Feminists with Female Sexual Dysfunction

Guest Post: Interview with Elizabeth on Asexuality

[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.

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.

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.

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.