McKenzie Yates: Female Sexual Dysfunction
Definition and Background:
Female Sexual Dysfunction (FSD) is any condition that produces disorderly effects to a woman’s “sexual response cycle.” Experts categorize the effects to this cycle as desire, arousal, and/ or pain (Sikon). FSD is the overarching disorder, defining many smaller component disorders that affect up to 43% of women 18-59 (Swerdloff). Prior to the definition of FSD, The Diagnostic and Statistical Manual of Mental Disorders (DSM) established Hypoactive Sexual Desire Disorder (HSDD), the predecessor to FSD. HSDD was defined as “a persistent or recurrent deficiency (or absence) of sexual fantasies and desire for sexual activity that causes marked distress of interpersonal difficulty no otherwise accounted for by a general medical or psychiatric condition,” (Cacioppo). This definition did not include the women who felt sexual desire, but fell into one of the categories listed above, thus they developed FSD as the general disorder composed of more specific conditions (Cacioppo). These FSD conditions include arousal disorder, orgasm disorder, Genitopelvic pain disorder, and penetration disorder including Dyspareunia and Vaginismus (Swerdloff).
Controversy:
A source of controversy surrounding FSD arises from its diagnostic methodology. The diagnosis of FSD is solely left up to the discretion of the clinician, and the criteria are often vague (Levine). Clinicians primarily use two methods for diagnosing women with sexual dysfunction: objective and functional. The objective approach compares the patient’s condition and dynamics to those of other women and pre-existing norms (Levine). Stephen Levine, an American psychiatrist noted for his research in human sexuality, explains that this approach is problematic due to the diversity of the disorder. Each case varies woman to woman, so comparing them is not the most effective solution. On the other hand, the functional approach focuses on how the patient’s sexual experiences benefit or cause issues for her (Levine). Levine says, “The amount that a woman orgasms is typically unimportant clinically in diagnosing sexual dysfunction,” demonstrating that FSD is not a routine disorder, many factors play key roles in determining whether a woman’s experiences demonstrate dysfunctional nature (Levine). Levine as well as other psychiatrists believe that clinician must take into account the dynamics and nature of their patient’s relationships: whether or not they are happy with their partner, if the relationship qualifies as “healthy,” etc. (Goldfarb). They must inquire about their patient’s mental and physical health condition. For example, depression and drug use are known to effect sexual desire/ arousal. Additionally, in order to assess a woman’s eligibility for sexual dysfunction, the clinician must learn about their patients’ sexual history (Goldfarb). John Bancroft, the former director for Indiana University’s Institute for Research Sex, Gender, and Reproduction argues that many cases of FSD aren’t dysfunctions at all stating: “It is likely that many cases of impaired sexual response or interest in women are psychologically understandable and hence adaptive reactions to problems in the sexual relationship, and hence not dysfunctions,” (Bancroft).
Another controversy concerning Female Sexual Disorder is how similar the female and male sexual systems are and whether or not they can be treated in a similar way. After the startling success of Viagra in the late 90s, researches have become more interested in Female Sexual Dysfunction (Gomez). A popular model of the Human Sexual Response Cycle referred to as “Masters and Johnson’s,” states that female and male sexualities are essentially the same. This caused researchers and pharmaceutical developers to assume a drug very similar to Viagra could have the same positive effects in women that it did in men (Gomez). Through the creation process they have discovered that creating and evaluating a drug that effectively treats women with FSD is a lot more difficult than they had anticipated. These researchers have concluded that female sexual issues are a lot more complex than male, making them more difficult to diagnose, and harder to treat. These same researchers take on the perspective that female sexuality is more emotionally based, while male sexuality is more genital based (Gomez). This perspective insinuates that contrary to the Masters and Johnson model female and male sexualities are in fact very different (Gomez). This idea is controversial because it legitimizes male sexual dysfunction by saying it has biological roots, while suggesting that female sexual dysfunction is more of an emotional issue.
