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.

Jennifer Drew, 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 paramount[8].

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 boring, 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 manner.

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 irrelevant.

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 ego.

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 ejaculates.

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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