Dysfunctional, moi? The Myth of Female Sexual Dysfunction and its Medicalisation

Jennifer Drew tears apart the the myth of 'female sexual dysfunction', and looks at how female sexuality is becoming increasingly medicalised.

, 16 April 2003

There have been a number of articles in the press recently concerning

female sexual dysfunction, and pharmaceutical companies are actively

researching for a female version of Viagra. Pharmaceutical companies

have claimed female sexual dysfunction affects up to 45% of all women

aged between 18 and 54. This claim is based on highly dubious research,

wherein women were only asked to reply yes or no to seven different

questions. One of them being, “have you ever suffered from lack of sexual

desire or arousal.” If they answered, “yes” these women were

immediately judged to be suffering from sexual dysfunction. The

pharmaceutical companies also claim lack of female sexual desire, like

male impotence, is due solely to a biological problem which can be easily

remedied by taking a “magic pill.”

defining female lack of desire as a disease reinforces phallocentric beliefs

So, why am I taking the trouble to write an article about female sexual

dysfunction and how this medicalisation will affect all women and

reinforce control of female sexuality – when, according to the

pharmaceutical companies within three years women will be able to take

a pill and their sexual lives will be radically improved? Because I believe

defining female lack of desire as a disease reinforces phallocentric beliefs of what is considered to be appropriate, approved and acceptable female sexual behaviour. This view also conveniently ignores and omits other complex issues, such as power differences in heterosexual relationships, the rigid and narrow heterosexist script for women and men, and gender inequalities.

If I were to ask any woman or man what does sex mean to them, the

majority of heterosexuals would say “it is sexual intercourse, wherein the

man penetrates the woman, he ejaculates and orgasms, with the woman

supposedly also reaching climax due to his penis and the sexual act is

completed.” But, you say, what is wrong with that; it’s normal, it has

been proven this is the way heterosexual activity is undertaken, it follows a

sexual script, Masters & Johnson proved it: they stated first there was

arousal, then foreplay, culminating in the act of sexual intercourse with the

man ejaculating[1]. My answer is – it

is male-defined and phallocentric, which privileges male sexuality over

female desires. Alfred Kinsey, a sexologist, wrote that sexual response is not

the same for any two individuals whether they are heterosexual or same

sex[2]. Yet, society is increasingly

becoming more narrow in constantly reinforcing the idea that “real sex” must

always culminate in reproductive activity and penetration, irrespective of

women’s sexual desires and needs.

Women have stated they do not always want or need penetration. What is wrong with other sexual

acts which are not centered around penetration of a woman’s body?

Intercourse is perceived to be a “natural” means to orgasm for male

heterosexuals, but it is more problematic for heterosexual women. Shere Hite

in her book “Female Sexuality” quotes women saying they feel

dysfunctional because they do not enjoy penetration, or reach a climax[3]. In reality, it is male sexuality which is seen

as the model for human sexuality and women’s sexuality is deviant or

abnormal[4]. Some young women even

dare to say they do not want or wish to engage in intercourse; instead they

desire and demand mutually satisfying and egalitarian relationships which are

not centered around sexual intercourse. However, these women say they have a

constant battle

with prospective male heterosexual partners, who still believe intercourse

is a male entitlement and right[5].

Some younger women have tried to negotiate egalitarian and more

safer ways of sexual activity, without having to endure unwanted

penetration. These young women have experienced more satisfying and

pleasurable sexual encounters, wherein they are the sexual subjects, not

objects of male pleasure[6].

“foreplay” is only a preliminary act preceding the “real thing”

But what about “foreplay”? Surely this takes care of women’s

sexual needs?

My reply is, once again, if I were to ask any woman or man

what does “foreplay” mean, the majority would say this is something most

women require. Supposedly unlike men, women need to be aroused in order for the man to commence real sex by having sexual intercourse with the woman.

In other words “foreplay” is not “real sex” it is only a preliminary act

preceding the real thing. But you say, why am I so angry, surely it is a

male heterosexual’s right to expect intercourse when sexual activity takes

place, since a sexual relationship means giving pleasure to each other.

Yes, I reply, but this is phallocentric and the primacy is on the ever ready

erect penis and effectively, a male sexual organ apparently defines “real

sex,” not the human being.

