Female Sexual Dysfunction

Sunday Sequel

2007-03-11T12:40:00.000-04:00

A few weeks ago, I mentioned learning about a clinical trial for a new FSD treatment.

I've found a bit more information.

According to ClinicalTrials.gov, it's a Phase III trial on an antidepressant called flibanserin which has shown some efficacy against female sexual disorder in early testing.

Aside: ClinicalTrials.gov is a really great site, allowing you to find any current or scheduled clinical trial by condition and/or geographical area, among other criteria.

Just as Viagra was originally tested as a heart medication that showed positive sexual side-effects, flibanserin

BusinessWeek has a more detailed account of the drug development history in relatively plain language.

For those with a more technical bent, Wikipedia has the chemical formula and a molecular diagram.

And if anyone has access to Medline articles, you can read further on the pharmacology of flibanserin.

At any rate, the clinical trials will be taking place all over the country.

If you're interested, check out the eligibility requirements to see if you qualify and get on the horn.

I'm not certain I'll apply even if I do qualify. Given the hormonal nature of my problems, I doubt I'll find relief from any nonhormonal treatment. While that may be of good benefit for science (showing that one-size doesn't fit all), I don't know if I want to waste that much of my time pursuing a treatment I don't think will work.

Stuck inside some wacky Broadway nightmare

2007-02-27T22:25:00.000-05:00

Okay, just read the Chicago Tribune article that inspired Broadsheet's piece.

Much more informative.

A few excerpts:

To get an idea of just how much remains unknown about an area that directly affects most people's lives, you need to drop in on the International Society for the Study of Women's Sexual Health.
...
Although social scientists have been studying women's sexuality for decades, medical science did not become interested until the advent of Viagra in the late 1990s raised the possibility that female sexual problems might be treated by medication.
...
The main session on Saturday morning was devoted to the topic, "What Is Sexual Desire and How Do We Know?"

Dr. Stephen Levine, a psychiatrist from Case Western Reserve University, argued that sexual desire feels a lot like sexual arousal, even though diagnostic guidelines distinguish between hypoactive sexual-desire disorder and female sexual-arousal disorder -- and researchers recruit patients suffering from one or the other for separate clinical trials of new drugs.

"Science must measure," Levine said, "so we measure how many times the patient said she had sexual thoughts or desired sex in the last four weeks. But we don't know what we're measuring."

To some members of the society, fearing that women's sexual complaints are being turned into medical illnesses for the convenience of doctors and the economic benefit of Big Pharma, that admission was a breath of fresh air.

"I think it's progress that we can spend two hours in this performance-driven society admitting that maybe we don't know what we're talking about," said Ellen Laan, a psychophysiologist from the University of Amsterdam.

Michael Sand, a sexologist who works in Germany, agreed.

"We don't understand normative, healthy sexuality well enough to make judgments about what's dysfunctional."

Since the 1960s, researchers have operated under a variation of the simple model proposed by William Masters and Virginia Johnson that says the human sexual response starts with desire, progresses through excitement or arousal and ends with orgasm. But experts argued that notion might reflect the experience of men more than women, many of whom don't see orgasm as a goal.

In recent years the field has moved toward a more complicated model based on the observation that many women go into a sexual encounter without being in the mood--perhaps they're seeking intimacy or hoping to please their partner--and may not really want sex until after they become aroused.

But it wasn't until very recently that anyone thought to test those theories by asking women.

Sand, who was awarded a prize for his innovative research, found that 57 percent of women felt a straightforward model best described their sexual experience. The 29 percent who endorsed the more complicated model were more likely to have sexual problems.

That made sense, Sand said, because Masters and Johnson recruited couples who liked sex a lot, while the more complicated model was based on the experiences of women with sexual complaints.

"We need to go back to the drawing board and come up with models that explain why some women have different sexual experiences, find out which models fit which women, so we can serve women more effectively when they have sexual concerns," Sand said.

Now, that's what I call science.

And it's a whole lot better -- and more promising -- than the way Broadsheet reported it.

I wonder which version is getting more links from the blogosphere... I should probably start searching to see who's posting misinformation that needs debunking, but I'm rather tired at the moment.

Sigh-ence

2007-02-27T22:08:00.000-05:00

Salon's Broadsheet is reporting on the science of women's sexuality:

Sex scientists stumped by women
Experts conclude: "Maybe we don't know what we're talking about."

Looking for signs of life on other planets seems a simple task in comparison with sex scientists' attempt to understand the inner workings of the Venus-born species. They're stumped and admitted as much during the sixth annual meeting of the International Society for the Study of Women's Sexual Health.

In fairness, their mission has faced a major setback: The subject of women's sexuality was largely restricted to the social sciences until Viagra hit the market in the late '90s, sparking interest in a similar drug for women, according to the Chicago Tribune. Despite medical interest, no drugs have been approved for treating female sexual dysfunction, which scientists aren't even sure exists. Of course, the downside to women's sexual lives being promoted to the medical sphere is the risk that their sexual complaints could be be medicalized and seized upon by Big Pharma. After all, as sexologist Michael Sand told the Tribune, "We don't understand normative, healthy sexuality well enough to make judgments about what's dysfunctional."

One of the greatest mysteries -- to scientists and inexperienced Romeos alike -- is the process of female sexual arousal. According to one of the governing models, it "starts with desire, progresses through excitement or arousal and ends with orgasm." Sand received a prize for his research on female sexuality, which, unusually, factored in women's accounts of their own sexual responses. He found that 57 percent of women identified with this previous model, while 29 percent reported that they sometimes start a sexual encounter before desire even registers.

But here's the interesting -- if not surprising -- finding: Women who reported this somewhat backward approach to sex (summoning desire in midact) were also more likely to report sexual problems. "We need to go back to the drawing board and come up with models that explain why some women have different sexual experiences, find out which models fit which women, so we can serve women more effectively when they have sexual concerns," Sand said.

Other interesting news from the meeting: There's a nasal spray in development for postmenopausal women that may increase sexual desire; the antidepressant bupropion has proved to improve menopausal women's sex lives; and a study found that physically active women report better orgasms. Still, gather a cross-disciplinary group of more than 300 experts in the field of women's sexuality and the general consensus seems to be, as psychophysiologist Ellen Laan put it, "maybe we don't know what we're talking about."

In other words, not much new under the sun (at least in the popular press) since I became involved in FSD from a patients' perspective five years ago.

The letters are just more of the same:

“female sexual dysfunction (as far as a viagra equivilant goes) was cured in I belive the 1970's with the invention of Atroglide”
[By that logic, taping a couple popsicle sticks to the penis cures impotence.]
“it's not their bodies or brains that are the problem, but their socialization and/or powerlessness in a relationship? Or...gasp...the (un)desirability of their partner”
[Should all impotence sufferers also blame their partners?]

One person blames feminism, another blames the patriarchy. Neither of which are much help in achieving an orgasm now. At least one person is on the right track, questioning the role of hormones and the birth control pill, but most letters seem to be written out of ignorant prejudice.

I finally got fed up enough to respond when I saw this absolute declaration:

A creative, open minded, uninhibited woman who eats healthy and is not afraid of being assertive does not have sexual problems, I can guarantee it!

I wish I knew what kind of guarantee this guy was promising, but I decided to void it anyway.

I haven't written many letters to Salon; I hope they don't delete mine for violation of their antispam policy, because I included the URL to my dedicated FSD page.

Which, if you're interested in actual information on the subject, I recommend reading.

Love Train

2007-02-15T23:05:00.000-05:00

Those who read the comments to my last post will have noticed that Ian got the car freed just in time to watch the train pulling away, a trip which took me nearly two hours to reach work.

I could curse the timing, but I'm going to think of it as fate, providence, kismet, Gd's will... call it what you like.

You see, if I hadn't been riding the train, I never would've picked up the Metro.

And if I hadn't picked up the Metro, I wouldn't've seen that advertisement from BostonTrials.com seeking voluneers for a medical research study on a possible medication for Hypoactive Desire Disorder.

Cube walls are so thin, that even though I'm open about FSD on my blog, I feel weird talking to somebody about it over the phone during business hours.

But I've sent them an email, describing my background and including a link to my FSD page where I describe my medical history.

I'll confess, since Dr. Goldstein left BUMC, I haven't been doing anything about my FSD -- much to Ian's frustration. Maybe during this break, the medical science will finally have gotten ahead of my condition.

Wish me luck!

Painless pelvics?

2006-10-18T19:50:00.000-04:00

For any women suffering from vulvar vestibulitis who find gyn exams painful, I had an idea after today's annual physical.

See if you can't get some topical anesthetic applied to the painful spots before the doctor starts in with the speculum.

If you do follow this course of action, let me know how it goes.

Alas, I only thought of this after my pap smear was finished, but you can bet that I'll be requesting this for next year's appointment...

Kill Pill?

2006-03-20T17:50:00.000-05:00

This morning's Salon includes an article on The battle to ban birth control.

It documents how activists have “pressured insurance companies to refuse coverage of contraception, lobbied for 'conscience clause' laws to protect pharmacists from having to dispense birth control, and are redefining the very meaning of pregnancy to classify certain contraceptive methods as abortion.”

Scary stuff.

For those who are pro-choice, the idea of fighting to ban both abortion and contraception seems contradictory: Contraception, after all, lessens the number of abortions. But once one understands what the true social and moral agenda of activists like [Mary, founder of No Room for Contraception,] Worthington is, and their attitude toward sexuality, the contradictions vanish. For them, sex should always be about procreation; since contraception prevents conception, it is immoral. At a deeper level, they believe that women's biological destiny is to be mothers.

[Former president of Planned Parenthood, Mary] Feldt says, "When you peel back the layers of the anti-choice motivation, it always comes back to two things: What is the nature and purpose of human sexuality? And second, what is the role of women in the world?" Sex and the role of women are inextricably linked, because "if you can separate sex from procreation, you have given women the ability to participate in society on an equal basis with men."

[... Author and vice president of the Institute for Reproductive Health Access at NARAL Pro-Choice New York, Cristina] Page says she has noticed, too, that some anti-choice groups tend not only to oppose birth control, they also oppose child care. In her book she points to some troubling statistics and anecdotes [...] "The trifecta is ban contraception, ban abortion, make child care impossible," says Page.

The movement has been laying the groundwork for years and is finally starting to move their rhetoric into the mainstream, just as abortion rights are under attack.

