The Sex Myth: Why Everything We're Told Is Wrong (4 page)

Other studies have uncovered a gap between the number of women who can be potentially diagnosed with FSD and those who seem to actually have a problem. A study in London compared the newly
developed diagnosis against the number of women who felt they experienced negative sexual dysfunction effects. While using the diagnostics found 38 per cent of women had sexual dysfunction, only 18
per cent of the women thought their symptoms concerning – and just 6 per cent rated it ‘moderate’ or ‘severe’.
¹³
Surely, if
there is a problem with lack of desire for sex, the best placed person to decide whether it’s severe or not is the woman herself . . . not some arbitrary clinical scale.

A Swedish study confirmed that less than half of women who reported decreased interest in sex over time considered themselves dissatisfied.
¹⁴
Another
study by Irwin Nazareth in London looked at subjects recruited from GP surgeries and suggested that in people who could be diagnosed with a sexual dysfunction, ‘reduced sexual interest or
response may be a normal adaptation to stress.’
¹⁵
In other words, could what is being labelled as a disorder actually be a natural ebbing and
flowing of desire over time?

What would be the reasons for such disagreement between the diagnoses and the number of people reporting problems? One reason could be that people were not discussing their problems with GPs
– possible, but the Nazareth
et al.
study suggested that patients are pretty honest with their doctors when it comes to sexual difficulty. While it is plausible that people who speak to their
GP about problems with sex
are a self-selecting group, making the study an undercount of people with the syndrome, there is no easy way to correct this. As this book will
explore later on, the ‘dark art’ of estimating unknown populations is a much misunderstood, and sometimes abused, approach to diagnosis.

Another reason could be that the criteria are defined too broadly. In some cases it looks like even an occasional event merits a scary diagnosis. But what would be the benefit of overdiagnosing
the population? Some diagnostic manuals, such as the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV), have been criticised for possible conflict of
interest between the committees who write the disease definitions and the pharmaceutical companies selling prescription drugs. Half of the people on the DSM committees have some kind of connection
to a drug company. On the committees writing definitions for some areas of disorders, the figure shoots up to almost 100 per cent.
¹⁶

Because of their controversial nature, there has been a push to reconsider the criteria for sexual dysfunction – considerations that may be reflected in the upcoming DSM-V. According to a
paper by Richard Balon and Anita Clayton, ‘Marked distress or interpersonal difficulty is a criterion of all DSM-defined sexual dysfunctions,’
¹⁷
since this helps determine what is and is not normal. But if large numbers of women being diagnosed say they are not distressed, then how can the diagnosis be real?

So it’s unsurprising that drugs hyped as potential ‘female Viagra’ have not done well. Along with the failure of Viagra-like vasodilation drugs and hormone treatments, drugs
that target neurotransmitters have also failed to have an effect. Procter & Gamble’s experimental testosterone patch was rejected by the US Food and Drug Administration in December 2004.
The German drug company Boehringer stopped developing its drug flibanserin after unsuccessful clinical trials in North America.
¹⁸

The assumptions made by Agenda Setters and the researchers they influenced all follow old stereotypes. The drugs either try to increase vaginal blood flow (implied: women don’t get turned
on easily, so drug intervention is needed), or they try to boost testosterone (implied: women don’t have hormones like men’s, so drug intervention is
needed).
Others focus on neurotransmitters (implied: there’s something lacking in women’s brain chemistry, so drug intervention is needed).

Characterising natural variations in women’s libidos as a problem that needs to be solved is nothing new. What is novel is the interest from big pharmaceutical companies and other Agenda
Setters in getting involved on a commercial scale. In the 1966 book
Feminine Forever
, author Robert Wilson suggested that the menopause is a ‘disease’ of female hormone
deficiency and that good sexual health could be saved by taking hormones. Wilson’s writing was hugely influential. In the following decades, hormone replacement became a popular option for
Western women above a certain age. It’s a treatment that is far from cheap and demands constant upkeep, and has been linked with some negative side effects including cancer and heart
disease.

Hormone replacement and its supposed benefits, particularly for older women’s sex lives, however, are at odds with the experimental evidence. With their famously extensive laboratory
research, Masters and Johnson showed in 1970 that ‘nothing could be further from the truth than the oft-expressed concept that aging women do not maintain a high level of sexual
orientation.’ The menopause does cause thinning of the vaginal walls and decrease in lubrication, but the studies found no decrease in clitoral function, which is the real cause of
orgasm.
¹⁹

Undoubtedly there are women who do suffer from sexual problems, and over the course of a lifetime, this can affect a large proportion of people at some point or another. But claiming it’s
a disease in approximately half of all women all the time? Not only does this exploit old stereotypes about women and lack of desire, it’s a strategy that hardly helps the smaller proportion
of women who are distressed and might actually benefit from targeted and sensitive treatment.

The characterisation of variations in female libido as a dysfunction has not led to a pharmaceutical success. This hasn’t stopped the interest of Agenda Setters, however – far from
it.

The World Congress for Sexual Health, held in Glasgow in June 2011, attracted sexual health experts from all over the world. Papers presented at the conference were published in the prestigious
Journal of Sexual Medicine
. Alongside the research areas you might
expect at the conference, like HIV prevention, teenage pregnancy, and gender and sexuality there was
a session entirely devoted to ‘Hypoactive sexual disorders among women and pharmacological treatments’. One of the major exhibitors supporting the conference was the drug company Bayer,
which has been developing and marketing an intra-vaginal drug meant to treat (wait for it) . . . female sexual dysfunction.

It’s interesting to note that while the Agenda Setters press on with their pharmaceutical solution, research indicates there may be a real, and cheap, way to address the problem for those
who are actually suffering.