Female sexuality is constantly derided, treated as problematic,

needing more stimulation and attention to the clitoris in order to prepare

the woman for “real” sexual activity when the man penetrates and once again

proves he is a real man, powerful, potent, dominant and a wonderful lover,

since he has not only ejaculated but also brought her to orgasm by his

mighty and wonderful penis. Which proves sex as it is currently socially

constructed is male-centered, goal-directed and phallocentric, with

women’s need for clitorial stimulation seen as something inferior, or an

extra, prior to the main event[7].

Ask any woman what does sex mean to her and most heterosexual women

will reply, it is making the man happy, putting his pleasure and satisfaction

first, their role is ensuring he reaches a climax. Some women would say

they would like to climax every time, but feel they cannot expect or ask

their male partner to satisfy their needs every time. Many women quite

justifiably are afraid to ask for what they desire, because of

socio-economic reasons, unequal power relationships and the belief female

sexuality is supposedly only responsive. Women must not initiate, they

can only respond to the superior male. After all, a man’s sexual needs are


Ask any woman or man what does an erect penis mean, the answer nearly

always is – it signifies the man’s wish to have sexual intercourse. Ask any

woman what sexual activity she likes and many women will say they

actually prefer touching, full-body contact and/or caressing, stimulation of

the clitoris. But we are told, these activities are not “real sex,” just


tedious foreplay, which focuses primarily on feelings and emotions which

are feminine and therefore unacceptable for real heterosexual men.

if intercourse does not happen for whatever reason, sex has not taken place.

The dominant male-centered view of sexual activity is that real men are always ready and willing to have as much sexual intercourse as possible; it is the man’s responsibility to initiate, teach and control his female partner in sexual activity. The sexual script for heterosexual men says they must have and maintain an erection in order to get down to the real business of directing and controlling the sexual encounter, and a woman’s responsiveness to his male body is a direct reflection of his masculinity.

All men know what women want and most women need

and always desire “hard-thrusting” sexual intercourse. Good sex must

always culminate in sexual intercourse, if it does not happen for whatever

reason, sex has not taken place. According to the male-definition of sex, it is the male’s responsibility to not only orgasm himself, but ensure his penis causes the woman’s climax[9]. If he does

not, he is not a “real” man. A woman’s role is to follow the man’s lead,

she must not be aggressive or too demanding, but instead supportive and

constantly massage his ego, by telling him what a wonderful lover he is.

Failure to recognise the male’s superior equipment, results in loss of

erection and horror – the man cannot complete intercourse[10].

All very well, you say, but what does all of the above have to do with

the medicalisation of female sexuality, and the idea that women have suddenly developed female sexual dysfunction or lack of sexual desire? The answer is – they are all heterosexist beliefs, which assume female sexuality is for the accommodation of male-defined heterosexual activities. Intercourse is still perceived to be the “main event,” and women are still expected to climax through this particular act. Real sexual activity has not taken place unless reproductive sex has been completed.

Women’s sexual desire is supposedly for the benefit of men’s egos. No

woman is supposed to express her sexual desires, she must always fit her

body to his needs. Women have received only negative messages

concerning their sexuality. If a young girl who is either pre-pubescent or

an adolescent dares to explore her own body she is behaving in a

degrading manner. Adolescent girls are not supposed to experience sexual

desire but instead suppress it[11]. The

belief is still widely held that a woman’s sexual feelings and bodily desires

can only be awakened by a man. Sexual activity continues to be

male-defined and male-centered, wherein the man initiates, controls and

directs. After all men have had years of experience in learning about sex

and sexual responsiveness from their own bodies. From the time a male

becomes an adolescent, he is expected to be always thinking about sex,

easily sexually aroused and is entitled to have his desires met. A man

knows what a woman wants, he knows her body more than she. This is

irrespective of the fact the man only knows his own bodily responses.

Women are socialised from the moment they are born to

suppress their sexuality

Women’s lack of sexual desire is caused not just by medical problems, it

is society’s demands and views of what actually comprises female

sexuality. Women are socialised from the moment they are born to

suppress their individual sexuality and feelings.

As young girls reach puberty and even before, they only receive

reproductive biological information regarding their bodies. Female

sexuality is believed to be dangerous, it is primarily for the enjoyment and

pleasure of men. Young women are held responsible not only for their

own sexuality, but also supposedly are able to control a male’s desires.

Males however, are entitled to pressurise, coerce and demand sexual

intercourse. They are entitled to ignore a woman’s own sexual agency.

If they engage in sexual activity, women know men expect and demand

intercourse as their right and entitlement, they are expected to put the

male’s sexual needs first[12].