One issue I feel I need to address:

In order to support the idea that contraception is dangerous, Worthington publishes articles on the site that take qualified language from scientific studies and distort their conclusions. [...] Finding these inconsistencies requires digging below the surface of the site -- on the face of it, Worthington presents her cases persuasively, and couches her arguments in the rhetoric of women's empowerment rather than that of morality. In another piece, titled "Chemical contraceptives kill her sex drive," she takes as her starting point a January 2006 study in the Journal of Sexual Medicine about the relationship between the birth-control pill and sexual desire. Worthington notes that "the conclusion of the study states that while there is a link between chemical contraceptives and a decreased sex drive, more evidence is needed for an accurate correlation to be seen." But then she blithely continues: "If The Pill is causing such trauma and stress in the lives of women, why is it promoted as the be-all, end-all for worry-free sexual relations?"

Worthington goes on to conclude: "Because of the use of hormonal contraceptives, men are equipped with the means to abuse women."

When asked to clarify that statement, she replied, "Chemical contraceptives are promoted as a means by which a couple can have sex all the time with no worries, but how can you expect a woman to have sex if the man is making her take a pill that decreases her sex drive?"

Chip Berlet [of Political Research Associates, a progressive think tank that tracks campaigns meant to curb human rights] calls this kind of explanation "faux feminist rhetoric": "It ... changes the appearance of what side you're on." Indeed, if you ignore their ultimate conclusion that birth control should be eradicated altogether, many of Worthington's arguments look a lot like feminist arguments. Concerns about the correlation between sex drive and the pill have been raised by pro-choicers, too, and on Worthington's blog is a startling post railing about how unfair it is that a male birth-control pill will probably never exist because men don't want to risk impotence, and women are expected to handle their side effects in stride. Take out the phrase "morally offensive" in relation to contraception in general, and there's not much in the argument for a pro-choice feminist to disagree with.

Frances Kissling, president of Catholics for a Free Choice, points out that there is a conscious effort to appeal to that "segment of the women's health movement who are suspicious of chemicals and IUDs and want to lead a natural life."

Speaking as someone who does blame oral contraceptives for my sexual dysfunctions^*, I totally disagree with Worthington's assertions that the Pill somehow subjugates women, and I most adamantly do not advocate further restrictions on hormonal contraception.

Personally, I believe that we should not reduce current oversight -- I do not want to see oral contraceptives available over-the-counter until more research has done. We need more education of patients and doctors, but I see no reason for these kinds of scare tactics.

Women obtaining hormonal contraceptions should be warned to monitor their libido and to see their doctors if they notice any changes, so they can switch prescriptions to a brand with fewer side effects. Ideally, I'd like to see women on hormonal contraception receive regular hormonal blood tests to make sure nothing's going sour.

Meanwhile, I want more research, so we can understand what's really going on physiologically. And hopefully that will lead to new contraceptive formulations, possibly with supplemental testosterone or other compensatory factors to forestall problems in those who may be prone to them.

Anyway, during during the Roberts and Alito hearings, many people pointed out that this isn't just about Roe v. Wade, but also Griswold v. Connecticut. So now that they've won that Court battle, they're coming out of the woodwork.

And I just don't recognize the world they're advocating as American.

^* Other posts about female sexual dyfunction:

Older posts:
- Spring/Summer 1998: Impotence and Inequities
- July 2003: Ian summarizes a lecture from the BUMC Institute for Sexual Medicine
- November 2003: My account of a seminar on FSD
- November 2003: Early research on the risks of oral contraceptives
- June 2005: A study about the risks of hormonal contraception
- June 2005: My personal history with FSD and the Pill
FSD Week, November 2005:
- November 15: The post that started it all
- November 15: A what-if regarding Viagra and male sexual dysfunction
- November 16: An egregious article in Ms. Magazine and my letter to the editors
- November 16: Links to my historical posts and some external sites (all linked above in this post)
- November 17: A lengthy rant countering common myths and misinformation
- November 18: I take on Dr. Leonore Tiefer (major anti-FSD advocate) and Our Bodies, Ourselves
- November 18: The World Health Organization's statement on sexual health
- November 19: Final words, with further references
More recent posts:
- December 2005: Rebuttal to a comment at I Blame the Patriarchy
- January 2006: Initial response to the Journal of Sexual Medicine study on the Pill

Pill, book and candle

2006-01-05T23:42:00.000-05:00

A new study on female sexual dysfunction has just been released, describing how some women experience long-term sexual side effects after discontinuing the birth control pill:

Impact of Oral Contraceptives on Sex Hormone-Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction.
Panzer C, Wise S, Fantini G, Kang D, Munarriz R, Guay A & Goldstein I. Journal of Sexual Medicine 3 (1), 104-113.

I do intend to write about this in more detail, but first I want to get ahold of the full text article, rather than relying on the abstract, press releases, and the mainstream media's attempts to digest it for laypeople.

At first glance, this appears to be the same study I blogged in June from the endocrinology conference (press release). But six months ago, the story received barely any notice.

This time it finally appears to be making some headway in the American mainstream media. Google News shows coverage from CNN, ABC, CBS and FOXNews, among other sites. And, with news coverage comes lots of blog posts, with varying degrees of accuracy.

Naturally, there's a lot of skepticism. People don't want to believe this could possibly be true. As I wrote in November 2003 when I first started hearing the actual research:

So many abstinence-only groups exaggerate the failure rates and risks of contraception in order to push their political agendas, it feels like conceding any ill-effects to contraception gives the anti-sex-ed forces further ammo.

But I can't deny that my own sexual dysfunctions began a few months after I began taking the birth control pill. When my sex life went sour, I scrutinized that period in my life looking for any possible cause or correlation, and the Pill stood out as the most plausible culprit. [More details on my sexual history.] And the more science is learning about women's sexual physiology, the more they're finding how the Pill dampens the necessary hormones.

In the meantime, my archive has plenty more information on female sexual dysfunction (FSD), including earlier studies relating to the Pill. If you have further questions I'm capable of answering (I am not a doctor!), feel free to ask.

PS: Rob Brezsny intends his horoscopes as self-fulfilling prophecies, an exercise in the power of positive thinking. Needless to say, I find myself particularly amused by this week's horoscope, which I saw before hearing about the study:

There's no delicate way to say this, so please stop reading and come back next week if you're offended by graphic references to pleasure. According to my analysis of the long-term astrological omens, you're on tap to experience more orgasms in 2006 than you have in any previous year. On average, your climaxes are also likely to be longer and more intense. Other varieties of bliss, rapture, and joy will probably occur at record levels, as well. Think you can handle it?

'Twould be nice...

Lather, rinse, repeat

2005-12-23T19:35:00.000-05:00

Flipping through the latest Carnival of Feminists, I discover I Blame the Patriarchy.

Her most recent post, a roundup of several unrelated stories, includes this gem:

Meanwhile, since decrepit old Viagra devotees are all dicked up with nowhere to go, research for a sexbot pill for women who aren’t wild enough carries on at a frenzied pace. Note that the sexpackets for women address “lack of desire,” which, in our pornsick society, is interpreted as an illness, but which is actually a completely normal expression of disinterest in being used as a submissive receptacle. If you need a quaalude to fuck him, girls, fucking dump him.

Sigh...

I can't tell whether I'm more annoyed at the attitude that FSD doesn't exist or the insults against my husband and the other supportive guys who stick around and suffer alongside us.

You know, though it wasn't always easy outing myself, on the whole I think it's a positive.

Among other things, it means I can just post a comment or send the blogger an email pointing to that week's archives rather than having to write a whole educational diatribe from scratch.

Anyway, if you see anybody who needs firsthand information on female sexual dysfunction, send 'em to http://www.osmond-riba.org/lis/journal/2005_11_13_j_archive.htm. Consider it an open invitation for an education.

Because, sadly, I don't think the issue is going away...

Final words on FSD (for now)

2005-11-19T23:40:00.000-05:00

So, as Saturday night is winding down, I think it's time to call an end to what I'm calling my FSD week. For easier access, I'm including a quick index of all my entries on FSD.

Keep in mind, I'm not a medical professional: just a well-informed patient who has been educating herself as best she can.
So here are a few resources for further information:

• I'll confess that I haven't personally read this work, but I have an extremely good feeling about For women only: a revolutionary guide to reclaiming your sex life by Jennifer and Laura Berman. The authors are a physician and psychologist, and together used to work in the BUMC Center for Sexual Medicine, before setting out to establish their own clinic.

• Dr. Irwin Goldstein has his own site, with separate information sections geared towards patients and more technical information for doctors.

• The Women's Sexual Health Foundation has several information pamphlets geared towards patients, including advice on talking to your doctor about sexual difficulties.

[If you know of other books/sites worth recommending, please share them in the comments.]

A certain amount of thanks to Pseudo-Adrienne whose posts at Alas, a blog and Our word inspired me to such heights of eloquence and depths of rantage this week.

Index of posts:

Older posts:
Spring/Summer 1998: Impotence and Inequities

July 2003: Ian summarizes a lecture from the BUMC Institute for Sexual Medicine

November 2003: My account of a seminar on FSD

November 2003: Early research on the risks of oral contraceptives

June 2005: A study about the risks of hormonal contraception

June 2005: My personal history with FSD

On this page:
November 15: the post that started it all, in response to Pseudo-Adrianne

November 15: A what-if regarding Viagra and male sexual dysfunction

November 16: An egregious article in Ms. Magazine and my letter to the editors

November 16: Links to my historical posts and some external sites (all linked above in this post)

November 17: A lengthy rant countering common myths and misinformation

November 18: I take on Dr. Leonore Tiefer (major anti-FSD advocate) and Our Bodies, Ourselves

November 18: The World Health Organization's statement on sexual health

Finally, as I mentioned in an earlier post, all the top hits when Googling "feminist and FSD" or "feminist and sexual dysfunction" are from the anti-FSD contingent. This page of my blog is actually within the top 100, but fairly low on the page.

I don't normally ask this, but if a few more of you would be willing to link to this week's archive using those keywords... well, at least that way other sufferers searching for help can more easily get this point of view as well for a more balanced picture.

Just sign me:
A feminist on female sexual dysfunction (FSD)

And thanks.

Female Sexual Dysfunction: A Truly Feminist Viewpoint

2005-11-18T19:10:00.000-05:00

So, now I've publically attacked two major feminist institutions, Ms. Magazine and Our Bodies, Ourselves, over their incomplete and one-sided coverage of female sexual disorders.

I'm just going to take a step back for a moment and see if we can't build some consensus.

The World Health Organization has released a statement on sexual health:

“Since health is a fundamental human right,
so must sexual health also be a basic human right.”

I wonder if everyone reading this, if everyone who calls themselves a feminist, can at least support this statement, whether or not we agree over the role being played by the medical establishment or drug companies or societal pressures or anything else.