History/ Relation to Politics of Health:
Female Sexual Dysfunction relates to politics of health because it has been medicalized and pharmaceuticalized throughout history (Angel). Twentieth century psychiatry continually medicalized, and by the time that the 30s hit, it also became much more psychoanalytic (Angel). Women dealing with issues pertaining to sexual desire, arousal, and pleasure in this time were thought to be straying from the norms of femininity (Angel). The idea of having too little sexual desire medicalized, and the failure to reach a vaginal orgasm was defined as “frigidity” (Angel). Society in the twentieth century believed sexual fulfillment was vital for a happy marriage, and it was the husband’s role to manage their wives sexual pleasure (Angel). Too little sexual desire in women was attributed to developmental psychopathy. All of this history demonstrates some of the ways in which society has shamed women for having abnormal sexual behavior. Due to the embarrassment that women often feel to admit to sexual difficulty and the spectrum of issues, cases of Female Sexual Dysfunction often go unreported, misdiagnosed, or left untreated (Swerdloff).
The medicalization eventually led to the desire to cure these symptoms, thus the syndrome was pharmaceuticalized. Women’s innocence was highly valued and it was believed that if it were too “assiduously awakened” they would be sent into “nymphomania,” a condition that then required admission to an insane asylum (Angel). This medicalization was further enforced by the Diagnostic and Statistical Manual of Mental Disorders (DSM) in their first edition published in 1952. They classified the symptoms of FSD as Sexual Deviation and a psychological autonomic and visceral disorder (Angel). Drug companies typically develop a drug to help a pre-existing condition, yet Dr. Gomez, a professor in the University of Granada’s Institute of Women and Gender Studies, says “In this case however the challenge was to find the right disease for the existing drug” (Gomez).
(The image shows a bottle of Flibanserin, the first drug approved to treat Female Sexual Dysfunction. It is prescribed to treat low sexual desire in women. The long-term safety effects of the drug are not well known. This link provides a video to further explain the drug: https://www.medscape.com/viewarticle/849867 )
(Ray Moynihan is an academic researcher who has written investigative books about the medical world. He wrote Sex, Lies, and Pharmaceuticals to “investigate the creation of female sexual dysfunction or FSD, and the marketing machine that promises to “cure” it.)
Work Cited
Angel, Katherine. “The History of ‘Female Sexual Dysfunction’ as a Mental Disorder in the 20th Century.” Current Opinion in Psychiatry, www.ncbi.nlm.nih.gov/pmc/articles/PMC2978945/.
Bancroft, J. “The Medicalization of Female Sexual Dysfunction: The Need for Caution.” Pubmed, www.ncbi.nlm.nih.gov/pubmed/12238614. Accessed 11 Sept. 2017.
Bartlik, Barbara D. “Female Sexual Health.” Principles of Gender Specific Medicine, pp. 400-07. Science Direct, www.sciencedirect.com/science/article/pii/B9780123742711000368. Accessed 11 Sept. 2017.
Cacioppo, Stephanie. “Neuroimaging of Female Sexual Des ire and Hypoactive Sexual Desire Disorder.” Science Direct, 23 May 2017, www.sciencedirect.com/science/article/pii/S2050052117300835?via%3Dihub.
Goldfarb, Shari. “Female Sexuality and Sexual Function.” Women and Health (Second Edition), 2013, pp. 347-57. Science Direct, www.sciencedirect.com/science/article/pii/B9780123849786000236. Accessed 11 Sept. 2017.
Gomes, Theresa Ortiz. Gendered Drugs and Medicine : Historical and
Socio-Cultural Perspectives. Taylor and Francis, 2014. ProQuest,
ebookcentral.proquest.com/lib/Vand/reader.action?docID=1678747&ppg=36.
Accessed 11 Sept. 2017.
Levine, Stephen B., et al. Handbook of Clinical Sexuality for Mental Health Professionals. Routledge, 2003. EBSCOhost, proxy.library.vanderbilt.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=106409&site=ehost-live&scope=site.
Nathan, Sharon G. “When Do We Say a Woman’s Sexuality Is Dysfunctional?” Handbook of
Clinical Sexuality for Mental Health Professionals, by Stephen B. Levine et al., 2003.
Sikon, Andrea L. General Gynecology. 2007. Science Direct, www.sciencedirect.com/science/article/pii/B9780323032476100164. Accessed 11 Sept. 2017.
Swerdloff, Ronald S. Endocrinology: Adult and Pediatric (Seventh Edition). 2016. Science Direct, www.sciencedirect.com/science/article/pii/B9780323189071001232.
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