The almighty glass of wine

02/07/2012 at 12:28 am | Posted in Uncategorized | 9 Comments
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How many readers here have heard a variation of the following statements, with regards to their sex lives?

“Have a glass of wine and relax.”
“Sex life is lacking? May I suggest some red wine to go with dinner.”
“A pill for sexual dysfunction is dangerous and ineffective! After all, it’s not like a glass of wine.”

*Raises hand* Heard it? I’ll keep on hearing it till the day I die! There’s a reason I included the ol’ wine glass advice on our FSD Discussion Bingo card, version 1.0. I’ve heard it from doctors, I’ve read about it in advice columns, and I’ve heard it from my own family members.

Follow up question… …Does this advice ever work???

I’m so sick and tired of hearing this! And I know for certain that I’m not the only one frustrated with getting the same generic, useless advice. From a commenter on Jezebel:

I suffer, on and off, from severe pain during intercourse (diagnosed as Vulvodynia), and the worse part for me, is the lack of researched treatments and even the lack of knowledge among doctors about the condition (three doctors told me to “try to relax more” when I had sex. Another told me to “try drinking a glass of wine.”

Even feminist sexologist Dr. Leonore Tiefer, organizer of the New View Campaign, suggests alcohol can improve women’s sex lives:

“I mean there are a lot of inexpensive products like a glass of wine or a massage.” - June 11 2010, related to the Flibanserin controversy.

(After what I’ve been through, I figure if you actually have a sex problem troublesome enough to merit drug use then chances are you’ve already tried a lot of other, inexpensive solutions without satisfactory results.)

This isn’t the first time I’ve heard Dr. Tiefer mention alcohol in the context of sexual medicine; In 2004 when testifying to the FDA about the potential risks of a testosterone patch for women as a treatment for low libido, Dr. Leonore Tiefer stated:

Intrinsia is not a glass of Chardonnay, and yet we have already seen that it may well be promoted with a giggle and a wink as “the female Viagra.” Not so – this is a steroid hormone women must continuously take for weeks before getting an effect.

Dr. Tiefer is absolutely right that the Intrinsia patch requires continued use before seeing any effects, so you can’t just slap it on one night and expect to get horny. And it’s absolutely true that the FDA did not approve it for use in the USA due to concerns about health risks. But what I’m really interested in is Dr. Tiefer’s dropping wine in the context of women’s sexual health. What do you suppose she meant by that comparison, anyway?

Now you may be thinking, “K, the chardonnay was just an example. Dr. Tiefer could have used anything in her comparison of sexual medicine.” But wait — I keep finding examples of alcohol specifically in discussions of sexual health. That’s two comparisons of drugs for sexual dysfunction vs. booze by Dr. Tiefer. I’m noticing a pattern…

Between Dr. Tiefer’s comments and repeated comments about booze and sex found elsewhere -

There may be cheaper and faster ways to reduce inhibition—like a glass of wine and a more attentive partner.The Daily Beast

Agree with your partner that you will devote every Wednesday night or whenever to talking, sharing a glass of wine, a video, relaxing together… At least once a week try to think of some little extra to add a touch of glamour or luxury to your love life – a bottle of sparkling wine, a scented oil, a flower.Dear Deidre

Plan a date that you can both really enjoy, with a movie or dinner beforehand, or perhaps a walk or a glass of wine by candlelight. walk, have a glass of wine by candlelight, whatever the couple likes to do as a couple.Sex Therapy Online

- Why, it’s almost as if booze is being held out as a magical panacea to all sexual problems! Even if it’s not an appropriate course of action for everyone’s sex problems!

(Note also that much of this sex life advice is directed at couples – does wine still work on single people? I wonder what folks with religious restrictions or recovering alcoholics with sexual problems think of this advice. Is this advice regularly given to young folks with sexual problems but still below the drinking age?)

Yet somehow the wine recommendation is supposed to be more complicated and nuanced than considering medication to address some sexual problems. I don’t get it; the medical model simplifies women’s sexuality, but the social construction model recognizes the complexity. By the way, have you heard that wine is good for your sex life…?

It sounds like a large part of the push for alcohol instead of medication has something to do with the idea that drinking is cheaper than prescription medicine, but then I keep thinking of that old adage, “Life is too short to drink cheap wine.” I’d really have to run the numbers some time – if a decent bottle of wine costs $20+, maybe $40? split between 2 people and a one-time use of Viagra costs about $10 split between … 1 or more people… Or we have some top-shelf vodka at what, $35? $40? which will last for more than 1 evening vs. about a month’s worth of a prescription gel… But then wine aficionados will point to decent wine under $10 per bottle… or will Box Wine bought in bulk suffice?

Anyway, let me confirm your suspicions so far and this admission is probably going to make me very unpopular:

I hate booze.

I hate all booze everywhere.

I hate wine.
I hate beer.
I hate liquor.
I don’t even like Champagne.
I hate alcohol!

Hate all the booze!

[Description: Bug-eyed stick-figure type white lady in a pink dress. 1 arm raised triumphantly, the other arm holding a broom. Mouth wide open, big teeth. Caption: HATE ALL THE BOOZE! Original picture by Allie Brosh @ Hyperbole and a half.]

I’m one of those people who throws out good booze instead of drinking it, because I get tired of looking at the bottle take up space that could be used up by tasty snacks instead.

hate all the booze?

[Description: Bug-eyed stick-figure type white lady in a pink dress. Not quite so triumphant anymore. Mouth frowny face, tears in eyes. Caption: Hate all the booze? Original picture by Allie Brosh @ Hyperbole and a half.]

Now before we go any further, let me assure you: I don’t hate your booze. I have no interest in taking your booze away from you and I accept that drinking is a socially acceptable way of – being socially acceptable. If anything, I’m the weird one. Almost everyone drinks and does so responsibly. I just ask that you extend courtesy to me and please stop pressuring me to drink. No thanks, I’m fine; I’ll be your designated driver or whatever.

Now let me tell you why booze + I don’t get along:

It all tastes the same to me and the taste is Bad; I’m almost 30 and I’ve heard enough iterations of “You just haven’t found the one you like” to know that I’m never going to find the one I like.

If I drink enough to get tipsy or drunk, then I act out of character – I get giggly. This is not conductive to relaxation, as I must then consciously self-monitor myself to prevent saying something foolish. I can’t keep up with conversations or movies. I lose my wits. The room spins.

Alcohol can cause dehydration, which can then lead to feelings of vaginal dryness. The sugar content can tip some sensitive folks over into yeast infection territory, or at least make it harder to recover from yeast infections. Since my yeast infections last up to six months and tend to be complicated with simultaneous bacterial vaginosis, this is a concern that’s always on the back of my mind when I drink, even more then when I eat junk food.

I hate the smell. I associate booze-breath stench with alcoholic family members and the feelings of powerlessness I endured when I had to put up with them.

Alcohol makes my pelvis feel funny, like my vulva is swollen with blood, yet it decreases my feelings of physical sensitivity, making it harder to orgasm.

Annoyingly, there seems to be a direct correlation between amount I drink and my desire to go to sleep. Unfortunately I wake up multiple times per night on a good night, due to bladder problems. Having to get up & go pee makes it hard to fall asleep in the first place.

The absolute worst part is that alcohol tears the fuck out of my bladder and makes me piss approximately every 5 minutes – not conductive to a satisfying sexual encounter. This is the part I hate the most. Ohh, getting up to go pee every 5 minutes – that’s so sexy. Having to pause, stumble over to the bathroom and pee only to do it allover again a few minutes later. (This goes on for hours when I drink…) Hot.

