Dysfunction Junction, What’s Your Function?
In October 1998, the city of Boston hosted the first international consensus development conference on female sexual dysfunction. This meeting was made up of physicians chosen by the American Foundation for Urologic Disease, and came to the conclusion that female sexual dysfunction was a legitimate, diagnosable psychiatric condition. The year 1998 just happens to be the year Viagra (sildenafil) was approved for treatment of erectile dysfunction in men.
According to Irwin Goldstein, MD, who chaired three later meetings in 1999 and 2000 to further define and establish appropriate treatment for FSD, putting it more or less in the same camp as the granddaddy of all male sexual problems — erectile dysfunction. As Goldstein, a Professor of Urology and Gynecology at Boston University School of Medicine, told womensenews.com, “Erectile dysfunction is a medical condition. You need to have women’s sex problems in some context.” Goldstein believes that a number of factors have led to the explosion in female sexual dysfunction, including childbirth and hysterectomy procedures that damage sexual nerves.
Since the announcement that FSD is a psychiatric disorder, many feminist writers have criticized Goldstein and the pharmaceutical industry — which had financial ties with the majority of physicians at the conference — for trying to profit by creating a new disorder which can potentially be treated by expensive drugs — Ã¡ la Viagra.
The problem is that pharmaceutical and medical device companies are not able to begin clinical trials and seek approval from the FDA for treatment of disorders that don’t exist. Until FSD was established as a psychiatric or medical condition, no treatment could be sought by these industries. I’m sure that comes as a huge relief to the nation’s public health officials; given that most estimates of the number of women who suffer from FSD ranges from 30 percent to almost 50 percent, the prevalence of FSD puts it well beyond epidemic status and into public health catastrophe. A cure is needed, and fast. However, trials of Viagra to treat FSD in women have produced disappointing results, and only one device has been approved by the FDA for use in female sexual dysfunction. On the non-medical side, mainstream sex retailers sell a huge variety of arousal creams, sensation gels and lubricants guaranteed to maximize her pleasure, not to mention the vast number of herbal supplements sold on the internet that assure “she will experience pleasure like she has never dreamed of!” as one of my inbox’s many uninvited visitors once promised me.
As Nancy A. Phillips, MD, of the Wellington School of Medicine in New Zealand, writing on the American Academy of Family Physicians web site, states in an article on FSD: “Sexual dysfunction includes desire, arousal, orgasmic and sex pain disorders… Long-term medical diseases, minor ailments, medications and psychosocial difficulties, including prior physical or sexual abuse, are etiologic factors.”
Assuming that enlightened physicians diagnose FSD based on the patient’s appetite for a satisfying sex life, rather than some arbitrary 1970s-era list of how many orgasms Helen Gurley Brown thinks a girl ought to have, what FSD boils down to is a patient’s self-reported lack of sexual satisfaction, caused by anything. But those symptoms and causes are familiar to anyone who has ever heard women talking honestly about sexuality. What woman hasn’t occasionally experienced less desire, arousal or orgasm than she wanted? And how is that different than a male patient’s self-reported dissatisfaction with the ease with which he achieves an erection? Answer: It isn’t. Men and women develop out of the same fetal tissues, with physical morphology (genital “innie” vs. “outie”) being determined by hormones in utero, not chromosonal makeup. Make no mistake, when a woman gets aroused, her clit and the rest of her genital tissues become engorged with blood every bit as much as a man’s penis does. However, physical presentation differs kind of a lot between the sexes, and a man’s hard-on (or lack thereof) is easier to spot than a woman’s. If you define sex as intercourse — and the medical community almost invariably does exactly that — then, with enough lube, women can have all the sex they want without getting the least bit turned on. Why else do you think there’s been so much ink given to the phenomenon of women “faking it”?
Does that mean, at the end of that presumably dissatisfying tryst, the woman in question could reasonably be diagnosed with FSD?
Stereotypes abound about how much loving, touching and squeezing women “need” in order to get turned on, or “ready” for sex. Most of us call this foreplay, but often “romance” is the preferred term. Whether or not these stereotypes are true — and I can testify firsthand that some women are a lot less interested in romance or foreplay than the randiest stud down at Blow Buddies — anyone looking at the approved or potential treatments for FSD should know that all of them have already been put through a huge number of — admittedly non-clinical — trials. Actually, I’m fairly sure some of them are as clinical as it gets, and I’m sure quite a few female medical fetishists could be found to testify before the FDA, but that’s another story.
