. She provides examples of Latina women with a history of sexual abuse or shame for whom the DSM does a poor job addressing the causes sexual problems, and she shows how the New View fits better. Yay! One client, Sarita, told Dr. Fontes her frustration with her pushy priest and doctor – they were urging Sarita to have sex with her husband, even though she was dealing with abuse triggers which made her uninterested in sexual activity. (Sound familiar to anyone?) This experience resulted in the expression contained in the title, translated as “But I am not a machine!”
So Dr. Fontes’ comes down pretty hard on a diagnosis of sexual dysfunction, at least for sexual abuse clients:

The “dysfunction” categories of the DSM-IV imply pathology as a variation from a theoretical normal pattern. It is more helpful to use an injury model – that connects suffering with the environment in which it occured an dthe person who caused it – than an illness model, which locates the source in the sufferer (Lamberg, 2000). An injury model implies recovery for victims of abuse. Yolana is on the mend – being labeled as “dysfunctional” at this time cannot help her recovery (36).

So for another client, Yolanda, a diagnosis of sexual dysfunction is a poor fit or outright counter-productive. But what about women like me, for whom incorporating the label “Dysfunctional” is part of my recovery – if you can call it a “Recovery” at all. At what point are you recovered, knowing you can never go back to the “Normal” which you once had? It may be worth noting here that according to Dr. Fontes’, Sarita did not meet the criteria for PTSD (35). But what about if she had? We get a clue as to Fontes’ feelings regarding an illness model in general with the following line:

“Using the New View, we are able to consider and treat Sarita’s discontent in its historical and current relational contexts, without reducing her to a body with a dysfunction, as if she were a broken machine” (35.)

Emphasis mine, because the problem with this statement is No no you know why am I even still doing this I am not doing this anymore I should not have to explicitly spell this out: If you think that diagnosing someone with a sexual dysfunction reduces them to a broken body, like they are a broken machine, then that’s your problem! Except that then it becomes my problem because then I have to struggle against this idea that there’s something wrong with me not just for having sexual problems but for needing medical help addressing them. You can have a sexual dysfunction and still be a rich, individual person. There has got to be a way to support abuse victims without using disablist language, especially since some abuse victims may very well have chronic illnesses – in fact, folks with chronic illnesses are more likely to be abused.

The third part of the book details the origins of the New View and contains more supportive materials. It’s the biggest and the most difficult section.

The longest chapter in the third section is Dr. Tiefer’s essay, Arriving at a “New View” of Women’s Sexual Problems: Background, Theory, and Activism. It’s very similar, even parallel, to Sex is Not a Natural Act. If you don’t have time to read all of Sex is Not a Natural Act, you could probably get a good idea of what it’s all about from reading this colorful essay. Dr. Tiefer shares her perspective of the history of the medicalization of men’s sexuality (and by extension, women’s,) the influence of Masters & Johnson’s human sexual response cycle research, criticism centering orgasm as the endpoint of sexual research, etc. This essay provides a lot of background information about why and how the New View Campaign came to be in the first place at about the turn of the millennium – with Viagra approved and prescribed, Dr. Tiefer and feminist colleagues wanted to challenge the supremacy of male-focused medicine defining what constitutes female sexual dysfunction, (no skeptic quotes from me) but they had to do so under time constraints – there was a sexual dysfunction conference a-brewin’.

Remaining chapters in this third section address gender and gender roles, sex education and coming of age, lesbian sex therapy, female sexual dysfunction, etc. The essays on lesbian sex therapy were interesting and they draw attention to this often-marginalized group, but even the authors seem disappointed by what they have to offer to their lesbian sex therapy clients. Much of sex therapy is informed by the work of Masters & Johnson and is heterocentric. You may think the same principles in heterosexual sex therapy should apply to same-sex couples but in practice, it frequently cannot. In response to the failures of Masters & Johnson’s sex therapy models, Marny Hall once tried a revolutionary therapy with lesbian clients that she called “Anti-sex therapy,” (168) with disastrous results.

As was the case in Sex is Not a Natural Act, I found myself tripping over problematic elements in these later chapters, which made it difficult to find redeeming elements. Jennifer R. Fishman and Laura Mamo in their essay What’s in a Disorder: Cultural Analysis of Medical and Pharmaceutical Constructions of Male and Female Sexual Dysfunction (about exactly what it sounds like) describe prescription drugs as,

…fast becoming popular consumer products, a capitalist fetish, where one is encouraged to think of such drugs as a means through which to improve one’s life. The shift to the biomedicalization of life itself is indicative of a cultural and medical assertion that one’s life can always be improved” (182).

(Emphasis original.) There is no consideration here for folks who need prescription drugs for mental illness or chronic pain or for folks who cannot afford much-needed medication. What stung me the most was the complete erasure of my existence as a once-adolescent young lady with sexual dysfunction when Deborah L. Tolman explicitly stated, “Female adolescent sexual dysfunction is an oxymoron” (197.) How am I supposed to react to that? Is this slap in the face supposed to snap me out of my reverie? I came away from many of the later chapters feeling very much as though some of our bingo board squares were staring me right in the face.