You tell me, men need and require sexual intercourse. After all, an

erect penis simply by its erection demands the act of intercourse. Men

who fail to have an erection on demand believe they are impotent and

incapable of having sex[13].

This is a narrow male heterosexist view, an erect penis does not mean it

has to be inserted into a passive willing or unwilling vulva. Still, not to

worry, help is at hand due to the discovery of the wonder drug “Viagra,”

men can now have erections as and when they wish irrespective of their

partner’s needs or desires. Everything is resolved, the man’s erect penis

will be inserted into the woman and he’ll have his orgasm, as for the

woman, well all the man has to do is to “twiddle” her clitoris a little, and

she’ll have an orgasm too. How simplistic and binary.

As for the concept sex means only one thing – intercourse, or rather

reproductive sex, is a nonsense, particularly when many women and men

do not want a child as a result of this act. But, you tell me, many women

too believe and insist sex is not sex unless the man has penetrated the

woman, regardless of the fact many women do not enjoy or even like the

act of penetration. But there I am speaking heresy – all women want

intercourse, all women want the man to dominate, all women are passive

and submissive. It is a biological fact, so we are repeatedly told by the

male-dominant medical and scientific establishment. Heterosexual women

who do not want or desire penetration are treated as deviant and abnormal

by the medical profession. Lesbian sex too, has in the past been defined as

not “real sex,” because the penis is absent.

Now for the myth of female sexual dysfunction, or the fact many women do

not experience sexual desire or arousal. When female sexuality is defined

as either passive or only responsive to active male sexuality, it’s no

wonder many women experience lack of desire. Active female sexuality is

condemned; such women are termed either nymphomaniacs or they

emasculate fragile male sexuality. But what about women who have

explored their bodies and have learned how to stimulate themselves not

only to orgasm but also to ultimate sexual pleasure. Well, you reply, these

women are deviant, when they dare to exercise their autonomy and tell

their male partner what they want, like and will not undertake. Such

women as these emasculate the male sexual drive, they reduce the man’s

erect penis to a limp one! Women who know their bodies are sexually

voracious, they are over-sexed, nymphomaniacs, lesbians and disrespectful

of the superior male sexuality.

Girls have frequently expressed the wish for more outercourse activities

such as full-body massage (horrors) touching kissing, all of which come

under the term “foreplay,” but male-defined ideas of acceptable and

“natural” sexuality still prevail.

we are regularly informed that male sexuality is unstoppable

As we are regularly informed, male sexuality is unstoppable once it has

been aroused, an erect penis has to inserted into an object, preferably the

vagina or more precisely the vulva. However, it can also be inserted into a

woman’s anus, which too privileges male pleasure, even though many

women experience pain or simply do not like this activity. But it is

becoming an increasingly accepted practice. So, you say, I am against this

activity, no I reply, it is because this act too, is beginning to be treated as “normal” and “natural,” and once again, women who do not like to be

anally penetrated are seen as frigid in denying their male partner his

entitlement to sexual pleasure. There is no reason why a heterosexual

male’s anus cannot also be penetrated by his female partner.

But what about oral sex you ask – well as we are all constantly being told,

fellatio is wonderful, many women apparently enjoy the act. Cunnilingus

surely is the female equivalent you say. Yes, I reply, but it is deemed to

be inferior to the mighty penis and many men feel it is degrading to be

expected to “go down on” a woman and stimulate her clitoris in such a


But you still insist sexual intercourse is a natural act, and women can be

helped by the medical profession to overcome their resistance. There are

various techniques which have proven successful and women have once

more engaged in sexual intercourse with their male partners. But, I

counter – consider how the medical profession treats women with sexual

problems and also women who are physically disabled or have

experienced debilitating medical illnesses, making intercourse very painful

or almost impossible. Medical Specialists intervene and endeavour to

restore a heterosexual women’s sexual functioning, in order that she may

once again be able to engage in sexual intercourse for the benefit of her

male partner. The woman’s sexual autonomy and wishes are totally

disregarded, instead the whole emphasis is on making her once again

available and receptive to “normal sexual intercourse.”

Wrong you say, many women like and enjoy the act of reproductive sex.

Yes I have no disagreement with that, what I am saying is intercourse, or

more correctly reproductive sexual activity is not central, it is only one of

many and varied pleasurable acts. Western society still pressurises women

into believing reproductive sex is on the only real act. As many

newspapers constantly report, sexual intercourse is the act of having full

sex. Does this mean other sexual acts are “empty” or “half full”? What

does full sexual intercourse mean precisely? In a nutshell it means the

man’s pleasure and sexual climax is paramount, sex ends when the man

has ejaculated and filled his female’s body with the all important semen.

