Culturally-Influenced Sexual Dysfunction?
There’s A Pill For That, Too
BY SARAH GORDON
ILLUSTRATION BY EDDIE HO
ILLUSTRATION BY EDDIE HO
I. SOME FOREPLAY
Orgasms are mysterious creatures, right? For 18 of my 22 years on this planet, I didn’t quite understand the whole thing. In conversations with friends about sex, the same question would come up: “But did you…you know, finish?” This question was always tinted with an embarrassed curiosity, because, though we would never admit it, we didn’t even know what that meant – to finish. Often, we lacked the language to describe the complex, beautiful, confusing, messy mechanisms of our own bodies. “Well yeah, I think? I probably did.” We settled on maybe. As I sat in my first Women, Gender and Sexuality Studies class, I was in awe that my professor spoke about the female orgasm and the female anatomy out loud. A clitoris? I have one of those? It turns out that my clitoris was discovered in 1486 by Heinrich Kramer, and again in 1545 by Charles Estienne, and in 1559 by Renaldus Columbus, and 1672 by Regnier De Graaf, and 1844 by George Ludwig Kobelt, and 1904 by Freud, and 1953 by Alfred Kinsley (Kolodny). If all of these male scientists found it, it must really exist! Only eight percent of women reliably orgasm from vaginal penetration, which means that the clitoris, and its erectile tissue and 8,000 nerve endings is often the one responsible for the female orgasm (Kolodny). So, why weren’t any of my friends speaking about the clitoris in conversations about sex? Why did I spend 8th grade health class labeling diagram upon diagram of the penis but didn’t even know the parts of my own reproductive system? Most importantly, why was no woman I knew confidently flaunting her orgasm? Only eight percent of women reliably orgasm from vaginal penetration. II. FACTS & FIGURES What I found was that in the absence of conversation, medication emerged. The inability to have an orgasm is actually a diagnosable mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSMV). While I didn’t have the language to explain my sexual experiences, I found the female orgasm tucked away in her home: sterile and non-threatening medical literature. The DSMV defines two sexual dysfunction disorders specific to women, Female Orgasmic Disorder (FOD) and Female Sexual Interest/Arousal Disorder (FSIAD). FOD is marked by a delay in, infrequency of, or absence of orgasm or reduced intensity of orgasmic sensations that persists for more than 6 months. FSIAD is defined as a lack of or significantly reduced sexual interest and arousal. These disorders are prevalent in between 10% and 42% of women. Let me repeat: up to 42% of the female population could be diagnosed with this disorder. The tricky part about the DSM definitions of female sexuality disorders is that they straddle the line between medical and social, even in the DSM – FOD and FSIAD can result from physical dysfunction or from emotional distress, stress, religious pressures, and cultural expectations (“Sexual Dysfunctions”). Since FOD and FSIAD are multifaceted and somewhat ambiguously defined and diagnosed, they have been widely ignored by physicians and society at large. Viagra commercials marketing to men with erectile function disorder are widespread, but the prevalence of erectile dysfunction in males is only 0-5%, compared to up to 42% of FOD and FSIAD in the female population (Simons). It is not just that women are not experiencing the pleasure associated with orgasms; sexuality disorders have also been linked to “lower health-related quality of life, lower general happiness and satisfaction with partners, and more frequent negative emotional states” (Parish). Almost half of the female population in the US is eligible for FOD or FSIAD diagnoses, which are shown not only to affect sexuality but also to decrease overall quality of life. With so few women having orgasms, it makes sense that so few women are talking about their orgasms. III. THERE'S A PILL FOR THAT In 2015, the FDA approved a drug for premenopausal women called Addyi, or flibanserin, known in popular media as “female Viagra.” Flibanserin was originally developed as an anti-depressant drug, and although it failed trials as an effective anti-depressant, it was found to be potentially beneficial in increasing a woman’s sexual desire. In original