So far alcohol & sex don’t combine well for my partner either. A single shot is enough to impair his ability to maintain an erection. He can still get one – but not for long. 2+ drinks and it’s just not happening – he’ll be too distracted & uncoordinated to give me the attention I need, and he becomes incapable of maintaining an erection & having an orgasm. Since we can’t enjoy each other sexually after drinking, I feel like if he drinks instead of fooling around with me, he chosen booze over me.
Worryingly, I think my boyfriend is more sensitive to alcohol than he acknowledges. Sometimes, booze will just knock him out even after 2 drinks. One time we split a small bottle of wine over steak and immediately afterward, he blacked out for awhile. He was conscious – or so it appeared – but he had no memory of playing a video game (and he accused me of taking his turn!)
That’s scary! I thought blackouts required more alcohol than that! So was he pulling my leg or is he really that sensitive…? I think we better not fool around after drinking. Nope, not gonna do it.

Yet I’m noticing a theme in the social construction arguments against sexual dysfunction: Women don’t need sexual medicine, because they already have booze. Wine can solve all your sexual problems. You’re just too uptight and need to loosen up, girl!

I don’t want to have to drink when I want to feel sexy. If I want to get drunk, then I’ll drink. If I want to have sex, then I’ll go work on that. The two things have, in my experience, combined very poorly.

So why sex therapists and sexologists suggest alcohol, which has known side effects on sexual health to patients with sex problems, I’ll never know. Perhaps the unofficial prescriptions had something to do with the common sense advice that red wine is good for you, except one reason why may need re-evaluation now, since a researcher’s data is in question. The effects of alcohol and sex are paradoxical: in some ways it might be good for you, but at the same time it can impair sexual health and enjoyment short term. This measurable negative effect has been researched mostly in alcoholics; yet almost half report positive effects.
However, in sexologists’ favor, there may be a link between drinking and higher levels of sexual satisfaction! So maybe there’s something to this advice after all in certain contexts – IF you live in Italy, where there are no doubt cultural differences to take into account, and IF you drink wine every day.

So when someone says about sexual medicine, “It’s not like a glass of wine,” I say…

Good!

I’m glad that sexual medicine isn’t like a glass of wine! Booze gives me more trouble than it’s worth. I say, “Not booze” is a benefit of our hypothetical sexual medication!

So please, reconsider that advice that I add a bottle of wine to my bedroom, and stop telling me it’s what I really need to solve all my sex problems.

Questions about Vulvanomics

11/17/2011 at 11:45 pm | Posted in Uncategorized | 2 Comments
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This Friday, the New View Campaign will be protesting cosmetic genital surgery clinics and clinics that perform procedures like laser vaginal rejuvenation. In case you’re new here, the New View Campaign is a feminist grassroots organization developed over a decade ago by Dr. Leonore Tiefer, a sexologist and college professor (among other things.) The group’s goals are to present a form of feminist resistance against female sexual dysfunction (their view is largely recognized as THE feminist answer to FSD,) and pharmacological treatments for the conditions that fall under its umbrella; to eradicate cosmetic genital surgeries (or at the very least, to force more research on procesures,) and offer some alternative, non-medical interventions to improve women’s sex lives. The last item means taking a social construction approach to sexuality, a cerebral topic which constitutes another series of blog posts. (Check my archives, I’ve talked about the New View and social construction before.)

This nationwide protest is visible activism as part of their recent Vulvanomics media blitz. The clinics in question have not been publicly named to my knowledge – the group communicates on a listserv instead. I haven’t joined it, due to a clause on the New View website that states joining the listserv means you endorse the group’s philosophy & actions. The New View Campaign does not represent my views and does not speak for me.

It is not the first time the group has publicly protested against vulvar modification. The intentions are good – draw attention to unnecessary asthetic procedures, which target women, are expensive and carry health risks. In spite of this, I wasn’t comfortable with it the first time around. And I remain uneasy, because I fear that their activism has the potetial for some unintended negative consequences.

Full disclosure: I may be a bit biased, seeing as I’m someone who actually knows what it’s like to undergo genital surgery, and as someone who actually has FSD.

As the campaign gets underway, I want to contribute to the hard conversation by raising a few questions about this planned event.

- I understand vulvar and general cosmetic surgeries to be a symptom of a larger problem – body snarking & policing, fatphobia, misogyny and racism – rather than THE problem. Take away cosmetic surgeries, and there will still be these underlying problems remaining. An example of this would be Austrailia’s practice of censoring naturally large labia in softcore pornography.
What steps is this current campaign taking to address the systemic, more intangible problems that may motivate permanent surgical changes in the first place?

- One goal of this round of activism is to get the FDA to monitor cosmetic and laser surgeries and require more rigorous research, to be made available to end users (clients.) That way, women can do better research and make informed decisions about what they do with their bodies.
However, I doubt this type of activism will end there. I got a feeling I can answer my own question above: Even if the New View gets exactly what it wants – which would be beneficial to women – the anti-surgery and anti-medicine activism is likely to move on to new targets. Perhaps then the New View will shift its focus to censorship vs. idealized & unrealistic body representations in pornography, etc. All of which is certainly eligible for a social construction critique.
However, since these systemic problems will still remain, and are likely to be the next area for activism, that means even if you read the material and wanted to go through with surgery, you’ll probably still have your decision questioned. It will never stop and there is no way to do a cosmetic surgery correctly, so you’re just going to have to deal with the stigma and shame of doing it wrong anyway.
So, the question is – are there any conditions in which it is socially acceptable for a woman to undergo cosmetic or sexual surgery on the genitals? If so, what are these conditons?

- One approach to address women’s insecurity about the appearance is to embrace vulvar diversity. But what do we mean by vulva diversity? In galleries of what normal vulvas look like, how often do we see vulvas with visible (if subtle) health problems? Does vulva diversity, a celebration of the wide range of normal, include vulvas like mine which, pretty much everyone including Dr. Tiefer, agrees, is in fact not normal? (Remember, when vulvodynia acts up, a lot of gentle and sexual touches will register to the vulva owner as pain.) And does the movement to celebrate vulvar and body diversify embrace those women who have already undergone modification?

- I notice that this campaign refers to cosmetic genital surgeries as FGCS – it’s not explicitly defined on the petition but I’m pretty sure the acronym translates to “Female genital cutting surgery,” with the intent of invoking FGC, aka FGM – female genital mutilation.
Recall that the film Orgasm, Inc. did not hesitate to use the term FGM, even though it carries a degree of stigma – the implication is that, if you’ve undergone FGM, then you are a mutilated mutant. FGC is more sensitive term.
But how does the New View respond to critics who claim there is a difference between FGC and vulvar cosmetic surgeries? Some critics here, for example, claim there is a difference between damaging girls’ genitals against their will & without their consent, vs. trained surgeons operating on women who seek such procedures out.

- During a recent Feministe shitstorm, (not actually that recent in blog-time but still to soon for me,) (Google “Feministe ‘don’t do this’ just because I’d prefer to avoid trackback trolls for awhile longer,) several commenters deflected questions about medically necessary genital surgeries. The idea seems to be that medically necessary procedures are exempt from critique. That’s different – and I still don’t understand why.
- So how are we defining medically necessary vs. purely asthetic? What criteria is necessary to justify a surgical procedure to a vulva? How do we quantify the amount of discomfort and danger required? How shall we address the intersection of medical, sexual and cosmetic concerns, for example in reconstructive surgery? To that end, were the current surgical facilities subject to the protest screened to ensure that medical patients will not receive unwanted attention?

