A rich man goes to his doctor and gets a prescription for Viagra. The doctor warns him about the float time, that he has to take it about an hour before he needs it, and sends him on his way.
A little while later the guy calls his doctor in a panic. “Doctor, I took the pill on the way home and now I’m here and my wife isn’t coming back for hours! What do I do? This is kinda painful.”
The doctor thinks about it for a second. “Do you have a maid? Have sex with her instead.”
The guy starts to whine, “But doctor, I never needed it with her before.”
I heard this joke a number of times after the drug Viagra first came out. As you can imagine, one of the reasons it stuck with me is it’s such a first-rate example of various unspoken assumptions about gender and class privileges. I was reminded of it when I read Charlie’s post today about his struggle with how male privilege factors into discussion about the research for drugs to “cure” women’s low libido. I agree with him that I had the same hesistation–a lot of women out there have a lack of sexual desire that’s incredibly troubling to them and in a way, it’s a testament to feminist advances that the medical establishment actually thinks that women’s desire is relevant enough to want to address it, instead of simply handing women a tube of KY and telling them to close their eyes and think of England.
Another cause of my hesistation to see some of the sexist assumptions behind the discourse around treatments for women with low libidos is the fact that Viagra was developed first, even though I know that the development of the drug really started by accident, when its benefits vis-Ã -vis erectile dysfunction were noted while it was being researched as a heart medication. And the drug is meant for and is primarily marketed towards aging men whose bodies aren’t as reliable as they were when they were young.
And when the drug came out, the amount of social anxieties it provoked were rather breath-taking–I remember trying to watch an episode of “Oprah” with some family members where they interviewed people whose marriages were helped by the drug and the amount of cringing on the show and in my living room was rather alarming. But one thing stuck out in my mind–the women on the program all said that it was a huge load off, not just because they were getting laid more often so much as because it made them stop beating themselves up.
I chatted with Charlie about this post he’s written before he wrote it, because I think we both had problems understanding how to understand that just because a drug that ups women’s libido can be hugely beneficial for individual women and still understood as stemming from an oppressive culture and afterwards, while I was still trying to suss out my feelings on this, I remembered the joke that I wrote above and I think it clarified some of my thoughts on this. The problem isn’t, as Charlie notes, individual couples who are seeking out practical solutions to mismatched libidos. The problem is that in our culture, the default assumption is that the responsibility for mismatched libido issues rests primarily with the woman. We even, as a culture, managed to fit Viagra into this belief system with jokes like above that imply men have to take it as a big favor to women who aren’t attractive enough to arouse them anymore.
I think ultimately that’s what troubles me about the discourse surrounding what should be treated as practical solutions to the extremely common problem of mismatched libidos–looking at what the men maybe could do is always treated as the last resort, after women have exhausted all possible options. I know that whenever this problem has come up for me in the past (never as an ongoing thing, more as a temporary thing), and it was me that was the, uh, hornier one but I also assumed that if I wasn’t getting enough, the responsibility was 100% mine for suddenly morphing into a hideous beast that was untouchable. And I’ve had boyfriends who were only to happy to feed into that notion, untrue as it was, because it helped relieve them of actually thinking about if they ever had the responsibility to make sure that I was satisfied with the sex in the relationship.* But on the occasions where I was demurring, it was also assumed that it must be my fault–ye old “I have a headache/cramps/it’s that time” excuse. I don’t think I’ve ever had it even raised as a remote possibility that my lack of desire at any given time was due to my partner’s lack of fuckability, but that I’d failed as a sex object was always the starting point when the roles were reversed.
Of course, if the problem persists and a couple sincerely wants to address it, then often they get past that and move onto actually looking for practical solutions. And there are practical reasons to look first and foremost for drugs to enhance libido, instead of ones to supress it, the number one being that sex is fun and good for relationships. That some people are certainly going to abuse this drug to avoid talking about relationship problems doesn’t mean that people who’ll use it responsibly should be denied access to it, if they ever do develop it. But it will be easier, I think, to clarify what responsible use is if we are open as a society to talking about the unfair standard that the responsibility for the sexual health of relationships (actually, and the emotional health, too) falls primarily on the shoulders of women.
*Seriously, ladies, if you feel that your self-esteem is getting perilously high, you can’t beat dating someone who’s prone to depressive moods that make him lose all interest in sex. If you’re lucky like me, the up and down roller coaster will result in you gathering a drawerful of lingerie you’ll never wear, a bucketful of make-up you never use, and if you’re smart, you’ll cut it out and actually ask him to deal with his problems before you develop an eating disorder. It’s fun! Try it! I will say, though, that the development of Viagra has at least opened up space where people can actually say that men do have some kind of responsibility, and that it isn’t all up to women.
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Blog for Choice!…
BushvChoice and NARAL Pro-Choice America are proud to announce the launch of the Blog for Choice campaign. Blog for Choice is bringing together top pro-choice bloggers to speak out on reproductive rights and health issues. I just want to say……
This reminds me of one of those conservative diatribes that was sent out on soem balst fax a few years ago. A study was being performed trying to understand female arousal. Given that there is a huge amount that is unknown because only recently has it be deemed worth studying what we have here was soem basic science. The study invovled having women volunteers watch different types of porn while being monitored for sweeling and moisture through what I imagine to be unfun probes. These women were paid a modest fee for their time. Anyway the problem of course is that the study received some NSF grant or some such. So there was goverent sponsorship of women watchign porn! It becaem one of those rallying stories of the government wasting money on women watchign porn. Something most would do for free! Of course there was no need to address the underlying issue of female arousal or to try to understand human sexuality. Women watching porn while being paid (partly of course) by teh government was terrible!