If we can at least come together to find agreement in this most basic statement of principle, that gives us a certain amount of reassurance that we're all on the same side, even if we disagree about the means of achieving it.

WHO provides further elaboration with some working definitions:

Sexual health is a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.
Sexual rights embrace human rights that are already recognized in national laws, international human rights documents and other consensus documents. These include the right of all persons, free of coercion, discrimination and violence, to:
the highest attainable standard of health in relation to sexuality, including access to sexual and reproductive health care services;
seek, receive and impart information in relation to sexuality;
sexuality education;
respect for bodily integrity;
choice of partner;
decide to be sexually active or not;
consensual sexual relations;
consensual marriage;
decide whether or not, and when to have children; and
pursue a satisfying, safe and pleasurable sexual life.
The responsible exercise of human rights requires that all persons respect the rights of others.

All in favor?

Anyone opposed?

More feminists against FSD

2005-11-18T07:05:00.000-05:00

I've got to stop searching the web for further feminist commentary on female sexual dysfunction. Supportive messages are few and far between, while most of what I find renders me inarticulate with rage. [It took me a while to decide whether to actually link to these sites and give them further attention/GoogleRank.]

The central locus of much of the anti-FSD crusade appears to be Dr. Leonore Tiefer, who runs a website called FSD Alert (fsd-alert.org). Considering her website's subtitle is "A New Medical Myth," it's pretty obvious where she stands on the issue. She's quoted in most of the articles I find that are critical of FSD, and even when she's not named, many of the arguments that incite me to rant parrot her claims.

Given how much of her rhetoric is rooted in the notion that the definition and treatment of FSD is all about profits, I should point out that Dr. Tiefer a psychologist and sex therapist. In other words, if women can find cures through medical means, it directly hurts her pocketbook. So her motives are just as compromised as those she criticizes. [You see? Two can play that game. I'm just a patient. My primary goal is obtaining treatment by whatever method works.]

Going back to that FSD creation myth one more time, a Good Vibrations article provides some necessary context these critics are missing:

In October 1998, the city of Boston hosted the first international consensus development conference on female sexual dysfunction. This meeting was made up of physicians chosen by the American Foundation for Urologic Disease, and came to the conclusion that female sexual dysfunction was a legitimate, diagnosable psychiatric condition. The year 1998 just happens to be the year Viagra (sildenafil) was approved for treatment of erectile dysfunction in men.
According to Irwin Goldstein, MD, who chaired three later meetings in 1999 and 2000 to further define and establish appropriate treatment for FSD, putting it more or less in the same camp as the granddaddy of all male sexual problems -- erectile dysfunction. As Goldstein, a Professor of Urology and Gynecology at Boston University School of Medicine, told womensenews.com, "Erectile dysfunction is a medical condition. You need to have women's sex problems in some context." Goldstein believes that a number of factors have led to the explosion in female sexual dysfunction, including childbirth and hysterectomy procedures that damage sexual nerves.

Since the announcement that FSD is a psychiatric disorder, many feminist writers have criticized Goldstein and the pharmaceutical industry -- which had financial ties with the majority of physicians at the conference -- for trying to profit by creating a new disorder which can potentially be treated by expensive drugs -- á la Viagra.

The problem is that pharmaceutical and medical device companies are not able to begin clinical trials and seek approval from the FDA for treatment of disorders that don't exist. Until FSD was established as a psychiatric or medical condition, no treatment could be sought by these industries.

Got that last bit?

[Along similar lines and at the other end of the spectrum, having a name for the condition also seems to make insurers more amenable to reimbursing patients for our expenses.]

Although I don't agree with everything in the Good Vibes article (hey, they've got a business to protect, too), a few other good lines are worth quoting:

We live in a world profoundly changed by generations of female sexual explorers, who have made it safe for a woman to walk into her doctor's office and say "Damn it, Doc, I'm not having enough orgasms. Do something!" But those women aren't getting much of the credit. The good news is that women who want sexual pleasure are perceived as a strong enough market that the medical community would want to market products and services to them. That has to be a good thing, since not too long ago it was a widely held belief that women didn't want or enjoy sex. Clearly doctors, male and female, now understand that women do want sex, and in fact will go to great lengths to get it.

When a woman walks into a doctor's office and describes the symptoms of FSD, she has as much right to receive appropriate treatment as she would if she had the measles.

Assuming that enlightened physicians diagnose FSD based on the patient's appetite for a satisfying sex life, rather than some arbitrary 1970s-era list of how many orgasms Helen Gurley Brown thinks a girl ought to have, what FSD boils down to is a patient's self-reported lack of sexual satisfaction, caused by anything.

Now, that last quote isn't entirely accurate, given (a) the various subcategories of dysfunction which I listed in my previous post, and (b) that crucial clause in most of the definitions “which causes personal distress.” It's like the legal definitions of disability, in which the impairment must "substantially limit ... major life activities." My problem goes far beyond mere dissatisfaction.

Humor break!
Rocky: "We're supposed to help damsels in distress."
Bullwinkle: "Hey, lady, are you in distress?"
Natasha: "Dis dress, dat dress, who cares? I'm distraught."
Bullwinkle: "Do we help damsels in distraught?"

One last point I wish to make about the positive side to assigning labels.

Sexuality -- particularly one's own sex life -- is a tough subject to discuss. Blogging makes it easier, since I'm sitting here at my computer and we're not face to face. But since I've opened up, because I've outed myself, other women have come to me to talk about their own problems.

And having clinical terminology makes these conversations easier. We don't have to get into embarrassing specifics about our intimate lives unless we feel it's necessary for understanding. And so what if the same disorder may have different root causes and require different treatments? The shared experience of dealing with similar symptoms still gives us a commonality to bond over!

But I digress. I intended to write about anti-FSD rhetoric from otherwise feminist sources.

Sadly, the latest edition of Our Bodies, Ourselves appears to be a major offender, parrotting the usual spin that doctors and pharmaceutical companies are trying to profit by creating problems out of otherwise normal variations. [At least the new version mentions the Pill can induce desire problems. That was totally absent in previous editions, much to my detriment.]

You can see for yourself in their companion content to their chapter on Sexuality, which they have the nerve to call Female Sexual Dysfunction: A Feminist View.

Hell, I'll just quote 'em directly:

Female Sexual Dysfunction: A Feminist View

Many of us have strong ideas about how much desire we think we "should" have. Movies, television shows and magazines often portray women as highly sexual. Drug companies and the popular media capitalize on these images and bombard us with messages about how to increase our sexual appetites. While these portrayals are accurate for some of us, they represent only a narrow slice of the wide range of women's experiences. Paradoxically, while desire is supposed to be invisible in girls, pharmaceutical companies (and medical researchers often hired by those companies) have begun to define low sexual desire in women as a medical disorder deserving of medical treatment. Yet what they label a disorder may, in fact, be a variation in sexual desire.

We've posted several articles that explore the issue in-depth. A New View of Women's Sexual Problems explains the limitations of the medical women's sexual problems, while Feminists Fight Drug Companies Over Vision of Women's Sexuality explores one woman's attempt to understand how and why drug companies pathologize women's sexualiy. Also check out The Making of a Disease: Female Sexual Dysfunction an indepth article from the British Medical Journal. (2003-- free) and The Marketing of a Disease: Female Sexual Dysfunction (2005 -- available for a fee) and the website www.fsd-alert.org.

<sarcasm> Isn't that a helpful, balanced overview of the issue? Notice anything missing? Growl...

I've already sent the Boston Women's Health Book Collective an email complaining about their coverage and requesting they strongly consider posting something from an alternate viewpoint as a counterpoint.

Still, they're headquartered in Boston, which has been the Hub of the fucking Universe as far as FSD research is concerned! Dr. Goldstein, the Berman sisters, the Center for Sexual Medicine all got their start in the Boston area, and have never been shy about educating anyone interested in learning more. So how did OBOS manage to completely miss it all!?!

As I understand it, BWHBC and OBOS were founded out of a desire for women to take control of their health into their own hands and out of a patriarchal medical system that ignored women's needs.

And now they're trying to recast the history of female sexual disorder research into that same mold.

Well, guess what. The acknowledgement of FSD as a disorder is exactly the kind of thing that BWHBC was working towards. It's a victory by angry frustrated women demanding of doctors and drug companies that "this is a problem" so loudly that the industry was forced to respond. We've spent years agitating for recognition that therapy isn't always the answer, and fighting for equivalent options as have long been available for men.

And then along comes Our Bodies, Ourselves telling its readers to "resist the attempt to medicalize sexual desire." [Bottom of page 191; you can read it through Amazon's Search Inside feature. Look for the mention of "Tiefer."]

Once again, it leaves me speechless, because everything I want to say right now sounds gratuitously and unhelpfully nasty to women whom I'm sure meant well.

We're not living in 1955 any more, when Valium was apparently handed out like candy to unhappy housewives. This is 2005. I am nobody's victim and I really hate this kind of disempowered portrayal.

In the meantime, I feel extremely sorry (and worried) for any women with FSDs who rely upon OBOS for medical information, and hope for their readers' sakes the BWHBC will correct it quickly.

Get your rant on

2005-11-17T20:15:00.000-05:00

This is a rant, full of anger and emotions and opinion. If you want solid facts about female sexual dysfunction (FSD), I suggest you jump to yesterday's post where I provide a few links on the current state of medical science.

For someone usually so... dispassionate, I find some of the rhetoric bandied about critical of FSDs infuriating. That's what rendered me incoherent last night. I'm going to try again to address some of the misinformation I'm seeing around the web.

What's most frustrating, is when I confront people in online discussions who claim that FSD is a myth by saying "I have FSD, I can show you the lab results to prove it, what are your questions?" they always seem to just disappear into the mists. Folks are perfectly happy making gross generalizations and spewing rumor, but when called on it by someone with personal experience, I feel like I'm addressing a roomful of crickets. No apologies, no justification of what they wrote before, no requests for further clarification. Just silence. Makes me wonder whether they're actually reading and learning from what I wrote, or if these same people will continue to spew the same tripe in the future. [Some comments may come from flyby's, but you'd think the person who blogged the original comment might have something to say.]

At any rate, to get some of this off my chest, here are a few of the myths and misconceptions I hear repeatedly in these discussions, with my response. To protect the guilty, I won't quote anybody directly, but I'll do my best to convey the tone in which these remarks are made.

“The definition of female sexual dysfunction is too vague. It's a catchall that will be used to stigmatize normal women.”