- Relatedly, some of the New View’s criticisms, and general feminist critique, of cosmetic surgeries include the fact that surgeries hurt, come with health risks, and cost a lot of money. Genital surgeries carry sexual health risks in particular, and the price tag can reach thousands of dollars – just like my medical surgery, which my insurance dicked around about & didn’t reimburse what they were supposed to.
But these concerns – pain, side effects, and cost – are present with medical surgeries as well. So, again, why are medical surgeries, which carry the same risks, not subject to the same critique? (Basically, if cosmetic surgeries are bad because x, y, and z… and I did a surgery that also involved the same x, y, and z… then what makes my situation any more forgivable? Intent? I thought the intent doesn’t matter.)

- During the same recent Feministe shitstorm, I saw a commenter raise concerns about the impact that anti-cosmetic surgery sentiment and activism might have on trans* individuals. Some transsexual women and men undergo top and/or bottom surgery.
Has the New View taken any steps to clarify the difference between GRS and cosmetic surgery? (Of course I suppose transphobes will look for any excuse to be transphobic – and if that means invoking the spectre of cosmetic surgery with all it’s negative implications, – then we’re gonna need a lot more activism to get that to stop.)

In fairness, most of the problematic comments about cosmetic surgery, including genital surgery, is derived from the New View’s work, rather than explicitly stated by representatives of the group. I’ve noticed that in her writing, Dr. Tiefer by and large is very thoughtful about what she puts in print. In contrast on the Feministe post I’m referring to, Jill & co addressed cosmeric surgery as largely an individual provlem, imploring indivduals not to go through with it. Buried in the comments, there was some effort made to address social problems contributing to the spread of this type of surgery… But I had to wade through a whole lot of crap to find it, to the point where I found the thread exhausting. I give up; you win; I disengaged.

The New View has been around for over a decade, stirring up uncomfortable but necessary conversations – and that, in and of itself, isn’t necessarily a bad thing. But its still largely the same organization it was ten years ago, and it really should take some time to examine & reevaluate some areas for improvement, especially with regard to its internalized ableism re: FSD and mental illness.

So, I just hope that on Friday, I don’t run into a protest group outside of an outpatient cosmetic surgery facility just like the one where my medical surgery took place. As much as I’d like to be a punk and counter-protest, (I’d be the one holding the sign that says, “New View doesn’t speak for me / Ask me about my surgically altered vagina”) I know myself well enough to recognize that a group of women protesting vulvar surgeries – by using props of tools like the ones used on me – will probably just set off a massive anxiety attack.

Doctors debate dyspareunia part 2: Is pain the only valid FSD?

08/17/2011 at 9:51 am | Posted in Uncategorized | 3 Comments
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Previously on Feminists with Female Sexual Dysfunction…

Many folks who experience sexual and/or genital pain share the experience of getting bounced around from doctor to doctor when seeking satisfactory resolution to their problems. In a recent post on this blog, I explored one of the many reasons the doctor shuffle occurs: there’s no definitive class of doctor designated to handle sexual & genital pain. And behind the scenes, doctors themselves are debating what medical specialty is best prepared to address this type of problem.

In 2005, a peer-reviewed journal published an article by Dr. Yitzchak M. Binik, Ph.D. His idea was to start a serious debate on how best to handle dyspareunia (painful sex.) Currently, under the DSM-IV, dyspareunia is classified as a sexual dysfunction. When the DSM-V revision comes out, it is likely to be kept there (though under a different name, genito-pelvic pain/penetration disorder.)

Dr. Binik made some compelling arguments in favor of of changing the classification of sexual and genital pain from a DSM-recognized sexual dysfunction to a pain disorder. But his position was controversial, and generated many professional responses against making the switch.

One such published response came from Dr. Leonore Tiefer, a feminist sexologist, author, college professor and organizer behind the New View Campaign, an organization opposed to the medicalization of sex, with a particular focus on the role of Big Pharma. I have read and reviewed some of Dr. Tiefer’s previous work on this blog, bringing to it my own unique perspective as someone who actually has FSD.

Unfortunately this time I won’t be able share the full ~2 page text of Dr. Tiefer’s response, Dyspareunia is the only valid sexual dysfunction and certainly the only important one, because it’s locked down behind an academic firewall. I think I can share a summary of what’s in it (with my own commentary,) but unless you’re enrolled at a school with journal access, you’ll have to take my word on good faith.

Dr. Tiefer’s disagreement with Binik’s reclassification argument focused exclusively on one argument: Nomenclature; the power of names. It’s a familiar theme in Tiefer’s earlier work – language is a powerful tool capable not only of reflecting reality, but of shaping it. And Dr. Tiefer has serious concerns about the language used to describe sexual problems in particular. In light of this, I was surprised to find that in her response to Dr. Binik’s article, Dr. Tiefer argued in favor of keeping dyspareunia classified as a sexual dysfunction instead of a treating it as a pain problem – At least, so long as such terminology is used by the American Psychiatric Association.

Dr. Tiefer starts her article by describing the origins and goals of the New View Campaign. One of Tiefer’s criticisms of female sexual dysfunction is that it’s based on the idea of deviations from a “Normal,” universal sexuality, but normal is arbitrarily defined and doesn’t account for all of the human population. In this case, the “Normal” sexual response cycle was defined by Masters & Johnsons’ work – the four-phase model that goes, excitement, arousal, orgasm and resolution. Sex doesn’t work that way for everyone, and so over the last few years – decades at this point – she has challenged the medicalization of sex, with a particular interest in libido and orgasm.

“My criticisms have, however, focused on the universalized notions of desire, arousal and orgasm in dysfunction nomenclature, and not on the inclusion of dyspareunia and sexual pain. Immersed in the feminist literature on women’s health, I was more than aware of the disgraceful history of neglect and mishandling of women’s complaints of pelvic pain and thus it seemed that dyspareunia was the only sexual dysfunction with validity in women’s lives (50, emphasis mine.)

(And that’s where the title of the article comes from. I don’t know whether Dr. Tiefer picked the name out herself, or if some editor arbitrarily decided it, but we have the same sentiment reflected in the body of the text.)

However, when criticizing female sexual dysfunction, Dr. Tiefer has in the past included pain. It’s true that she doesn’t talk about it much, relative to her body of work on orgasm and desire. But in the past she has let pain stay under the broad umbrella of the term, “Sexual dysfunction,” complete with scare quotes:

We believe that a fundamental barrier to understanding women’s sexuality is the medical classification scheme in current use, developed by the American Psychiatric Association (APA) for its Diagnostic and Statistical Manual of Disorders (DSM) in 1980, and revised in 1987 and 1994. It divides (both men’s and) women’s sexual problems into four categories of sexual “dysfunction”: sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders. These “dysfunctions” are disturbances in an assumed universal physiological sexual response pattern (“normal function”) originally described by Masters and Johnson in the 1960s.

In the New View manifesto, Dr. Tiefer kept sexual pain disorders lumped with all the other dysfunctions that merit feminist skepticism and critique. Feminist critique, such as the perspective that DSM criteria for dysfunctions (including pain) are excessively genitally, and therefore reproductively, focused (Sex is not a Natural Act, location 737.) However in 2005 we see support for leaving dyspareunia behind, as the only valid sexual dysfunction.

