Dysfunction or Dissatisfaction?

When it comes to discussing Female Sexual Dysfunction (or perhaps Dissatisfaction), all the medical jargon and scientific theories as to why women “don’t like sex and are therefore dysfunctional” come out. Some doctors and pharmacists think FSD can be easily solved with a pill or patch– no big deal. However does this “just give ’em a pill or a patch, and they’ll start happily humpin’ and climaxing” line of thinking conveniently gloss over the larger issue that some women are perhaps dissatisfied in their intimate relationships? What about stress from working, having to take care of children, and running errands all day? What about their past experiences with sex? Were some of them sexually abused or raped? What if the environment within their relationship and their partner make them feel uncomfortable about discussing their sexuality? What about society’s stigmas around women being open and frank about their sexuality? Does a male-dominated medical and scientific field have anything to do with the lack of human-oriented (as in actually talking to women and getting them to be more open and frank) research of FSD? Don’t these other concerns matter in the debate over FSD? Or are some women just doomed to remain sexually dissatisfied or dysfunctional for various reasons? Sigh— just keep on faking it, ladies (or visit your local sex-toy store). Well Planned Parenthood has recently put out an interesting article on FSD and the issues surrounding the “controversy” of women’s sexuality and women being open and discussing their sexuality.

[…]FSD: New and Improved!

One thing is clear: the FSD of today is not what it used to be. FSD was originally defined in the Diagnostic and Statistical Manual of Mental Disorders, the bible of the psychiatric world, as a psychiatric disorder that was usually treatable with therapy for the individual or the couple.

But the staggering market success of Viagra, a drug prescribed for erectile dysfunction (ED), prompted pharmaceutical companies to consider treating female sexual problems in the same manner. The first hurdle, however, was that female sexual problems are not as clearly defined or as objectively measurable as (ED), or impotence. Female complaints tend to be more vague, like lack of interest or problems with arousal … neither of which lends itself to medical diagnosis and treatment.[…]

A New Definition Under Fire

[…]Critics argued that the “new” FSD was a useless category as far as genuine scientific and medical research were concerned. One reason was the subjectivity of the disorder. Two women, for example, who share the same symptoms could have different diagnoses based on whether or not they felt bothered by the symptoms.[…]

Dr. Leonore Tiefer is a clinical associate professor of psychiatry at the New York University School of Medicine and a leader of the New View campaign, an “educational campaign to challenge the medicalization of women’s sexual problems.” She calls FSD “a garbage lumping-together of apples and oranges and all kinds of things.” She argues that labeling a disparate collection of symptoms as “dysfunction” results in the oversimplification of the more nuanced and complex problems some women have with sex.[…]

Dr. Jean Fourcroy, a retired medical officer from the FDA who is now a consultant, was among those who addressed the researchers who convened to redefine FSD in 1998. She began her presentation by drawing a circle with the word “women” in the center, and arrows pointing inward from every direction. The arrows represented different factors that could affect women’s sexual feelings. “Most of them,” she says, “have to do with the environment or relationships.”

Fourcroy says that the medical and biological problems that can … and do … affect women’s sexual interest are “one very small part” of the whole picture. She worries that the attempt to find a medical silver bullet to solve women’s sexual problems will gloss over the many environmental and personal issues that comprise the larger part of the picture.

For example, being in an environment or with a partner that makes discussing one’s sexuality and desires (in this case a woman’s) uncomfortable. Some women don’t want to discuss their sexual desires and sexuality because they think it might “intimidate” their partners, or make them appear to be “slutty,” or knowing “too much” about sex and the intimate regions of their bodies.

What the Future May Hold

[…]”We need to learn a lot about hormones,” says Fourcroy. She is highly critical of what she sees as a push to market off-label use of hormones to treat women’s sexual problems. “No one has ever proved that there is a deficiency disease,” she says. “When we treat hypogonadism in men [a condition in which there is low or no production of sex hormones in the testes], we can measure it. We can’t measure [FSD] in women, because we don’t know enough.”