Overall, it is a challenging book, esoteric, though for readers of this blog it might be one worth reading. But it should be taken with a grain of salt — The New View may not be the panacea for women’s sexual problems it was hoping to be. In breaking away from the problems contained in the medical model, the New View stumbles into and creates new, different problems. It could be strengthened with revisions following a deeper understanding of disability activism and the potentially harmful consequences of stigmatizing both illness and medicine. The goal of the New View is to recognize that sexual problems are often caused by forces outside the body, and then to work for social change to address the causes for these problems. But social change takes time, and some of us cannot wait that long for revolution, especially when there are so few support structures in place to begin with. Some of us genuinely do have sexual problems that originate from within. Some of have problems that are so complex, we cannot isolate the body from the social, and we should not have to choose between social change or medicine. This really isn’t an either-or situation; people want better sex education with which to make good sexual choices and access to medical options. Others face problems so widespread that even feminism can’t fix everything. We have problems and dysfunctions now. While I can see some merits to social construction in looking at sexual problems and dysfunctions, overall with regard to the New View, I remain unwilling to co-sign.

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.

Guest post: GUILT, FAILURE AND A PRE-ORGASMIC FEMINIST

10/17/2010 at 1:30 pm | Posted in Uncategorized | 13 Comments
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[Dear internet, we have a guest poster today! This is a post by pro-BDSM activist Clarisse Thorn, who blogs at Pro-Sex Outreach, Open-Minded Feminism.]

I’ve been working on a long article about my experiences with sexual dysfunction. It’s a project that’s been in the making for quite a while, but now that I don’t have so many distractions I’m ramping it up.

This is a complicated and difficult subject for me. I have a satisfying sex life now — I’ve gotten pretty good at communicating with partners, setting boundaries, seeking what I want, and masturbating to orgasm. It took me a long, long time to get here, though, and I had to get through a ton of confused feelings. Not just about coming into my S&M identity, though that was certainly a factor, but also dealing with feelings around the orgasmic dysfunction itself — for example, feelings about how my apparent inability to have orgasms meant that I was broken. (I had and still have some vaginal pain, too. Not every time, not even most times, and nothing overwhelming — but enough that I’ve developed coping mechanisms.)

In order to write this article, I’ve been going through a lot of years-old journal entries. One quotation particularly struck me:

[My boyfriend] comforted me the other night when I broke down and cried. I wept and wept and he said it was okay, you’re not broken, there’s nothing wrong with you. It’s okay, he said, not to want sex. But I do want sex, I’m just sickened and terrified and disgusted by it, and I don’t want to be anymore. I want to be able to watch sex scenes and not be enraged and disgusted, to read sensitive ones and not collapse in tears.

I wasn’t entirely sickened and terrified and disgusted by sex, of course: I often liked it. Loved it, really. Sex usually felt good even before I could have orgasms, even before I’d found S&M, even before I’d parsed out my feelings and learned more about sexual media such as porn. And I’ve talked a lot about how awesome and sex-positive my sex education was.

But I knew I was missing something, something crucial and integral to my sexuality. And I hated the way society seemed to always be informing me how to sexually act: I felt crushed into approaches that obviously weren’t working, weren’t meant for someone like me. It was hard to walk the line between craving sex and being unable to stand it.

Here’s another excerpt from my journal, around the same time:

I really hate reading explicit sex scenes. I didn’t used to hate it as much as I do now, and since I broke down in tears during the last one, I guess it’s pretty obvious why. Jealousy and hurt and hatred of the ideals I feel like they’re trying to forge into me, [one ideal being] that love and sex and particularly orgasm are all irrevocably intertwined, and that by missing out on orgasm I’m missing out on not only an aspect of sex but of love.

But mostly I guess the discomfort does come from not wanting to read the intimate details of another’s sex life … and the jealousy for the orgasm, still there, too deep to banish. Christ, it’s fucking ridiculous. I shouldn’t be this miserable about this. It’s so fucking unimportant in the grand scheme of things. — but the tears that startled me in my eyes as I typed tell me just how unimportant it really is to me, I guess.

I started reading some sort of book on having orgasms and wept all through the first chapter because it was so miserably true. And because it was so miserably true I feel as though I ought to read the rest of the book, just give it a chance and go with it, and maybe make it that way, but it hurt so much and I’m so scared that it won’t work, and then I’ll be really unhappy. (A reaction the book even outlined, by the way. Yes, it’s about as true as it gets — the only thing I’ve ever found seems to understand how I really feel about this.)

The book that struck me so much is the monumental For Yourself, by Lonnie Barbach. It’s a famous book. I searched it out at the San Francisco library recently, and spent an afternoon sitting around the Mission branch, trying to locate the passages that once touched me so much. A few quotations:

Do you sometimes feel that you would be happier if sex were eliminated from your intimate relationships altogether? If so, possibly you feel abnormal in this regard, or like a misfit or not whole as a woman. Or, perhaps you just feel that you are missing something everyone else has enjoyed, a part of life that you’d like to have be a part of yours, too. You probably feel as if you are one of only a few women who have this problem. But the truth is that you are far from alone. (page xiii)

A real fear that can keep some women from doing anything to solve their sexual problems is the fear of failure. When Harriet joined the group, she didn’t believe she could become orgasmic. She said, “If I tried, I’d only fail, and then I’d be really miserable.” … Harriet eventually did defy her fears, as did all the other women mentioned. It takes time and effort to counteract these fears. It means saying “I’m afraid” and yet pushing beyond. (page 14)

Is it because you’re embarrassed to ask for what you want at a particular time; afraid your partner will refuse, get angry, or feel emasculated? (page 15)

Empathetic and accurate so far. (As it happens, the only lover I ever directly asked for help during this orgasm-discovery process refused and got angry, which just goes to show that being afraid he might react that way was not all in my head.) Merely confronting so much understanding was hard to face.