Dr. Tiefer’s quote about the importance of dyspareunia as dysfunction is problematic for additional reasons: The implication here is that no other sexual dysfunctions recognized in the DSM have any merit as a health problem. That’s a key point of the New View Campaign: Desire, arousal, and orgasm problems may not be problems at all, and when they are, the problems can be addressed with lifestyle and social change instead of medicine. But here I interpret the idea that pain is a sexual dysfunction, and the only valid one, as maintaining a sexual dysfunction hierarchy. It elevates physical pain above all others. My problem matters; yours doesn’t. My physical pain is real, your emotional or psychological pain isn’t.

So what does this mean for folks who have one of the less-important, invalid dysfunctions? To whom can they turn when they have exhausted virtually all of the non-medical interventions for long-term sex problems?

Dr. Tiefer then briefly expands on some implications of Masters and Johnson’s work. In the next section of her response, she describes an alternate, benevolent way of looking at the inclusion of sexual dysfunction in the DSM: Recognizingsexual problems as health and medical problems legitimizes such problems in the public’s eye. Suddenly, sexual problems are no longer just about sex, which (according to vocal conservatives anyway) is dirty and wrong and immoral – sexual problems are now about the body and health, which is (relatively) socially and politically acceptable to talk about. “Looked at from this perspective, the inclusion of women’s problems with sexual pain in the sexual dysfunction classification system was a positive step” (50,) because then the ISSVD and NVA can harness that legitimacy for raising awareness and research funding.

It strikes me as odd that Dr. Tiefer mentions the NVA and ISSVD by name as working for the benefit of patients with pelvic pain problems. Not because I have any question that both organizations do good for the public, but because in Sex is not a Natural Act, Dr. Tiefer had this to say about patient advocacy organizations:

These advocates for medicalization include self-help group and newsletter promoters who have created a market by portraying themselves as something between consumers and professionals. The formation of Impotents Anonymous (IA), which is both a urologists’ advocacy group and a self-help group, was announced in the New York Times in an article including cost and availability information on penile implants. (Organization helps couples with impotence as problem 1984.) … The advocates for medicalization portray sexuality in a rational, technical, mechanical, cheerful way. Sexuality as an area for the imagination, for political struggle, or for the expression of diverse human motives or as a sensual, intimate, or spiritual rather than performative experience is absent (locations 2277-2282.)

Basically, according to Dr. Tiefer, patient advocacy groups – at least those for erectile dysfunction – existed partly in order to sell sexual health problems, to promote a select few doctors qualified to treat the problems, and then to sell medical treatments for big bucks. In these earlier statements, Dr. Tiefer made it sound like patient advocacy groups were just part of the packaging that came with so-called selling sexual dysfunction. In fact, the formation of patient advocacy groups is one piece of what motivated Dr. Tiefer to organize the New View Campaign in the first place:

This backlash dovetails with the analysis and critique of “medicalization” over the past several decades within sociology, the women’s health movement, the “anti-psychiatry” movement, and newly, from cultural historians examining the social construction of illness and disease. All these scholars argue that the medical model, with its hallmark elements of mind-body dualism, universalism, individualism, and biological reduction, is not well suited to many of the challenges of contemporary life and suffering.

Yet, at the same time, patient advocacy groups are clamoring for medical legitimacy, increased funding and research, and, above all, new drug treatments. And the drug industry continues to expand.

Allying with the backlash, I convened a “Campaign for a new view fo women’s sexual problems” in 2000 to provide a feminist anti-medicalization perspective in the debate about “female sexual dysfunction” (location 3550.)

Given these prior statements on patient advoacy groups, I’m surprised that Dr. Tiefer didn’t skewer genital & sexual pelvic pain advocacy groups in her 2005 response to Dr. Binik.

Furthermore, by classifying dyspareunia as a sexual dysfunction, isn’t dyspareunia and its treatment subject to the same criticisms that Dr. Tiefer has previously made about sexual dysfunction and Big Pharma broadly? I’ve seen the rhetoric used by the New View used (and unfortunately warped) in feminist arguments against sexual medicine. And let me show you, it can get real ugly real fast. Leaving sexual pain as a sexual dysfunction might lend medical and social legitimacy, but not when you do everything you can to undermine the legitimacy of sexual dysfunction broadly and stigmatize those who experience it.

This post is getting way too long, so we’re going to stop abruptly here and come back after you’ve had a few days to digest our story so far. To be continued…

About Northwestern University

03/08/2011 at 1:53 am | Posted in Uncategorized | 3 Comments
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A recent controversy in sex education involves one Prof. John Micheal Bailey, from Northwestern University. Professor Bailey teaches a Human Sexuality class to some 600 college students. He is a controversial figure, as described on the wiki page linked to – previous work includes his theories about homosexuality (he believes it is largely an inherited orientation,) and a book about transsexuality, which has been heavily criticized by trans activists for racism & transphobia (Plus Bailey engaged in unethical conduct while making the book.)

Bailey’s sexuality class includes optional events with guest speakers who talk frankly about sex & sexuality. The controversial event in question was titled, “Networking for Kinky People,” and the guest speaker was Ken Melvoin-Berg, associated with the Weird Chicago Tours group. Melvoin-Berg brought his partner and a kinky, engaged, exhibitionist couple with him to the event. (The couple has been named by some sources while others are keeping them anonymous; I’ll stick to the anonymity route here since outed kinky folk face safety risks.)

According to this Salon.com article, during the day’s lecture, Bailey presented a lesson on the G-spot. The Chicago Tribune says that the lecture included an educational video about the G-spot. Melvoin-Berg, his partner & the kinky couple arrived early, so they happened to be there for Bailey’s lecture and video. Melvoin-Berg’s group members were all unimpressed. So just before their speaking part was about to begin (after the lecture was officially over,) Melvoin-Berg asked Bailey for permission to demonstrate to the class what a g-spot orgasm looks like, in person, with a fucksaw. (Exactly what it sounds like: This is basically a modified power-tool with a dildo on the working end.) Bailey hesitated but decided that the demonstration would fall within the bounds of the scheduled speaking event, since such a demonstration is undeniably kinky.

So that’s what happened. The couple Melvoin-Berg brought with him, did exactly that – after giving an hour & half speaking lecture with a Q&A session first, according to Rabbit Write (the same Rabbit Write who organized Lady Porn Week.) When Melvoin-Berg’s crew finished the speaking portion of their presentation, the boyfriend used the fucksaw on his girlfriend and she had several g-spot orgasms in front of about 100 or so present students.

After that, the student newspaper reported on the event. From there, a lot of mainstream news sites picked up on the story. Reports about sex are easily sensationalized & they sell well or generate page views, whatever. So now there’s a lot of backlash & controversy going around now.

I can’t decide whether I’m in favor of this event or not. At first I was all for it – I thought, “That sounds useful,” and I understand that sometimes, written instructions, diagrams and educational videos fall short because they do not provide experience. I needed help learning how to find and then use my own pelvic floor muscles. Although I had anatomy diagrams and written instructions on how to dilate, I eventually hit a wall with my at-home dilator kit and needed to get physical therapy to progress with treating my vaginismus. (It was an incredibly clinical, non-sexual and useful experience – not really all that much different from rehabilitating any other muscle group, except for all the cultural baggage and weight assigned to people’s genitals.) But that was something I initiated, and since it took place behind closed doors, there was no risk of making anybody else know what was going on.
But then the more I read about Professor Bailey and the Northwestern University event, the more I started to change my mind & think to myself, “Hmmm… maybe this wasn’t such a good idea…”

Even Bailey himself has issued a formal apology, of sorts, for drawing such negative media attention to NU. If he could do it over again, he wouldn’t.

