The debate around the “Medicalization” of Female Sexuality

Written by on December 31, 2012 in Features - No comments

If I hear one more time that women’s sexual dysfunction is a myth created by the media and that the search for medical solutions is merely a thinly veiled way for the pharmaceutical companies to fleece innocent and gullible women, I may shoot someone.

The Numbers

Ask around:  women have long been complaining to each other and their physicians about various sexual problems that present issues in their relationships and with their own quality of life:   “I have pain.”  “I don’t get turned on.” “I can’t have an orgasm.” Even if you do believe that the pharmaceutical companies are looking for ways to keep their shareholders happy, it is difficult to find fault given these statistics.

Current studies indicate that 43% of women express dissatisfaction with their sex lives at some point in time. Hmmmm. Let’s say the “real” number is being inflated by 100% — that would still leave us with one quarter of all women suffering from these conditions and their unhappy consequences.

How real is this?  For the skeptics,  let’s say that number is still inflated and the real, discounted number is only 10% of all women who are experiencing female sexual dysfunction.  Even that would 30 million women in US alone!  Do the math:  21% would be 60 million women.  And 43% would be 120 million.

Are we painting a clear picture here?   Whether it’s 30, 60 or 120 million women suffering from female sexual dysfunction, it’s only reasonable to accept that it’s a problem worth addressing.

Big Bad Pharma

Now let’s talk about the big bad pharmaceutical companies accountable to their shareholders. Profit and share-price are the motives for making a product which works and will sell to a large patient population driven. No question.

When they look at the statistics they must be salivating!  What a huge group of prospective users!  An effective drug that solves low desire, for example, would be a boon!

So what’s wrong with that?

What if the motivation for studying a solution for millions of women is profit?  Personally, I don’t really care what their motives are as long as they are working on the problem. If Big Pharma is trying to produce a drug that may help low desire or arousal, good for them!  This may also be good for some my patients, which is the point, isn’t it?

Medical treatment and psychotherapy

Strikingly, you most often hear complaints about the “medicalization” of female sexual dysfunction from psychotherapists.  Many seem horrified at the possibility that physiology may be at the root of female sexual dysfunction, and claim that practitioners will push suffering women into spending their hard earned dollars on questionable medical treatment.

In our practice, we have the opportunity each week to refer some of our patients – including some who have found medical treatment for their fsd – to local psychotherapists for longer term counseling connected with their experiences with sexual dysfunction. We recognize that the priority is getting patients the help they need in whatever way best suits their temperament, medical condition and wallet.  Even though we believe that our approach of integrating the psycho-sexual with the physiological is powerful, we accept that some women will decide on traditional talk therapy to address their needs. Just because there may be a physiological reason for a particular sexual condition, does not mean that there cannot be related psychological – or even psychiatric – dysfunction that needs to be addressed by a specialist.  But let’s be fair – the reverse is also true.

And finally, as part of the health care debate it’s hard to disagree with effective medical treatment that carries an annual cost of less than $2000,  particularly when compared to upwards of $7000 per year for psychological counseling alone.  So, factoring in the cost of different treatment options must be part of the equation for every patient.

“Quick Fix” vs. the “Long Haul”

To women who experience ongoing sexual difficulties, the choice between a quick fix and an interminable journey is unhelpful.  Calling medical treatment for female sexual dysfunction a “quick fix” undermines the hard work patients do to face their condition head on.  Patients will often overcome great embarrassment and insecurity to seek treatment.  They may try unfamiliar or even uncomfortable procedures to address their problems.  They may need to involve a disappointed or resistant partner in order to make progress.  None of this describes a “quick fix” and the psychotherapeutic community’s knee-jerk assignment of that term demonstrates disrespect for women who are sincerely struggling with an untenable situation.

Two key questions remain at the fore when a patient considers treatment options:  will it work and is it safe?  After that, the next question is often: how long will it take (the adult version of, “Are we there yet?”)?  Of course, the fact that medical treatment of FSD often resolves problems within a few months may alienate therapists who believe in a longer-term process.  That, we believe, needs to be left up to the patient.

At the root of this argument is another assumption:  that intimacy and sex are the same. The sooner we recognize that this is not true in every case, the more open the psychotherapy community will be to considering other channels to help patients find complementary paths to solving the distress of FSD.

A “quick fix” for the media.

As we watch the media respond to the news regarding Flibanserin,  Boehringer Ingelheim’s drug to improve sexual desire in women currently in clinical trials,  we see how desperate they are to find a  pithy, newsworthy way to present an issue.  That’s where “Flibanserin, Viagra for women” comes from.

Such a synopsis ignores the different way the medications work (vascular for Viagra, hormonal/neurotransmission for Flibanserin) and disregards the complexity of sexual dysfunction for women.  The lack of depth in describing the problem and its possible resolution is astounding and only reflects poorly on responsible media coverage.

“The consumer is not an idiot. She is your wife”

This quote is only one of many tenets of advertising and marketing proffered by David Ogilvy, considered the father of modern advertising.

To suggest that women will be sheep and buy whatever cream or pill is recommended, and keep using it even if it’s not working, is ludicrous and infantilizing. Women are smart consumers. When they have a problem they try a solution and they stop if it doesn’t work. I can list a slew of herbal “remedies”  that have been on the market for sexual dysfunction. Some had significant marketing and PR dollars behind them, and nearly all of them are no longer being sold.

I have the utmost confidence in women who are seeking solutions to obstacles that stand in the way of their goals.

An intelligent, responsible person will evaluate treatment options with her own needs at the fore, and with an eye towards efficacy and safety and effort.  She will not be convinced by phony claims, snake oil or an unsatisfying experience.

So, as you can see, this is not snake oil or fantasy, but a set of sound alternatives based on medical practice and fact.  Virtually all conditions can be addressed in far less than one year with follow up assessment as needed.    If you’ve ever met a young married woman who has been unable to consummate her marriage, a vibrant mom of teenagers who simply cannot find her libido, a post menopausal 55 year old who can no longer achieve orgasm, a young single woman who wrestles with her relationship because she cannot feel aroused, then you know how important it is to be prepared with all possible solutions.  It is our job the help her have the sexual life she wants, regardless of what the critics say.

By Bat Sheva Marcus, LMSW, MPH, PhD
Medical Center for Female Sexuality

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