But, although I read it a long time ago, I think I’ve figured out what it was that made me unable to read further: the way Chapter 1 ends is a bit much. The last page of For Yourself‘s first chapter contains this:

You have to assume responsibility and be somewhat assertive. Our culture has taught us that a woman should depend on a man to take care of her, which means she can blame him for any mistakes. It’s nice to be driven around in a car, but it’s also nice to be able to drive yourself so you can go where you want to, when you want to. But to do that, you’d have to assume some responsibility.

Well, okay. Except that how do you assume responsibility for something if you have no idea where to even begin? If you know something’s missing but you’re not sure what it is? If you’re sure your partner will be frustrated and resentful when you ask for help?

This is especially complicated by the fact that along with the typical advice of “Take responsibility!”, the other typical advice is “Let go of control!” Over at Lady Sex Q&A, Heather Corinna writes:

Orgasm involves us surrendering to what we’re feeling, and really rolling with it, even if and when it feels very emotionally precarious. It’s control we’re letting go of, really, and that’s harder for some folks than others.

I’ve been an off-and-on sex & gender geek throughout my life, so I already knew these things intellectually. I’d already absorbed these ideas: that I must both take responsibility for my sexuality, and lose control in order to enjoy it. I think even then I knew that both of these ideas are actually good advice. But the problem is that they’re often put in patronizing and less-than-helpful ways. For example, “It’s nice to be driven around in a car, but it’s also nice to be able to drive yourself so you can go where you want to, when you want to. But to do that, you’d have to assume some responsibility.” Condescending as hell! To me, those words implied that I was making myself into a helpless child. Pulling a wounded-bird act and forcing other people to take care of me. I couldn’t stand the idea that I was doing that!

I am frustrated by the insensitive guilt trips that often happen, even (especially?) in feminist and sex-positive circles, where people will sometimes act as if these things are simple, as if it is oh-so-easy to stand up and take on one’s own sexuality and Just Deal With It. Especially when you’re in a situation where you know for a fact that some men you have sex with will resent you if you’re honest about not having orgasms, and yet you don’t know how to have orgasms and aren’t sure how to start on the journey. What then?

Some women end up faking in those contexts (I didn’t very often, back in the day, but once or twice I did). Of course, some feminists and sex-positive writers are especially unhappy about this:

I’m sure I’ll offend some choice feminist who thinks that it’s unfair to criticize women who make the totally autonomous choice to flatter a man with a fake orgasm instead of working towards a real one, but I’m taking a stand on this one. It’s un-feminist to fake, ladies!

I don’t advocate faking orgasms, and I actually also don’t advocate dating a man who gets angry and resentful when a female partner asks him to pitch in. (Oh my God, sometimes I have nightmares that I’m back in that relationship, and it’s been years.) At the same time, the idea that screaming “It’s un-feminist to fake!” will fix the problem is ridiculous. It’s the kind of idea that will just make feminists (like, say, myself many years ago) feel even worse about trying to figure out our relationships while not having orgasms. I see, so now not only am I failing to be responsible, I’m also un-feminist? Awesome.

This is not easy. It’s actually really hard. I get that people have to want to work on their sexuality, in order to do it — obviously I get that. But telling people that they’re being weak or self-centered or un-feminist because they aren’t sure how to do it? Or are actively pressured out of it?

Not okay.

Book review – The Camera My Mother Gave Me

08/31/2010 at 6:29 pm | Posted in Uncategorized | 3 Comments
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[Trigger warning for rape]

The Camera My Mother Gave Me is both one of the easiest and hardest books I have ever read.

Years ago, shortly before I received a tentative diagnosis of vulvodynia by my main gynecologist, I started looking for support and information about what causes vulvar pain. The Camera My Mother Gave Me is one of the earliest books I read about the topic. At the time, it was one of a very few books available that talked about vulvodynia with any amount of detail. Most of my other sources were scientific & peer reviewed medical journal articles or anecdotes from the internet. What sets The Camera My Mother Gave Me (henceforth I shall refer to it as TCMMGM) apart to this day is that unlike informational resources that talk about treatments, it is a memoir. It’s a first-hand personal recollection of author Susanna Kaysen’s life with vulvodynia over about two years.

Yes, you read that right, the author is Susanna Kaysen – this is the same author made famous for her previous memoir, Girl, Interrupted, which was made famous by Hollywood – though I understand the film distorted the facts in the name of artistic license. However, I have not read Girl, Interrupted and will not be talking about that today. Whether Kaysen’s experience with psychiatry in the 1960s has anything to do with her vulvodynia later in life, I cannot say.

So, TCMMGM is both an easy read and a hard read for me. How is this contradiction possible?