However, demonstrations like this have taken place before – just not on campus. Let’s all turn to Page 13 of Sex Toys 101: A Playfully Uninhibited Guide by Rachel Venning and Claire Cavanah. Some of the relevant parts are available on pages 13 & 14 from Google Books. Unfortunately not everything got scanned in – it looks like all the pictures are missing, and page 14′s relevant text is blocked out (It should be on the left side of the page.)

To summarize the relevant passages, the book says that a couple of years ago, sex educators affiliated with Babeland (then still known as Toys in Babeland,) took their G-spot program to a “Carnival-style book release party of a friend of Babeland…” (The next page says this event took place at a bar.) The sex educators set up a tent and one of them called out to passers-by, asking patrons to go in. People who went into the tent (up to 10 at a time) received a lesson in human female anatomy, complete with some suggestions for ways to find the g-spot. But the lesson didn’t end there, “Once they were inside, we gave them more than just a lecture.”

One of the sex educators took safe sex precautions (a glove and lubricant in this case,) and said, “Okay, who wants to experience it [a g-spot orgasm]?” So one lady and her boyfriend stepped up and the lady sat down in the hot seat. The description on page 14 says that this volunteer took off her underwear & used a vibrator on herself, so onlookers would have her masturbating. Then the sex educator with the lubricated glove on inserted two fingers into the volunteer’s vagina & found the g-spot. It’s not clear from the text on this page whether the volunteer had an orgasm on site. The text makes it sound like this scene was repeated throughout the evening.

So one reason I don’t fully understand exactly what the problem with the February 2011 demonstration is that there’s precedent for g-spot demonstrations just like the one at Northwestern University. This already happens. The show-and-tell described in the Sex Toys 101 book didn’t use a video, puppet or a piece of fruit as a stand-in.
On the other hand, this article from GoodVibes says that events which GV hosts do use stand-ins or clothed volunteers. So okay, sex educators can go either way when it comes to live demonstrations.

At first I thought the reason the school program caused so much controversy is that it must have been paid for with school funds, because that’s what was going on when feminist pornographer Tristan Taomino was initially un-invited from speaking at Oregon University. The student newspaper says that NU has events sponsored by Weinberg College of Arts and Sciences, and this Chicago Tribune article says that NU provides funding to Bailey & his speakers (including Melvoin-Berg but not the kinky couple) via this organization. But according to this statement from Bailey, he arranges the class events at “Considerable investment of my time, for which I receive no compensation from Northwestern University,” which makes it sound like he pays for the class’s extra-curricular speaking events out of his own pocket. So now I can’t follow the money trail because there’s like 3 different things going on there. (Maybe the school doesn’t pay him for the time it takes to arrange speakers but it does cover their fees? Like, no overtime pay for whatever networking is required to set everything up?)

So far what I’ve read about the event says that, participants who stayed for the demonstration aren’t the ones who are upset about it – as of 3/6/11, Bailey says that all the feedback received from attending students was positive. It is people who were not present for the show and found out about it afterwards that are registering complaints. They’re upset that it took place at all. I’m seeing similar complaints in comment sections of articles summarizing the event, and the negative comments usually contain some variation of “Immoral,” “distasteful,” “exploitative,” or “sick.” Something to that effect, which focuses on the content of the demonstration. Since kink is widely misunderstood & berated, I’m thinking that such comments would inevitably be made of such a demonstration or sex act regardless of the setting.

Every once in awhile a commenter will bring up the viewers’ ability to fully consent, which I think is a stronger argument against the demonstration, since it was spur-of-the-moment. An event like this should have required time to plan it out and better distribute information about the content. There wasn’t time to include this on the syllabus, basically (though being an optional event, it wouldn’t have been required either.) But even then, the articles say that Bailey & Melovin-Berg took steps with the limited time they had to make sure that the students understood what the content of the demonstration was going to have & that they had the option to leave without penalty, which some students did exercise. Yet, one student Bailey’s class explicitly told the media, “Then, just out of nowhere, the girl just takes her pants off, takes her shirt off, takes her underwear off.” That the student used the phrase “Just out of nowhere” suggests to me that adequate preparation for the students was nonetheless lacking. It should have come from somewhere. This student, though, also acknowledges that students were given adequate opportunity to leave.

So with regards to what the real problem is with this NU event, I keep getting different answers – including the “Nothing wrong” answer. I can’t pinpoint it down. But having done just a cursory background check on Bailey himself, even I am now resistant against throwing all my support behind him too. Will NU administrators be more translucent with their investigative findings now than they were when claims of impropriety were previously leveled against Bailey?

P.S. Good god almighty can I just express my own frustration with this entry –  this was hard to research; every source I checked had different pieces & I couldn’t get a comprehensive tell-all! And then before I knew it I had 1600 words and okay fine, up it goes.

For (belated) Lady Porn Day: What are the experts saying?

02/26/2011 at 7:39 pm | Posted in Uncategorized | 9 Comments
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February 22 was Lady Porn Day, a blogging event organized by Rachel Rabbit Write. This is the same blogger who, last year, organized “No makeup week.” In this case, “Day” is something of a misnomer, as today is actually the last day of the week-long Lady Porn event. (A good thing, too, considering my recent writer’s block.) In an interview with the Huffington Post, Write said the purpose of Lady Porn Day was to, “Essentially to celebrate porn and masturbation. I’m inviting everyone to talk about their porn experiences, share stories and to ultimately share their porn recommendations. This is about not only opening up a dialog about how porn is good, but also how porn is hard, how it can be an issue for women, in terms of dealing with guilt or body image or their sexuality.”

What’s been on my mind for awhile and has finally been knocked loose by this event is the subject of pornography and sex therapy. I’ve been thinking about this topic because I’m seeing a conflict between sex therapists who embrace pornography as a healthy & valid part of human sexuality vs. those who view it as the source of all kinds of sexual problems. Sex therapy is a possible treatment option for some folks with sexual dysfunctions and problems, so clients could find themselves in the middle of a political, academic & psychological tug-of-war between experts.
I’ll show you what I’m talking about, but with a caveat: you must bear in mind that I myself have not had sex therapy and I have absolutely no desire to do so, to the point where I’m actually quite resistant to sex therapy as a treatment for my dysfunction.

Whether or not sex therapists and sex educators are pro-porn or anti-porn looks to me like it’s largely a function of their own personal politics.

Notable sex educators who have articulated porn-positive arguments include the following:

Dr. Marty Klein is a long-term sex therapist and author who is very much anti-censorship and who consistently defends the use of pornography. He does identify as feminist and is clearly pro-choice; however one theme I’ve noticed in some of Klein’s writing is that he is critical of feminism – or at least, select vocal feminists and feminist groups. Oh well, so am I.
Dr. Leonore Tiefer, a feminist sexologist who is highly critical of female sexual dysfunction and so spearheaded the New View perspective of FSD (a perspective which I myself am highly critical of,) likewise recognizes a valid place for pornography in women’s sexuality.
Jessi Fischer is a sex educator who you may know better as The Sexademic. She recently got into an academic debate about pornography, opposite Gail Dines and Shelley Lubben – two notable anti-porn activists. (Each side of the debate was joined by additional activists, so it wasn’t just Fischer Vs. Dines & Lubben.) The pro-porn side of the debate came out on top – the audience members voted on who made the more convincing argument and decided it was Fischer’s team.
Dr. Carol Queen, sex educator with GoodVibes, wrote a post in favor of porn and Lady Porn Day – which makes sense considering her involvement with instructional & graphic sex videos. Most porn is not for educational purposes, but there’s some out there that is.