I don’t know if this is really off-topic or not, but I’ve been thinking about stuff like this in my current relationship. In my opinion, we definitely have a problem with mismatched libidos - mine’s stronger than hers - as well as other sexual issues. Drugs that treat ED can be healthy for a relationship in which there is an actual physiological factor contributing to sexual problems, but I sometimes wonder if their presence creates an easy out for some couples and allows them to avoid talking about deeper issues.
I hear what you say about men considering more what they could do, but oddly, I feel like it’s reversed in my case. My current partner doesn’t seem to think she needs to do a whole lot to keep me aroused, and when I don’t stay that way, she suggests later that maybe I have a physiological problem. She may have a point, but I suspect there’s a underlying motive of putting all of the responsibility on me, so she doesn’t have to consider that she needs to contribute to the solution as well.
Sorry if that’s TMI for y’all.
An aside.
Sometimes, you luck out and both of people in the relationship have depression and really low libidos. Like me and my boyfriend.
The irony for me is that my mother, whose so morally offended that we live together, assumes that we’re constantly boinking. The truth is far more unexciting. We have sex maybe once a month, maybe once every few months.
Yeah, there’s probably something wrong with us (I’ve had to choose between suicidal thoughts and having a sex drive), but at least we’re in sinc.
Drugs that treat ED can be healthy for a relationship in which there is an actual physiological factor contributing to sexual problems, but I sometimes wonder if their presence creates an easy out for some couples and allows them to avoid talking about deeper issues.
Actually, in practice it seems to be having the opposite result.
I’ve got a physiological sexual dysfunction that has kept me unable to perform. I’ve been seeing one of the top doctors in sexual dysfunction, and learned many interesting things.
And what they’ve found is that men often would come to his office complaining of impotence thinking Viagra would resolve their problems. They’d get Viagra, be able to get it up, and then discover that their problems are a bit more complex than simple hydrolics. After realizing Viagra wasn’t the panacaea cure-all, the patient would come back for sex therapy or relationship therapy and deal with the root issues that the impotence may have been masking.
One of the problems regarding FSD is that it isn’t quite so obviously physical as men’s problems. So for the longest time, therapy was the only solution for women. In my case, I’ve spent years (and thousands of dollars) on every kind of therapy, only to have my problem diagnosed in one visit after the right labwork.
PS: If you’re interested, more on FSD from one with firsthand knowledge
in our culture, the default assumption is that the responsibility for mismatched libido issues rests primarily with the woman.
I think it rests on whichever partner has a lower sex drive, too — although when that is the woman, far more so. If a woman wants it more than a man, I think people will be divided on which partner needs to be fixed, whereas if he wants it more, people who don’t make the sexist assumption that this is the way of the world (with the usual winking jokes about how sex falls off once a couple commits and insinuations that she uses sex primarily as a carrot and stick for the man rather than a bonding experience and/or a plesurable act) will almost always assume she needs to be fixed.
That is, it’s true that for a number of people it is always the woman’s fault when there are mismatched libido issues, the reasoning is different depending on which parner is hornier: if it’s her, she’s broken because she’s “oversexed,” and if it’s him, she needs adjustment because se’s not providing him the sex he’s entitled to, and you’re not allowed to rape your wife anymore in most places.
When same-sex couples have a mismatch, how is the blame apportioned?
Lis Riba:
Good points, and thanks for the cite.
No one ever covered this subject better than Woody Allen in “Annie Hall.” Talking to his psychiatrist, Allen’s character complains that he and Hall “hardly ever” have sex — “two three times a week.” Talking to her therapist, Hall complains that they’re “constantly” having sex ‘’ “two or three times a week.”
Probably a minority of sexual problems warrant drugs. Most are more likely emotional and relationship issues that play out in the sexual relationship. I highly recommend the book Passionate Marriage by David Schnarch for anyone interested in exploring how sex works in committed relationships. The website is http://passionatemarriage.com/ca_passionate_marriage.shtml
I think you neatly condense the entire Patriarchal Or Not? argument in these two quotes:
it’s a testament to feminist advances that the medical establishment actually thinks that women’s desire is relevant enough to want to address it, instead of simply handing women a tube of KY and telling them to close their eyes and think of England.
So…not.
On the other hand:
I don’t think I’ve ever had it even raised as a remote possibility that my lack of desire at any given time was due to my partner’s lack of fuckability, but that I’d failed as a sex object was always the starting point when the roles were reversed.
Whoa, THAT rings a bell. A very patriarchal bell, I might add.
So, yeah. This whole FSD issue is complex. That we choose to look at it is a huge leap forward. But, unsurprisingly, we are still largely looking at it through patriarchy-trained eyes.
Because I am (a) in favor of more choices, and (b) in favor of high libidos, my tendency is to come down in favor of FSD research and treatment, and deal with the patriarchal side effects as they arise.
I don’t get it.
I feel like this Russian guy I used to work with.
“Where is joke? Is funny?”
I think [blame/responsibility] rests on whichever partner has a lower sex drive, too � although when that is the woman, far more so. If a woman wants it more than a man, I think people will be divided on which partner needs to be fixed, whereas if he wants it more, people who don’t make the sexist assumption that this is the way of the world (with the usual winking jokes about how sex falls off once a couple commits and insinuations that she uses sex primarily as a carrot and stick for the man rather than a bonding experience and/or a plesurable act) will almost always assume she needs to be fixed.
I disagree to a certain extent.