drug trials, the flibanserin group had an increase in sexual events as compared to the placebo group, but the flibanserin group “did not show a meaningful increase in e-Diary scores [denoting sexual desire] compared to placebo”(Sang). The FDA did not approve the drug two years in a row because the meager benefits failed to outweigh the side effects – drowsiness, vertigo, fatigue, and vomiting. After pressure from pharmaceutical companies and from feminist groups seeking gender equality in sexual dysfunction disorder treatment, the FDA approved the drug in 2015. The drug remains controversial because of its questionable effectiveness, it’s inconvenience (women have to take it every day and can’t drink alcohol), and it’s cost. The drug costs $800 per month as compared to male sexual dysfunction drugs, which cost on average $400 a month (Thomas). Still, some feminist activists argue that the pill is important because it represents equal male and female sexual dysfunction treatment. Given the complexity of sexuality and the causes of sexual dysfunction, for most women, a pill is not enough. IV. FROM THE BOTTLES TO THE BEDROOM In the United States, despite an increasing tendency to discuss sexuality in public forums, the “female orgasm remains a mystery to many people” (Evans). A recent social media article stated that 10% of U.S. women never experience orgasm, only 29% of women regularly experience orgasms, and 33-50% of women experience infrequent orgasms (Shannon). However, these statistics are only recently coming to the forefront of feminist discourse. There have been many feminist scholars tackling this issue in the past decade, an analysis of which I don’t have space to get into here – but see the end of this article for further reading. In an effort to dig a little deeper in my community, I distributed a survey to several woman-identifying WashU students about their experience with the ever-allusive female orgasm. From 20 responses, the overwhelming majority indicated that they learned about sexuality from their friends and from the media, as opposed to from sex education in schools or from their parents. Overall, the education was generally lacking, as one of the students put it: “I didn’t even know what a clitoris was until college.” In sex-ed, little was discussed regarding pleasure and instead, the focus was on shame and the dangers of having sex. One woman wrote, “Over the past couple years of college, I've been shocked to find out that a fair amount of my female friends have never had an orgasm." Another wrote, “Most of my friends, even in relationships, have never orgasmed.” Does this qualify them for the DSMV Female Orgasmic Disorder, or is there some deeper problem at play, like the fact that many women have never learned about their own sexual anatomy? Other responses talked about the stigma attached to female pleasure seeking and the invisibility of female desire in heterosexual hook-up culture. One woman wrote, “Just biologically the way sex usually happens is that it’s over after the boy comes, so it’s kind of easy to disregard the female orgasm altogether.” While all the students stated that they feel somewhat comfortable talking about their sexual experiences with friends, a striking number wrote that they are not comfortable discussing the details of sex with sexual partners, because of associated stigma. Most argued that simply medicalizing female sexual dysfunction is not enough – it is a social and cultural issue as much as a medical issue for most women. One student wrote that for many women, sexual dysfunction “is not the problem. Anatomy is. Boys and girls do not understand how to facilitate female orgasms.” "I’ve been shocked to find out that a fair amount of my female friends have never had an orgasm.” While the results of this survey represent just a small sample of women’s experiences with their sexuality and are by no means all-encompassing, they deserve some analysis. The trends in these responses are problematic. Patriarchal social norms and a profound lack of education have created a culture where women are taught to be satisfied without orgasming. As opposed to the expected male orgasm, which for one woman above signified the “biological” end of sex, the female orgasm is systematically ignored and misunderstood. Instead, the orgasm is nestled