It’s easy because it’s short. It’s only about 150 pages with paragraphs double spaced. If you’re interested in reading it, it probably won’t take more than a few hours to finish; maybe a day or two tops. Kaysen uses everyday language instead of heavy academic jargon, so you don’t necessarily need to be a doctor or be familiar with vulvodynia in order to follow along.

But it’s hard because every time I read it, for all the progress I’ve made and improvements I’ve seen over the years, I am instantly transported right back to square one – that daunting, hopeless, barren place where the walls of pain obscure every available path. It’s hard because when I read it, I remember everything… the questions unanswered, the ignorant doctors, the uncertainty …the pain. I’m in my early 20s again and I don’t know what’s going to happen to me.

Another reason this book is so hard for me because no one understands this book unless they have vulvodynia. Perhaps I’m not giving folks enough credit. Perhaps that’s an exaggeration… but not by much. TCMMGM has received mixed reviews, many of them negative. The negative reviews usually contain some variation of gross-out due to TMI or frustration with Kaysen’s lack of progress in treating her pain medically. It’s TMI and gross because vaginas and vulvas are generally considered vulgar and gross – at least outside of feminist circles – sometimes even within feminist circles, because don’t talk about vaginas too much or else you reduce yourself to a big walking vagina – and thus it’s a shock to read such frank language and descriptions about the vagina. Frightening, too, to have to think about an area that’s supposed to be capable pleasure feeling instead only pain. If readers are frustrated with Kaysen’s lack of progress, that may be because Kaysen herself was frustrated and was deliberately trying to convey that feeling – trying treatments she felt comfortable with, avoiding the ones that she didn’t want but that were nonetheless pushed upon her over and over again. When she opened up about her vagina and all its problems, Kaysen also left herself open to invasive personal questions, “Why didn’t she do this, why didn’t she try that.” If the book feels unresolved at the end, that’s probably because vulvodynia is itself a chronic problem, often with no clear resolution. There are still loose ends by the time the book ends, because in Kaysen’s real life the struggle with vulvodynia was ongoing.

So what’s the book about?

The briefest answer is to say that it’s about Kaysen’s vagina. One day, mysteriously, “Something went wrong with it” (3.) Everything else follows over about a two-year period.

A more comprehensive answer is to say it’s about Kaysen’s experiences during a time when she had to re-evaluate her relationship and sexuality as she navigated the gauntlet of modern medicine in search of answers for her debilitating vulvovaginal pain.

Kaysen began experiencing vaginal pain that “Felt as if somebody had put a cheese grater in it and scraped” (3.) The reasons for this pain are never made 100% clear. We learn that Kaysen had a bartholin’s cyst surgically drained some 20 years earlier, and the pain felt intense at the surgical site – but the pain radiated to other areas of her vulva as well. She was approaching the age at which many women enter menopause (though I could not tell what her age was when the pain started.) Her gynecologist initially misdiagnosed Kaysen with a run-of-the-mill infection and prescribed some treatments that probably didn’t do any help. At some points, Kaysen explores the possibility of psychosomatic causes.

This pain interfered with her everyday activities like “Wearing pants” (8), “Taking a bath” and “Too much driving – it hates that” (146.) She maintains a pain diary, measured on a scale of 0-5, with her pain frequently hovering around a 2 and sometimes spiking above 5. She had good days and bad days.

The pain interfered with her sex life, to the point where her sex life and her relationship with her own body fundamentally changed. Very early on, Kaysen tells her gynecolgist,“Listen, I said, everything’s getting worse. I’m really having trouble with sex. My vagina hurts all the time now. If I have sex it hurts more, but it never doesn’t hurt” (9). Unfortunately an expanded definition of “Sex” did not adequately address Kaysen’s problems:

“I tried a lubricant named Astroglide that was more glue than glide. My boyfriend and I tried all sorts of varities of sexual activity: very quickly, so it wouldn’t have time to hurt; without moving, just in there; only fingers in there; nothing at all in there, only outside. Whatever we did, it hurt” (10).

She was not even able to enjoy arousal in and of itself, because “Just getting aroused hurts” (55).

When her pain first manifested, Kaysen visited multiple doctors specializing in different fields. She lived in Boston at the time, which is home to some real-life vulvovaginal specialists. She visited her gynecologist, an alternative medicine practitioner, an internist, a vulvovaginal specialist, and a physical therapist. Some of these doctors pass her off to other doctors – notably, when her primary gynecologist was stumped, Kaysen felt that he was “Washing his hands of me! After twenty years” (9). She was tentatively diagnosed with vulvar vestibulitis and tried multiple treatments – conventional western style and alternative – but none of them were right for her. Kaysen was acutely sensitive to side effects, and in some cases the side effects just made things worse. Even physical therapy, a treatment that I had very good luck with, only set her back farther. (Having a crummy physical therapist who ignored her wishes probably didn’t help.) Other treatments, notably surgery, she did not want to try, though the doctors and her boyfriend pushed and pushed.

The doctors left Kaysen with a lot of unanswered questions about vulvar pain…

With her gynecologist:

So what is it? I asked him.
I don’t know, he said

But what is it? I asked him. What’s wrong with me?
I don’t know, he said.
(9).