Ideally, the future will bring much more research that will tell us about the long- and short-term effects of hormones on women, and whether medical treatment of FSD is even appropriate in the vast majority of cases. At the very least, Fourcroy and Tiefer both hope that the increased interest in FSD will increase communication about things like female desire and arousal and will spur women to discuss their sexual issues with both partners and practitioners. “In the ideal world, I would like to have every provider comfortable discussing sexuality instead of pushing drugs on [women],” Fourcroy says. […]

Hey, if a pill can solve ED surely you can do the same thing for FSD, right? And apparently this is the latest in women gaining “equal sexuality rights.” No comment from me on vaginal rejuvenation (I’m still debating that with myself), but Jessica over at Feministing has one. Anyway, to me the problem is that some women still feel uncomfortable and even ashamed about discussing their sexuality due to social stigmas and taboos, especially when it comes to women wanting to be equally pleased in bed like their partners. Rather than just lying there like an empty vessel who moans on cue in order to please someone else, and completely ignore their own desires. So until this issue is solved, like I said, just keep faking it. Or better yet, find someone who is willing and open to discuss your sexuality and sexual desires.

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23 Responses to Dysfunction or Dissatisfaction?

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  3. 3
    Diane says:

    Throwing pills and patches at so-called sexual dysfunction isn’t just for women. Sex therapy (including the obvious intervention of making sure that men over 40 have sex in some way or another frequently, in order to create testosterone) has all but disappeared since the creation of Viagra and similar drugs. I have nothing against treating symptoms if such treatment causes the problem to completely go away, which is the case with most sexual issues, but when you consider the side effects of treating symptoms with drugs, there are complications.

    It has been my experience that most sexual problems in both genders are psychological in nature. An unbelivably large number of women have sexual problems because of unresolved or partially resolved childhood sexual abuse. Sexual function is generally the last thing they regain, and by that time, their sexual relationships are often a mess, even with very understanding partners. Men who were sexually abused or who saw their sisters sexually abused have multiple sexual issues, ranging from avoidance to compulsive sexual behavior.

    If physicians are not comfortable taking sexual histories of their patients, then they are not providing proper medical treatment. At the very least, they should have someone on the staff who isn’t all repressed about sex who can interview patients.

  4. 4
    ginmar says:

    Yeah, they just want to throw pills at women without actually dealing with the woman. What does she think? What does she feel? Who cares, here’s a pill. Medicine has long regarded women as inadequate men. If women got to have a say in sex, well, then, what they might want and say would be unpleasant. Maybe men would have to change. Can’t have that, can we?

  5. 5
    RonF says:

    Count me in as against the “let’s just throw drugs at it” philosophy. This is not to discount that there may be physiological issues at work in some cases, and that in such cases a drug (either a current one or one to be developed) may be appropriate. But it seems pretty obvious to me that there are likely to be numerous other sources of sexual dysfunction in women that can’t be cured with a drug.

    Gentlemen; don’t discount the effects of your attention to what your wife/girlfriend/S.O. thinks is important, as opposed to what you think is important; and I’m talking about both in and out of bed. You’re more likely to get what you want if the woman in your life has good reason to believe that she’ll get what she wants.

  6. 6
    michelle says:

    The one thing they never, ever suggest as a reason for “dissatisfaction” seems to be the most obvious: maybe the male partner just plain isn’t good at it.

  7. 7
    Glaivester says:

    I thought that this was the latest in equal sexuality rights.
    I, too am skeptical as to how often these pills are going to be used to treat the “dysfunction” that she just doesn’t want sex as often as her partner.
    I also wonder in how many cases people think that giving someone a pill that makes her horny is a lot easier than actually trying to, you know, like, find out what she likes.

  8. 8
    Josh Jasper says:

    While I’m certainly not a fan of ‘lets throw drugs at it’, if you actualy do have a diminished libido due to, say, menopause, a hormone imballance, or other reaons, having a means of engaging one’s libido is important.

    I clearly see the danger of these drugs, and the potential for being a bad substitute for actualy caring about someone. But I happen to know people who, if offered a pill that could bring back thier libido, or bring into existence a libido that never really existed, would take it.

    I wonder if such a drug drug could be taken along with anti-depressants or anti-anxiery meds, and if it would counteract the libido deadening effects some of them have.

    BTW, the drug in question is being tested right now, so it’s a real thing, and may well come to market soon.

  9. 9
    donna says:

    Geez. They *could* just train men in how to be better sexual partners, already…

  10. 10
    RonF says:

    Hey, Donna; who’s “they”?

