The vagina dialogues

Hundreds of doctors gather in Boston for their annual gabfest about women's sexual dysfunction -- but some of their colleagues say they're misguided.

By Barbara Raab

Oct 26, 2000 | The good news is, doctors and drug companies are paying more and more attention to women's sexual problems. Or -- wait a minute -- is that the bad news?

It all depends on whom you ask.

If you ask Dr. Irwin Goldstein, a high-powered and Pfizer-funded Boston University urologist and one of the head honchos of the so-called FSD -- female sexual dysfunction -- movement, he'll tell you it's great news. He'll tell you that as many as 50 percent of men and women in America have some sort of sexual problem. He swears by Viagra for men and will now tell you, "If we can better understand the processes of female sexual function, we can eventually improve our treatments for female sexual dysfunction."

For the next four days, Goldstein will preside over the third annual "New Perspectives in the Management of Female Sexual Dysfunction Forum." Some 500 people from 23 countries will converge on the plush Marriott Copley Place hotel to take part in 93 presentations with titles like "Central Neurophysiology and Pharmacology of Female Genital Sexual Function" and "FDA Guidelines for Clinical Trials in Female Sexual Dysfunction." Yes, if you ask Goldstein, he'll tell you all of this is terrific news, and that his "ultimate goal" is to help women enjoy sex more.

But then ask Leonore Tiefer about this gathering -- indeed, ask her about this whole FSD movement. She'll tell you this is bad news -- very, very bad news -- for women. Tiefer, a well-known clinical psychologist, professor and author ("Sex Is Not a Natural Act and Other Essays: Psychology, Gender and Theory") who has specialized in sexuality and sex therapy for 30 years, will tell you she's appalled by what she calls the "competitive commercial hunt for 'the female Viagra.'"

She'll tell you about the insidious inadequacy of the bible of the psychiatric profession, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which divides all female sexual problems into four neat little categories: desire problems, arousal problems, problems having orgasms and pain. She'll tell you she's certain that dozens of lectures, slide shows and discussions about rabbit clitorises, rat vaginas and devices to measure blood flow are not going to help improve most women's sexual lives.

Tiefer will tell you that, yes, she'll be one of the hundreds of people converging on Boston to talk about sex. While locals and tourists spend this weekend enjoying the New England autumn -- the crisp air, the foliage bursting with color, the festivals celebrating everything from Scottish culture to cranberries -- Tiefer and a small group of other psychologists, sociologists and anthropologists who have formed the Working Group on a New View of Women's Sexual Problems will be at the Marriott Copley Place fighting the good fight, trying to raise some consciousness about what they believe is "the urological/pharmaceutical co-option" of women's sexual problems.

Salon spoke with Tiefer this week in New York, where she lives and works, just before she left for Boston, where her group was planning a press conference to unveil its blueprint, "A New View of Women's Sexual Problems."

You talk about the overmedicalization of the female sexual dysfunction movement. What do you mean by that?

Too much of the research about women's sexual problems is funded by drug companies and narrowly conforms to their interests. There's just too much emphasis on claiming things are physical and then selling products.

The pharmaceutical companies want products they can market, which I distinguish from products that will help women with their sexuality. Their criteria for many trials exclude women with so many real-world problems -- they exclude women with psychological problems, or partner and relationship problems. They're interested in studying women with purely physical problems. So they find drugs that work on these physical problems, but then their marketing strategy, as we've seen with Viagra, is to market romance. Their strategy is not to be specific and say something works with this kind of person who has this specific kind of problem. They just say, "Use the drug, start dancing!"

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