First, there’s the one approved treatment for FSD: Eros. Eros retails for more than $350, and essentially provides a disposable tip (at $6 a pop) attached to a suction pump. Eros’ function is to draw blood into the clitoris in the same way a penis pump draws blood into the penis. This increases engorgement and, as a result, arousal. But Eros is suspiciously similar to one of the garden-variety clit pumps like the Power Woman 6000 or the One-Hand Pump with a Nipple/Clit Cylinder attached. I doubt the FDA talked to the many thousands of women who, for years, have used such toys — and similar, if slightly less safe adaptations of existing products like the Panasonic Pore Cleanser, which produces much the same effect — to enhance their sex lives. Because we sell these things, I am required to tell you that the Power Woman 6000 and the One Handed Pump are under no circumstances intended to diagnose, prevent or treat any disease. UroMetrics, who manufactures Eros, can tell you that their device is intended to treat a disease, but they sure as hell don’t have to tell you that a similar product is available for $30 or that women in the S/M community have been using clit pumps for years because they feel good.
Nor are clinical trials of Viagra needed to tell us that some women have enjoyed it. One erotic adventurer I know — and she does not have FSD, by her own or anyone else’s standards — took Viagra recreationally with a lover and found it an exciting and exotic sexual experience. “All of my erectile tissue felt really sensitive, tingly and receptive,” she told me. “My lips and tongue were lots more sensitive than usual, and I got incredibly wet incredibly fast. My clit was hard as a rock, and I came much harder than usual, and much easier.” My friend is a very naughty person for taking a prescription drug without being diagnosed with something first, but she’s hardly the first person to abuse prescription drugs.
Similarly, the creams, ointments, lubes, balms and lotions sold by various online and “mom and pop” porn stores — unregulated by the FDA — are far from the exotic compounds derived from rainforest beetles and rare Arctic ferns that their marketing copy would have us believe. That marketing copy is exceedingly vague, promising “pulsating pleasure” and “tingling sensations,” mostly because the products’ benefits are exactly that — vague. If there were chemical balms that would bring a woman to uncontrolled heights of orgasm, trust me, more than just Irwin Goldstein would be talking about them. On the contrary, these balms usually offer a watered-down version of the same sort of “tingling sensations” provided by products like Ben Gay and Tiger Balm — both of which, you guessed it, have long been in use in the S/M community to provide unusual genital sensations, as have, incidentally, various kinds of toothpastes. Products like Ben Gay bring a rush of blood to the skin’s surface, producing a feeling of engorgement and the very acute sensation of heat. (Whatever you do, don’t get it in your eyes, nose or mouth.) Other products offered by many porn retailers are actually dangerous — like the numbing creams sold for anal sex or the balms which can supposedly give your vagina that “snug” feeling when, in fact, what they do is dry out the mucus membranes — dangerously so.
In much the same way that depression can illuminate an underlying unhappiness or dissatisfaction, FSD might crop up for a woman because, well, a woman’s sex life just isn’t all that great. But is the first step toward making it great an expensive medical device that insurance, in most cases, won’t pay for?
We live in a world profoundly changed by generations of female sexual explorers, who have made it safe for a woman to walk into her doctor’s office and say “Damn it, Doc, I’m not having enough orgasms. Do something!” But those women aren’t getting much of the credit. The good news is that women who want sexual pleasure are perceived as a strong enough market that the medical community would want to market products and services to them. That has to be a good thing, since not too long ago it was a widely held belief that women didn’t want or enjoy sex. Clearly doctors, male and female, now understand that women do want sex, and in fact will go to great lengths to get it.
But it disturbs me — though I know I should expect it — that the medical community seems to think the lengths women go to in their quest for pleasure should start with the prescribing of a device or a clinical trial for Viagra. The medical world seems completely ignorant of the many women over the last 30 or more years who have explored sexuality and discovered all sorts of new sensations and experiences — from casual sex to orgasm, porn to talking dirty, erotica to — gasp — vibrators. All these are options that women have to help them enjoy sexuality. When a woman walks into a doctor’s office and describes the symptoms of FSD, she has as much right to receive appropriate treatment as she would if she had the measles. But it makes me sad that that woman might be prescribed a device in hopes of making her “responsive” again — rather than being tipped off to everything that might turn her on, and where she can go to find it. I hope you won’t think it disingenuous of me if I wish that some day, every woman diagnosed with FSD would get a copy of the Good Vibrations catalog and a weekend or two alone.