Nonetheless, porn-positive activists can be critical of porn. Pornography can, and often does, have problems. Criticisms of porn from sex-positive therapists may consist of something like, “This element is good, that element is neutral, and if you will look over there there, there is the element is the inherently problematic one that needs fixing.” And the element that needs fixing may be something like, the marketing of porn rather than the content itself. A great example of this took place a few weeks ago when actress Nicki Blue elected to film her first vaginal intercourse experience for the pornographic website, kink.com. The initial marketing for Blue’s film shoot was highly exploitative and inaccurate.

But I’ve seen activists, educators and licensed therapists go in the opposite direction too, and come down hard against pornography. Often this stance against pornography is lumped with a warning against sex and masturbation addiction – which is another extremely controversial topic. However, I’ve repeatedly seen more acceptance of the term “Compulsion” instead of “addiction” to describe obsessive sexual behaviors, to the point where such behaviors interfere with someone’s personal or sexual life.

Dr. Mary Anne Layden is a clinical psychotherapist and Director of Education at the Center for Cognitive Therapy, part of the University of Pennsylvania. In 2004, she went before the US Senate to talk about the so-called dangers of pornography. In another interview with the Washington Examiner, she talked about the process of becoming addicted to porn when she said, “There’s always an escalation process. We don’t know what the threshold is, and those with addictive personalities will start it earlier. But I see a lot of people who didn’t show any psychological problems before [viewing porn].”
Jason McClain is a UK therapist who considers himself to be a former porn addict. He runs an organization, Quit Porn Addiction, and now he counsels clients who likewise want to break away from porn.
Dr. Alvin Cooper is a sex therapist and director of the San Jose Marital & Sexuality Center who contributed to a documentary, A Drug Called Pornography. According to the linked synopsis, this film’s thesis is that, “Pornography is an addiction. Its effects on users and their loved ones are just as habit-forming and destructive as heroin, tobacco, or any other addictive agent… The program features disturbing interviews with pornography addicts, many of whom are convicted sex offenders. They talk frankly about how pornography affects their psyches and systems, coloring all their activities and relationships.” And according to this Time article, Cooper also gives seminars about addiction to cybersex.

In addition, Googling search terms such as, “Sex therapy addiction” or “Sex therapy porn” brought up many, many more results for therapists and organizations that prominently feature treating sex and masturbation addiction among their services.

I am confounded, though not surprised, to see that sexuality experts with licenses, teaching jobs and more credibility than me have not come to a unified agreement on porn’s place in sex therapy. It’s not surprising that sex therapists haven’t come to a standard approach on how to deal with pornography, because there’s precedent for a lack of resolution: Pro-and-anti- porn debates in politics, academia and feminism remain unsettled.
But it is confounding, because who am I supposed to believe, and why?

Actually, I have been convinced by the arguments of the porn-positive side. I especially appreciated Violet Blue’s analysis of the for-profit agenda of major anti-porn activists. This analysis, and others like it, also note that anti-porn rhetoric is also often anti-masturbation – a healthy sexual activity. There are numerous other arguments in favor of pornography that I have heard which have contributed to my “Up with porn” POV… the only reason I’m not getting into them right now is because it will take too long to document everything.
Though I’ll also admit that most porn has problems which could and should be handled better (but won’t,) and, like just about any other tool, it can be used for the forces of good or for evil… and everything in between.
(Plus I’ll admit to some potential bias – I have a subscription to a porn site which I regularly check on. I have not noticed any ill effects from doing so…)

So there’s a couple of scenarios with regard to porn use that I envision as potential problems in a sex therapy setting. While I have no experience with sex therapy myself, I nonetheless speculate that these scenarios have probably come up before many, many times in clinical practice. So I would be surprised if practicing therapists and educators didn’t have tools in place to address such situations. How could such conflicts not come up?
The problem is, because so many google search results for “Sex therapy addiction” or “Sex therapy porn” result in facilities looking to treat addiction to porn & masturbation, I am not able to find out what these client-therapist conflict-resolving tools may be. The search results are too bogged down with stuff I’m not looking for. (Little help? Anyone?)

One of my concerns is with regard to pornography and sex therapy is that if you’re entering into a therapeutic relationship with a licensed professional, there’s inherently going to be a power imbalance. The therapist has probably had more exposure to educational materials, which may have their own biases & agendas. You and your therapist are probably going into that relationship with some ideas about pornography to begin with. If there’s a match between your beliefs and your therapist’s, then in terms of personality you may not have a problem, and you may be able to swiftly work out a plan of action. But if you and your therapist have conflicting beliefs about pornography as a tool in your sexuality, then you may have a problem.

So what happens if you are someone with a sexual problem or dysfunction who just happens to have a history of porn use? If you find a sex therapist who is anti-porn, will your previous or current use be zoomed in on as the source of your problems to the exclusion of other contributing factors?

Or what happens if, due to the conflict between you and your therapist re: use of porn in sexuality, you decide to find another therapist? That may be possible, depending on your geographic location. Finding a good therapist may take time and transportation, depending on where you live and what sort of resources are available in your area. Checking my own local area via the American Association of Sexuality Educators and Certified Therapists, I was surprised to find one licensed sex therapist! The next “Local” one, though, would be about 45 minutes away by car – not exactly the worst commute, but certainly not convenient, either. Finding Kink-aware therapists may be another option.
I’d like to imagine that sex therapy may be easier to provide now and in the future though, thanks to technology like Skype, though this is speculation – I do not know if there are any therapists willing to use this remote communication service with clients. But,  hypothetically, if I were very unlucky, then I might be stuck with a therapist I don’t agree with, or no therapist at all.

Basically, for Lady Porn Day, like many bloggers my concern is what happens to the porn users and their partners who are stuck in the middle of it all. This conflict between professionals is unlikely to be resolved  any time soon. The most neutral article about porn use in a relationship was this one from About.com, which says, in the end, “Whether or not pornography will add to or lessen a couple’s sexual enjoyment is up to each couple.”

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.

In defense of “Dysfunction”

10/25/2010 at 7:25 pm | Posted in Uncategorized | 5 Comments
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I identify as having female sexual dysfunction. For me, it’s an accurate and neutral term, as honest as describing my eye color or my gender as feminine. (It is, however, a personal thing which I won’t disclose to everyone in my social circle, and you’d never guess with a first impression.) I wouldn’t say I’m exactly happy about having sexual dysfunction, but I’m no longer ashamed of it, either. (At least, I try not to be.) Some folks may question why I say I have sexual dysfunction, since it’s such a controversial term. …Then they find out that the main sex problems that are causing me so much trouble are pain due to vulvodynia and vaginismus. So long as folks know what those two conditions are, the questions about my self-identification tend to back off. Still, there are some experts in the professional field who question the validity of sexual pain as a sexual dysfunction, questioning if it should instead be classified as purely a pain condition. Then, even if sexual pain was considered a chronic pain condition independent of sexual dysfunction, that would still place me on the disability spectrum.

Since I have FSD, I have vested interest in learning more about it – what it is, what treatments are or aren’t available, how it impacts individuals’ lives (if at all,) etc. It’s not just reading though – I’ve talked to and received feedback from women who themselves have FSD in one or more forms. I’m especially interested in how FSD is perceived and what people say about it! It’s meta, and its fascinating. So what are people saying about it? When I read about FSD, I notice a few familiar themes pop up repeatedly…

Again & again I’ve run into mainstream articles and published journal studies like, “Big pharma’s newest fake disease.” “Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance.” “The making of a disease: female sexual dysfunction.” Magazine articles like “Lust, Caution.” Slogans like, “Sex for our pleasure? Or their profit.” Blog posts covering FSD – or rather, not covering it, because it’s not a valid diagnosis to cover in the first place. Instead, almost all of these articles focus on the role of Big Pharma in the promotion of sexual dysfunction, with the end goal of selling medication for huge profits. The idea goes something like, if a commercial enterprise can create and then capitalize on sexual anxiety, then there’s a potentially huge market to make big bucks off of. After all, who hasn’t dealt with some sexual insecurity issues?

