The Medicalization of “Female Sexual Dysfunction”

While at Arizona State University’s Gender Studies Graduate Association’s conference, I attended a panel entitled “On Bodies Inhabiting Clinical, Natural, and In-between Spaces.” One of the presenters explored the issues surrounding medicalization of female and male sexual dysfunctions. While the presentation and the argument needed some work, it got me thinking.

According to the Mayo Clinic:

“If you have persistent or recurrent problems with sexual response — and if these problems are making you distressed or straining your relationship with your partner — what you’re experiencing is known medically as female sexual dysfunction (FSD).”

So what are the symptoms? Once again, according to the Mayo Clinic:

“Your problems might be classified as female sexual dysfunction if you experience one or more of the following and you’re distressed about it:

  • Your desire to have sex is low or absent.
  • You can’t maintain arousal during sexual activity, or you don’t become aroused despite a desire to have sex.
  • You cannot experience an orgasm.
  • You have pain during sexual contact.”

Possible causes include physical conditions (arthritis, urinary/bowel difficulties, pelvic surgery, fatigue, headaches, pain problems, neurological disorders, medications that decrease sex drive and ability to achieve orgasm), hormones (menopause, post-childbirth, breastfeeding), and psychological and social conditions (untreated anxiety or depression, stress, worries of pregnancy, conflicts with partner, cultural and religious issues, body image).

Got that? Pretty much anything can cause sexual dysfunction in women. For men, sexual dysfunction is simple. Can you get it up? Of course, for men the physical ability to penetrate is often closely tied with their virility and masculinity. However, for women, sexual dysfunction, as defined by the medical community, includes low sex drive, arousal difficulty, inability to orgasm, and pain.

Much of the presentation revolved around the lack of a “pink Viagra,” or the fact that there is no medical miracle drug for women with “sexual dysfunction.” Instead, the speaker presented the NuGyn™ Eros Therapy device, the first FDA approved product for women who suffer from arousal and orgasmic disorders.

Eros therapy device

How does this work? Well, according to the website, “it is a small, hand-held medical device that uses a gentle vacuum to improve your sexual responses by increasing blood flow to the clitoris and external genitalia.” It is recommended that you use the Eros Therapy device either prior to having intercourse or therapeutically without intercourse.

It costs $395.00 and requires a doctor’s prescription.

On the one hand, this is really cool. The medical community is (finally) recognizing women’s need for sexual satisfaction. Women will know that they are not alone, and that other women experience similar difficulties. Sexual problems can be explained as a genuine medical problem. Hell, some health insurance providers will even cover the cost of the Eros Therapy device.

However, I am not sure how Eros differs from other vacuum sex toys that have been on the market for many years, although I suppose it provides a socially acceptable alternatives for women who would never step in a sex store.

Clitoral Pump, $26.99 at Eden Fantasys

Playgirls signature pump n' please, $26.99 at Eden Fantasys

Additionally, the medicalization of FSD and the Eros therapy device seem centered around the notion of penetrative sex. If a woman doesn’t experience sexual pleasure while engaging in penetrative sex with a male partner, something is wrong with her.

Let’s look at the four symptoms again:

  1. “Your desire to have sex is low or absent.” According to the Eros website, the increased blood flow to the genital area may result in increased clitoral and genital sensitivity, improved lubrication, improved ability to achieve orgasm, and ultimately increased overall sexual satisfaction. However, it is not going to make up for a unattractive partner, a stressful life, or the exhaustion of raising children and working full time. While it might aid in physical desire, it’s not going to cause mental desire, although thinking about sex more may eventually cause more desire.
  2. “You can’t maintain arousal during sexual activity, or you don’t become aroused despite a desire to have sex.” This happens, yes, and may be due to prescription medications or hormonal changes. It could also be that the sexual activity a woman is not engaging in activity that feels good, or she has not had sufficient foreplay (physical or mental) prior to engaging in sex. Women’s sexual response may develop slower or less apparent that men’s, but that doesn’t always mean something is wrong.
  3. “You cannot experience an orgasm.” Many women do not experience orgasms from penis-in-vagina sex, because they do not get the clitoral stimulation they need. Perhaps, we should be looking at what sort of sexual activities women find pleasing. Manual stimulation, maybe? Oral sex, perhaps? A combination of one or both of the above, with or without penetration? The Eros device draws blood to the genitals, making them more sensitive, as does any other form of arousal. It seems the ultimate solution may be learning one’s own body and educating one’s sexual partners(s). Eros might help with that, but it surely isn’t the only solution.
  4. “You have pain during sexual contact.” There are a couple of issues with this one, and pain can be a result of multiple causes. If the problem is insufficient natural lubrication, perhaps some lube is the solution. Lube is good. It’s always good. Even if you have sufficient natural lube, extra lube makes it better. If the problem is involuntary spasms of the vaginal muscles (vaginismus), gradual dilation may be necessary. If that problem is insufficient attention to the woman’s pleasure, then it is a relationship issue.

I think it is good that the medical community is recognizing female sexual pleasure as a valid concern. However, I am not sure a medical diagnosis and a fancy sex toy is the solution. The broad definition of FSD suggests that most women are inherently disordered. Has any woman not experienced one or more of these symptoms coupled with a distress about their sexual experiences? The quoted statistic is that 43% of women experience FSD at some point in their life. If so many people have this “disorder,” should it really be considered a disorder. 43% is almost a majority, and I suspect that more people experience symptoms but do not discuss them.