With the internist:

But why does it hurt all the time? I asked. Why does it hurt when I’m not having sex? When I’m sitting on the sofa?
I don’t know, said Doctor Matthew
(21).

With the vulvar specialist:

Why did this happen? I asked him.
Eh, he said. He shrugged.
What is it, anyhow?
Eh, he said. He returned to the stool and resumed his Q-tip (28).

What’s the matter with me?
You have a sore spot, he said
(30).

WELL THANK YOU, CAPTAIN OBVIOUS!!! A sore spot! Of course! Why didn’t Kaysen think of that?! That explains everything!!!

*headdesk*

It goes on like that in some fashion over the whole book. Just as it continues to go on day after day in real life for still all too many women.

[Trigger warning for rape]


Kaysen’s nameless boyfriend was not sympathetic to her situation or open minded about the kind of sex he wanted. For two years prior to the events described in TCMMGM, Kaysen and her boyfriend had enjoyed a sexual relationship. Her partner had a strong interest in sex – “It was one of the things I had loved most about him” (95), though they never say “I love you” to each other. But when sex hurt, Kaysen began to lose interest in sex. While they stayed together for the first year that she looked for treatment, the boyfriend nagged and coerced Kaysen to have sex with him – even if it meant she was performing against her will. Readers of this blog would probably recognize what Kaysen describes as rape. She didn’t say no, she acquiesced under pressure, but certainly she stopped giving any kind of enthusiastic consent. She spends days after sexual activity coping with the painful after effects. Kaysen herself never uses the word rape to describe what she went through with her boyfriend, even when it caused her to disassociate during the act and left her in physical pain for days afterward. When asked by a biofeedback specialist if she had ever been sexually assaulted, she answers “No,” but when the question is rephrased to “Have you ever had sexual relations against your will,” Kaysen says “Yes” (82). When she recounts the last straw to her friend, Kaysen questions herself, her boyfriend’s actions, her own fear at the time, and what actually happened.

[/TW]

Even after evicting her boyfriend, Kaysen continues to feel pain long-term. It wears her down over an extended period of time. “Low-grade pain is debilitating in a subtle way” (121.) Eventually she loses interest in sex, and this is a painful experience for her, but in a different way. When Kaysen talks about sex and eros, it’s clear to me that prior to these events, she really did enjoy sexuality in her life. For her, it was a source of unpredictability. At one point, after throwing her boyfriend out of the house and struggling to rediscover pleasure from what once felt only plain, she tells a friend, “When eros goes away, life gets dull. It’s as if I’m colorblind. The world is gray” (125.) She eventually decides that the best course of treatment is to stop treatment. Eventually she makes a limited, partial recovery… But by then her relationship with her vagina, vulva and her own sexuality are fundamentally changed. Maybe forever.

Kaysen’s language may be plain and easy to understand, but it’s not without criticism. She uses frequently the word “Vagina” even though a more accurate word is “vulva.” Or maybe it is accurate for her to describe her pain as vaginal, since with vulvodynia the pain can radiate and spread beyond the vulva. In practice, when the pain feels like it’s everywhere, it can be very hard to pinpoint. One social construction argument against female sexual dysfunction as a valid diagnosis is that women with sexual problems may not be educated enough to understand their own anatomy; however Kaysen demonstrates that she is aware of her own anatomical structures and function.

Overall though, I would hope that readers accept Kaysen’s idiosyncrasies and simplified language. She uses other inaccurate terms, most likely as deliberately as she chooses to forgo with quotation marks when recalling conversations. She refers to her doctors as the “Vulvologist” and the “Biofeedbackologist” instead of as “The vulvar specialist” and “the physical therapist.” But when you’re encountering these specialists for the first time, perhaps not knowing such fields even existed before, what else are you supposed to call them??? The title of the book itself is an error. The title is based on Kaysen’s memory of a scene in a movie, with some artistic license exercised. (According to this interview with Kaysen about TCMMGM, technically the title of the book should be The Camera My Father Gave Me.) She receives materials from the “National Vulvodynia and Vestibulitis Association” instead of National Vulvodynia Association. And so on…

But this is her story in her words. I hope we can forgive her for taking liberties with some of the language – though it does have some disableist moments that are questionable and perhaps not so flexible.

I don’t know if Kaysen ever found relief for her pain in the years since TCMMGM came out, though it seems unlikely. Around 2003, the following was written about her on Salon.com:

Though she lives in the Boston area, the doctor capital of the world, Kaysen never found a workable medical treatment. Today, Kaysen hasn’t so much lost or won her battle; rather, she’s signed a treaty, with massive concessions. “Celibacy is a great cure!” she said wryly in a recent phone conversation. “I wasn’t interested in having sex again. The only thing I was interested in was not having pain. Pain eclipses desire.”

So who might be interested in reading TCMMGM? Who might benefit from exposure to such a taboo subject and who should approach the book with caution?