But who is the target audience of these articles? What do these articles say to and say about women who experience sexual dysfunction? How am I, someone who actually has sexual dysfunction, supposed to react when I see “‘Sexual Dysfunction’ in women: Myth or Fact?” as a header on page 543 in my 2005 version of Our Bodies, Ourselves? I’m standing right here, so my immediate reaction is to wonder how much able-bodied privilege (in terms of not having FSD) the editors were stewing in to overlook the fact that FSD is a broad topic that goes beyond libido alone and that perhaps some of their readers would have sexual dysfunction. The above articles make some good points to consider, but I feel very shut out of these conversations. There’s plenty of talking about, but not so much talking with.

To put it very simply, with both the medical and social construction models of FSD, sexual dysfunction is “Bad,” it’s something you don’t want. Both models contribute to the stigmatization of sexual dysfunction.

Briefly, the medical model is like, “You don’t want to be dysfunctional, right? So here take this pill/use this device/have this surgery and you’ll be cured! BTW here’s the bill…” (In practice however, it doesnt always work out that way – it can take a very long time before patients find a doctor who will be willing to listen to sexual problems and then offer intervention. And even prescriptions can have only minimal effects on the problem, plus they come with side effects.)

The social constriction model is more like, “You don’t want to be dysfunctional, do you? Not to worry; you’re not! It’s just that culture’s views of sex are so screwed up and limiting, these limits create sexual anxiety.” (If guided by a therapist through this process of coming to terms with sexual problems, there will still probably be a bill at the end of a long process of changing your world view.) Sounds great, however I’m uncomfortable with the promotion of guilt and feelings of foolishness if you do use sexual medicine that I’ve seen under the social construction model. I am concerned about the means used under the social construction model. For an example let’s return to this comparison of guys with erectile dysfunction to Jackie Gleason of the Honeymooners:

I am a 37 year old man with erectile problems for 2 years. I have used 50 mg. Viagra 4 times. All of those times have resulted in a very good erection and intercourse. The side effects are headache, upset stomach, stuffy nose, and facial flushing… About 30 mins after taking Viagra I take 2 Tylenol and a Tums and start drinking water. After about 15 mins I take another Tums and use a nasal spray for my stuffiness. I will continue this combination and it will work for me.

This sounds more like a Jackie Gleason routine rather than a romantic evening, but I think it is close to the reality of what life with these drugs will be like… How does his sexual partner feel about the whole drama with the Tums and the nasal spray and the Tylenol?

Found in Sex is Not a Natural Act, location 1109. No one wants to be a shill of the pharmaceutical industry, right? So don’t take that pill and whatever else you need to feel stable. It makes you look foolish anyway, bumbling around like that. The author, Dr. Leonore Tiefer, implies that this gentleman’s partner must think he’s a huge joke. Uh-oh – I go through a“Whole drama” with my stretching & dilator exercises when gearing up for PIV sex.

All of these articles I listed above imply that sexual dysfunction is something new and invented only within the last few decades, guided by the invisible hand of the marketplace. Sexual dysfunction, or increased awareness of it, is something to resist the spread of in the future. It’s something to fight against – like there’s something inherently wrong with being or thinking of yourself as sexually dysfunctional, and especially like there’s something wrong with wanting and needing medical help in the bedroom. The aim of the resistance is noble enough; protect women from being exploited medically, in relationships, and financially. But the means used to achieve that goal don’t always do a good job of acknowledging the reality of life with sexual dysfunction for those that do have it.

Some therapists who take a very strong social construction approach to sexual problems state that whatever you’re going through, it’s not a dysfunction:

So as this latest chapter in the medicalisation story closes, let’s be very clear. Women do experience sexual problems that cause them distress, discomfort and dissatisfaction. These are often linked to other factors and do need attention, but they are not a clinical condition or a dysfunction, and they do not require a new and separate diagnosis. A summary of common reasons women experience problems with sex can be found here.

(Emphasis mine.)

So one of the common themes I keep running into, particularly in feminist, social construction-informed spaces, is this idea that female sexual dysfunction isn’t a valid diagnosis. This view is gaining popularity – it’s covered in women’s studies classes: There’s so much sexual diversity that it’s not fair for doctors or Big Pharma to dictate who does and doesn’t have a “Normal” experience. We don’t really know what “Normal” means, even. And indeed, it is well within the realm of normal and fine to have low or absent sexual desire, it is normal and fine to have orgasms that don’t necessarily rock your world. Everyone’s different. Generally, authors who take a strong social construction approach to sexual dysfunction admit that yes, sexual problems do sometimes happen and yes, they’re real. However…

Nonetheless when sexual problems do happen, it’s not a dysfunction. Don’t call it that. Sexual problems are real, but sexual dysfunction isn’t.

What’s scary to me personally about the above quote is also that sexual pain in and of itself can be caused by a clinical condition (like vulvodynia.) My painful sex and all the issues that stem from that is merely a problem rather than a dysfunction?

The very existence of sexual pain is also a source of internal conflict that I haven’t been able to reconcile because depending on who you ask, sexual pain either is a valid and important sexual dysfunction or else pain as dysfunction is still a myth. I cannot figure out how sexual pain can simultaneously be a sexual dysfunction and not a dysfunction, and also sexual dysfunction is something that isn’t legitimate. I also can’t figure out why pain as dysfunction should be elevated to the pantheon of reality (whether it’s considered a pain condition or a sexual dysfunction) but other non-painful sexual dysfunctions shouldn’t be recognized as such.

The problem is that calling sexual dysfunctions by the euphemism, “Sexual problems” does not recognize the degree to which the sexual problem(s) interferes with someone’s life. According to this article from Harvard.edu,a key component of what separates a sexual problem from a sexual dysfunction is personal distress.

I have a few overlapping sexual problems, which cause a lot of anxiety to this day. My problems can (and do) bleed out into other, non-sexual areas of my life, so when that happens it’s impossible to ignore. To this day I can’t afford to slack off too much on my pain management exercises (like the stretches,) because if I do the muscle tension & pain comes back. Other times, the pain is well-managed but the fear remains. This is a serious problem for me; I think about it a lot and it interferes with my quality of life. And I’m one of the lucky ones who was nonetheless able to find significant improvement through medical intervention.

Lots of people have sexual problems that do not pass the threshold into dysfunction. These problems are nonetheless important and valid experiences, or at least as important as it is (or not) to each individual. But I suspect that the person who has a sexual problem does not experience the kind of anxiety and distress that I do from sexual dysfunction. Does someone with a sexual problem as opposed to a sexual dysfunction feel the need to think 12 steps ahead of every sexual encounter and have all kinds of contingency plans ready if and when something does go wrong? Do people without sexual dysfunctions even think of contingency plans in the first place? Do people with relatively minor sexual problems think about what’s going to happen as they age? How would I know? I would think that someone with a sexual problem but that feels overall pretty comfortable with themselves hasn’t had to spend buttloads of time and money searching for a professional prepared to compassionately handle their sexual complaints.

