Female sexual dysfunction: real or imaginary?
For some years researchers and pharmaceutical companies have been extremely interested in female sexual dysfunction, ranging from loss of sexual desire and vaginismus to difficulties in reaching orgasm.
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But is this recent interest motivated by medical or commercial concerns? Doctissimo highlights the most pertinent aspects of female sexual dysfunction, exploring the very real distress experienced by some women, together with the dangers of over-medicalization.
In the prestigious British Medical Journal 1, the American journalist Ray Moynihan, controversially states that female sexual dysfunction may be an invention.
Female sexual dysfunction: an unclear definition
Female sexual dysfunctions (FSD) can be extremely diverse and include having a low sex drive, delay or absence of orgasm, sexual aversion, and pain before, during, or after intercourse. In spite of this very general definition, a study published in the Journal of the American Medical Association2 reported that a large number of women suffered from sexual dysfunction. The study conducted by sociologists found that of the 1749 women interviewed, 43% experienced sexual problems.
However the way in which sexual problems were defined, and the methodology used, were extremely controversial. The women in the study were asked whether they had experienced problems with seven aspects of sexual functioning over a period of at least two months during the previous year (these ranged from low sex drive, performance anxiety to vaginal dryness). They were identified as suffering from female sexual dysfunction if they gave a single positive response. Despite the scepticism expressed by other experts 3, and the absence of any proper diagnosis, this figure is constantly cited by media and scientific sources.
When is a sexual problem really a sexual dysfunction?
In October 2002, the team led by Dr John Bancroft, Director of the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University (USA) posed the following question very simply: “When is a sexual problem a sexual dysfunction?” According to Dr Bancroft, in many situations, a decrease in sexual desire is the normal, practical response of women who are suffering from stress, fatigue or who feel under pressure from their husbands.
He concluded by reopening the debate on the need for a clearer definition of sexual dysfunction. “Until we can distinguish between such adaptive inhibitions of response and those that are maladaptive dysfunctions, we will have difficulty in predicting when pharmacological treatment will be helpful”.
According to Dr Bancroft, failure to agree on a more rigorous definition will result in: an over-medicalisation of a sexual problem which neglects other aspects of women’s lives; an increase in the number of woman believed to be suffering from a sexual dysfunction, without any firm basis for the diagnosis; and finally, an increased focus and emphasis on sexual intercourse as the most important sexual activity.
Paying attention to real sexual dysfunction distress
However, we must be careful not to oversimplify the issue; some sexual problems may need to be treated medically. Nevertheless, while there may be agreement on the need to treat vaginal dryness or pain during intercourse medically, with other problems, for example, difficulty in achieving orgasm or lack of sex drive, there is no such consensus.
It’s regrettable that the medicalisation of woman’s sexual problems seems to preclude the adoption of a more holistic view of sexuality, one that considers, for example, the couple’s relationship, social pressures, or problems specific to women. Current medical research into female sexual problems is attempting to create a drug like Viagra®. However, there are significant differences between men and women and inductors of penile erection don’t work in the same way as “interrupters.” Viagra, for example, has no effect whatsoever if the man feels no desire. And there’s little to indicate that drugs currently being developed for women will fare any better.
However, one can also argue that everyone should have the opportunity to enjoy a full sex life. After all hasn’t the World Health Organisation (WHO) recognized sexual health as a basic need and fundamental right for very individual. It would be too easy to demonise the pharmaceutical companies, accusing them of creating sexual illnesses.
After all, we’ve only begun to appreciate the extent of erectile problems since the introduction of erection drugs. Even if these drugs aren’t a miracle cure, they have helped millions of men escape the fear of failure, rediscover a sex life and more generally, regain confidence and develop a positive self-image. Problems achieving orgasm are sometimes medical, caused by reduced blood supply to the clitoris. Just because we haven’t managed to separate the psychological from the organic/physiological, does that really mean that we can’t make any progress on the pharmacological front?
So how should one treat female sexual problems: should one adopt a medical or psychological approach? The answer to this question is far from clear. In the future, treatment may indeed consist of medication and psychotherapy.
For the moment, however, despite huge advances in technology and extensive medical research, there is no miracle love drug for women. So until then, you’re in charge of your own delicate chemistry of sex.
1. BMJ 2003; 326: 45-7
2. JAMA 1999 Feb 10; 281 (6): 537-44
3. Arch Sex Behav 2002 Oct 31 (5): 451-5
4. Arch Sex Behav 2003 Jun; 32 (3):193-208
Copyright © 2009 Doctissimo
Posted 20.07.2010
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