Before I had a diagnosis regarding my low libido, much of the well-meaning advice we received centered around things my husband could/should be doing to put me in the mood. Not just the “he should be helping with the housework more” (though I’m the breadwinner and he’s the housekeeper in this relationship) but stuff that really cut into the core identity of what it means to be male.
If I wasn’t in the mood, then clearly he must be a lousy lover, or maybe just unattractive. He needed to romance and woo me with candlelight dinners and flowers. Maybe he was too pushy and overdemanding (and thus uncaring of my needs).
I carried my share of guilt as well, but most of my advice was more positively phrased. Try this herbal supplement, relax, have a glass of wine before, masturbate to get in touch with your body…
There’s a certain cultural expectation regarding male prowess (part of the reason women give for faking enjoyment) and when he couldn’t live up to that, it was difficult. Not something one can talk about easily with others.
As I commented to Charlie (thanks for the link, Amanda!), if we hadn’t gotten a diagnosis that absolved us both from guilt, I suspect the stress would’ve broken us up by now.
Again, this is just our experience, and may not be universal.
it’s a testament to feminist advances that the medical establishment actually thinks that women’s desire is relevant enough to want to address it, instead of simply handing women a tube of KY and telling them to close their eyes and think of England.
One other aspect to that. Much of the reason the medical establishment is actually addressing women’s desire is because after Viagra’s release, women with sexual dysfunctions stood up and demanded attention.
I remember Viagra’s release well. Here are a couple posts I wrote at the time about feminist aspects to the differing treatment men’s and women’s sexual problems got.
And Dr. Irwin Goldstein, who was then best known as an expert in male sexual health, reports women calling him “in droves” — partly the partners of impotent patients, but strangers out of the blue as well. He actually calls Viagra an “empowerment moment” when women realized that we shouldn’t have to rely solely on mental health solutions, but that doctors should be looking at our bodies as well…
Oh, and FWIW:
[Viagra] is meant for and is primarily marketed towards aging men whose bodies aren’t as reliable as they were when they were young.
Most of the clinical trials for hormones/medications for women with FSDs are only being tested on postmenopausal women.
And the hormone supplements I’ve been taken are offlabel use of products either geared towards men (which means trying to partition a “single-use” packet of testosterone gel into the correct smaller dosage for females) or for postmenopausal women.
Given the frequent controversies on feminist boards every time the subject is raised, I suspect products will continue to be marketed towards seniors for the forseeable future.
As someone who works in this field, I can tell you that 90-something% of Viagra-type drugs are prescribed unnecessarily. For a few men, there is a non-fixable physical barrier to their having or maintaining erections; for the rest, the problem is either psychological or related to age. The former can be fixed in short-term sex therapy, which hardly anyone does anymore; the latter by producing more testosterone, which is done by having more sex (which includes with oneself).
Viagra and that whole family of pills is mainly an orgasm-creator for the drug companies. They knew they had a winner because, as you say, the culture will readily do anything to help men have more pleasure and retain high self-esteem. Once a man’s “problem” is “fixed,” then it is assumed–the ads are very up-front about this–that the woman will be all happy and everything will be okay.
In my years of treating women with sexual dysfunction, the two main causes I have observed are unresolved childhood sexual abuse and perimenopause/menopause. These problems are not restricted to heterosexual women, either. Both men and women complain that they have lost inteest in sex because of emotionally unavailable or sexually inhibited or fumbling partners. A Masters and Johnson-type approach to sexual dissatisfaction (and problems like e.d.) can still help more than anything I know. It is people’s unwillingness to talk about sex that makes the problem grow. Again, this is not limited to women. Women don’t talk about their needs because, as women, they are conditioned not to. Men don’t talk about their needs because they have never been taught how to.
Obviously, I am not pleased about the prospect of women taking pills to help increase their sexual desire. Maybe a few would need to, but years of working with people in this area has convinced me that the problem is almost always not physical (except with perimenopause/menopause, and not all of that is), and people do not need more pills.
On the other hand, treating symptoms is, contrary to popular opinion, not always a bad thing, and–especially in the sexually arena–can bring about real change.
Just for shits and giggles, don’t forget the expectations around the definition of “sex.” For some people, when they’re depressed or “the flesh is weak,” so to speak, there are a myriad of other alternatives. For others, that man-in-woman action is sex, all else is foreplay. No performance anxiety there at all.
Let’s also talk about how desires can conflict with logic. Such as someone having a moral problem with anti-depressants (the “un-natural chemical” issue), even though they’re working. While we’re on that subject, railing at a guy about one kind of medication is not conducive to getting them to take another kind. Just sayin.’
There’s a certain cultural expectation regarding male prowess (part of the reason women give for faking enjoyment) and when he couldn’t live up to that, it was difficult. Not something one can talk about easily with others.
As I commented to Charlie (thanks for the link, Amanda!), if we hadn’t gotten a diagnosis that absolved us both from guilt, I suspect the stress would’ve broken us up by now.
That too. In my case, the stress DID break us up. Sex wasn’t the only issue, but it certainly was one of the most damaging ones.
Looking at your partner(s) and saying “but you’re a man/woman/straight/queer/chinchilla, you MUST…” is unhelpful. Thinking about yourself with those words is equally unhelpful. One thing is for sure, that Ideal that you’re thinking of when you drop someone in a category does not resemble the person you’re referring to; if it did, you wouldn’t be making the statement. These things can be a guide, knowledge about the way the body works can be extremely enlightening, but “what’s really gone” is guaranteed to be more complicated than that.
I don’t care what your chromosomes or feelings say. Patriarchy may be in the bedroom with you, but so are a million other things - and none of them but you and whoever you’re with are maintaining the dwelling, paying the rent, changing the sheets, etc. It will be a continuous process to keep looking at the person who is really standing there trying to figure out who they’re with, but it’s worth it - and sometimes what you learn is that you need to not be in that relationship. Even that realization can be a triumph against the system.