If the reviews online are any indication, many readers will be disappointed and frustrated with the book, but a few will strongly emphasize with what Kaysen went through. I am one of those people, and would like to see more people read and attempt to understand Kaysen’s situation. The frustration that so many reviewers are left with may be exactly what readers most need to feel, to better understand the frustration that still too many patients with vulvodynia have to deal with when running the gauntlet of modern medicine in search of adequate treatment.
The book is a memoir of one woman’s experiences with what is probably vulvodynia, and therefore it should not be taken as an advice or how-to book. This is all stuff that happened to Kaysen. It’s not necessarily going to happen to you. Some readers with a history of vulvar pain may find the book depressing because at so many points, things appear hopeless. Others take comfort knowing that they are not alone. It’s been a few years since the TCMMGM came out too, so there have been some advances in treatment since Kaysen conducted her own research and treatments. Your mileage may vary.
TCMMGM is short and small, but it’s not light fare. Although it has moments of dark self-deprecating humor, it’s not something to read if you want to feel good (except perhaps through schadenfreude.) It’s kind of a downer, to be honest. Because Kaysen describes a rape and post-rape scene with frank language, the book may be triggering to those with a history of sexual assault.
TCMMGM is available online from several retailers and it is available in E-Book format for Kindle. If you’re still interested after reading all this, then may I suggest that you make a purchase through the NVA’s book list, since they have a referral program set up for financial support.

As with all reviews conducted at Feminists with Female Sexual Dysfunction so far, I had to pay for TCMMGM with my own money, and I receive no compensation for posting a review of it.

Symbolism, archetypes and stereotypes: What experts have said about vaginismus

07/21/2010 at 7:03 pm | Posted in Uncategorized | 6 Comments
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While browsing for interesting (and often outrageous) coverage of sexual dysfunction via Google Books, I’ve occasionally stumbled across experts (doctors, sexologists, laypersons, etc.) interpretations of vaginismus and the women who live with it. I’d like to present some of my findings to you now. Full disclosure: I haven’t been able to finish every book I’d like you to look at today.  But on the other hand, I’m not doing a full book review today either and I am not certain what context, if any, could redeem the following passages.

One of the points Dr. Leonore Tiefer made in Sex is Not a Natural Act (yes we’re returning to this title again) is that we need to look at sex symbolically. Sex has meaning beyond the obvious that we can see and feel, and to understand sex and sexual problems, we need to figure out the meaning behind it. Consider some of the following quotes with emphasis added by me (thanks to Kindle’s word search feature:)

“It’s the symbolic investment that makes sex ecstatic” (location 1215).
“The first [story about doing the ‘Viagra tango,’ as she puts it] is about how Viagra the pill, but more importantly, Viagra the symbol, may affect the sexual conduct and experience of women and men in many parts of the world” (location 1315).
“[Orgasm is] just a reflex. It’s the symbolism that makes it feel so good” (location 1195; available online.)

And it goes on like that at a few more points throughout the book. We need to look at the symbolism of sex, phalluses, the Viagra family of sexual medicine, etc. We need to pull the curtain back and understand the why behind a woman’s libido crash. Some contemporary examples of where understanding sex and symbolism would be helpful are with the very expression “Sex symbol” and with sexual imagery used in advertisements.

There’s just one potential problem: Some so-called experts on women’s sexuality have already done that – looked at sex, women, women’s sexuality and sexual problems symbolically – and the results haven’t been pretty. Sometimes the ugly things people say about FSD and the women who have it doesn’t come from hack journalists and misogynist comments on message boards. Sometimes – often times – it comes from the professional sphere and trickles down.

Let’s focus on vaginismus as an example. Vaginismus, if you didn’t already know, can be described as an uncontrollable spasm of the pelvic floor and vaginal muscles, usually during sexual activity. It’s most obvious when attempting penetrative activity, like sexual intercourse, but it may also occur with a dildo, tampon use, or during gynecological exams. The spasm may be strong enough to completely prevent an object from entering the vagina, or it may be possible to insert something, but with pain. As such, it can be the cause of dyspareunia (painful sex.) Vaginismus is often recognized as a sexual dysfunction, however, some sexologists question the validity of sexual dysfunction broadly as a diagnosis at all and vaginismus in particular. For some folks like me, vaginismus a chronic problem connected to medical issues, other times it’s situational.  Some folks say it’s purely psychological and can be treated without physical intervention, others say there’s a physical component and that it can be addressed physically.
Vaginismus does not necessarily require any treatment at all, but when folks with vaginismus do seek assistance to address it, that assistance may come in the form of talk therapy with a counselor or sex therapist, dilator use, learning how to kegel, or more extreme medical intervention such as botox injections (not for cosmetic purposes) or physical therapy.

And some sexologists have described vaginismus symbolically.

One of the first, if not the first, books to deal with vaginismus exclusively is 1962’s Virgin Wives: A Study of Unconsummated Marriages, by  Leonard J. Friedman. It’s out of print now, but you may still be able to find a used copy online or through your library. I first came across this title while slogging through Linda Valin’s When a Woman’s Body Says No to Sex: Understanding and Overcoming Vaginismus, a book about vaginismus, from the perspective of someone who has personal experience with it. Valins acknowledged Friedman’s contributions to her own book, but alas Google Books does not offer me the complete text of Virgin Wives or a preview version to pursue at my leisure.

However, because authors like Valins have referenced Friedman’s work, we can get a pretty good feel for what he thought about women with vaginismus. Valins is a big fan of his, so it probably isn’t all bad – but I found the following disturbing.

