Once upon a time people couldn’t see. They bumped into walls, they had trouble reading, they saw double, they had horrible pain in their eyes and in the worst cases they went blind. This was a big problem and since this was a hundred years ago no one really had good language to use to describe different problems.
They didn’t realize that there were some people who could see close-up but not far off; or those who could see in the distance but could not read clearly within an arms’ distance. They certainly didn’t realize that you could scratch your cornea and have pain, develop a film over your eyes as you aged or go blind from certain diseases and too much eye pressure. All they knew was that people had “sight problems.”
Luckily, over generations, our understanding of the eye has increased dramatically. We understand that the eye has lenses that can get scratched or bent. We understand that diseases can create deterioration and change and we have given these conditions descriptive names often with medical emphasis. People are now near-sighted and far-sighted, have strabismus, macular degeneration, glaucoma and corneal disease. As more and more numbers in our population present with these conditions, we have begun to better understand the fundamental differences between them and because we understand them better we have been able to treat them appropriately. Treatment devices include glasses, ocular exercises and surgery.
So what does all this have to do with FSD — Female Sexual Dysfunction?
The term FSD was coined about ten years ago as a broad catch-all phrase to include women’s low sexual desire, problems with arousal, trouble achieving orgasm and painful sex. These over-arching diagnoses were too general to be helpful at times, but they represented a first step in acknowledging the very real concerns that many women have with their sexual function. By using the term FSD to characterize these conditions, the medical and psychological community loaned legitimacy to problems encountered by a large swath of the population, problems that interrupted the natural progression of relationships, marriages and productive self-esteem.
Liz Canner in her new film, Orgasm Inc., makes a legitimate case that FSD, as a diagnosis, has been created by the companies that hope to make money off their treatments. The film links FSD as a diagnosis to the launch of Viagra. Viagra allowed society to begin discussing sexual health in a more open manner around men and their sexual function. The film suggests that pharmaceutical companies saw a cash cow nestled in the common complaints from women about sexual satisfaction. If it worked for men’s erections, might it work for women’s sexual desire? The film’s analysis of FSD stops years ago when the practice of treating women for sexual issues was young, and the press was hot to trot out event after event about sexual health.
But if we examine the topic and the real progress made over the past ten years, Ms. Canner’s argument looks more and more like a straw man.
The field is no longer simplistically defined as “female sexual dysfunction.” A decade or more of experience working with women has helped us understand the difference between arousal and desire problems, between pain sourced in muscular contractions in the introitus or pain due to skin irritations, between physical conditions and issues that lie mainly in a personal history or relationship. These layers of understanding help professionals in the field tailor treatment protocols so they can have the best outcome.
It is true that the bucket of FSD diagnoses has exploded in the last 10 years. Today, we have a much more sophisticated understanding of the myriad issues that a woman might be facing and the solutions that might help her. From my seat across the table from these women every day, that’s a good thing.
The point is, this is a new field. And as in all new fields the initial challenges of identifying, classifying and understanding the variations is a tricky practice, especially when trying to do it in a respectful, thoughtful manner. And those urologists, gynecologists, vulvar physical therapists, psychiatrists and psychologists and sexologists in the field, all dedicated to women who come for help, need to be considered as the professionals they are, not lumped in with spokepeople for pharmaceutical companies or snake oil salesmen.
There’s no way we’re going to get it perfectly right the first time around. And things that seem obvious to us today, may seem erroneous tomorrow. But we are trying. The fact that abuses may occur on the way does not mean the entire initiative should be delegitimized and discarded. If that were the case, the thousand women we see every year would have nowhere to turn for help.
Allowing women the freedom to express their concerns about their sexuality and giving them broad approaches to solutions is, in my mind, the only reasonable way to effect change. We will never find one solution and there is no one drug or one behavioral therapy that will help all women. The more tools we have in our arsenal, the more pieces of the puzzle we understand the better we will be at helping women find solutions that work.
One thing I know for sure. We don’t tell people who are having trouble seeing that watching a sunset, looking at a painting or admiring a flower should be something in their past, that they should be willing to live out their lives without that pleasure. We also don’t tell them that they should spend a year in therapy mourning the loss of the pleasure of vision. What we do is address the problem and help them see again, as well as possible. Don’t women deserve the same with their sex lives?
