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A Twisting Path to Heart of Female Sexual Dysfunction

September 16, 2002|KATHLEEN KELLEHER | SPECIAL TO THE TIMES

"I have said that I could live the rest of my life without ever having sex again," mused a lithe, stylish West Los Angeles mother of two who has been with her husband for 17 years. "Then when I have sex and get into it, it surprises me. I think oh, this is great."

The woman said that she doesn't know why her interest in sex has diminished so dramatically. She speculated that it might have to do with her exhaustion at day's end, niggling resentments toward her husband that make her feel less than amorous, the natural effects of aging or a combination of those things.

If there were a magic pill that would revive her lustiness, she said she would take it. "It would be fun, and it would keep my husband happier," she said laughing. "It would be good for my marriage."

Although there's nothing on the market yet that can do for women what a diamond-shaped blue pill has done for men, drug companies such as Pfizer, Eli Lilly and Bayer have been on a competitive quest over the past four years to develop what many are calling "the female Viagra."

Social scientists and mental health clinicians are cautioning that after "the female Viagra" becomes available, women experiencing normal lulls and changes in their sexual life may be persuaded by drug companies' marketing campaigns and doctors that they have a sexual dysfunction.

"The concern is that a [Viagra-type] drug will be marketed to women who don't need it and can't afford it and that the marketing will lead women to feel insecure about their sexuality," said Leonore Tiefer, an associate clinical professor of psychiatry at Albert Einstein College of Medicine in New York City and co-editor of "A New View of Women's Sexual Problems," (Haworth, 2001), a newly released collection of writing by clinicians, social scientists and academics on the subject. "We are concerned that the definition of a sexual problem will be expanded to include every woman."

John Bancroft, a psychiatrist and director of the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University in Bloomington, said that the sexuality of men and women differ markedly. "We can't just transfer concepts that are being used for men in regards to sexuality and sexual dysfunction to women," said Bancroft, author of a cautionary article about the "medicalization" of female sexual problems in next month's issue of the journal Archives of Sexual Behavior. "We need to have an open-minded look at what is important for women in their sexual lives."

Bancroft said that the American Psychiatric Assn.'s Diagnostic and Statistical Manual of Disorders--the DSM IV--which codifies commonly accepted standards, "is singularly unhelpful in assessing women's sexual problems and addressing what women's needs are. It is just not relevant." The manual divides men and women's sexual "dysfunction" into four categories: sexual desire disorders, sexual arousal disorders, orgasmic disorders, and pain disorders.

The definitions of dysfunction are based upon the assumption that there is only one physiological sexual response pattern or a "normal function," according to Tiefer's manifesto, "A New View of Women's Sexual Problems," available on the Web site www.fsd-alert.org. This description of normal function begins with the sex drive, followed by stages of desire, arousal and orgasm, she writes. But women don't usually separate desire from arousal, Tiefer said. They care more about subjective arousal than physical arousal, she argues.

Also, Tiefer said, women's sexual complaints more often focus on relationship difficulties that are not described at all in the DSM IV. "The majority of women's sex lives that are not good will not be helped by medication," Bancroft said. "Most people go through circumstances in their lives when they are not particularly sexual because they are depressed, too tired, stressed or there are relationship or economic problems," Bancroft said. "The key is distinguishing whether it is a [sexual] dysfunction and a situational circumstance. Often, the machinery is OK."

Tiefer thinks one of the reasons the search for the "female Viagra" hasn't resulted in a marketable pill is that there is no single measurable behavior or outcome that is the equivalent of a male erection. Indeed, researchers have found that, unlike most men, women do not tend to be goal-oriented about sex. In one survey, 2,632 self-selected women who were asked to describe sexual satisfaction, most frequently mentioned feeling close before sex, emotional closeness after sex and feeling loved, said Carol Rinkeleib Ellison, a clinical psychologist who detailed the survey results in her book "Women's Sexualities: Generations of Women Share Intimate Secrets of Sexual Self-Acceptance," (New Harbinger, 2000). The ways in which women express and experience their sexuality, Ellison said, varies radically.

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