This is probably OT, but one of the pieces of sex advice that has always rankled me is given to women after they’ve given birth. Sure it may hurt, sez this narrative, but have a glass of wine and loosen up.
Yeah. I have a line of stitches keeping my vagina and asshole separate from one another, and all you have to give me is “drink and submit”? Fuck you.
Lauren, Holy Crap!! Do these assholes not understand that there are plenty of kinds of sex that do not involve penetration of a women’s vagina (or anus)? Or do they know that, but get so used to dealing with a public that are locked into the PVI model?
How about, “your clitoris still works, but give your vagina plenty of time to heal and take it slow when you start with penetration again.”
There’s a post about BDSM on Alas, and one of the topics is whether the BDSM community’s emphasis on open communication outweighs any negative effects from eroticizing power imbalance. Well, here’s exhibit A: medical professionals in this culture cannot even think outside the box (pardon the pun) when talking to a woman who’s just had an episiotomy! I’d say that any honest discussion of sexual practice is pretty much a huge plus.
Re: This is probably OT…
Oh yeah, that’s a nasty one.
One of the pieces of sex advice that rankles me is doctors telling women the problem is “you think too much.” Usually accompanied by the suggestion to have a glass or two of wine.
Happened to me more than once, and after I outed myself about FSD on my blog, a friend told me about her experiences to ask my advice. And it turns out she got that from her doctors, too.
Sometimes it feels like there’s some inherent stereotype associating “frigidity” with women getting too smart for their own good. You can have brains or you can have great sex, but how dare you be uppity enough to demand both! And of course the contrast — associating good sex with not overthinking — is reminiscent of the dumb blonde or bimbo stereotypes.
I could not be more astonished at the conclusion (even by someone who works in the field, Diane) that the vast majority of these drugs are prescribed unnecessarily. There are millions of male diabetics in this country, for whem Viagra, Cialis, and related drugs are a godsend. Of course not all diabetics are alike, but after 50-ish, erectile difficulties are extremely common . . . and now, treatable.
Traven: Your point is … what, Woody Allen was (probably unconciously) sexist thirty years ago?
Diane:
Obviously, I am not pleased about the prospect of women taking pills to help increase their sexual desire.
Why should it be obvious? Like StealthBadger, apparently, I’ve had this discussion elsewhere regarding (other) mental illnesses such as depression. Why should taking a pill always automatically be the less desirable solution. It’s not for more overtly physical problems — people do suggest thinking TB away, but we call those people “quacks.” Why don’t we call people who say you should get your libido up (no pun intended) solely by talking it out quacks also?
I suspect the answer has to do with a belief (cultural? Hard-wired? What would an evol. psych. say?) that anything too easily obtained isn’t worth anything. A pharmaceutical solution is considered a quick fix, like using chemicals to fix neurochemical problems is somehow cheating.
That’s assuming it is indeed a neurochemical problem, rather than one of abnormally low horemone levels or something that is literally outside the reach of a talking cure.
Herschele — I’m not sure I had a point beyond that it was funny. Or that people (as human beings sometimes, sometimes as men and women) have different ideas of what constitutes a “normal” level of sexual desire.
Patrick — Read the last line as, “But doctor, I never needed it with the maid before.” If you don’t get it now, there’s no hope.
There’s a certain cultural expectation regarding male prowess (part of the reason women give for faking enjoyment) and when he couldn’t live up to that, it was difficult. Not something one can talk about easily with others.
It’s a side effect of the rape culture, women are expected by default to require goading into sex because they don’t like it, and as men are all horny beasts who want it all the time, it is their obligation to get the sex off of the women, so it is entirely a man’s problem if the couple are not having sex as much as either would like, and so the man is the one to find proactive solutions to any sexual dysfunction felt by either partner, and the woman’s only trouble is if she got a man who isn’t potent enough to get the magical sex mojo off of her.
traditional masculinity is pretty fucking evil for all involved really.
I think an argument can be made that Viagra commercials (and all the other ED commercials) are a fine example of consumerism hurting men as well as women. While the product may have initially been directed towards older men who were experiencing that quaint thing we call “aging”, the commercials make it clear they are targeting younger and younger men, implying you have to be a hot stud, ready to go at any second…oh, and that’s all your woman wants too - no foreplay, just fuck me and go.
While I’ve never taken any of the medications offered to women for a “diminished libido”, several years ago, when I started taking anti-depressants (which I no longer take) my physician was very frank about the fact that they may in fact eliminate what little libido I had left, and if that happened, and if I was unhappy about it, she would prescribe something.
As to who gets it worse when there’s a mismatch, I don’t know. I can say, from personal experience that I certainly blamed myself when my libido was running higher than my ex-husbands. I also know from conversations about it, he blamed himself. And I have no way of knowing how I’ll react in the future (becuase I’m assuming it *will* happen again at some point)
Based on conversations I’ve had over the years, it seems to me that when it comes to individuals, both parties blame themselves, but when it comes to the culture, women are often seen as the primary responsible party, since so much of our culture spends so much time sexualizing us from a young age to promoting us baby-factories.
Just my opinion, of course.
Yet another pertinent topic is what about women who’ve been socialized to think of sex as ‘dirty’ and someting ‘nice girls’ shouldn’t want to do. Some women report that they wish they had stronger libidos and that they don’t find their partner unattractive. But “something” stops them from either desire and/or orgasm. Repression of female sexuality is something the ‘patriarchy’ has been hard at for centuries.
