Fab sex just a pill away
Women’s level of desire and arousal is being pathologized
The sex therapist told Charlene to do “whatever it takes” — watch porn, use toys, masturbate — to reignite her sex life, no matter how exhausted she was from her double shift juggling her full-time job and running the household.
Another woman was prescribed testosterone for her “inability to orgasm.” Still another was encouraged to undergo hypnosis to deal with her “negative associations with sex.”
And next month, there will be another option for women with “sexual difficulties”: popping a pill to enhance sexual desire.
But as the first “Pink Viagra” to be approved by the U.S. Food & Drug Administration — called Addyi, or flibanserin — is set to go on sale, some critics say the impact on women may not be such a turn-on.
They argue all these treatments, whether medical or do it yourself, pathologize women for not fulfilling a certain sexual norm, a script that reads something like this: high desire, high arousal, lots of intercourse and “orgasm as end point.”
Even the “disorder” the makers of Addyi claim to address — called hypoactive sexual desire disorder (or HSDD) — is highly controversial. Critics say it is just the latest, seemingly neutral, term for “frigidity,” the notion women are naturally sexually “cold,” but could be “heated up” by their husbands or partners.
As Thea Cacchioni says in a new book, Big Pharma, Women and the Labour of Love, this brave new world of sex drugs could bring new pressure on women to improve “dysfunction” that may or may not exist, while risking side effects - such as dizziness and sleepiness.
Yes, acknowledges Cacchioni, a University of Victoria professor of sociology and women’s studies who testified against the new “sex drug” before the FDA, some women are desperate to regain the excitement and empowerment of an active sex life. But many others are struggling with a culture of “compulsory sexuality” — all those magazine headlines screaming about how to be better in bed — not arousal. The word she hears a lot in her interviews with women on their sexuality is “chore.”
Pills could make things even worse.
“I think the marketing (for Addyi) will be very seductive and powerful, and I do think there will be a lot of partners who will think, ‘Oh, I don’t need to try anything different. I don’t need to put my own work into this,’ ” says Cacchioni.
“I can encourage her to get a prescription from her doctor and that will solve everything.’”
Part of the problem is desire itself.
Caroline Pukall, a professor of psychology at Queen’s University in Kingston, Ont., says low desire, in both sexes, is notoriously difficult to treat, and numerous factors — relationships, stress, past sexual experiences — play into it.
Addyi and Viagra are also different drugs. Unlike Viagra, which works on the mechanics of erections by improving blood flow to the penis and is taken only when needed, Addyi was developed as an antidepressant. Its makers claim it rebalances neurotransmitters or brain chemicals that affect sexual desire, as long as users take it every day.
Even then, the drug only works some of the time. Despite the huge business interest in Addyi (Quebec pharma giant Valeant Pharmaceuticals International Inc. announced last month it will spend $1 billion to acquire Addyi’s makers, North Carolina-based Sprout Pharmaceuticals), the pill only produced about one extra “sexually satisfying event” per month compared with the placebos.
For all that, Pukall believes Addyi is an important addition to treatment. But she doubts it will transform women’s sex lives.
“I don’t think it will work for everybody,” she says. “Women are putting a lot of pressure on themselves to be the perfect career woman, the perfect parent. (Low desire) may be the result of a lot of pressures that have nothing to do with sexuality.”
Cacchioni agrees. She doesn’t believe women have a lower natural desire for sex than men. But she argues they have been socially conditioned to make sure everyone in the family is “emotionally” looked after — children, aging parents and husband — and are increasingly extending that “emotional” labour to their sex lives as well.
For her book, Cacchioni interviewed 31 women who self-identified as having sexual problems. But it took her more than a year of advertising the study, on university letterhead posted in coffee shops, community centres and sex toy stores, to find women willing to talk to her.
Contrary to the portrayals of female friendships on TV, many women don’t even talk about these issues with close friends, she found. As one woman put it, “You just don’t go there, because you’ve got to seem like you’ve got it all together.”
The women who did respond to Cacchioni’s ads ranged in age from 21 to 62 (the average was 33). Predominantly white and middle-class — and heterosexual, since that was the focus of her book — their jobs included gas station attendant, teacher, nurse, stay-athome mother, airport ground staff, yoga instructor and environmental scientist.
In many cases, they spoke about engaging in “duty” or “obligation” sex. “They normalize it as part of a long-term relationship,” Cacchioni says. In varying combinations, however, “they did not desire sexual activity frequently, had difficulty with arousal, found intercourse painful (for medical reasons) and/or could not orgasm easily, or at all.”
Some experts Cacchioni interviewed acknowledged men’s role in all this.
“She may not have an orgasm because her partner doesn’t have a clue how to stimulate her and he’s taking two minutes of foreplay and moving onto intercourse,” one therapist told her.
Paradoxically, expert sex advice was once almost exclusively aimed at men, Cacchioni writes in Big Pharma.
“Sex manuals dating back to medieval times had an assumed heterosexual male audience,” she says. Marriage manuals of the early 20th century “continued to call on men to hone their sexual skills.”
By the 1950s, though, the focus turned to women. Manuals such as How to Hold Your Husband: Frank Psychoanalysis for a Happy Marriage largely ignored the possibility of “faulty male sexual technique,” Cacchioni says, and instead blamed women for their failure to experience desire and pleasure.
For the women in Cacchioni’s study who were “working” on it, the most common strategy — and the one most often advocated by any kind of medical or sex expert she spoke with — was a kind of “discipline” work.
That “discipline” could involve using pills, creams, herbal remedies and dildos, or women allowing their bodies to be “examined, monitored and assessed” by doctors.
Other women engaged in “performance work,” otherwise known as “faking it,” Cacchioni says.
Many of the women in Cacchioni’s study also developed strategies to avoid sex, “a form of work in and of itself,” she writes. They fell asleep before their partners did; they encouraged their husbands to travel more often.
Dr. Rosemary Basson of the University of British Columbia says women are often motivated to initiate sex by an urge for intimacy, bonding and the “expectation of increased well-being of the partner.” The more she gets into it, the more she moves from a state of “sexual neutrality” into a state of sexual pleasure and arousal.
But Cacchioni thinks that’s true for men as well.
“I think the happiest women I interviewed were the ones who may have tried working on (desire) in various ways, but ultimately what gave them satisfaction was learning about their bodies, sex education and accepting their sexual functioning for what it was,” she says.