I suppose folks could get that perception if they only read the few sensational stories that reach the mainstream press. But the mainstream media in general does a pretty poor job reporting on complex medical issues, and sexuality is a particularly difficult topic. By the time it's been simplified for the lay-audience, accuracy gets sacrificed, so I would never take such reporting at face-value without checking against more scientific/technical publications.

Anyway, Female Sexual Dysfunction is an umbrella term encompassing several different disorders. Patients may experience only one of these or may suffer from multiple problems. Here are some brief definitions of the current subcategories:

• Hypoactive Sexual Desire Disorder (HSDD):
Persistent or recurrent deficiency and/or absence of sexual fanatasies/thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal distress.

• Sexual Aversion Disorder:
Persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress.

• Sexual Arousal Disorder (FSAD):
Persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress. It may be expressed as a lack of subjective excitement, or a lack of genital lubrication, or swelling, or other somatic responses.

• Persistent Sexual Arousal Syndrome (PSAS):
A subclassification of female sexual arousal disorder, PSAS is defined as feelings of spontaneous, persistent and intense genital arousal with or without orgasm, with or without genital engorgement, in the absence of sexual desire.
(Read more information about PSAS; Read personal experiences of women with PSAS)

• Orgasmic Disorder:
Persistent or recurrent difficulty, delay in or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress.

• Sexual Pain Disorders:

• Dyspareunia:
Recurrent or consistent genital pain associated with genital intercourse.

• Vaginismus:
Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration which causes personal distress.

• Non-Coital Sexual Pain Disorder:
Recurrent of persistent genital pain induced by non-coital sexual stimulation.

(Read more information about pain disorders)

• Female Androgen Insufficiency Syndrome:
A pattern of clinical symptoms in the presence of decreased bioavailable testosterone and normal estrogen status. Free testosterone values should be at or below the lowest quartile of the normal range. (clinical symptoms)

Is that more clear? Seem reasonable?

And notice that repeated phrase "causes personal distress." If the woman doesn't have a problem with her situation, then it's not FSD. Nobody's talking about drugging unwilling women into compliant Stepford wives.

“Drug companies are manufacturing problems to make money off women's insecurities”

In other words: Viagra's so profitable, they've turned their greedy eyes onto women as an untapped market.

Sounds plausible, but I was paying attention back then and saw the pressure coming from the other direction.

I was already experiencing problems when Viagra was released (yes, it really has been that long). I followed the news avidly looking for the slightest hint of something applicable to my situation, or even mentioning women as something other than the partner of someone in need of Viagra. [My "Impotence and Inequities" essay was written during that time.]

And apparently I wasn't alone. This 2004 news story recalls the response to Viagra's debut:

Suddenly women started asking, "If men can have their sex lives fixed, what about us?"
So women began calling the offices of Dr. Irwin Goldstein, an expert in male sexual health at Boston University School of Medicine.
The women, he says, were calling "in droves. It was amazing." And, as CBS News Medical Correspondent Elizabeth Kaledin reports, a new era was born.
"Viagra became this empowerment moment, so a woman would say, 'Well, perhaps this little pill could help me, cause this problem is killing me,'" says Goldstein.

So don't assume this is externally imposed, evil industry taking advantage of women. A lot of women have been frustrated for a long while and agitating for attention. What we're seeing now is long overdue.

“Most sexual problems are psychological (or cultural), not physiological, so focusing on physical causes will prevent people from getting much-needed therapy.”

Near the labia, there are teeny little tear-duct like pores. Sometimes, in some women, these can become inflamed and/or infected (possibly related to androgen deficiencies). Think of them like pimples. They're no bigger than pinpoints, but they hurt like the dickens when touched.

That condition is called vulvar vestibulitis.

After two-and-a-half years of therapy with the doctor who wrote the book on sexual pain, fifteen minutes in the stirrups with a knowledgable doctor diagnosed it more accurately. And a quick dose of topical anesthetic proved it correct. [Okay, that was midway through a four-hour intake appointment, after I already filled out assessment surveys and gave blood and narrated my sexual history to their office shrink, but still... he was able to identify the problem astonishingly fast.]

While self-actualization and self-awareness are admirable goals, that's not necessarily the best (and certainly not the quickest) way of treating FSD. We spent years trying solo therapy, group therapy, couples therapy, sex therapy, reading self-help books and so on. And none of that brought us one step closer to resolving the problem we were seeking help for. Therapists gave our relationship a clean bill of mental health -- we communicated well, respected one another, did everything right except we still had no sex life.

Dr. Goldstein was able to diagnose me during our initial visit, through gynecologic exam and bloodwork and other tests.

Yet even now, I hear of friends whose doctors suggest therapy as a first resort. And all I can think is that a one-time blood test would be so much more informative.

If the problem is at root hormonal, then supplements and medications will probably be necessary, whether or not they're supplemented by therapy.
In contrast, blood tests can also quickly rule out hormonal problems, which would point more confidently towards mental health providers.

It's so easy and so useful, you'd think it would be obvious.
So why do patients have to talk their doctors into taking this step?

‘Helpful’ advice...

The general mainstream folk-wisdom tips that people blithely offer can often make patients feel worse. I know the intent is well-meant, but the underlying message is often one of blame.

Too stressed? Overtired? That meant I wasn't relaxing enough. "You're thinking too much." How the hell do you respond to that!?

Often this advice boils down to a requirement one reexamine one's entire upbringing and make fundamental personality changes. Inhibited? Repressed? Shy? Gotta get over those...

Because my symptoms superficially resemble those of sexual abuse victims, I wracked my brain fruitlessly trying to think of any possible time I might've been abused as a child, in case I was subconsciously repressing trauma. I'm quite certain I wasn't, but in reaching that conclusion I put a lot of innocent people under suspicion.

Ian and I scrutinized every inch of our relationship to see whether I might be withholding sex as some kind of sublimated response to other dissatisfactions.

As for Ian... That leads into another common theme:

“Clearly, her guy's no good.”

You wouldn't believe how many times in discussion of FSD, I see snide remarks that the root of the problem is in the man's incompetence/insensitivity. He doesn't help around the house enough, he isn't supportive of her needs, or he's a lousy lay. You wouldn't believe the crude jokes and nasty insults that women crack about men when the subject of female sexual dysfunction comes up.

Let me speak from the heart: You're not helping the situation.

I will say openly, my husband has been a saint regarding this matter.

You won't believe the guilt and self-doubt he went through, wondering whether this meant he was a bad lover or unattractive or selfish or pushy...

Now, some of the advice may help in some situations. But it's repeated so incessantly, like a drumbeat, it's pervasive. It gets under your skin and festers.

We didn't even realize how much self-blame we were both carrying around until my hormone deficiency was diagnosed. What I remember most about that day was feeling like a tremendous weight had been lifted off our shoulders. We had spent years second-guessing every aspect of our lives, trying to find the cause, and it was invisible biochemistry. You can't imagine what a relief it was to finally know neither of us was at fault. We could finally relax and not only accept ourselves and our relationship, but feel good about it.

Or, as Ian put it:

“The fact that we have no sex life is not harming our relationship. But the fact that for years, we thought there must be something wrong with our relationship because we had no sex life -- that was causing damage. Discovering that there was a physical problem removed that stress from our relationship.”

And that's one reason I advocate so adamantly that FSD does exist and that it's real. Because I don't want to see others suffering the way we did.

There are more issues I'd like to cover, but that's enough for now.

What really burns my britches is how many of these objections to FSD come from self-proclaimed feminists.

I know FSD isn't the first medical condition that people have tried to dismiss or deny; some people don't believe in ADHD or PTSD. [I don't have a comprehensive list of frequently-challenged conditions, but I wonder whether this is more common among ailments predominently affecting women, such as fibromyalgia or chronic fatigue or postpartum depression.]

But I think those were cases where patients were challenging the medical establishment for recognition. Here, the medical establishment is trying to understand and come to grips with a long-overlooked problem and feminists are trying to stop it.

I mean, I can understand the objections of conservative Christians. It angers me, particularly when they try to block funding for necessary research, but I never expected their support when it comes to improving female sexuality. I'm not even terribly surprised that therapists are prominent in arguing against physiological treatment -- heck, it cuts into their business.

But the fact that I'm mostly arguing against other feminists? Disappointing, to say the least...

So how are you?

Let's talk about sex(ual dysfunction)

2005-11-16T12:00:00.000-05:00

For folks dropping by seeking info on FSD, here are a few historical posts that may shed a little light on matters:

July, 2003, my husband blogged a lecture we attended on "Women without orgasm: now or not ever" presented by the Institute for Sexual Medicine at the Boston University Medical Center. This provides a good overview of the state of scientific knowledge at that time.

November 2003, the ISM held a free seminar on FSD, mostly geared towards doctors and therapists, but intended to educate anyone interested. Near the end, an invited panel of patients spoke about their personal experiences... and I was among them. Afterwards, I wrote up what I learned (not as much as I could've, perhaps, which is why I recommend Ian's earlier post) and shared early research on the risks of oral contraceptives.

June 2005, news about the Pill hit the fan, and I wrote it up here followed by my personal history showing why I find it so plausible.

Outside this site, The Women's Sexual Health Foundation remains an excellent all-around resource, particularly for laypeople. BUMC's Institute has closed up shop, but Dr. Goldstein's website also has good information.

These links mostly cover the medical and scientific aspects of FSD. Later I'll compile some of our comments on the political side of the fence.

And if there's anything else you want to know, feel free to ask. As long as I've outed myself about this, I want my knowledge and experiences to benefit others.

Ms.Taken

2005-11-16T08:00:00.000-05:00

I was out last night and didn't have much time for blogging new material (I want to gather links to all 48on FSD ild news that I never posted to this journal because it happened while I was jobhunting and I really didn't want potential employers seeing this as their first impression of me.

In the Summer 2004 issue, Ms. Magazine published an article on female sexual dysfunction that I found particularly egregious. A few excerpts:

[W]omen are not like faucets that get jammed up and will not turn on. We're all naturally sexual -- the survival of humankind would otherwise be in jeopardy.
Clearly, by this logic, impotence or infertility must not exist either. We must eat to survive, so there must be no such thing as food allergies or acid reflux. We must breathe, so asthma is a fiction...

[Viagra] increases blood flow to the penis, and for 20 percent of women in Pfizer's study caused an increase in vaginal lubrication. What it doesn't do is create women's desire, arousal or orgasm.
Therefore, because this one medication doesn't treat all sexual dysfunctions, the entire notion of physical dysfunctions must be fallacious.

Let's be frank: Women are not sexually "dysfunctional."
The author consistently used quotemarks like these (or refers to "women's so-called dysfunction") throughout the article, to create a wholly dismissive tone.