Diane is probably right that most sexual problems are psychological. However, psychoanalysis is lengthy and not always beneficial. If a pill helps, go for it. Even if the main effect is a placebo effect, so be it.
For older people, however, it is often physical. Women don’t lubricate as well and males don’t maintain maintain an erection as well. It is a lack of vasocongestion. These are often people who now have the leisure to enjoy one another but less ability to do so. “Better living through chemistry” I always say.
I don’t know how the new female drugs work but Viagra doesn’t make a male have an erection. It allows him to. If he isn’t turned on, nothing is going to happen anyway. Presuming the female drug works the same way, if she is totally stressed out she’s not going to take a pill and become an instant nympho.
The pills could end up as power trips by the other person but that would mean that you were with the wrong person. The use of these drugs should be a communal decision
I’ve been thinking about this post for a while now, trying to formulate my thoughts on it.
So here goes:
I think that, maybe, before considering sexual therapy or drugs to treat FSD that some other things that might dampen women’s libidos should be considered:
1) Exhaustion from the double and triple shifts of working, doing most of the housework, and most of the childcare.
2) The confusion and lack of desire that can result from being steeped in a culture, from birth, that only ever views sex through male (patriarchial) eyes.
Meds are sometimes the height of quackery too don’t forget, and considering the rather hit and miss affair that is modern psychopharmacology you can never be too cautious when deciding to put strange chemicals into your blood stream and brain.
Most of the more visceral reactions to pill popping come from the inherent distrust of chemical dependancy though - which is what most psychopharmacology calls for, a regular reliance on a chemical substance to keep you in whack, with no discernible end to the need for treatment in sight, and the whole point of the chemicals is to alter the way you think and behave, which should leave most people a bit distrustful and cautious. There’s also no sense of accomplishment when you get better, that’s why poeple will buy self-help books before seeking chemical based treatments, despite the fact that anything called a self-help book is a fuckign oxymoron, and probably won’t help anyone but hte author in the end, but it does give the buyer the illusion of “helping themselves” and that they have some contorl over their lives.
Meds take the control from them totally, and puts it in the hands of the doctor.
Irene, diabetic men are in that small population of patients who should be prescribed Viagra, of course. But most prescriptions are not going to diabetic men.
Hershele, by “obviously” I meant in the context of my own post. I think my post makes it clear that I think there are unnecessary pills being taken. As for depression, again, it depends on the cause. It usually doesn’t take long to determine whether someone’s depression is the result of a life-long brain chemistry issue or the result of something else. For the former, antidepressant medications are wonderful. For the latter, they are either not needed at all, or they can be used a short-term remedy while the person learns to change her/his thinking and environment.
Read the last line as, “But doctor, I never needed it with the maid before.� If you don’t get it now, there’s no hope.
Oh wait, wait, I think I get it! The doctor told the guy to just fuck the maid, like she’s a piece of property with nothing to say about it, but then it turns out he’s been doing that all along!
Or no, wait a minute, the joke is that his wife is ugly and his maid is hot! And he cheats on his wife!
Either way, HI-LARIOUS, right?
Another joke:
Man after taking Viagra: “What am I supposed to do the other two hours? Hang laundry on it?”
Wife: Yes.
Thomas: “How about, ‘your clitoris still works, but give your vagina plenty of time to heal and take it slow…”
I want to point out that the forchette/fork is, in fact, part of the clitoris (the lower part) and is composed of erectile tissue. So if an episiotomy has been performed (doctors really need to stop doing this willy-nilly), then nerve endings have, in fact been lost and sexual pleasure may be diminished. Shorter: your clitoris may *not* work as well as before. Incontinence surgery can have the same effect, since doctors learn so little about women’s sexual parts in medical school and are still under the impression that the clitoris is very small and localized.
Something that bothers me about the attitude towards FSD: that “it’s all in our heads” AKA therapy should be the first route. There’s something troublesome about the insistence that most FSD is primarily emotional, not physical. I’m thinking primarily of complaints of physical discomfort and pain, not low libido (hormonal birth control and antidepressants have plenty to answer for in that area). If a woman states that PIV sex *hurts*, it makes more sense and is more respectful of her experience to look into/eliminate any physical causes *first* rather than immediately assume she’s neurotic. Agreed? That does not mean prescribing us anti-depressants for complaints of physical pain and sending us on our way (that’s no better than telling us to get drunk and submit!) Since women’s pain tends not get as much respect as it should (see: cramps being “no big deal”), it pays to consider that we may, in fact, be telling the truth about pain. We deserve the option for physical or chemical treatment. Keeping in mind that…
Given the history of how women have been diagnosed and “treated” re: anything sexual, yeah, we have to be very careful. The medical/pharma/therapeutic establishment do exist in a patriarchal culture and don’t always have our best interests in mind. Which is why FSD is such a complex issue. We shouldn’t have to be constantly watchful of those who are supposed to be there to help us, but we do. More knowledge, generated from women’s actual experiences, is key.
I’m not sure I had a point beyond that it was funny.
Sure, but the glimmer of recognition that makes it funny is the notion that sex is something that makes men feel satisfied and women feel put-upon. Woody Allen, although a straight-up ’60s liberal, may not have been trying to put women down, though.
Magis, psychoanalysis is rarely done anymore; in most communities, it is non-existent; I am puzzled that you would present it as the only alternative to a pill.
Sex therapy is short-term and can be extremely helpful in that it treats symptoms successfully. And for women (and men) who want to deal with underlying psychological issues, psychotherapy is available and recommended because those issues are generally having a negative effect on more than one’s sexual life.