According to the medical definition of FSD, I was disordered before I even turned twenty. At one point, my inability to maintain arousal and reach orgasm was an issue that troubled me and my partner separately, and ultimately our relationship together. There were a couple possible causes, including a medication that I was taking. It was when we stopped worrying about the elusive orgasm, and we spent a lot of time exploring our own and each other’s bodies that these worries disappeared. Fuck, I couldn’t stop cumming, but it took time to get there.

Maybe FSD should not be defined as a disorder. I certainly don’t know everything about sex, but I do know that women have varied sexual reactions and experiences. Male sexual dysfunction is defined by the inability to achieve/maintain erection. Medication can fix that. For women, hormone therapy may enhance sex drive or reverse some effects of menopause. However, the issues of low desire, inability to maintain arousal, inability to achieve orgasm, or pain may well have to do with the types of sex a woman and her partner(s) are having or not having. Before we label women’s sexual experiences as disordered, it seems like we should examine our familiarity with our own bodies and our communication with our partner(s). The disorder may reinforce women’s feeling that there is something wrong with their body, instead of encouraging women to find their own path to pleasure. I fear that FSD is yet another example of medicine based on a male model, forgetting the fact that women may experience sex very differently than men and that, for women, sex can be a complicated experience.

What do you think? Is the diagnosis of FSD a step in the right direction, or does it disorder women’s experience (given that 43% of women- according to statistics- experience symptoms)? Is the Eros a medical breakthrough or a socially acceptable sex toy?  What advice should medical professionals give women who are experiencing sexual difficulties?

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    • K
    • February 28th, 2010

    I think I really wish that more people who talk about the medicalization of FSD would actively listen to women who actually HAVE FSD. I think I’m very disturbed by the stigma surrounding FSD since I’m kind of stuck in the middle of it all. I think that a medical diagnosis and “Fancy sex toy” (dilator kit) helped me quite a bit – among other things of course.

    It’s surprisingly complicated & nuanced.

    Ouch.

    • I think you might have missed my central point. If a quoted 43% of women experience symptoms of FSD (and I have too, to the point that I discussed it with my doctor), should it really be considered a disorder? 43 percent is an awful lot of women. Maybe the fact of the matter is that for women, sex is often complicated.

      I certainly think sex toys (fancy and otherwise) can help people. They helped me. They helped you.

      This post was primarily a summary of the opinions and attitudes presented at a conference and gathered from widely available online literature, as well as a call for further discussion.

      You say the diagnosis helped you. How so? Did it allow you to talk about it? Did it justify your experiences in your eyes? (or the eyes of your partner?) What tools or insight did it provide you?

        • K
        • March 1st, 2010

        That 43% statistic has come into question – you may already be aware of this, but the study it came from, there was influence behind one of the people in charge of it, he was affiliated with a pharmaceutical company somehow (I’d have to check the study again to refresh my own memory of what exactly happened.) Plus that study arbitrarily declared that participants had a dysfunction if a problem happened during sex, regardless of the participants own feelings about the problem. For some couples and individuals, sexual problems don’t lead to feelings of distress. No distress, no worries.

        Still, I’ve seen that 40-43% number pop up repeadtly in other studies too, so the problems happen. So do they matter?

        There was a more recent study that put the actual % of women with sexual dysfunction somewhere around 12% after factoring in that personal distress qualifier, but, even that study’s controversial – it’s got connections to this company that’s working on producing Filbanserin. Plus that study didn’t take pain into consideration!

        One of my big sticking points is, if FSD isn’t a disorder, then what is it? Where does that leave me, as someone who has and will likely continue to live with sexual dysfunction? When I hear experts saying things like FSD isn’t real, it’s like erasing everything I’ve been through.
        And then there’s the other articles that suggest FSD isn’t even real and those doctors are just out to get all my money. Oh sure, I’ve seen journal articles suggesting that sexual pain in and of itself is the only valid sexual dysfunction, so I don’t know where that leaves other women without sexual pain but who still have problems interfering with their sex lives to the point where they’re bothered by it.

        Are you asking me how the diagnosis helped me rhetorically or seriously? Because if you’re asking it seriously then you’re asking me to summarize 1 & 1/2 years of blogging all about it. I’m dealing with vulvodynia & pelvic floor dysfunction and so the diagnosis got me treatment.

        My crotch hurt! Now it doesn’t hurt as much!

        That wasn’t my fault or my partner’s fault, it wasn’t a reflection of our relationship or inability to communicate our sexual needs, it wasn’t a reflection of me being unfamiliar or insecure with my own body. It just was. There really was, and even is to this day, something wrong with my body – it’s better than it was but this is going to be a long-term thing.

        Getting a diagnosis & treatment didn’t hinder me from seeking out my own path to pleasure – it helped me find more paths.

    • K
    • March 3rd, 2010

    I’d rather have a broad diagnosis that can help women that really need the help rather than no diagnosis. Honestly, some women can have the greatest relationships and have the most giving partners and they still can’t enjoy sex. Something is obviously wrong. Those women might be a smaller percentile than what this diagnosis is aiming for, but it’s not like the treatment plan is harsh drugs or anything particularly detrimental. So I don’t see a problem with a big net catching some extra fish.

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