So how did the author explain women's complaints? It all boils down to: Fatigue, troubling emotions (anger, anxiety & shame), and antidepressant medications.
Her concluding advice:

Make sex a habit. For those in long-term relationships, I suggest Rx sex once a week, minimum. No exceptions, no excuses.
Tell that to women suffering vaginismus or other sexual pain. Frankly, that sounds more like a prescription for abuse: you must have sex whether or not you want it. Ugh.

Not only did the article content itself appal me, but moreso to find something like that in Ms. of all places.

In response, I:

wrote an email to the author (she's a shrink, so I wanted her to have the correct info so she doesn't misinform her patients),
wrote Ms. a letter to the editor, and
sent Ms. a query letter and writing samples, offering an article from my POV or to be an interview subject for them.

I never heard back from them, but six months later Ms. published a heavily truncated version of my letter.

Here's the letter I sent the magazine; they only printed the portion highlighted in yellow:

Your recent article on women's sexual health ("Viagra or an Rx for Sex?" Summer 2004) made my blood boil. I am a woman with a physical sexual dysfunction. I do not have a "so-called" dysfunction, but a medical diagnosis supported by physical evidence.
Ms. Hankin's rationalizations boil down to "it's all in your head." That's an astonishingly patronizing message to see in your magazine. Men can suffer from physical equipment failures. Why is it so difficult to believe that women experience something similar?
Sexual dysfunctions include low desire, arousal difficulties, inability to orgasm, and painful intercourse -- and women often experience multiple symptoms in combination. These problems can come from injury or disability, hormonal imbalances, complications of pregnancy or hysterectomy, or any number of other factors that doctors are only now discovering.
All the therapy in the world won't cure a physical problem. I know. I've spent years of my life trying all kinds of therapy, with no luck. And yet, when I finally found the right doctors (the Institute of Sexual Medicine at Boston University), blood tests and a physical exam led to a speedy diagnosis.
Women with sexual dysfunctions need support and information. Sexual medicine is a new field. Doctors are unfamiliar and often uncomfortable with the subject, so patients often need to take the initiative with their own treatment.
Several women with sexual dysfunctions founded the Women's Sexual Health Foundation to share information [*] and resources on the subject. Their website, http://www.twshf.org/, contains brochures to educate women and health care providers, and I recommend them highly. For readers in the New England area, Boston University School of Medicine is one of the top institutions devoted to the field. They also provide information on their website (http://www.bumc.bu.edu/sexualmedicine) and hold regular information sessions that are free and open to the public.
The World Health Organization has stated that sexual health is a basic human right for both men and women. I would hope that Ms. Magazine could get behind that.

I do wish they had printed more of the factual material about what sexual dysfunctions entail, but hopefully that was enough to help readers with problems recognize themselves and their options.

And I hope the editorial staff read the uncut original (I meant what I said about "patronizing") and will think twice before writing so dismissively of women's health issues in the future...

And now y'all know some of the things I get up to that I don't blog.

On MSD

2005-11-15T17:55:00.000-05:00

When Viagra first hit the market, I don't remember hearing anybody argue that medical science shouldn't be studying impotence, that impotent men would be better off seeking therapy, or that the problem lay in inconsiderate sexual partners rather than physiological problems.

There was some criticism and concern regarding healthy men taking Viagra as a lifestyle drug, but it was nothing like the overwhelming chorus I hear whenever the discussion turns to female sexual dysfunction.

Though that happened before I started blogging, "Impotence and Inequities" is an essay compiled from my Usenet posts during that period, pointing out the disparities in the treatment and coverage of sexual health for men and women. It's still worth a read, IMO, for a look at the underlying attitudes that influence our opinions.

Sigh

2005-11-15T07:59:00.000-05:00

Female Sexual Dysfunction is in the news again, yet again questioning its existence as more than a marketing tool.

Pseudo-Adrienne over at Alas, a Blog provides the latest iteration of the spin:

When it comes to discussing Female Sexual Dysfunction (or perhaps Dissatisfaction), all the medical jargon and scientific theories as to why women "don't like sex and are therefore dysfunctional" come out. Some doctors and pharmacists think FSD can be easily solved with a pill or patch– no big deal. However does this "just give 'em a pill or a patch, and they'll start happily humpin' and climaxing" line of thinking conveniently gloss over the larger issue that some women are perhaps dissatisfied in their intimate relationships? What about stress from working, having to take care of children, and running errands all day? What about their past experiences with sex? Were some of them sexually abused or raped? What if the environment within their relationship and their partner make them feel uncomfortable about discussing their sexuality? What about society's stigmas around women being open and frank about their sexuality? Does a male-dominated medical and scientific field have anything to do with the lack of human-oriented (as in actually talking to women and getting them to be more open and frank) research of FSD? Don't these other concerns matter in the debate over FSD? Or are some women just doomed to remain sexually dissatisfied or dysfunctional for various reasons? Sigh– just keep on faking it, ladies (or visit your local sex-toy store). Well Planned Parenthood has recently put out an interesting article on FSD and the issues surrounding the "controversy" of women's sexuality and women being open and discussing their sexuality.

I'm here to say, “Yes, Virginia, there is FSD.”

Pardon my cynicism, but I've heard it all before. In fact, the issue comes up like clockwork every time the FDA makes another announcement. They're preserving male privilege with pills instead of dealing with women's real issues.

FSD is a real issue faced by women, too. It could be an equally valid feminist argument that actually studying women's physiology is an extremely overdue development...

I have to wait for their moderators to approve my comment on their site, but nothing prevents me from sharing it here with you:

I am a woman diagnosed with FSD.
I've experienced years of "let's throw therapy at it," reaching a point where my therapist (with permission) brought my case to a conference of sex therapists, before finally throwing in the towel and saying she couldn't help me further.

Unless you've been through it, it's hard to understand just how hard therapy can be. I scoured my background for any hint of possible repressed abuse (since my aversion is similar to that of abuse victims). My husband went through his own guilt that he was too pushy or not helpful enough or a lousy lover.

Why put people through that unnecessarily?

When a hormone test showed my hormones were off-the-scale low, it was such a relief for us both. It wasn't our fault.

If the physical aspects of FSD can be diagnosed with a hormone test, I don't see why there's such resistance to it. Perhaps in most cases, it will rule out the physical diagnosis and lead people to therapy anyway.
But therapy is expensive and timeconsuming and not always accurate. Knowing onesself better is a good thing, but when it can't solve the problem the patients want to resolve, it's a waste.

Physical bodies have flaws. We accept that with men, in part because the problem is so visibly one of hydraulics. But the notion that women should seek therapy first seems almost a throwback notion that "it's all in her head" and only if we can't get her head straightened out should we look at the rest.

I don't want to be accused of hijacking the discussion, but here's my personal history with FSD.
Feel free to ask me further questions on the subject.

I may post further on this here, since it's not hijacking when it's my own journal. Because if it's being discussed in one journal, it's probably all over the blogosphere, and I want this side of the story to get out as well.

PS: I know that coworkers and family members read my journal. If this is topic borders on TMI for your comfort level, you may wish to take a day or two off. I won't let you miss my London reports if you don't want to read about my (lack of) sex life...

My day...

2005-06-21T18:00:00.000-04:00

Got a clean bill of health from the doctor this morning. [I was not, in fact, late, as I worried in this morning's post.] No real changes from my last exam. I should get more exercise, drink more water. He also agreed with my mother that calcium supplements are a good idea, not just for me, but also for the (two younger female) medical students observing my exam (see, Mom, I do listen to you!). Though I forgot to print out the abstract, I told my doctor about the latest study on the Pill, and then during the gyn part of the exam I explained a bit further about androgen insufficiency to the medical students.

On the way home, I stopped at the library to return a couple books. No parking spaces, so had to double-park in the lot. Being me, I of course skimmed through the New Arrivals section (rather than just dropping off at the front desk and departing) and picked up two books: Savage pastimes: a cultural history of violent entertainment and Words on fire: the unfinished story of Yiddish. [I need to remember to print out my intended reading list so I have it handy for these impromptu library visits.]

I got into work at 11:45 with just enough time to snarf some lunch and catch up on e-mail before a 12:30 meeting. And the rest of my day has been the best kind of busy, researching interesting and intellectually-stimulating subjects for management. [Oh, how I wish I could go to the ALA Conference this weekend.]

Medical research idea:

Had an interesting thought while driving home from the doctors', which I'm going to forward to Dr. Goldstein as a possible avenue of further study.

At its crudest description, the birth control pill (and other hormonal contraception) works by simulating pregnancy. The woman's body doesn't produce eggs while gestating. These hormones can also depress libido.

But when naturally-occurring, pregnancy hormone changes don't just stop cold-turkey, the way women go off the Pill. In pregnancy, the body chemistry changes in other ways related to giving birth and post-natally (through breast-feeding, etcetera) before returning to "normal."

Now, there are some women whose libidos don't bounce back after preganancy.
Question: How did these pregnancies end: abortion, miscarriage, vaginal birth, c-section? Did the mother breastfeed or use formula (no judgment calls! Several of my friends had problems breastfeeding and I know not every woman can)? And how do those numbers compare with women who don't experience such androgen insufficiencies. Maybe there's some correlation between how the pregnancy proceeds/concludes and how well testosterone levels bounce back.

Depending on those results, maybe we need to consider changing the way women go off hormonal contraceptives. Instead of just stopping cold, maybe we ought to investigate a regimen of other transitional hormones to restore balance more naturally.

I am not a doctor (nor even a med student) but that just makes sense to me as an avenue worth exploring.

Anybody with a more academic background care to evaluate and help me refine this proposal? Maybe I do have a PhD dissertation within me...

History and science

2005-06-17T12:35:00.000-04:00

People seem to be greeting my earlier post with a lot of skepticism. It was only a limited study. Many women do take the Pill without experiencing such problems. And there are so many loons out there funding phony studies and telling lies to discredit contraception, that disbelief is a natural reaction.

I wish it weren't true, because I know it will give ammo to those I oppose. But we're supposed to be part of the reality-based community and not ignore research that contradicts our biases.

Via e-mail, somebody asked me what my doctor had to say about the study.

Well, one of the study authors is my doctor.

I've been a patient of Dr. Goldstein at the Instute for Sexual Medicine for about four years.

I wasn't part of this study and haven't spoken to him since seeing this in the news, but it certainly fits with my history:

When my relationship with my husband got serious enough, I decided to go on the Pill so we could stop using barrier protection. Within a few months, intercourse became increasingly unsatisfying and then excruciatingly painful. My primary care physician was no help; she said she couldn't diagnose the pain unless I came in while hurting, and the idea of purposely inflicting injury on myself for the doctor's convenience really didn't appeal.