I thonk what I meant to say before is this: low libido is seen as a problem per se. The solution is never for the partner on the lower end to find someone more compatible in that area, or for the partner on the higher end to put up with it (or take saltpeter), it’s always to raise one person to the other’s level.
Like Patrick, I didn’t get the joke until Sophonisba explained it.
It was funnier when I didn’t get it.
Michelle, good point. The nerves of the larger clitoral complex (Greater Clitoris Metropolitan Area?) can be impacted by an episiotomy. It’s easy to forget how far-reaching that complex of nerves is, because nobody talks about it.
About hormonal contraception killing libido, there is not enough frank discussion of that, either. After my wife gave birth (unplanned C-section), we got back to sexual activity quickly. Then her libido fell off a cliff. We had both been told that the sleeplessness and physical changes and such kill libido, so we tried to take it in stride, but we really use sex for intimacy.
After a while, she had a skin problem with the contraceptive patch, which she started using for the first time after giving birth because her blood pressure has been a problem with oral contraception. As soon as she stopped the patch, her desire was back. Nobody said that the patch might kill her libido even if the pill never did. She said that the doctors did her a real disservice by drumming into her that having a new baby kills sex drive, because she internalized the message so well that it concealed a real problem.
Diane:
O.k., pshychotherapy. My point was that some people have issues and some people don’t. If there are other issues, fine, they need to be worked out. But a large population doesn’t have issues with the other person, they just want a libido boost or a confidence boost.
I want to point out that the forchette/fork is, in fact, part of the clitoris (the lower part) and is composed of erectile tissue. So if an episiotomy has been performed (doctors really need to stop doing this willy-nilly), then nerve endings have, in fact been lost and sexual pleasure may be diminished. Shorter: your clitoris may *not* work as well as before.
So it’s effectively a form of clitorectomy that results from giving birth, lovely.
But remember folks; giving birth is a magical and wonderful thing with no serious side effects but love. Who could object to having that forced on them?
Just curious, anyone know how much (if any) real study has been done about female libido?
In re the porn thing, how much data did they get from that? Aren’t we constantly being told that women get very little stimulation from the purely visual? (ok, that’s a statement I have always thought was a crock)And how the hell is watching porn supposed to teach us about libido, which is a lot more than “does something make me horny right this second”
And it just occured to me…what about men? How are the studies about the male libido conducted? Because if these studies aren’t done in a way that takes all kinds of stuff into account, then they aren’t really worth dick are they?
Just curious, anyone know how much (if any) real study has been done about female libido?
Speaking in terms of physiology rather than psychology, not much, and most of it is relatively recent (post-Viagra). That’s actually one of the major problems in treating FSD. Medical science understands so little about healthy women’s sexual functioning that it’s hard to tell what’s broken or how it can be fixed.
I’ve attended a few lectures/seminars, and every time I learn something new. Summer 2003, my husband wrote up a good summary of the state of knowledge back then. [I’ve attended further lectures since, but I tend to get more caught up in the FSD aspects]
In re the porn thing, how much data did they get from that? … And how the hell is watching porn supposed to teach us about libido, which is a lot more than “does something make me horny right this secondâ€Â?
First of all, there are more kinds of sexual dysfunction than low libido. Some women have healthy libidos but arousal difficulties. Some have healthy libidos and no difficulty with arousal, but can’t orgasm. Many women have a combination of symptoms. [Lucky me, I hit the trifecta.]
This particular study was more about arousal than libido.
The notion was for healthy women to arouse themselves while hooked up to various monitors. Then they could measure the physiological changes occurring during arousal: what’s going on with bloodflow, erectile tissues, lubrication, etcetera.
I suspect they used porn (and would’ve looked for women who could get aroused through porn) because the monitoring devices might impede (or be hindered by) other forms of stimulation.
In other words, the point of this study was to figure out more about how a woman lubricates, rather than how she gets there, if that makes sense.
And it just occured to me…what about men? How are the studies about the male libido conducted? Because if these studies aren’t done in a way that takes all kinds of stuff into account, then they aren’t really worth dick are they?
Studies on males are somewhat easier because their functioning is so much more obvious. It’s up or it’s not. Researchers can see and measure tumescense much more easily than they can measure lubrication. So they’ve been the subject of more studies.
Lis -
Thanks for the information, and I’ve read several of your posts about FSD, thanks to one of the previous carnivals, but I think (unless I’m totally missing you) that it just kind of proves my point that although the word “libido” is being used, what we’re really talking about is pretty much strictly physical arousal. And while it’s obvious that physiology plays a part in libido, it isn’t everything.
michelle:
Re: your middle paragraph, hooray, brava, and I agree 1000%
Hershele Ostropoler:
I think what I meant to say before is this: low libido is seen as a problem per se.
To be accurate, the clinical definitions of FSD include the notion that the lack of libido “causes personal distress” [link]
If it doesn’t seriously bother the patient, it’s not a dysfunction.
That’s one reason why discussions of FSD often get caught up in relationship dynamics. If I were single, my lack of libido wouldn’t be anywhere near as problematic. But I do have a partner, whom I love very much, and this is something I want to do with him.
Despite that, the diagnostic criteria involve self-evaluation. It’s not asking what one’s partner wants.
Lorenzo:
I think that, maybe, before considering sexual therapy or drugs to treat FSD that some other things that might dampen women’s libidos should be considered…
There is one other hurdle you’re maybe not considering.
Before reaching the decision of therapy or drugs, there’s first the hurdle of actually deciding to raise the issue with a doctor.
