Written by Cathleen Finlay

It’s the seven words that all men dread: “Not tonight honey, I have a headache.”
The international phrase for a woman’s low libido is now in the middle of an international controversy.
The four categories of Female Sexual Dysfunction (FSD) have been labelled: decreased sexual drive/libido, female arousal disorder, female orgasm disorder, and pain during intercourse.
FSD has been dubbed fact by some, and invention by others. But how can a dysfunction, recognized by medical physicians, be deemed false?
Leonore Tiefer is a clinical associate professor of psychiatry at New York University’s School of Medicine and the Albert Einstein College of Medicine. She is also the founder of the New View Campaign, which opposes the recent medicalization of sexuality that has helped pharmaceutical companies sell drugs to millions of Americans every year.
“FSD as a medical disease? No. It doesn’t exist,” said Dr. Tiefer in a phone interview from her office in New York. “There are a lot of lies and misinformation out there.”
Dr. Tiefer views the recently defined dysfunction as part of the newest trend in medicine today.
“[It’s about] disease mongering. It’s about marketing – the marketing of attitudes and diseases,” she said. “The marketing of models of sexuality are a part of the marketing of drugs and treatments.”
Disease mongering includes the widening of the definition of illness and disease to allow pharmaceutical companies to profit off the ‘cures’ for new sicknesses. There needs to be a disease in order to necessitate a drug to cure it.
The masses accept medicalization, according to Dr. Tiefer, because it promises fast, simple, and expert solutions to sexual difficulties.
“There are a lot of interesting books to read about sexuality,” said Dr. Tiefer. “Don’t go to a doctor – go to a bookstore. I think women have sexual difficulties, but dysfunction? No.”
The question of sexual ‘dysfunction’ versus ‘difficulty’ has not been ignored by physicians who treat FSD.
“I think the word dysfunction is terrible. That’s really a misnomer,” said Dr. James Clark, a physician who runs the Central Florida Female Sexual Dysfunction clinic. “I think the reality, in better words, is female sexual difficulties or female sexual problems.”
But Dr. Clark’s discomfort with the term dysfunction does not mean that he doesn’t embrace medical treatment for FSD.
“It’s a very common issue for young women to have pain with intercourse,” he said. “There are medications that can help relieve painful intercourse, especially for those that have pain upon insertion, which is another type of painful intercourse.
“There are so many different treatments, depending on which of the four categories the problem [is in],” he continued. “Often, there’s overlap – it’s more than just one of the four categories. So, the treatments are as extensive as the reasons and the diagnoses behind them.”
One of the most contentious aspects to the debate on FSD is the validity of the statistics on American women who suffer from the dysfunction.
Dr. Clark’s website claims that 43 per cent of women in America suffer from FSD. When asked where this statistic came from, Dr. Clark cited a 1999 study done by Edward O. Laumann et al., published in the Journal of the American Medical Association (JAMA).
Tiefer scoffed at Clark’s choice of proof.
“[The study was a] re-analysis of sociological data from 1994,” commented Dr. Tiefer on the 1999 study (referred to as the JAMA paper). “It is completely fraudulent as health data.
“One of the authors of the JAMA paper has been quoted as regretting the widespread publicity of the study. He had no idea it would be used in this way,” said Dr. Tiefer. “The reiteration of that 43 per cent figure signifies a lack of concern with academic rigour.”
The second study cited by Dr. Clark is the 2008 PRESIDE study by Jan Shifren, published in Obstetrics and Gynaecology which found that 44 per cent of women “reported experiencing a sexual problem of some kind.”
The study also concluded that of the 44 per cent, only 12 per cent said that they had problems that caused them distress.
“[Shifren] went one step further, and this is kind of important,” said Dr. Clark. “Of the 44 per cent of women, only about a quarter of them are disturbed by the sexual dysfunction. It’s not that 44 per cent have a real bothersome problem; probably it’s only 10 or 12 per cent.
“[A woman] may not get orgasms, but if they don’t have a partner, and they’re staying at home knitting sweaters, it really doesn’t matter,” added Dr. Clark.
Another issue that has been raised is the role of pharmaceutical funding in research, such as the PRESIDE study, which was funded by pharmaceutical company Boehringer Ingelheim.
Studies (like the 2003 BMJ paper by Joel Lexchin et al.) have shown that a bias favours products that are made by the company funding the research.
“The problem is in the real world, if we don’t have pharmaceutical companies funding these studies, most studies won’t get done,” insisted Dr. Clark. “Because that’s the only place the money comes from.
“So there won’t be any medical breakthroughs or any research, because the National Institute of Health or any government organizations don’t have the money anymore to fund this kind of research.”
It is statements like this that has led Dr. Tiefer to believe that “Sexuality has been hijacked by pharmaceutical companies.”
Ideas about the ‘normal’ sexual functioning of women have always been in flux according to University of Guelph History professor Linda Mahood.
“In the Victorian era, women who showed overt sexuality were seen as suffering from female insanity which could lead to incarceration or institutionalization,” said Dr. Mahood.
Is FSD a medical dysfunction? Does the existence of FSD open the floodgates for pharmaceutical companies to create the next Viagra for women? Or does the invention of this disease signify new social ideas surrounding ‘normal’ female sexuality?