I remember asking her whether the Pill could have had any effect, given the correlation in timing. But she dismissed that notion. After doing a lot of reading on my own, I pressed her for a hormone test, which she performed and told me everything was in normal range -- without further elaboration of what any of the numbers meant. I remember that my testosterone was low-normal, and noticing that two hormones were actually so low as to be out of range. I wound up going to the library to look up what those hormones did, and eventually found out that they were the ones the birth control pills suppressed... and that the birth control pill could reduce women's sex drive. Now mind you, given the timing, I had been looking for any evidence of that in other literature: the BCP inserts and Our Bodies Ourselves, and neither of those saw fit to mention this little fact. [It was shortly after this, btw, that I found myself a new primary care physician.]

That was nearly ten years ago. By the time I went off the Pill, the damage was done. My sex drive has never bounced back.

We tried couples therapy, which determined my husband and I had a perfectly healthy relationship EXCEPT for our sex life. I went to group therapy with a sex therapist (the author of A Woman's Guide to Overcoming Sexual Fear & Pain), and then saw her privately (and with my husband). She couldn't find anything wrong. She even (with our permission) described our situation to a sex therapy conference, and we stumped the best minds in the field. My PCP was also trying other avenues, tinkering with psychopharmeceuticals and pursuing other avenues, including Viagra. None of it resolved the problem.

Eventually, after the sex therapist said there was nothing more she could do for me, I found out about Dr. Goldstein and made an appointment with him.

The initial session intake appointment involved a half-day-long battery of tests -- questionaire, bloodwork, ultrasound, session with a therapist... the whole nine yards. And about halfway through the day, he told me I appeared to be a textbook case of hormone deficiency. He'd have to wait for the lab results to be certain, but he'd seen enough other women like me --women whose problems couldn't be helped by their primary care physicians, specialists in existing fields or therapy. And sure enough, the blood tests confirmed it.

And that's my story.

Some people may not experience any problems on the Pill. Some women with high testosterone levels may actually benefit.

But, it's tough to be sanguine after a decade of fruitless treatments. Though I've been following the research, I'm really despairing of ever having an enjoyable sex life, much less an orgasm.

It's not a pleasant experience, especially when even the helpful advice smacks of blame (you're too tired, you're too stressed, or it's your partner's fault).

If I can prevent other women from suffering as I have, well, maybe something positive can come out of all this.

I suppose my points are that:

This may not happen to everyone, but it happens in enough cases that women should at least be aware of it and monitor themselves (maybe self-observation is sufficient if women know what to look for).
But there needs to be better education for patients and doctors. Physicians Desk Reference mentions vague "sex drive changes" in a laundry list of other side-effects. Medline doesn't even include that much.
Some people blame the drug companies for trying to manufacture insecurities where they don't exist. But the best therapy in the world won't cure a physical problem. [I speak from experience here.] So why are people so resistant to include "have a hormone test" in advice for women who do have complaints? I mean, whether it's normal or low, at least it provides a little more concrete evidence for narrowing down the cause...
There need to be more studies. Medical science barely understands the physiology of healthy female sexuality, much less the pathology.

Does that make more sense?

Given my history (and what I know anecdotally about Dr. Goldstein's patient population) I suspect further research will confirm this problem does exist. And when that happens, the abstinence-only advocates will latch onto it as a club to bash contraceptives.

Consider this our opportunity to frame the discussion and get the word out in ways that will mitigate the harmful rhetoric (while protecting women's health). Self-awareness and hormone testing can catch complications early and may be sufficient. Who knows, maybe reformulating the Pill with supplemental testosterone would be sufficient for those at risk. But I don't think it's healthy to bury our heads in the sand and hope it goes away.

Any further questions?

Women's Health Warning

2005-06-16T23:35:00.000-04:00

If you are female and have ever taken or are considering Birth Control Pills, read this!
[If you know somebody in the above categories, please pass it along.]

I don't want to be writing this. I wish this weren't true. But it is, and you have to take care of yourself, because the research is so new, it probably hasn't trickled down to your physician.¹

Taking oral contraceptives may result in permanent loss of libido even after a woman stops taking the pill, according to research at a US sexual dysfunction clinic.
It has long been known that most women suffer a reduction in libido while taking the pill, but the study published in New Scientist is the first to suggest the effect could be permanent.

-- TVNZ Health News

[The] survey produced such dramatic results that lead researcher Dr Irwin Goldstein advised any woman on the Pill who has sexual problems to stop taking it and try another method of birth control.

"There is a possibility it is imprinting a woman for the rest of her life," he said.

-- The Herald Sun

[Doctors] Claudia Panzer and Irwin Goldstein tested 124 women being treated for sexual dysfunction. Half used the pill regularly, 39 had just come off the pill and 23 had never used oral contraceptives.

The scientists analysed blood samples from all the women for traces of a substance called sex hormone binding globulin (SHBG). The pill makes the body over-produce SHBG, which mops up testosterone, the hormone that drives sexual desire.

The blood tests showed that women who regularly used the pill had very low levels of testosterone, but four times as much SHBG than women who had never been on the pill.

Further blood samples from the women who had come off the pill revealed that four months later, levels of SHBG had dropped but were still nearly double that found in women who had never taken oral contraceptives.

"What concerns us most is that the levels of SHBG show no sign of dropping any further in those who came off the pill," said Dr Panzer.

"You would expect levels to drop back to normal after about six weeks, but the worry is that these women will always have more. That means they will have very low testosterone, which has huge implications for their sexual function."

The researchers fear that levels of SHBG, which is produced by the liver, might be permanently raised in women who go on the pill, regardless of whether they later stop.

-- The Guardian

Few people (aside from the anti-sex fundies pushing abstinence-only lies on teenagers) will want to hear this. Most news articles include quotes from local doctors expressing disbelief.

Believe it.

For over ten years now, I have suffered from permanent physiological sexual dysfunction.² Based on my personal history and the timing of when things went sour, I've long hypothesized that it was caused by the Pill.

The research above was reported to the American Association of Clinical Endocrinologists. Here's the press release and you can find more of the report within the conference abstracts. The study was titled "Androgen Insufficiency and Oral Contraceptives: A Pathophysiologic Mechanism."

I haven't heard whether this research also applies to other hormonal contraceptives, such as injections or Depa Provera, but since they act in a similar manner with only a different delivery system, I would suspect so. Obviously, further studies are needed.

So, does this mean goodbye to the Pill? Not necessarily.

I am not a doctor, but based on my experiences here's what I'd recommend:

Have a blood test to check your hormone levels before you start the Pill to get a baseline of what's normal for you.³ Be sure they examine both total testosterone and free testosterone levels. They're both necessary to evaluate what's going on.

Once you're on the Pill, if you start to notice a loss of libido, lubrication problems, increased difficulty achieving arousal or orgasm, pain, or any other sign of sexual dysfunction, don't hesitate!!!⁴ Talk to your doctor and either switch to another formulation of the Pill or get off the Pill entirely. Dr. Goldstein used to prescribe supplemental testosterone to patients on the Pill to replace the lost hormones. I'm not sure whether the quote above indicates a change of opinion.

Even if you don't notice any signs, have a hormone test every three months to check whether your testosterone levels are dropping. If so, again consult with your doctor to stem the loss before it's too late.

I haven't seen any recommendations from Dr. Goldstein and the other researchers yet, but for now that's my advice.

You have to be proactive on this, because this is cutting-edge research and most doctors are not up on it.⁵

For further reading on female sexual dysfunctions:

The Women's Sexual Health Foundation was started by other patients with sexual dysfunctions to provide the information that they wished they had. It has articles geared towards patients and towards doctors so even if you're healthy, you may want to print some of this out for your physician. Wouldn't it be nice to indirectly help other patients suffering in ignorance?
Dr. Goldstein really has been at the forefront of this research. Some of his stuff is a bit technical, but I always learn something new.
Back in 2003, I explained how the Pill acts upon testosterone, well before this study but as the links were coming to light. In the following post I summed up a full-day seminar on FSDs.

So how am I reacting to the news? Feeling vindicated that my assumptions are being proved correct. Concerned how this will play politically: hoping the people who need the information will get it in time, and worried how advocates with agendas will distort the findings. And I can't help wondering how much of this the drug companies knew or suspected or were covering up, and whether there's grounds for (or interest among other patients in) a class action suit.

Any questions?

Note: If you came directly to this entry from an external site, please take a look at my my next post which provides some additional context. Thanks.

Footnotes:

¹ Disturbingly enough, aside from a few minor local papers, all the press coverage in Google News is from the foreign press. Even though it involves American doctors reporting research at a conference in the US, the American papers appear to have ignored this so far.

² I have a medical diagnosis supported by physical evidence. It most certainly is not caused by psychological problems, stress, insufficient sleep nor side-effects of other medications. And don't you dare even hint that my partner might be at fault for any of this.

³ If you're already on the Pill, you should still have the bloodwork done.

⁴ That was a judgment error I made when my problems first began. Thought it was just a natural ebb and flow, and waited for it to return. It never did.

⁵ Even my own primary care physician, an exemplar, sits back and lets me tell him about sexual medicine.

Women's health warning: a bitter pill to swallow

2003-11-24T15:15:00.000-05:00

This is difficult to write. So many abstinence-only groups exaggerate the failure rates and risks of contraception in order to push their political agendas^**. It feels like conceding any ill-effects to contraception gives the anti-sex-ed forces further ammo. And yet, medical science is discovering an undocumented risk to oral contraceptives (birth control pills).

I don't have a heavy background in the sciences, so please bear with me as I try to explain: Within the human body, the enzyme 17-20 lyase produces the sex hormones the body needs to feel desire, arousal and orgasm. This enzyme turns itself on just before puberty (adrenarche), and without this enzyme, the body returns to a pre-pubertal state.

Progesterone, a hormone involved in pregnancy, birth control pills, and many hormonal based contraceptives (Depo-Provera, patches, etcetera) inhibits this enzyme. Oral contraceptives also reduce the sex hormones in two ways:

A large portion of women's testosterone is produced in the ovaries. By shutting off the ovaries (to prevent egg development) it also turns off that source of testosterone.
There are two forms of testosterone in the bloodstream: free and bound. Only free testosterone is "bioavailable," meaning it can be absorbed where it's needed. Taking estrogen orally sends it to the liver, which produces extra SHBG (sex hormone binding globulin), further reducing the body's stores of free testosterone.