Calling sexual dysfunctions by the euphemism “Sexual problem” lumps all problems and dysfunctions together, and it minimizes the reality for those with major distress. Refusing to acknowledge the personal distress that accompanies sexual dysfunction equates my long-term pain (which I worry about) with the handful of times that I’ve been unable to orgasm from masturbation (which I’m not worried about. I do not perceive these two personal problems of mine as equal. I did not weep for months when I was unable to orgasm a half a dozen times in my life, but I did weep for the hundreds of times I was unable to comfortably insert something into my vagina.

But no it can’t really be that bad, right? It’s just a problem, strongly influenced by some intangible outside force.

It’s ironic when you think about it – part of the resistance against the term “Dysfunction” is because it’s totally not fair to classify every little sexual variation as a sexual dysfunction. Doing so maximizes the assumption of negative feelings regarding sexual performance. But by refusing to leave room for dysfunction, the distress that may be caused by a sexual problem in and of itself is minimized. The phrase “Sexual problem” misses half of what I’m dealing with here.

Refusing to acknowledge the reality of sexual dysfuction erases what is for some people may very well be a valid medical conditon. A few months ago, frequent commenter and occasional guest poster Flora picked up on the similarities between the way vaginismus and non-sexual, invisible chronic conditions were handled:

Some older studies on CFS/ME were on people who were told that their minds were unconsciously manufacturing their symptoms because they wanted to get out of a hectic work life, and called it “yuppie flu.” It happens with purely neurological things, also; it used to be widely believed that autism was symbolic of “withdrawing into yourself” due to child abuse or neglect. So it’s… nasty but also in some ways unsurprising that people would try to interpret vaginismus along the same lines.

This is really happened. But just because you can’t see it, doesn’t mean it’s not real. Not every bodily phenomenon has to have a deep symbolic meaning behind it… Sometimes things just happen.

So when someone insists that sexual dysfunction is a purely social construct with no medical validity, that is getting stacked on top of a long history of denying the validity of many chronic conditions and disabilities – some of which disproportionately effect women, and which may overlap with sexual dysfunction. I don’t see what’s so new & revolutionary about that.

It’s an act of erasure when someone who is not me, who doesn’t even know me, declares, “You don’t have FSD because it isn’t real.” Oh no; this is quite real. And I’ve worked really hard to accept and incorporate sexual dysfunction into my identity. It’s part of who I am, it will follow me into any future relationships I may have, and to embrace that was not a decision made lightly. But still I must be all wrong; I’m not dysfunctional… It must instead be the case that I am foolish, gullible and brainwashed. Snap out of it. Now isn’t that so much better than having something wrong with you?

But wait!

There’s widespread controversy about sexual dysfunction, yet even among sex therapists, there is not a unified agreement on what is and isn’t sexual dysfunction, whether or not it’s a valid terminology, and when/whether medical intervention should be acceptable. There are some sex therapists out there who accept the validity of sexual dysfunction and who would not rule out medical treatments.

For example here’s Dr. Marty Klein on anti-flibanserin activism:

It’s accurate, of course, to say that there isn’t a single level of desire that’s “normal.” But women who experience dramatic drops in their desire know there’s something wrong. And isn’t it obvious that one definition of “healthy adult” is the experience of sexual desire when the conditions are right?

Millions of women (and their partners) know their lack of sexual desire causes suffering. Whether taking a drug is the best treatment for any woman isn’t the point. Dismissing B-I’s drug and its marketing as “disease mongering” is terribly disrespectful to the many women who struggle with low desire.

You may know Dr. Klein as a Ph.D., sex therapist, as the blogger behind Sexual Intelligence, and as the author of several books about sexuality. So he’s been working at sex education and therapy for literally decades. Yet after everything he’s seen, after raising his own questions about the validity of certain diagnoses such as sexual addiction, still, he acknowledges the importance of potential treatments for low libido types of sexual dysfunctions.

Still don’t believe me when I say that there’s disagreement among sex therapists about what constitutes sexual dysfunction? Here’s another well-known sex educator, Dr. Carol Queen, on nomenclature, in response to a reader query:

Question: Hello. I am twenty years old and unfortunately suffer from sexual dysfunction. Before seeing your blog on Good Vibration’s website I had no idea this was an issue with other woman. I was wondering if you knew where I can find help, any kind of help with this issue. I didn’t know there were people who studied this or that I could talk to. So if you can, please help me out. Thank you so much.

…it is really pretty common for young women to have sexual issues that might be called “dysfunctions.” Keep in mind that it is only a dysfunction if you are unhappy about it. If you have low libido, or have a hard time getting aroused, and you don’t have or want much sex and don’t feel troubled by this, it is simply the way you are, not a dysfunction. If, however, you are concerned about it, then that language might be appropriate.

…In short, unless you have really gone on a hunt to get good information, the schools and the culture have not made sure you learned enough about sex to have *good* sex. And this does not make YOU dysfunctional — if anything, it means our society is dysfunctional!

…So far I haven’t really said anything about sexual dysfunction itself; I’ll do that now. It’s possible that in spite of what I said above, you *do* have some sort of sexual dysfunction, but it’s likely that it is something that can be helped via knowledge. It’s not as likely that you need some sort of medication, which is good, because so far, the pharmacological remedies available to women to help us with our sexual problems are, at best, untested and insufficiently understood.

Emphasis mine. What’s this? Dissent among the ranks! Here, Queen explicitly recognizes that every once in awhile, sexual dysfunction is a valid and proper terminology. Unfortunately even when it is, there still aren’t a lot of medical options available for many sexual dysfunctions. Knowledge helps, but it only takes me so far. You may recognize Dr. Queen as a prolific author and editor of sexuality anthologies and she’s a sex-positive Ph. D., sexologist and activist – so like Dr. Klein, she has seen plenty of shit go down in the realms of sexuality and politics.

So these two sex therapists who are open to recognizing sexual dysfunction and treatments for it, aren’t at all fly-by-night therapists, or in the pockets of Big Pharma. These two have been around long enough to have seen the positive and negative effects of sexual medicine.

Humm… I guess that if you’re seeing a sex therapist for sexual dysfunction, how you’re treated, what language you’re allowed to use to describe your experience, how you’re allowed to identify and what options are made available to you are going to depend on who you’re talking to. I guess that’s why it’s so important to find a sex therapist who’s right for you if you choose to go that route.

Of course, I speak only for myself here. I’m comfortable with the term sexual dysfunction, but not every other woman with a sex problem is, (especially since not every little problem is the same thing as a dysfunction) and probably very few folks will embrace it, perhaps for some of the reasons enumerated by experts on the social construction model of sexual problems. Remember though, I do not claim to be an expert on the topic by any means; don’t have a Ph.D. or a journalist resume to flaunt (yet); I just blog so I don’t know everything. But I’ve come to terms with it – I’ve come to terms with the term. I’m starting to think that this binary vs. mode between the medical model and social construction is creating some messed up language on both sides.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This is the response that the anonymous commenter received:

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

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

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

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

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

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

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

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

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

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

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

Wow…

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

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

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

(I don’t think anyone is listening…)

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

The same comment goes on:

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

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

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

There’s more to this comment:

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

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

Anything that can be used, can be abused.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Enough.

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

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

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

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

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

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

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

08/04/2010 at 8:12 pm | Posted in Uncategorized | 17 Comments
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Part two in our hopefully never-continuing series on what people are saying about female sexual dysfunction, the women who have it, and how to address it. I hate writing these posts so much. Feeling masochistic? Click here to visit part one.

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

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

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

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

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

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

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

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

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

More,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Huh? Well that’s a new one to me.

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

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

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

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

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

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

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

The drug is an antidepressant.

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

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

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

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

Then things started to get really weird.

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

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?

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