Last week, I tweeted one of my findings regarding symbolism and vaginismus, from Google’s preview of 1987’s Sexuality and Birth Control in Community Work, by Elphis Christopher. Based on what I can see in Sexuality and Birth Control in Community Work, Friedman described three archetypes of women who tend toward developing vaginismus:

(1) ‘The Sleeping Beauty’: this occurs where the woman denies her own sexuality and waits for the man to awaken her sexually. Unfortunately, she often chooses a ‘safe’ partner, i.e. a man who is uncertain of his own sexuality and may suffer from impotence. He is often praised as a ‘good,’ nice boyfriend because he did not attempt pre-marital intercourse.
(2) ‘Brunhilde’: this refers to the woman who is always looking for a man strong enough to conquer her. She usually chooses as sexual partners men whom she despises.
(3) ‘Queen Bee’: this refers to the woman who manages to get pregnant without allowing penetration so that she can claim the pregnancy for herself.

What… the… fuck…?

I have no reasoned, rational response to this. Do I need to explain the multiple layers of Wrong with this picture to you?

We got here, above all, the assumption of heterosexuality, and according to these personality types, if you have vaginismus you are likely to be:

1. a woman who refuses to own her own sexuality and instead waits for some guy to come along and give it to her. But for some reason the author decides that a man with basic human decency who did not coerce his partner into sex simply must be sexually insecure and possibly “Impotent” (as if there’s anything wrong with having erectile dysfunction.)
2. I don’t know wtf this is – Some kind of Viking archetype I think where a woman who doesn’t settle down with any ol’ jerk and who doesn’t take shit is asking too much. Or else if she’s got vaginismus, it means she must hate her partner.
3. I don’t know wtf this is either. I think term is dated because I had to look it up. I think this archetype is supposed to conjure up images of a bossy lady who, frustrated with vaginismus, gets pregnant the “Wrong” way – minus the ejaculation of a penis inside of her.

So, what the fuck, which one of these archtypes am I then? Anybody here identify with one of these three archetypes? Does anybody here appreciate being described like this? Does anybody here in a relationship appreciate having your partner described like this?

“Now wait, K,” you may be saying. “That paragraph starts out talking about non-consummation generally, and then the next paragraph is about vaginismus.” Fair enough, so let’s make an effort to double-check and make sure that we’re talking about the same thing. Here’s a website that mentions the three archetypes of women who are prone to vaginismus, and it says:

Friedman (1962) describes three types of women inclined to vaginismus:
* the sleeping beauty (father-type relationship with partner and various feelings of guilt)
* the Brunhilde (the woman perceives sex as a battle between the sexes, and the male dominance has to be opposed)
* the queen bee (the woman perceives sex as dirty and sinful, she is afraid of pain in coitus and, in principle, she wants to get pregnant)

Again, what… the… fuck…?

Still don’t believe your eyes? I’ve got one more piece of evidence I can present, from the Science/Fiction of Sex: Feminist deconstruction and the vocabularies of heterosex. I’ve been picking it up and putting it down every once in awhile, browsing random passages – because every passage is so cerebral. This book is hard. Alas, unless you’ve got a copy of the book you won’t be able to read page 210 so let me fill you in. This is, as the title says, a feminist deconstruction of sex, so the author does not necessarily endorse what I’m about to show you.

Annie Potts references the work of Eve Adler, who submitted an article to the British Journal of Sexual Medicine in 1989. I have tried to access the journal article myself but have not yet been successful through my usual means. Adler described several archetypes of women with vaginismus, including one of particular interest to Potts:

Less commonly seen today is the primary vaginismic patient, Sleeping Beauty; an emotionally immature woman awaiting a sexual awakening without taking responsibility for it. These ‘good girls’ have often been brought up to believe that sex is bad or dirty; she had to save herself for marriage! This type can appear quite ‘little-girl-like,’ pristine, clean an tidy and very controlled generally; or she may look quite sexy, enjoy sex play and experience orgasm with clitoral stimulation. Her partner is often ‘a gentleman’ in every sense: an unassertive, gentle, literally non-pushy man who may well have hidden anxieties about his own sexual abilities (Adler 1989 in Potts 2002)

What… the… fuck… What is the meaning of this bullshit?!

“Emotionally immature?” “Little-girl-like?” “Unassertive?” This is in print, people! This is how women with vaginismus and their partners have been described. In books and journal articles. What about descriptions like “Creative and resourceful?” Or “Resilient?” How about some of that?

Don’t be too angry with Annie Potts for re-printing that passage above though; she analyzes it, though you may not agree with her analysis either…  It gets far out there when she starts talking about vaginismus as a form of political resistance against a phallocracy, and hey did you ever notice how phallic your fingers and a newborn baby are.