Studies of treatments for FSD that only take a pharmaceutical approach have been negative or mixed. Studies that include erotic images, however, have been far more successful in getting results.
Postmenopausal women on oestrogen-replacement treatments were treated with sildenafil (the generic name for Viagra) in an attempt to restore orgasmic ability.
²⁰
While the drug on its own did not do much, the study also combined pharmaceutical treatment with watching porn. The paper notes that ‘[t]he erotic video significantly
increased subjective sexual arousal in all women’ but that they ‘do not benefit from sildenafil’.

Or in other words, put a sexual context back into women’s lives, stop harping on about a supposed dysfunction, and before you know it they may start to sexually respond. It’s not
really all that surprising, is it?

A pity for the Agenda Setters that they aren’t in the business of producing porn films. Or at least, they aren’t . . . yet.

The power of sex and sexuality over our lives goes far beyond producing offspring. The reasons for this are far older than our society, older than humanity, even. Evolutionary
theory suggests several main drivers of survival. Natural selection is one of the most well known. Natural selection says the traits that prevent death before maturity become more common in a
species over time. This is because the individuals with the traits live long enough to pass it on to the next generation. For example, a variation that enables a moth to be camouflaged better, so
predators can’t see it, makes it more likely to live to
reproduce and pass that gene on. The offspring that inherit the mutation will also benefit, and be more likely to
continue reproducing.

But sexual selection is also important: from the cold point of view of animal reproduction, if you can’t attract a mate, it hardly matters whether you made it to adulthood or not. The
large horns of the male red deer, for example, are used not for gathering food or anything else related to day-to-day survival. They are used for the express purpose of fighting other males to
impress, and thus gain access to, females. The elaborate feathers and mating dances of the male birds of paradise are an adaptation that serves a similar purpose. It doesn’t affect whether
they make it to adulthood, but it does make mating and procreation more likely for the genetically fortunate.

Natural selection and sexual selection can work together in the same species: the muted, camouflaging colouration of a pea hen is a result of natural selection because it keeps her safe. The
male peacock’s extravagant tail feathers are a result of sexual selection because it makes him attractive as a mate.

Until recently, the question of why humans evolved large brains and language abilities focused on natural selection. Our brains, as a percentage of our body volume, are much larger than those of
our closest ape relatives. Scientists suggested that human brains grew in response to a need for greater cognitive skills, and that these were necessary for getting food. Language skills were
attributed to a need for aiding co-operation (and therefore survival) within a family group.

However, some have started to ask whether the size of our brains is actually the result not of natural selection, but sexual selection. After all, relying on natural selection alone does not
address very much of what makes us human. The abilities of creating music and appreciating literature, for example, don’t give much advantage in hunting food, avoiding predators, or seeking
shelter. You don’t need art to reach puberty.

But when such adaptations are recast as developments in the eternal race to attract and mate, some of the human abilities that are unnecessary in the day-to-day survival world of the caveman
begin to make sense.

Geoffrey Miller poses an interesting question in his book
The Mating Mind: How Sexual Choice Shaped the Evolution of Human Nature
.
²¹
‘Why omit sexual desire and sexual choice from the pantheon of evolutionary forces that could have shaped the human mind, when biologists routinely use sexual choice to explain
behavioural abilities in other animals?’

Not only does he make a thought-provoking point, it is a point that considers women to be equally as involved in sexual choice as men are. Women have aptitude for music, art, language, and every
other non-survival adaptation humans have developed, just as men do. If they weren’t as interested as men were in mating but adapted merely to survive, surely they would be less like the
flamboyant peacock and more like the poor pea hen: drab, dull, hiding in the undergrowth while she waits to be won.

Of course, as with most theories in the young field of evolutionary biology, it’s an idea that is very speculative and hotly contested. It’s only an idea. In order to prove it, far
more research would need to be done from many different areas of the scientific spectrum, and even then it may never be confirmed whether the truth is one or the other (or both, or neither). But it
is food for thought when considering women’s interest in sex. Particularly when many have long assumed women’s interest in sex is strictly tied to security and child rearing.

Sex is a powerful social glue. People who suppress or are incapable of having children still have rich and active sex lives. Postmenopausal women still want to, and do, experience sexual
feelings. The abundance of reliable birth control methods does not eliminate the desire to have sex.

We are not the only species where the female sex drive is about more than just procreation. The bonobo, which along with the chimpanzee is our closest relative in the animal kingdom, has what
can only be described as a wild sex life.

Bonobos were formerly known as pygmy chimpanzees. For a long time they were assumed to be the same species as chimps, and were only recognised as a separate species in 1933. One of the more
well-documented differences between chimps and bonobos is their behaviour . . . specifically, their sexual behaviour.

One of the many things bonobos and humans share is the pursuit of sex even when procreation is not possible. Couplings between the
same sex are widely observed in bonobo
communities, as well as sex with individuals too old to reproduce. Interestingly, this happens in both bonobos and humans even when procreative, heterosexual sex is possible and available.

Another similarity with humans is that sex is also integrated into the natural social life of the species. In
Sexual Nature, Sexual Culture
, author Paul Abramson records in great detail
the varieties and frequencies of sexual acts among bonobos.
²²

Other apes like gorillas and chimpanzees mate in the ventrodorsal, or ‘doggy style’, position. But bonobos, like humans, also like to copulate face-to-face. Mouth kissing and mutual
masturbation are frequent activities with bonobos, just as they are with us. Fellatio and cunnilingus happen frequently, as do male-male and female-female genital rubbing. And the activity is not
necessarily just a reproduction strategy. While sexual activity is far more frequent in bonobos than in chimpanzees, the fertility rate for the two species is about the same.