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Commentary | PERSPECTIVE ON HEALTH

Viagra for Women Is the Wrong Rx

Prescribing a pill for loss of sexual interest in women masks the true causes--and only benefits drug companies.

October 20, 1999|LEONORE TIEFER and CAROL TAVRIS | Leonore Tiefer is a sex researcher and therapist; Carol Tavris is a social psychologist

Viagra is doing so well for men--especially for men in the pharmaceutical industry--that legions of sexologists and urologists are trying to find a way to market it to women.

If men have erectile dysfunction, though, what do women have? There must be something comparable. It's only fair. Accordingly, a new category of disorder is now being promoted, "female sexual dysfunction," or FSD.

At the Boston University School of Medicine, urologist Irwin Goldstein is planning a conference on FSD, to be held in Boston this weekend. The program has many well-known speakers from the world of sexology who will be paid by Pfizer and other drug companies to give their talks. The payment is indirect, of course; it comes in the form of "unrestricted educational grants" to the host institution. Two sessions are scheduled to discuss the creation of a new society--probably a Society for the Study of Female Sexual Dysfunction, modeled on the pharmaceutical industry-funded Society for the Study of Impotence. There's even a session on "how to run a drug trial," which is most unusual at a scientific meeting.

Whose interests would be served by the Boston meeting and this new organization? Which points of view will be present and which will be absent? Which groups of people interested in and knowledgeable about women's sexuality will be present and which will be absent?

Organizers of the meeting have invited people from many "health care disciplines." No invitations, however, were sent to researchers in women's studies or gender studies, social psychology, sociology or anthropology, gay and lesbian studies, history or cultural studies. Thus, people who have social, psychological or cultural perspectives on sexuality will not be heard at this conference on "female sexual dysfunction."

The audience therefore will not learn that the very notion of "normal" functioning, let alone definitions of "dysfunctioning," are culturally and socially determined. They are not analogous to medical conditions or diseases like arthritis or gout. The audience will not be required to think about questions like: Who decides what's normal? Who decides what is a "dysfunction" and what kind of treatment is appropriate?

If this new "disorder" takes off, another big step will have been taken in the ongoing medicalization of life's ordinary problems. It will work like this: Drug companies will pay for endless studies of minute components of the genitalia. Data will be presented at expensive meetings (in exotic places) underwritten by drug companies and published in new books and journals, supported by drug company ads.

Health and medical journalists will report on the new disorders of genital function and herald the new treatments. The dire new statistics about Americans' sexual unhappiness will be trumpeted on the front pages of newspapers and discussed on TV talk shows.

Epidemiological studies about FSD will be paid for by drug companies to create and identify new markets. Urgent government and commercially funded conferences will be held to decide how best to deal with the new problem. And the answer will be, of course, taking an expensive pill--and taking it permanently because drugs don't teach anyone how to kiss, how to talk or how to listen.

The manifesto for the new medical approach to female sexuality appeared in the September issue of Urology: "Female sexual dysfunction: Incidence, pathophysiology, evaluation and treatment options," by the unflagging Irwin Goldstein and two women who work with him (who have been on TV touting the virtues of Viagra for women based on their very limited work). The article begins, "Female sexual dysfunction is age-related, progressive and highly prevalent, affecting 30%-50% of women."

Yikes! It's "progressive"! This means the older a woman is, the more "dysfunctional" her sexual response is likely to be. Never mind that surveys since Kinsey have found just the opposite: As women get older, most become more comfortable with sex and more satisfied.

Loss of sexual interest more likely results from emotional conflicts with the partner, lack of sex education, the partner's poor technique or lack of sensitivity to the woman's needs, the partner's premature ejaculation, the woman's self-consciousness about her body, consequences of trauma, psychological inhibitions or shame, fear of pregnancy, fatigue, depression or internalized cultural or religious prohibitions.

Could these old-fashioned, low-tech causes of FSD explain why the first published studies of Viagra on women have had such poor results? Such negative findings will not, of course, daunt the medicalizers or be discussed much at Goldstein's conference. Instead, as the conference material promises, we will hear about how feeding rabbits a high cholesterol diet causes their clitoral blood vessels to clog up, and how this research provides a great comparison for women.

Frankly, we won't pay much attention until they come up with a female rabbit who complains, "I don't feel sexy tonight, Peter; 36 of our kids pestered me for attention all day, and besides, my thighs are too fat."

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