That generally doesn’t happen until the people consider the problem relatively severe. Unless something sudden/dramatic/painful has happened, usually by that point they’ve tried some of the home or folk remedies. That’s true whether somebody has a persistent sore throat or problems with their sex life.
Before I got my FSD diagnosis, we looked into the division of household chores. I scrutinized my entire history for any possible abuse or other dissatisfactions I might be sublimating. And so on and so forth.
It’s not an easy subject to discuss with strangers (even doctors), so if there’s something couples can work out with one another, don’t you think they’ll try that first?
Thomas:
Well, I’m glad that she’s gotten better. My problems seem related to the Pill. Even though I’ve been off hormonal contraception for at least eight years I’ve never bounced back.
Fortunately, medical science is finally paying attention.
Here’s a 2003 post of mine explaining how hormonal contraception can cause sexual side effects.
Last summer another study came out showing some women continue to have problems after going off the Pill
And just last week, another study was published (it appears to be further work with the same population)
The latter studies are preliminary, but doctors are beginning to get a handle on the physiological component of what taking hormonal-contraception does to sex hormones.
BTW, IMO, none of that is a reason to get rid of hormonal contraception. IMO women on hormonal contraceptives need to be made aware of the risks and possibly have regular hormone tests so they can take steps if the sex drive starts going sour, before it causes permanent damage. If they start having problems, either stop/switch the hormonal contraceptives or add supplemental testosterone to compensate for what’s being lost by the contraceptives…
Magis,
Understood.
However, I didn’t mean to imply that the issues were about the other person. Many of the issues have to do with childhood experiences. But since you bring the subject up, short-term marital therapy, whether overly sex therapy or otherwise, is successful if done properly.
On the other hand, there are men who have become so caught in the “If I think about it I won’t maintain the erection, but how can I not think about it?” trap, that one or two successful experiences–such as they would get with Viagra–could indeed be enough for them to break the anxiety cycle, and I’m all for that.
Diane:
I see what you mean.
Re the other idea: I got in that trap once. I was prescribe a high blood pressure but neither the doc nor the pharmicist bothered to tell me about the side effects. It was a misery. When I finally went to the doc (having no idea) he cavalierly said, “Oh, must be the pill.” He could have saved me a lot of pain by being a better doc.
I didn’t mean to imply that therapy is not a good idea (though I probably did). Many people benefit from it and many more would if they tried it. I’ve always thought it the most perfectly crazy thing that a couple can have the most intimate relationship but they can’t bring themselves to talk to each other about it. Now that’s crazy.
women who don’t / won’t …
men who don’t / won’t …
This came up before in a Previous Pandagon post, (”Opting Out, it’s Great, We Swear”, if memory serves). The issue of people dealing with a partner who just wouldn’t / couldn’t (etc). The response of one poster who raised the same issue in her marriage (but from a female view that I had seen in my old law practice (from males’ views) prompted me to ponder the gender issue, and do a bit of research. I found a message board devoted to people stuck in no-sex marriages, with some very sad, painful but enlightening stories to tell. They seem to break down fairly evenly across the gender board. Apparently, a sex-positive blogger ( http://www.herdesires.net/about.html ) started a thread on the issue and the response to it was so large and often heartrending that she started up a separate section, and then later a separate posting site: http://pub15.ezboard.com/bsexlessmarriage .
Definitely worth a read.
Linnaeus- Mismatched libidoes is not just a problem with het couples. My last relationship ended partly because my drive was stronger than his and he felt I was pestering him.
Very true, and I didn’t mean to imply otherwise; I was only going on my own experiences.
And it really is a conundrum. On one hand, one has to respect the wishes of one’s partner and not coerce or manipulate him or her into having sex; that’s, to put it mildly, a totally shitty thing to do. At the same time, one’s own sexual needs shouldn’t be delegitimized or cast aside, either.
Lis: I seem to be seing misogynists under the bed, then. The trouble seems to be that I’m a misanthrope and assume the worst of everyone.
Sophonis, Patrick, et. al. : I think the point of the joke was that the problem wasn’t a physical one, yet it was being treated as such.
Mismatched libidoes is not just a problem with het couples.
I asked about that, but no one answered.
I’ll answer–it’s kind of a problem in my 10+ years-long lesbian relationship. My partner has a much higher drive than I do, and it’s caused some serious problems in the past.
Oddly, I found that going on oral contraceptives (oh, the irony) actually increased my libido tremendously. But that was probably due to the same factors that put me on them in the first place: a lack of natural estrogen production that left me permanently menstruating (as if the symptoms alone wouldn’t kill your sex drive after the first couple weeks). Unfortunately, I couldn’t stay on the pill, as I have no health insurance, but that’s another rant.
Why should it be obvious? Like StealthBadger, apparently, I’ve had this discussion elsewhere regarding (other) mental illnesses such as depression. Why should taking a pill always automatically be the less desirable solution. It’s not for more overtly physical problems � people do suggest thinking TB away, but we call those people “quacks.� Why don’t we call people who say you should get your libido up (no pun intended) solely by talking it out quacks also?
I think the discomfort comes from the idea of considering a low libido a problem that needs to be fixed.
I think the discomfort comes from the idea of considering a low libido a problem that needs to be fixed.
And I think that partly comes from getting technical information filtered through the mainstream media.
Brad Delong constantly complains about the way the press mishandles economic information. And I’ve seen other subject-experts make similar criticisms about how the media covers areas they understand.
Would you be more comfortable if instead of discussing “low libido” we talked about the problem as “persistent or recurrent deficiency and/or absence of sexual fanatasies/thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal distress”?
No, Lis, I would not. I’m not interested in getting into the issue with you.
