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Among other trends that have been counterproductive for healthy sexuality, there have been tendencies in the medical community to approach sexual problems as "medical issues", an idea called “medicalization.”

Today, women’s sexuality--at all ages—is receiving much attention, particularly in the scientific community. In the May 29, 2000, cover story in Newsweek Magazine entitled, "The Science of Women's Sexuality" Leland stated, "Drug companies, research clinicians and traditional therapists are all leaping into the fray" to discover causes and provide solutions for sexual concerns.

The seeming proliferation of drugs and devices designed to "fix" whatever is "wrong" has led to complaints that sexuality is being “medicalized” and depersonalized and that sexual expression is being reduced to a performance act, often devoid of intimacy. Concerns exist that this may be more attributable to marketing and profit making concerns than with a desire to facilitate a healthy and enjoyable sexual life.

The debate about the medicalization of sexuality becomes further fueled by research findings linking female sexual problems with physical causes. As reported in Science News (June 8, 2005), Connell and a team of researchers at Yale School of Medicine and the Albert Einstein College of Medicine found that female sexual dysfunction (FSD) affected 48.2 percent of women and that these women had decreased sensation in the clitoris, which increased the risk of sexual dysfunction.

Connell (2005) noted that although epidemiological studies have shown that about 10 million women between the ages of 50 and 74 report sexual complaints, including decreased desire, inability to reach orgasm, and increased pain with intercourse, there has been little research into possible physiologic mechanisms involved in women’s sexual response. Connell stated, “The sexual response is complex and involves interaction between the nervous system, the vascular system and the musculoskeletal system. Alterations in any of these systems could potentially cause FSD.”

The New View Campaign

In response to the apparent trend toward looking for physiologic or medical causes of sexual problems and developing devices and substances to enhance female performance, the New View Campaign was formed in 2000. The founders state:

“Our goal is to expose the deceptions and consequences of industry involvement in sex research, professional sex education, and sexual treatments, and to generate conceptual and practical alternatives to the prevailing medical model of sexuality.” (New View Campaign, 2007).

The Campaign does not ignore the physiologic or medical aspects of sexual experience, but it uses no normative list of dysfunctions (of desire, arousal, or orgasm). Instead, it holds that there is no necessary or universal sequence or list of components to a sexual experience, and proposes that the idea of a dysfunction as a deviation from some norm is not useful.

The New View nomenclature considers 4 categories of causes of sexual problems in order of likely prevalence and suggests that interventions be considered in this order as well, ensuring that educational interventions are always considered. These four categories are shown below.

Four Categories of Causes of Sexual Problems

1. Sexual problems due to sociocultural, political, or economic factors
2. Sexual problems due to partner and relationship factors
3. Sexual problems due to psychological factors
4. Sexual problems due to physiological or medical factors

The New View Campaign has a number of resources for professionals, including two Medscape Psychiatry and Mental Health internet programs (Hicks, 2005; Tiefer, 2006).

Confounding viewpoints and information leave clinicians frequently questioning the best course of action to pursue. For example, consensus on such issues as hormone use in women seems to change every few months. In regard to sexual desire in women, much of the research shows that low desire is a contextual matter and rarely a strictly hormonal one. At the same time, there are many situations in which hormonal approaches make sense as part of a comprehensive treatment plan.

Sexuality Factoid

20% of American men and 31% of American women have had one sex partner in their lifetime

Source: Laumann, E., Gagnon, J.H., Michael, R.T., and Michaels, S. The Social Organization of Sexuality: Sexual Practices in the United States. 1994. Chicago: University of Chicago Press

While clinicians who are not specialists in sex and sexuality may feel some reticence about choosing sides in this particular debate, there are professional and ethical considerations involved in approaching this issue conscientiously. For health care professionals, the lenses through which one sees the world ought to be inclusive and consider the range of available treatments and the efficacy of each of these for patients/clients. One anonymous clinician sums up the sentiments of many others:

“I think it’s egregious how pharmaceuticals are being pushed on younger and younger men, and I think this really promotes performance anxiety in the extreme. On the other hand, the more I study the serotonin/dopamine connection in the brain and its effects on libido, the more I personally wish there was there more integration between medical therapies and sex therapy. A pill should never be taken in lieu of communication, creativity, diet, and health. On the other hand, as someone who suffered from PE, (premature ejaculation), I would have appreciated an integrated approach.”

Individual circumstances need to be considered in planning a course of action. For example, for a woman in an abusive relationship whose husband is complaining of her lack of sexual desire, the treatment of choice will not be a drug to increase her desire, but will more appropriately be interventions to address relationship issues.

In the future, women as well as men will likely have available to them a variety of drugs and devices to increase sexual desire and performance. The ideal is that their use will enhance and not replace key elements of an intimate relationship. Mutual respect and communicating with one another about thoughts, feelings, the relationship, physical and emotional needs, and life goals will continue to be important as women and men move forward in creating their world as individuals and as couples (Lehr, 2000).

Sexuality Factoid

Men's sexual fantasies tend to be more sexually explicit than women's; women's fantasies tend to be more emotional and romantic

Source: Zurbriggen, EL & Yost, MR (2004). Power, desire, and pleasure in sexual fantasies. Journal of Sex Research, 41(3), pp. 288-300.