So, the pill disables one of the sources of testosterone and locks up much of the rest. Is it any wonder that many women notice reduced sexual functioning while on the pill? [Early studies suggested that women felt sexually freer on the pill, but some of that may be attributable to reduced worries of pregnancy.]

For many women, this is just a temporary problem. Going off the pill restores their normal sexual health. But some women (raises hand) never bounce back. Their bodies completely stop producing the enzyme and they lose sexual function permanently.

Fortunately hormone therapy can put back what the enzyme has stopped producing. But that requires regular blood tests and may necessitate hormones that are only available via prescription. Also, since there are no medicines currently on the market geared towards women's sexual dysfunctions, everything is being taken off-label, which may be an issue for some people.

This information isn't in the medication inserts nor in the literature -- neither books aimed towards the general public (and I've searched!) nor in that given to physicians. [Look at the PDR for oral contraceptives: Side effects may include sex drive changes (in the middle of a lengthy paragraph of everything under the sun) but nothing in the Special warnings section. Medline's Drug Information doesn't mention any sexual side-effects, and the entry was last revised within the year!] As far as the popular literature is concerned, I suspect that's partly political: to avoid giving more ammo to the pro-abstinence forces. For the rest of it, women's sexual health has never been much of a priority in the past.

Scientists are only just starting to research this area. As Doctor Goldstein said at the start of his presentation, "Therapies for women with sexual disorders have not been based on a sound physiological understanding of women's sexual function." And many attempts to research this area (can't know what's pathological without knowing what's normal) have been easy targets for political disapproval.

Doctor Cynthia Graham recently conducted one of the first double-blind placebo-controlled studies of oral contaceptives effects on women's sexuality (involving women who had already been sterlized, so there was no pregnancy risk). Quoting from the abstract: "The [combined oral contraceptive] adversely affected sexuality in the Edinburgh women, with 12 of the 25 women in this group also reporting the side effect of reduced sexual interest. There were modest negative effects of the combined pill on mood, more noticeable in the Edinburgh women. The [progestogen-only pill] was associated with no adverse effects on sexuality and some improvement in well-being in both centres." [Graham, C.A., Ramos, R., Bancroft, J., Maglaya, C., & Farley, T.M.M. (1995). The effects of steroidal contraceptives on the well-being and sexuality of women: A double-blind, placebo-controlled, two centre study of combined and progestogen-only methods. Contraception, 52, 363-369.] Someone in the audience said that since issuing this and other articles attributing adverse sexual effects to contraceptives, Dr. Graham has lost some funding and the pharmeceutical industry has been trying to suppress these studies and shut down new research in the area. I have no evidence of this one way or the other, but it sounds sadly plausible.

It's possible that reformulating birth control pills to provide extra testosterone could protect women from pregnancy without damaging their sex drive, but as far as I know, none of the pharmeceutical companies are even looking into this. At any rate, one of the first steps in solving a problem is awareness that a problem exists. If nobody speaks out that loss of libido is an unacceptable undocumented risk, then what reason do the FDA and corporations and medical establishment have for improving the situation?

Anyway, I'm not saying people shouldn't take the pill. It's every woman's choice, but it should be done with full knowledge of the tradeoffs, an understanding to stay alert for changes, and an ability to take action in case of adverse effects. If problems occur, maybe switching to a different formulation will resolve them. Doctor Goldstein mentioned one patient who decided the pill is worth the loss of libido, and takes supplemental testosterone to maintain healthy hormone levels while on the contraceptives. Whatever the solution, it needs to be an educated choice, which means doctors and patients need to get educated on this.

Let's talk about sex

2003-11-24T12:20:00.000-05:00

I am probably not the best person to write up a summary of the seminar on Female Sexual Dysfunction since (a) I've attended enough of Dr. Goldstein's lectures and (b) my interest is narrow enough that (c) I probably didn't take notes on the scientific aspects of general interest to most people. Also, Dr. Goldstein's lectures seem to exemplify information overload. Slides chock full of anatomical diagrams, charts, numbers, comments from sufferers, while he's talking about related matters. My notes are nearly illegible. I tried to grab numbers from charts, but now no longer have the context. Very frustrating.

At any rate, based on current studies, 43% of women (presumably American women, though I'm no longer sure) have female sexual disorders. Far greater numbers than men. FSDs include pain, problems achieving desire, arousal, and orgasm, combinations of these symptoms, and other issues.

Dr. G got his start treating male sexual dysfunctions, and only within the last decade has he started seriously studying women's problems. So, he's well aware of the similarities and differences between the sexes.

Men's sexual dysfunctions are most often unidimensional. They have a problem achieving an erection or climax too early or something else. Women's problems are generally multidimensional, involving several of the factors listed above. Less than 10% of men have sexual dysfunctions before the age of 50. After 50, systems go to hell. In contrast, over 30% of premenopausal women report problems. And, even among older adults, more women have problems. A London menopause clinic reported 86% of the patients reported sexual problems. [So the problem rate goes from one-third to four-fifths!]

The number of men with erection problems is half the rate of women with lubrication difficulties. And yet, there are now three prescription medicines treating the former and none for the latter. That said, he has found that treatment for male sexual disorders and female sexual disorders are often quite similar, generally involving the same medications (though they all have to be off-label use for the women, since the FDA hasn't approved anything yet for FSDs). There is a physical component to female sexual disorders -- 70% of the women who come to his clinic report restoration of sexual function with conservative Rx within one year, generally through hormone treatments.

Why do so many women have sexual problems? There are a variety of causes, including physical injuries, side-effects of various common medicines, pregnancy (both hormonal changes and injuries caused by forceps deliveries, episiotomies or other traumas to the genital areas), hysterectomies, bicycle riding, and so on. There's some reason to believe that the high level of sexual disorders among younger women (a recent study showed 32% among 18-29 year-olds) may be related to the birth control pill; more on this in a later post.

By the way, as long as this is turning into an angry political rant, Dr. Goldstein is spearheading a movement to abolish the term "hysterectomy" from the medical language. Call it like it is -- a "uterus-ectomy." Hysterectomy literally means "to cut out that which causes hysteria," which is both offensive and inaccurate.

I'm somewhat sorry this has turned into more of a political rant than educational/informational/medical post. It's been over five years since I wrote this rant, and though things are getting better, the inherent biases still exist and women are suffering because of them. I'm still hoping for more responses to my survey, but so far none of the men report a doctor dismissing a symptom as "all in your head", while the majority of the women have experienced that. In other words, doctors treat women's complaints as mental problems, which seems like a throwback to the Victorian notion of women's hysteria. What, me angry?

The institute has much more information on their website, at http://www.bumc.bu.edu/sexualmedicine, as does http://www.twshf.org/, a support group founded by patients. Both sites have pamphlets with information for yourself and your medical provider. And I strongly urge you to share this info with your physicians. Doctors were not taught this material in medical school. This is an emerging field. Even if you are fortunate enough not to experience these problems, spreading the word to friends and medical professionals can benefit other patients who may not be aware of all this.

I'll just close this post with a PSA:

The Institute for Sexual Medicine at Boston University School of Medicine is very excited to announce that Sue Goldstein and Lillian Arleque are collecting the stories of women with sexual dysfunction, with the intention of compiling a book on FSD, Female Sexual Dysfunction: Stories & Solutions. Their hope is that these stories will serve to educate and inspire others to seek help.
A portion of the proceeds from the book will go directly to the Institute for Sexual Medicine to fund research in FSD.
If you are interested in participating in this exciting project, please mail a brief summary of your story and contact information to:
Institute for Sexual Medicine
720 Harrison Avenue, Suite 600
Boston, MA 02118
ATTN: Sue Goldstein
Or complete the online form at www.bumc.bu.edu/sexualmedicine/stories
You may be contacted by either Sue or Lil. Names will be changed to protect privacy, and some stories may ultimately be a combination of several women's contributions. The authors are looking for a wide range of experiences.

Some thoughts and information from the Boston University Medical Center lecture last night

2003-07-17T14:53:00.000-04:00

Posted by Ian Osmond

Lis and I went to a lecture on "Women without orgasm: now or not ever" presented by the Institute for Sexual Medicine at the Boston University Medical Center last night. As usual, the general topic was sort of explored, but the basic point of, at least, Dr. Goldstein's part of the lecture was to inform people of the findings and new discoveries that the ISM was making.

Which is fascinating stuff. The ISM has two parts, a basic research department, which is doing clinical research, animal trials, and so forth, and a treatment clinic. These two sections are closely tied together, and each benefits from the experiences of the other.

The lecture consisted of four parts -- one of the psychiatrists did a presentation on the psychological factors, a patient spoke about her experiences, Dr. Goldstein did a lecture on some of the most recent findings they'd uncovered, and then questions-and-answers.

The psychological part was nothing new. I mean, in all honesty, there's been no real progress in the psychological treatment of sexual dysfunction in years. Obviously, it's important, and there are a couple things they're doing a little better than they used to -- an improved Sexual Distress Scale questionaire, stuff like that. But nothing really exciting.

But the physiological side. . . that's just amazing what they're doing. It's a completely new field. They're discovering things about how hormones work, what they are, what they do, what affects what . . . stuff that's never been studied before.

As people who know Lis and me know, we've been in treatment for Lis's sexual dysfunction for years. We started out with psychological treatment, and, after years of this, discovered that Lis has no emotional or psychological traumas, has a perfectly fine body image, no sexual hangups, and no sex drive.

The entire field of actually studying what can go wrong PHYSICALLY with women's sexual responses only started five years ago.

Almost everything can be traced back to hormone levels. But it's amazing just how many things those hormone levels impact, and in how many ways.

Okay, obviously, low testosterone leads to low desire. Fine. We knew that. But it goes on from there. . .

Screwed-up hormone levels lead to the inside lining of the vagina all but going away. That's the part that lubricates. So, if you don't have the right hormones, you lack most of the part of the body that causes lubrication. And the amount of lubrication it secretes has a higher water percentage and lower mucus percentage than if the hormone levels are working -- so it's a lousy lubricant anyway.

The hymenal opening has vestigial musk glands around it -- they also produce some lubrication, but basically, once upon a time, they were musk glands. With proper hormones, they produce mucus and clean themselves out. With low androgens, they don't produce mucus, and become a haven for bacteria, which settle in and cause infections. Imagine how painful intercourse would be if you had swolen infected glands surrounding your vaginal area. . . Lis doesn't have to imagine this. . .

Those were things we'd heard about previously (the actual animal studies on rats on the inside of the vaginal lining were new, but that was suspected last time we'd heard this). And they'd discovered the vaginal glands the last time we saw them.