Even safe sex is defined as sexual intercourse with a condom. What’s

worse, a woman is expected to put the condom on the man. Is he

incapable of putting it on himself? Once again the woman is sexually

servicing the man.

Phallocentric ideas treat both women and

men as machines or just objects.

In fact, phallocentric ideas serve to disconnect a man from the rest of his body. One might even

say it is the penis not the man which is sexual; otherwise why do so many

men want a huge erect penis? Heterosexual male sexuality which is

centered around a “huge erect penis,” reduces male sexuality to one of

hydraulics, with failure remedied by Viagra. Reducing sex to a

biological, reductionist male-centered concept treats both women and

men as machines or just objects. Eroticism, sensuality and feelings are


Males are socialised not to want intimate acts such as touching and

caressing, these are feminine ones and therefore inferior. Male sexuality is

seen as goal-orientated, demanding and controlling. Men are terrified that

if their “feminine” side is revealed they will become emasculated.

Nonsense – the term foreplay should and must be abolished. So too the

biological belief male sexuality is unstoppable once an erection has

occurred. As one eminent feminist stated, if a male was in the act of

penetrating a female and someone came into the room, his immediate

reaction would be one of withdrawal and limpness would ensure; this is

not unstoppable sexuality. It is in fact a combination of body and mind. In

an ideal world, both women and men would be able to communicate what

they want sexually, and this means both their desires and eroticism.

Intercourse would happen with mutual consent, many women would be

able to say precisely what they would like in a sexual situation and social

pressure would not be placed on women to perform for a male’s fragile


Still, you disagree with me – you still think sex is “biologically natural,”

women “naturally” are more responsive to men initiating sex. Sex is not

sex unless intercourse has taken place. You are wrong!

When women try to restrain or limit their sexual desires within

male-defined boundaries, I am not surprised many women experience low

or non-existent sexual desire. The constant pressure of trying to fit one’s

body to male expectations is debilitating and depressing. Sexuality is

socially constructed within rigid, narrow sexual scripts for both women

and men which effectively reduces women to spectators not participators.

Most sex manuals reinforce the same limited reductionist message – real

sex only occurs when tab A – penis is inserted into tab B – vulva and male


Phallocentric, genital obsessed notions of what constitutes “real sex” must

be discarded.

Phallocentric, genital obsessed notions of what constitutes “real sex” must

be discarded. Instead of constantly denigrating and trying to impose

male-centered ideas of sexuality, sexual activity must be widened to

include non-genital activities and less on male-centered ideas of

performance, which privilege male pleasure. Women can and do

experience sexual desire, but sexual scripts constantly tell women they

must not be too aggressive, or too knowledgeable, only the man must be

active, he must always initiate, otherwise the male ego will suffer.

Improving sexual expression and mutual satisfaction for both women and

men means sexual intercourse is not central to the experience, it is only

one of many different activities. It is no wonder many women suffer from

a lack of sexual arousal, when they know sexual activities will follow a

boring, limited, male-defined and male-dominated pattern; wherein

penetration of a woman’s body is inevitable and women’s sexual feelings,

desires and agency are still derided, seen as inferior or “lacking,”

compared to the male “heterosexist” ideal. Heterosexual men too, feel

they must always be able to “perform,” any variation in the sexual scripts

are ones of failure.

To conclude, women have the right to decide for themselves whether they

wish to engage in intercourse and penetration. Women who do not desire

penetration are not deviant, unnatural, or unfeminine. Equally, there is

nothing wrong with women who do desire penetration. It is a woman’s

right to define her own individual sexuality, not one imposed on her by

hegemonic heterosexist men.

Male heterosexuality too, is not defined by an “erect, hard thrusting

penis.” Penises do not always remain erect, they go up and down! This

does not mean male heterosexuals are impotent or incapable of sexual

activity. Men too, are more than their penises, male sexuality is not

centered around the penis, it is the whole body and mind. Men can be

penetrated and if they desire this, it is not deviant[14]. Sexuality is diffuse and individual, not a universal

phallocentric script, wherein “one size fits all.”

Until all women are free to express their sexuality for themselves,

including the right of self-stimulation nothing will change.

In the words of Lenore Tiefer “the only magic pill for women’s sexuality is

broad-spectrum freedom.”[15]

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