away in the DSMV waiting to be diagnosed in association with a mental illness rather than celebrated. V. GO ON, PEAK UNDER THE HOOD A pill will not teach a woman where her clitoris is, and a DSM diagnosis will not solve the decades of sexual repression or the lack of education surrounding female sexuality. Solely focusing on the medical and ignoring the complex social, cultural, and religious oppression of women’s sexuality as underlying issues leading to female sexual dysfunction is irresponsible and unsustainable. We don't talk about pleasure enough, and maybe that is because we often lack the language. Maybe we are ashamed, scared, or confused. However, in the absence of open dialogue and expression, medical institutions have monopolized the discourse surrounding female sexuality, creating a discourse about dysfunction that makes the female orgasm seem elusive, broken and unattainable. We don’t talk about pleasure enough, and maybe that is because we often lack the language. This is not to argue that medical intervention is never necessary regarding sexual dysfunction. For some women, the DSM diagnoses are appropriate and potentially life-changing. However, for many others, the problems are much more likely to be caused by a society that fails to validate female sexuality while it is hyper-focused on pleasuring men. The complexity of the interactions between religious, political, socioeconomic, and medical spaces that result in this sexual illiteracy cannot be an excuse for lack of conversation. WORKS CITED Brandon, Marianne, and Abraham Morgentaler. "Male and Female Sexual Dysfunction in a Rapidly Changing Cultural Environment: Addressing Gender Equality versus Equivalence in the Bedroom." Sexual Medicine Reviews 4.2 (2016): 96-102. Science Direct. Web. 14 Dec. 2016.<http://www.sciencedirect.com/science/article/pii/S2050052115000281>. Evans, Dayna. "Meet the Woman Who Started a Blog About Female Orgasms." The Cut. N.p., 2 Sept. 2015. Web. 15 Dec. 2016. <http://nymag.com/thecut/2015/09/how-to-make-me-come-q-a.html>. Kolodny, Carina, and Amber Genuske. “The Over-Due, Under-Told Story of the Clitoris.” Huffington Post, 18 May 2015, projects.huffingtonpost.com/projects/cliteracy/intro. McCool, Megan E. "Prevalence of Female Sexual Dysfunction Among Premenopausal Women: A Systematic Review and Meta-Analysis of Observational Studies." Sexual Medicine Reviews 4.3 (2016): 197-212. Science Direct. Web. 15 Dec. 2016. <http://www.sciencedirect.com/science/article/pii/S2050052116000810>. Parish, Sharon J. "Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment." Sexual Medicine Reviews 4.2 (2016): 103-20. Science Direct. Web. 14 Dec. 2016. <http://www.sciencedirect.com/science/article/pii/S2050052115000529>. Sang, Jae Hong, Tae-Hee Kim, and Soo Ah Kim. "Flibanserin for Treating Hypoactive Sexual Desire Disorder." Journal of Menopausal Medicine (2016): n. pag. Journal of Menopausal Medicine. 22 Apr. 2016. Web. 15 Dec. 2016. <http://e-jmm.org/DOIx.php?id=10.6118/jmm.2016.22.1.9>. "Sexual Dysfunctions." Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, n.d. Web. 15 Dec. 2016. <http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm13>. Shannon. "9 Things You Didn't Know About The Female Orgasm." Women.com. N.p., 13 Dec. 2016. Web. 14 Dec. 2016. <https://www.women.com/shannon/lists/10-things-you-didnt-know-about-the-female-orgasm?utm_source=homepage>. Shin, H., B. Min, J. Park, and H. Son. "A 10-year Interval Study to Compare the Prevalence and Risk Factors of Female Sexual Dysfunction in Korea: The Korean Internet Sexuality Survey (KISS) 2014." International Journal of Impotence Research (2016): n. pag. International Journal of Impotence Research. 8 Dec. 2016. Web. 14 Dec. 2016. <http://www.nature.com/ijir/journal/vaop/ncurrent/full/ijir201641a.html>. Simons, Jeffrey, and Michael P. Carey. "Prevalence of Sexual Dysfunctions: Results from a Decade of Research." Archives of Sexual Behavior. U.S. National Library of Medicine, Apr. 2001. Web. 15 Dec. 2016. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2426773/>. Thomas, Katie, and Gretchen Morgenson. "The Female Viagra, Undone by a Drug Maker’s Dysfunction." The New York Times. The New York Times, 09 Apr. 2016. Web. 15 Dec. 2016. <http://www.nytimes.com/2016/04/10/business/female-viagra-addyi-valeant-dysfunction.html>. |