  11. 11
    BritGirlSF says:

    Lack of interest in sex isn’t necessarily a dysfunction. What if a woman just isn’t attracted to the man she’s with? That’s a problem, sure, but not one that a pill can fix. What if the reason she’s not feeling so horny lately is that she’s actually not attracted to men at all, or has a kink that she’s been to scared to explore? And how exactly are we defining dysfunction anyway? In the past it’s been defined as a woman wanting “too much” sex…given the history, is anyone really taking this seriously?
    On another note, I think that the real issue here is women being pushed into the role of object rather than subject in a pretty universal way. If your entire sex life consisted of being appealing to others and never getting your own needs met, how interested in sex would you be?
    Not that that’s inevitable – I’ve never been in that situation for any length of time, but it does seem to be pretty much SOP for a lot of women. That’s the real issue, and it’s not something that Big Pharma can fix (although if they stopped pretending that the whole thing was a matter of hydraulics that might help!).

  12. 12
    BritGirlSF says:

    Lack of interest in sex isn’t necessarily a dysfunction. What if a woman just isn’t attracted to the man she’s with? That’s a problem, sure, but not one that a pill can fix. What if the reason she’s not feeling so horny lately is that she’s actually not attracted to men at all, or has a kink that she’s been too scared to explore? And how exactly are we defining dysfunction anyway? In the past it’s been defined as a woman wanting “too much” sex…given the history, is anyone really taking this seriously?
    On another note, I think that the real issue here is women being pushed into the role of object rather than subject in a pretty universal way. If your entire sex life consisted of being appealing to others and never getting your own needs met, how interested in sex would you be?
    Not that that’s inevitable – I’ve never been in that situation for any length of time, but it does seem to be pretty much SOP for a lot of women. That’s the real issue, and it’s not something that Big Pharma can fix (although if they stopped pretending that the whole thing was a matter of hydraulics that might help!).

  13. 13
    BritGirlSF says:

    Sorry for the double post, don’t know quite what happened there…

  14. 14
    sophonisba says:

    Geez. They *could* just train men in how to be better sexual partners, already…

    Which would solve the problem[1] of women having low levels of arousal and sexual interest just fine, if women only became aroused or interested in sex in response to a man’s efforts. In the real world, women have, y’know, libidos and hormones and impulses of our very own. Unless we don’t, which is usually a sign of sexual dysfunction.

    [1]I’d hope it would go without saying, but: it’s only a problem if it’s a problem for her, and ‘low’ is subjective.

  15. 15
    Lis Riba says:

    I am a woman diagnosed with FSD.
    I’ve experienced years of “let’s throw therapy at it,” reaching a point where my therapist (with permission) brought my case to a conference of sex therapists, before finally throwing in the towel and saying she couldn’t help me further.

    Unless you’ve been through it, it’s hard to understand just how hard therapy can be. I scoured my background for any hint of possible repressed abuse (since my aversion is similar to that of abuse victims). My husband went through his own guilt that he was too pushy or not helpful enough or a lousy lover.

    When a hormone test showed my hormones were off-the-scale low, it was such a relief for us both. It wasn’t our fault.
    Why put people through that unnecessarily?

    If the physical aspects of FSD can be diagnosed with a hormone test, I don’t see why there’s such resistance to it. Perhaps in most cases, it will rule out the physical diagnosis and lead people to therapy anyway.
    But therapy is expensive and timeconsuming and not always accurate. Knowing onesself better is a good thing, but when it can’t solve the problem the patients want to resolve, it’s a waste.

    Physical bodies have flaws. We accept that with men, in part because the problem is so visibly one of hydraulics. But the notion that women should seek therapy first seems almost a throwback notion that “it’s all in her head” and only if we can’t get her head straightened out should we look at the rest.

    I don’t want to be accused of hijacking the discussion, but here’s my personal history with FSD.
    Feel free to ask me further questions on the subject.

  16. 16
    Myca says:

    Count me in with Lis.

    I have no idea whatsoever whether drugs are too often proscribed for FSD or not. Perhaps they are. Hell, probably they are. God knows we overmedicate and overdiagnose and ‘just throw drugs at’ everything else, so why not that?

    That’s a seperate issue from whether or not FSD is a real condition or whether it’s just a symptom of lousy male lovers.

    *shrug*

    I think of it like ADD. I believe that ADD is real. I believe that it’s overdiagnosed and overmedicated, and we need to be sure we look at other causes before we label something ADD that may have other, environmental (rather than chemical or physiological) causes and, yeah, sometimes what we call ADD is just a symptom of lousy parenting. This is all true. Regardless, I do also believe that ADD a real thing and that medicating it has helped plenty of people to live better lives.

    —Myca

  17. 17
    Becky Zoole says:

    I’m extremely happy that the medical establishment has finally starting studying women’s sexual response! For too long, the right of women to be fully sexual beings has been denied. Women who had healthy libidos were looked on with fear. At last, women’s desires are being looked at seriously!

