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Whose Sex Drive Needs Fixing? : Medicine: Healthy women are being hormonally 'cured.'

May 30, 1994|KAREN ENGBERG | Karen Engberg is a family-practice physician in Santa Barbara. and

Medical researchers are busy playing catch-up. Studies are being designed and rethought to include the impact of various drugs, lifestyle changes and environmental factors on women's health, to balance the data available exclusively about men's health. This process is fraught with obstacles to clear thinking presented by the way researchers, both male and female, have been socialized.

One example of this is the search for medicines that will boost women's sex drives. A news release from a major medical school and research center came across my desk recently announcing"relief for menopausal women." It went on to say that "menopausal women suffering from reduced sexual desire may find relief from an alternative type of hormone-replacement therapy." The words suffering and relief in this context bothered me. The release further claimed that "women who took estrogen plus androgens reported improvement in libido and sexual satisfaction as early as three weeks after treatment began. . . . Their husbands reported the same thing." It made me wonder precisely who was being studied.

This perspective might not be so troubling were it not so pervasive. Not long ago, a male colleague sought my opinion about a patient who had come to see him because of her "decreased sexual drive." The patient was a woman in her mid-30s who, after having been married for 10 years, had a child, and then a year later, a second child. She had returned to work soon after the birth of each child and, at the time she saw my colleague, was working full-time and mothering 1- and 2-year-old daughters. She reported being exhausted most of the time. This patient's husband was distressed because his wife seemed uninterested in sex, hence her visit to the doctor.

After presenting this social history, my colleague went through the unremarkable findings of the physical exam and the negative results of several lab tests. What, he wondered, did I make of this case? I told him that his diagnosis was almost certainly in the first couple of sentences of the presentation and that his patient, happily, was a healthy, albeit overburdened, woman.

Similarly stymied was a friend of mine, an extremely bright, socially competent and insightful woman, whose 15-year marriage had been in bad shape for some time. From many conversations, I gathered that her husband had particular and frequent sexual needs, but not the essentials of tenderness and respect. Over the years, she had undertaken couples counseling, read everything she could and repeatedly tried different ways of understanding her predicament. Despite all this, she called me one day and asked what she could take to "improve" her sexual desire. I told her I didn't think she needed improving.

In my practice, this pursuit by patients--to medically understand and alter the woman's sexual desire--is not uncommon. I have yet to hear, however, of a male patient seeking to deamplify his libido to meet his partner's needs. As a society, we hold very tightly to the notion that the male sex drive is a given and that any adapting must be done by women. How many men fake orgasms?

The curious aspect of this is that rarely do women's sexual impulses result in victimization. Women don't rape men, mothers don't sexually molest their sons, women teachers and ministers don't accost those in their trust. When we elect our first woman to the presidency, it's not likely that a series of men will emerge from the woodwork to accuse her of sexual harassment. The damage resulting from sexually aggressive women is sparse; that from male sexual aggression is legion. Still, we look to perk up the female's sex drive to meet the male's.

Though the ethics may not have been fully examined, we long ago headed down the road to medically manipulating behavior. Drugs like Prozac can chemically influence people's psychodynamics, changing their lives and relationships. Soon it may be possible to modify much of what we don't like about human behavior. Libido, in women, is the target of hormonal manipulation. Aside from not knowing the long-term health consequences of this hormone exposure, it may be that we're treating the wrong people. This possibility needs to be contemplated with caution, thoughtfulness and an eye to the biases that underlie our assumptions.

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