But they found out a number of new things about neuron activity and androgens.

The nerves in the genital area require testosterone to function.

So, if you have no, or very low, testosterone, you have less feeling in your genitals.

Basically, Lis might have as much feeling in her clitoris as most people have in their forehead.

You know how difficult it is to give someone an orgasm by licking their forehead?

No wonder she's never had an orgasm.

It's not my fault.

Anyway -- why does this happen? Well, that's not known yet. But they're starting to come up with hypotheses. . .

(Just a quick reminder of how steroidal hormones work -- the body takes cholesterol, then whaps it around a bit, and it turns into DHEA, and then the body takes the DHEA and whaps it around and turns it into testosterone. It goes through other pathways, too, turns into various things in between, and estrogens are made and stuff like that. I'd need a chart to follow exactly what turns into what how, but that's the basic idea. Stuff turns from cholesterol into other stuff, and that other stuff turns into Stuff You Need.)

Apparently, testosterone is produced in like two different places in a woman's body -- I don't remember exactly where, and I wasn't taking notes, but I think they were like the adrenal gland and the pituitary gland. Birth control pills completely shut of testosterone production from one of these. Not only that, but they also produce a secondary something-or-other which bonds to free testosterone and neutralizes it.

So -- they cut off like half your production of testosterone, and neutralize a good chunk of the rest of it.

If you manage to make so much testosterone that, even after losing over half of it, you still have enough testosterone to maintain neural pathways to your genitals, and maintain the vaginal wall thickness, and maintain the health of those glands, and all those other things, then you're fine. But if you don't, you're fucked. Or, more to the point, you're NOT fucked.

Oh, and once that gland has been told not to produce testosterone for long enough, it won't. Even if you go off of birth control pills. That function of it is just plain dead. It's been destroyed.

Again, if you manage to produce enough testosterone anyway, this isn't really that bad. But, if you don't, Everything Dies. Desire, ability, lubrication, the triggering chemicals in the brain that tell you to have an orgasm, the sensation in the genitals, the bits of the hymenal glands that keep it from becoming painfully infected -- it ALL GOES AWAY.

Now, it seems that there are other things out there that can cause a lack of testosterone in women, besides birth control pills. But I can't help but wonder if the sharp increase in the reported incidence of sexual dysfunction in women comes, at least partially, from the point when birth control pills became so prevalent that women could be given them very shortly after the onset of menses. Lis was on birth control pills by her third period or so -- her body CAN'T have finished figuring out how to manufacure all the hormones it would need as an adult by that point. And now it never will.

Obviously, you'd need to do a large-scale study to find out if there is any correlation between the age at which women went on the Pill and sexual dysfunction. But it seems like it would be a reasonable hypothesis.

So, anyway -- what can you do about it? You can take DHEA suppliments. Those are not only over-the-counter, they're not even counted as DRUGS by the FDA. Which is bad. Because if a bottle says "25 mg of DHEA", there's no way to be sure that there is ANY DHEA in it, let alone 25 mg. There's no oversight authority. So the BUMC does tests. They buy various brands, and test for the presence of the hormones in the amounts they claim.

That helps some women. If the problem is that their bodies can't turn cholesterol into DHEA, but they can turn DHEA into other stuff, then that's all they really need.

But if the problem is farther down the line, adding DHEA isn't enough. You have to directly add testosterone, too.

Topical testosterone is manufactured. It's for men who don't produce enough testosterone. It's in a gel form. And the amount of testosterone each dose has is appropriate for a man for a day.

It's ten times what a woman needs. A woman needs to divide this gel up into ten little bits and use it over ten days.

And the FDA hasn't approved ANY topical testosterone for women. So pharmacists have refused to fill ther perscriptions. . .

I'm still furious at Congressman Jeff Flake.

Impotence and Inequities

2002-04-24T00:00:00.000-04:00

This essay comes out of three Usenet posts I wrote in 1998, just after Viagra was publicly released.

Fortunately, some things in the medical arena have changed in the last four years, but the initial disparity still exists.

For example, a recent New York Times article pointed out how women's physiology may mean that they suffer more pain than men, yet "women's pain reports are taken less seriously than men's, and women receive less aggressive treatment than men for their pain" and that women were "more likely to have their pain reports discounted as 'emotional' or 'psychogenic' and, therefore, 'not real.'"

A report in the Journal of Law, Medicine & Ethics, titled "The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain" is available online, and makes for some very interesting reading on the subject. ["One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication."]

But, four years ago, I wrote (more anecdotally) about similar issues in the treatment of sexual dysfunctions:

Impotence and Inequities

Lis Riba, Spring/Summer 1998

Last week, the U.S. Food and Drug Administration approved the first pill for impotence. According to a New York Times article, "there were a number of impotence treatments before Viagra, but all carried one or more drawbacks that the drug will not have: a need for surgery, interruption of lovemaking, or pain." In an Associated Press article, Dr. Harin Padma-Nathan (of USC and director of The Male Clinic in Santa Monica, CA) "predicts half a dozen oral impotence medicines will hit the market in the next seven years." Male impotence also made news back in January, when a new baldness cure listed impotence as a possible side effect.

When men can't have sex, it's a major health issue. In comparison, news about women's sexual problems has been almost nonexistent.

So, where are the treatments for pre-orgasmic women? None of the male remedies have even been tested on women to see if we might benefit. When other drugs affect the male libido, it makes headlines. When a woman's sex drive is impacted, you MAY see it in the fine print. Did you know that reduced libido is a common side-effect of the birth control pill?? I found that in Our Bodies Ourselves; none of the manufacturer's informational inserts thought that was worth mentioning.

Another NYT article on Viagra notes "relatively little is known about sexual function and dysfunction among women. Until researchers solve that problem, Pfizer's plans to test the effects of Viagra on women cannot begin." But even though the drug only helps men, its manufacturer is "considering advertising the drug in woman's magazines, hoping women will encourage their partners to seek treatment." (Wall Street Journal)

This inequity in handling sexual dysfunction is an insidious and subtle form of discrimination. Compare the underlying assumptions:

Men need to have sex and orgasms. Men with sexual dysfunctions cannot perform at all. Therefore, any problem is a major one.
Women don't necessarily need to have sex or orgasms. Women with sexual dysfunctions can still perform, so it's not as serious. (Even unwilling women can be penetrated, and women have the option of "faking it")
When men are unable to have or enjoy sex, there are numerous medical treatments available -- implants, injections, and now pills. A man with sexual dysfunction has a physical problem.
When women are unable to have or enjoy sex, the main medical advice is to seek a sex therapist. A woman with sexual dysfunction has a mental problem -- "it's all in her head"
Often, articles on sexual dysfunctions talk about "impotence and infertility" as if they were parallel and gender-specific problems. Equating men's lack of pleasure with women's inability to reproduce implies that female sexuality is primarily for procreation, and women's pleasure is secondary.

Even if you have a wonderful sex life, these assumptions affect all society. Once you trivialize women's sexual pleasure, it's easy to deny that women have any desires at all. Abstinence-based sex education often teaches that girls must resist boys' desires. And, with all the responsibility belonging to the women, it's easy to separate "good girls" from "bad girls" -- the whole virgin/whore dichotomy.

Last Saturday's New York Times had an article titled: "Scientists Weigh Viagra-Like Drug For Women." The article begins like so: "About 100 scientists from drug companies, academia and the Food and Drug Administration met in a hotel here Friday to ask a pressing question: If Viagra or a drug like it works in women, how would you know?" Later in the article, we get the following comment: " Norman Mazer, vice president for clinical research at TheraTech Inc, a small drug company in Salt Lake City, stated the difficulty: 'A man knows he has a problem. But in the case of a woman, she can perform. She doesn't necessarily think of herself as having a problem.'"

Do these people really think women are so ignorant of their sexuality? Apparently, as long as women can take it and fake it, there isn't any problem. If scientists making medical decisions about adult women can make such offensive statements, we all deserve a second opinion.

The article then contradicted these experts by saying: "Although the actual definitions of female sexual dysfunction may seem elusive, those who were at the meeting agreed that women do complain about their sex lives. Large surveys in the United States and Europe have found that as many as 50 percent of adult women say that they have lost interest in sex or that they have difficulty becoming aroused."

A full quarter of the adult population is having sexual problems, and this isn't newsworthy.

Good news is on the horizon. Pfizer has taken the first steps to study Viagra in women. However, many doctors aren't waiting for the drug company and have begun prescribing it to women already. "Drug companies and individual doctors were clearly rushing into the female sexual-dysfunction arena."

Pfizer has been testing Viagra as an impotency drug since 1993 on over 3,000 men. Over five years of study, and they couldn't examine one woman? Once again, women are the medical afterthought, completely ignored in all the trials. Medical studies on women are finally underway, but it may be years before results are available. So without tests, women and doctors have already begun gambling with this untested drug. Pfizer earns the same amount per pill whether the patient is male and female, but since the women are paying to be experimented upon, it's a net gain for the company.

Women are 50% of the population. Drug companies need to test their medicines on both genders, and shouldn't profit by turning half the population into paying guinea pigs.

>I'm responding to this old posting now, and in a slightly different
>context, because I recently read an article in my local paper once again
>decrying the "sexism" of insurers paying for Viagra but not birth
>control pills.

>I would urge people not to misconstrue standard insurance company
>"logic" as sexism, or not caring about women. Viagra and the pill are
>not comparable. One is an impotence drug and one is a temporary
>contraceptive.

The Pill has other valid uses besides contraception. Because the Pill is a regulated dosage of hormones, it is often prescribed for women with hormonal problems, such as irregular menstruation or extremely painful cramps.

In these cases, the contraceptive features of the pill are a side-effect, rather than the primary effect.

Also, look at what the Pill and Viagra do in a social aspect. Both pills free people to have sex with fewer consequences. The Pill allowed women to have sex without fear of pregnancy. That was a very real fear and stigma in the 1950s around unmarried women who get pregnant (read the EXCELLENT book The Fifties: Women's Oral History to see just how inhibiting that mindset was)

The changes that the Pill wrought on women's sexuality are *extremely* similar to the current hysteria regarding Viagra. It had such a liberating effect that many doctors would only prescribe the Pill to married women.

If the insurance companies are willing to pay for something that frees men to have sex, they should do the same for women. [I understand that several drug manufacturers are working on "orgasm pills" for women. We'll see how insurance companies cover that...]

Plus, paying for contraception is cheaper than paying for an abortion which is much cheaper than paying for delivery and childcare. The insurance industry is extremely short-sighted by not covering such a basic need.