    There are plenty of women who used to enjoy their libidos, and who miss them. These aren’t necessarily women in relationships with men, either. Lesbians and enthusiastic masturbators can find themselves inexplicably “not in the mood”. Women with plenty of leisure time and a skillful partner or two can also become frustrated when their bodies just don’t respond like they want them too.

    Sometimes this is a complication of diabetes, or cardio-vascular disease, or ovarian cysts, or early menopause, or even low-level chronic yeast infection.

    It’s awfully condescending to tell these women that their lack of sexual desire or inability to orgasm is “all in their heads”.

    Dissuading medical researchers from looking for a Viagra-analog for women, is tantamount to telling these women to just lie back and fake it because their sexual desires aren’t legitimate.

  18. 18
    Jennifer B. says:

    Ahem. I’ve been taking supplemental testosterone for nearly three years now, to raise my libido from a near “zero” to what is now a very satisfactory level (close or equal to what it was in my teens and early twenties). I keep hearing arguments against “just throwing a pill at it” and claims that low or nonexistent libido in women is all in their heads, or some fad, or due to past sexual abuse, or whatever. I’m here to say, it’s definitely not all in MY head. I’ve been in a good marriage for 18+ years, sex has been good most of that time, and my sexual arousal and desire was also usually good…until ten years ago, when it all slowly started to go downhill. No particular cause that I can point to. I was in my early thirties. By the time I got to 37, I basically had no desire, no sexual thoughts, no ability to reach orgasm, no desire to masturbate, nothing. I had lost a whole chunk of my life–my sexuality. After a few months on testosterone (under a doctor’s supervision) I regained most of it, and regained all of it by the end of the first year. I have not needed couseling, or sex therapy, or any of that, because that was never the problem. I was quite brutally raped in the past (at 17) which was certainly traumatic, but it never affected my sex drive. So. to all those who disparage the role that “a pill” can have for helping some women regain their sex drive, please stop talking about things you don’t understand. Obviously there are cases where the cause of FSD is psychological or at least not physiological. But in quite a few of the cases it is exactly that–a correctable physiological issue. I’m very grateful that some doctors and researchers are willing to believe that, otherwise I’d still be walking around with my libido as nothing more than a fond, far-off memory.

  19. 19
    Lis Riba says:

    Sorry, but I couldn’t resist responding to a few more comments

    Sex therapy (including the obvious intervention of making sure that men over 40 have sex in some way or another frequently, in order to create testosterone) has all but disappeared since the creation of Viagra and similar drugs
    Do you have any stats on that?
    Dr. Goldstein (formerly of the Institute for Sexual Medicine) has reported the opposite among his patients. Men who thought they had simple problems start taking Viagra, and then discover their impotence was only the most obvious sign of more complex issues. And then they go into sex therapy to deal with the rest.

    And how exactly are we defining dysfunction anyway?
    Here are some brief definitions of the current subcategories:

    Hypoactive Sexual Desire Disorder (HSDD): Persistent or recurrent deficiency and/or absence of sexual fanatasies/thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal distress.

    Sexual Aversion Disorder: Persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress.

    Sexual Arousal Disorder (FSAD): Persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress. It may be expressed as a lack of subjective excitement, or a lack of genital lubrication, or swelling, or other somatic responses.

    Persistent sexual arousal syndrome: A subclassification of female sexual arousal disorder, PSAS is defined as feelings of spontaneous, persistent and intense genital arousal with or without orgasm, with or without genital engorgement, in the absence of sexual desire. (read more information about PSAS; read personal experiences of women with PSAS)

    Orgasmic Disorder: Persistent or recurrent difficulty, delay in or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress.

    Sexual Pain Disorders
    > Dyspareunia: Recurrent or consistent genital pain associated with genital intercourse.
    > Vaginismus: Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration which causes personal distress.
    > Non-Coital Sexual Pain Disorder: Recurrent of persistent genital pain induced by non-coital sexual stimulation.
    (read more information about pain disorders)

    Female Androgen Insufficiency Syndrome: A pattern of clinical symptoms in the presence of decreased bioavailable testosterone and normal estrogen status. Free testosterone values should be at or below the lowest quartile of the normal range. (clinical symptoms)

    Relatively clear?
    The mainstream media isn’t good at covering complex medical issues. FSD is not as vague or broad as some on this thread are making it out to be.