Because you have a filtering issue as well, which is that you seem unable to consider any discussion on the issue without filtering through the lens of your own situation.
Not every instance of “low libido” is a medical problem, or anything more than a mismatch between partners. It makes no sense to pathologize the person who has the lower libido, particularly when there is no physical cause and other, more conservative options have not been explored.
I agree that not every instance of low libido is a medical problem, nor do I wish to pathologize people with a normal libido.
That’s why I’m trying to point out the difference between low libido and something extreme enough to cause personal distress.
My mailbox is filled with V1agra spam, too. But maybe if we can make the point that these aren’t about everyday dissatisfactions, it can improve matters for all parties. Reduce the pressure on those who are healthy to see mere “low libido” as a problem, as well as helping those who do need further treatment.
zuzu writes: Not every instance of “low libido� is a medical problem, or anything more than a mismatch between partners. It makes no sense to pathologize the person who has the lower libido,
I’m not sure how saying that some instances of low libido may have physical or chemical causes is inherently “pathologizing” people with low libido. If the person experiencing it feels that it’s a problem, then shouldn’t exploring all possible causes be part of trying to find a solution? Not every instance of depression is chemically-related, but if you don’t consider that as a possibility, you’re running the risk of not helping people who genuinely need help.
I’m not sure how saying that some instances of low libido may have physical or chemical causes is inherently “pathologizing� people with low libido. If the person experiencing it feels that it’s a problem, then shouldn’t exploring all possible causes be part of trying to find a solution? Not every instance of depression is chemically-related, but if you don’t consider that as a possibility, you’re running the risk of not helping people who genuinely need help.
Look. It’s the hammer and nail problem — when all you have is a hammer, everything looks like a nail. Doctors who have a medication available will prescribe it, even to people who don’t need it or who would be better served by a different approach.
Of course, the fact that everything looks like a nail doesn’t change the fact that some of those things that look like nails actually are nails. But it also doesn’t change the fact that the hammer is the wrong tool for screws or staples, nor does it mean that there’s something wrong with the screw or the staple because the hammer isn’t the right tool.
But we’re experiencing the hammer and nail problem right now.
All doctors have for women is therapy (individual, sex-therapy, couples-counseling, you name it), so everybody gets sent to therapy, even people who don’t need it or who would be better served by a different approach.
This research adds tools to the toolbox, gives two options for treatment: body and mind. Heck, research on hormone levels actually helps doctors find ways to determine which approach may be best, through diagnostic blood tests.
I got nailed for about five years of therapy before getting my diagnosis. Five years of therapy which insurance generally doesn’t cover and which didn’t bring us any closer to resolving our problems. I was lucky that during that time I was in a job where I could afford to pay for all that out of pocket. I know that most women aren’t even in that position.
In contrast, the future I’m seeing is where women with sexual problems can get bloodtests from their doctors. Some of them will be indicated as candidates for hormone replacement or other treatment of physiological basis. Others will have this approach ruled out, so look at other causes, such as therapy. [Nothing prevents the first group from therapy either, of course.]
I don’t see why that concept should be so controversial.
Zuzu has a good point.
A low libido is only a problem if you think it is. If a person is happy with their sexuality it isn’t a problem. And who defines low? Is it your partner? How do you know yhat your’s isn’t low but rather that their’s is abnormally high? All quite relative, no?
If a person has experienced a prolonged decrease and they want to correct it, fine. Some people are perfectly happy being ‘chaste.’ I can’t really understand that but neither is it any of my business.
Here’s yet another reason not to abstain before marriage. You should be damn sure you and your partner are compatible on all levels.
I think the discomfort comes from the idea of considering a low libido a problem that needs to be fixed.
I don’t think it’s low libido that needs to be fixed, but you seem to agree that if there’s a mismatch in a relationship, it’s a real problem, not just a superficial one. And I think Americans have a problem with acknowledging that. Sex is supposed to be a low, base motive for getting into a relationship, and someone who insists that sex be a part of a relationship is deemed shallow or oversexed.
A low libido is only a problem if you think it is. If a person is happy with their sexuality it isn’t a problem.
Exactly.
But again, I want to point out that “low libido” is only how it’s described in the mainstream media. That phrase rarely appears in the medical literature. [I just conducted full-text searches of Medline and Cinahl to confirm.]
The clinical definitions refer to “persistent or recurrent deficiency and/or absence of sexual fanatasies/thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal distress” which is a much stronger and less abstract description.
If a person has experienced a prolonged decrease and they want to correct it, fine. Some people are perfectly happy being ‘chaste.’ I can’t really understand that but neither is it any of my business.
Again, I agree 100%. I don’t think anybody’s talking about rounding up satisfied celibates and forcing lust-potions on them.
But people seem so worried about this possibility that they disdain (and thus possibly deter) any research into treatments for those who are seeking help.
And who defines low? Is it your partner? How do you know yhat your’s isn’t low but rather that their’s is abnormally high? All quite relative, no?
That’s one of the reason these matters are best diagnosed by talking with one’s doctor. Questionaires and interviews can separate the Woody Allen-joke complaints that are within the norm from actual problematic situations.
I hope spoilers like this won’t reduce their effectiveness, but you can judge for yourself. Read some of the questionaires used in diagnosis. They’re extremely patient-focused, and skimming over the survey instruments for women, I don’t see anything measuring the partner’s satisfaction, though the there are psychological questions asking about the relationship in general (which can clue the physician into whether this is the patient’s distress or partner pressure).
And again, it is partly relative. I suspect many couples would perceive sex once a month to be sign of a severe problem. My husband and I would be delighted to achieve that rate.