Let’s go a little deeper and focus on Sleeping Beauty since she keeps popping up re: vaginismus. The myth of Sleeping Beauty has been reinterpreted by various authors. According to one interpretation by Joan Gould, when Sleeping Beauty pricked her hand and fell into an enchanted sleep, the spindle that cut her represented a phallus and sexual maturity; the blood that came out of the injury represents menstruation. Sleeping Beauty was protected from spindles (sex and puberty) by her royal family up her 15th birthday – the age by which many girls reach menarche. The sudden appearance of sex and adulthood upon her (and Snow White, too, for that matter) was too much to bear all at once. The sleep she fell into was not necessarily a passive time; she spent the century mulling over impending adulthood and all the responsibilities that came with it. At a predetermined time, a prince came to wake her up and she was transformed into a woman ready to act as an adult. Usually we think of the awakening as romantic, stemming from a kiss but some versions have her shocked out of her sleep by rape or nursing her babies – conceived in sleep during rape, the perpetrator long gone (Gould, 86-126). Gould’s explanation of the myth of Sleeping Beauty, coincidentally, also addresses the myth of Brunhilde. However we cannot ignore the well-known 1959 Walt Disney version of Sleeping Beauty, in which Aurora was at last rescued from an evil witch’s spell by an active, handsome prince – who she was scheduled to be married to anyway. We need to think about that version too, especially since Disney’s Sleeping Beauty was released by the time Virgin Wives was printed.

Edit 7/22/10 – The boyfriend suggested I add more pictures to the blog. Here’s a picture of Disney’s Princess Aurora, Disney’s Sleeping Beauty.

Disney Aurora

Disney Princess Aurora

[Image description: A picture of Disney’s Princess Aurora wearing an iconographic pink dress.]

Is this the true face of Vaginismus? What the hell does she have to do with vaginismus? You think of vaginismus, what’s the first thing you think of, Disney, right? No. (Via.)

But wait, there’s more! Last week, when I Tweeted a link to my findings about archetypes of women with vaginismus, @NevillePark responded back with a very good question:

Wow. Uh, dykes, genderqueers, masculine folk, trans guys, etc., can’t have vaginismus? NEWS TO ME #youreadthisstuffsowedonthaveto

Indeed, good point! Because Friedman was looking at unconsummated marriages back in the 1960s, the most likely scenario is that he wasn’t interested in anyone who wasn’t cis- and heterosexual. After all, marriage was then (and remains to this day in the US on a federal level) defined as a legal union between man and woman. I would love to get my hands on a copy of Virgin Wives just to confirm that he had no interest in queer sexuality and vaginismus.

Alas, I cannot offer a complete answer to the question @NevillePark raises. However, we can turn to another body of work for partial credit.

Last week on Google Books I found Sexual Salvation: Affirming Women’s Sexual Rights and Pleasures, a book about women and sex, with an interest in often marginalized groups of women. I’m surprised to report that it does have a Kindle e-book edition (though the Kindle version is out of my price range right now! $63?! For a sex therapy textbook!? That’s not on the budget!) Overall it sounds interesting and potentially valuable – the Amazon summary says the author spends time talking about feminism and marginalized groups of women, including seniors, disabled women, and sex workers. And I can see from looking at the indexes to Sexual Salvation and (once again for the millionth time,) Sex is not a Natural Act that the authors, Naomi B. McCormick and Dr. Leonore Tiefer, respectively, reference each others’ work. Hmm…

The discussion of vaginismus starts on about page 190, preceded by a discussion of dyspareunia (painful sex) and followed by a discussion of sexual dysfunction, especially in men, and then sex therapy.

There’s a lot we could talk about with this one section of the book, but for now let’s focus on the following:

Taught that the only “real sex” is sexual intercourse, heterosexual women are susceptible to two sexual problems that are largely unknown to lesbians, dyspareunia, painful coitus, and vaginismus, involuntary spasms of the vaginal musculature which prevent penetration. (McCormick, 190).

Well there’s an answer. This leaves room for the possibility of lesbians to experience painful sex and vaginismus, but according to McCormick, that’s almost unheard of. (An unfortunate side effect of establishing profiles of ‘typical’ patients for diagnosis of problems though, is that if you don’t fit the profile, you may have to work even harder to get a caretaker to take your complaints seriously.) She does, however, go on to describe situations in which a lesbian may find herself in a heterosexual relationship and experiencing vaginismus, and some pages later, she describes a lesbian couple coping with cancer and sexual problems including genital pain. Meanwhile, the Vaginismus Awareness Network goes on to address two myths about vaginismus and sexual orientation (Emphasis mine):

A woman MAY be a lesbian if she has vaginismus, just like she may be a lesbian even if she was able to have painfree intercourse with a man.

This myth seems to spread from the belief that lesbians won’t have penetrative sex. Though that may be true for some of them, others will use strap-ons etc and have ‘intercourse’ too. So clearly vaginismus has little to do with one’s sexual orientation since so many heterosexual women in love with their partners have it. It has more to do with lack of knowledge of one’s private parts, lack of information on their PC muscles, lack of sexual education and lack of kindness…

You know, I don’t always agree with the VAN. I have the sexual education I need to understand my own anatomy and how to do a kegel, and my partner is kind to me, yet somehow I still have vaginismus. Maybe we shouldn’t paint all women with vaginismus as one big homogeneous group. But compared to the other Freudian analyses described above, even I prefer this. I’m very uncomfortable by the way women with vaginismus have been described in literature like what I’ve shown you today. For how long were these archetypes and stereotypes repeated and used in clinical settings? To what extent do the myths and stereotypes about women with vaginismus still exist, and what effect do they have now?

Navigating PIV sex with a history of painful PIV

07/14/2010 at 8:17 pm | Posted in Uncategorized | 20 Comments
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