    Does a male-dominated medical and scientific field have anything to do with the lack of human-oriented (as in actually talking to women and getting them to be more open and frank) research of FSD?
    What research are you talking about?
    The primary means of diagnosing FSD is through patient questionaires, such as these. These are entirely about dealing with the woman. What does she think? What does she feel? It doesn’t ask about her partner’s satisfaction with her performance, but focuses on what she’s experiencing.

    Combining such surveys with other labwork, medical science found a corellation (in some cases) with physiological traits such as reduced hormones. And now they’re investigating which corellations might be causal and can thus provide effective treatment. But I’ll bet you, the patients in those clinical trials are being evaluated using surveys like these.

    Seriously. I keep hearing critical comments about “the research” without seeing one pointer to an actual study that commits these flaws. I’m laying it on the line here. I wish somebody would give an example of what studies talking about when they disparage “the research”, because otherwise it’s starting to sound like a mythical boogieman.

    Incidentally, I find the repeated quips (here and other feminist boards) that female sexual dysfunction is somehow the partner’s fault to be incredibly insulting. How would you react if someone blamed impotence on the woman being a lousy lay? Feminists would be outraged! So why is it acceptable rhetoric when the shoe’s on the other foot?
    Speaking from experience, this kind of talk can be poisonous to all parties in a relationship. We suffered years of this kind of second-guessing before my problems were diagnosed as hormonal. What I remember most about that day was feeling that a tremendous weight had been lifted off our shoulders.

    I have no idea whatsoever whether drugs are too often proscribed for FSD or not. Perhaps they are. Hell, probably they are.
    Actually, last time I checked, there are no medications currently on the market exclusively for FSD. It’s all been offlabel use of hormone-supplements for postmenopausal women, and taking men’s medications and dividing them into female-appropriate dosages. [Normal levels of testosterone for women are one-tenth that of men. It’s a real nuisance trying to take a “single-use” packet of gel intended for men and divide it evenly across ten days…]
    And research into FSDs didn’t really begin until after Viagra hit the market and women complained to their doctors “what about me?” so it’s a very new science.

    If physicians are not comfortable taking sexual histories of their patients, then they are not providing proper medical treatment.
    And on that, we can agree. The Women’s Sexual Health Foundation was founded by and for patients and offer advice on how to talk to doctors about sexual matters.

    And thanks for sharing your story, Jennifer B. Gives me hope.

  20. 20
    beth says:

    i’ve been reading this blog for a while, but came to this post via riba, after seeing her post linked at another source.

    i have to say i’m shocked. every single one of these arguments about “throw a pill at it”, all of these disparaging judgements…they sound a lot like many of the arguments made against antidepressant medications, arguments i internalized, believed, and which kept me from getting help long enough to almost cause my death.

    it’s easy to say “the problem is that some women still feel uncomfortable and even ashamed about discussing their sexuality due to social stigmas and taboos…” without bothering to ask or read the stories of people who have actually had the problem. just like it’s easy to say “the problem is that you’re weak and can’t handle life…” to someone with major depression, or “the problem is you haven’t met the right woman yet…” to a gay man.

    i expect more from your site than this. i really do. at the very least, a response to riba’s thoughtful comment or the post she made in reaction to this one.

  21. 21
    Lis Riba says:

    FWIW, I just concluded a week’s worth of posts on FSD over on my journal, so if anybody reading this wants more of my feminist’s experience with female sexual dysfunction, just follow the link.

    Thanks to those of you who posted comments of support; I will keep checking back in this thread in case anybody else responds. [Benefit of the doubt, I’m assuming Pseudo-Adrienne has been offline. I also want to state I hold no animosity against her, but her post provided a useful springboard for things I’ve been bottling up for a while.]

  22. 22
    Pseudo-Adrienne says:

    Lis Riba,

    The reason why I haven’t been blogging often is due to my school work, studying for final exams, finishing up papers, working out my Spring ’06 schedule, getting ready for the LSAT, and such. Usually I don’t post comments on my own threads and I just let the commenters have at it themselves (but I do read through the comments). I’m sorry if you felt as if I was ignoring–I wasn’t. And really, thanks for those links, info, and personal view-points you provided in your comments.

  23. 23
    Lis Riba says:

    No problem; like I said, I figured you were busy with something else.
    Good luck on exams, and if you have any further questions out of anything I’ve written, either comment on my blog or you can probably work out my e-mail address and send them my way.

    One good thing out of all these threads is that a coworker approached me to talk about her problems and ask advice. So, hopefully that will be one tangible bit of good out of this…