The making of a disease: female sexual dysfunction
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7379.45 (Published 04 January 2003) Cite this as: BMJ 2003;326:45All rapid responses
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I too am a 27 year old very happily married woman with no children.
Except for sex which I am no longer interested in and is painful when I do
engage. My body does not respond to sex the same way as it did just one
year ago. I was never raped and have had no negative experiences that many
attribute as a reason for FSD.
I have blamed myself though I could not think of what I could have
done to cause this. I just know that my gynecologist upon examination
tells me it must be phychological because there is nothing physically
wrong.
For all of you who have never experienced this hell, thank God and
please refrain from criticizing any proven pill or cream on the market
help those of us with this nightmare that we live. I assure any doubters
that FSD is very real.
Competing interests:
None declared
Competing interests: No competing interests
Some of the concerns around this issue are clouded by the terminology
Disease should be confined to a demonstrable physical process or
abnormality.
Illness should be restricted to the patients experience.
Disease may or may not cause illness and illness may or may not be caused
by disease. We in general have a fair track record of dealing with disease
and are less good at illness.
If the drug companies wish to describe how people feel as illness in a way
that creates a marketing opportunity why shouldn't they? We do after all!.
They should not describe it as disease.
There is no moral issue here. Of course they will make profits if their
products are desirable and of course they ( and the consumers) will live
with the consequences of any adverse effects within an explicit legal
framework.
Competing interests:
None declared
Competing interests: No competing interests
On June 30, 2003, during a 1000 participant medical conference in
Paris on "Erectile and Sexual Dysfunctions," a debate was held to follow
up Ray Moynihan's influential article in the BMJ of January 4, 2003. The
debate was on the motion, "Is female sexual dysfunction (FSD) a marketing
construct of the pharmaceutical industry?" The debate was initiated by
Pfizer (the global Viagra marketing director, whose idea the debate
apparently was, refused all efforts to modify the motion), perhaps the
primary target of Moynihan's exposé, and thus it was held during Pfizer's
satellite symposium rather than being a formal part of the scientific
meeting. The debate details were handled by Healthcare 21 Communications
Ltd under contract to Pfizer, and no expense was spared. Honoraria,
expenses, and travel were offered to the debaters, and large fancy pink
(!) folders were provided all conferees containing photos and bios of the
debaters. The organizers brought plexiglass lecturns, barstool chairs,
equipment for video magnification, lavalier mikes, big YES/NO signs for
debaters and audience - it was a highly theatrical stageset and atmosphere
suited more to entertainment than a sober discussion of complicated
issues.
I was the lead debater on the affirmative side, and obviously this
report represents my perspective. I specifically insisted that I not be
"sponsored" by Pfizer, and so in the program I am "sponsored" by the BMJ.
I attended the conference as a member of its scientific committee, and no
additional support was needed. I refused the honorarium. Although I think
of myself as an experienced speaker and even a witty one, I found the echo
from the mikes deafening, the lights blinding, and the situation somewhat
overwhelming. I can see that as an American without debate training, I was
unprepared for some aspects of this genre of drama.
There was a full house for the debate - the only standing-room
session of the conference. My first words were "This is really bizarre,"
but when people didn't laugh I realized I might be in trouble!
My debate partner, Amy Allina of the U.S. National Women's Health
Network, and I stuck to the topic and defended the debate motion. We both
believe that "female sexual dysfunction" has been overmedicalized,
overpromoted, and overpublicized to create a market for drugs that will
rival that of Viagra. We each began by acknowledging that many women had
sexual problems but that we were here to discuss the role of the
pharmaceutical industry. I believe my strongest single point was that the
June 19, 2003 New York Times, reported that for Pfizer to meet its target
profits of $54B in 2004, Pfizer has to introduce 5 or 6 new drugs annually
that could each generate $1B in sales each year. This requires that Pfizer
create huge markets for blockbuster drugs. I also contrasted the
industry's huge investment in FSD with its total neglect of antiviral
microbicides to be used by women against HIV/AIDS.
Graham Jackson, MD, the editor of International Journal of Clinical
Practice (and I believe a person on the Pfizer speakers' bureau), was the
lead debater for the negative position. He adopted what I am told is the
British style of debating, and was full of insults to me and to the BMJ.
He got lots of laughs with his put-downs, such as "I'd prefer we refer to
the BMJ as the British Used-to-be Medical Journal." His editorial from the
IJCP critical of the BMJ article on FSD was given to all attenders in the
fancy pink packet along with Moynihan's article. Jackson had done quite a
bit of e-research on me, and managed to quote out of context things I have
written or journalists claimed I have said. I don't think he said a single
word about the pharmaceutical industry.
Alessandra Graziottin, MD, the other opponent, a gynecologist who works
with many women with sexual problems relating to cancer, simply gave many
examples from her practice of how women's sexual problems were not all
psychological.
Each debater had 10 minutes, and after comments from the floor, I
delivered our rebuttal and Jackson delivered theirs.
There were about a dozen comments from the floor and to my surprise
they were about evenly divided pro and con. One man said, angrily, that
after Moynihan's BMJ article was published, his UK gov't funding for sex
research was rescinded. Several speakers said they felt they agreed with
both sides. Supporters of our position attacked excesses of the
pharmaceutical industry.
At the end, although she was explicitly asked not to do this, the
moderator, Lorraine Dennerstein from Australia, took a straw vote. I
estimated that about half those in the room voted, and, of those, perhaps
90% voted for the other side and 10% for our affirmative side. I am
guessing that the large contingent that agreed with both sides probably
didn't vote at the end.
Unfortunately, there is no tape or transcript of the debate, although
I can e-mail my remarks to anyone interested.
The FSD story is not going away, and I look forward to the next
opportunity to try and tell the whole story.
Competing interests:
None declared
Competing interests: No competing interests
FEMALE SEXUALITY - A TIMELESS PROBLEM
The British Medical Journal (BMJ) expose [1] on
the role of pharmaceutical companies in defining female sexual dysfunction
as a DISEASE has triggered controversy about a problem dating back 4000
years in medical corpus [2]. The fact that common female "neuroses" have
been caused by the failure of intercourse to provide orgasm for women has
been an enigma of gender relating from past to present. The cover story
"No sex, please, we're married"
in a recent issue of Newsweek magazine [3] blames the problem on "stress,
kids, and work." But one married
woman ponders, "[M]aybe, it's all those libido-dimming antidepressants
we're taking." Her question may reflect
a morbid syndrome that has obscured the real problem and created
additional ones. Neither the BMJ nor the Newsweek article addressed the
most timeless problem of female sexuality and new researches that have
been effective
in "treating" the problem.
AN HERSTORIC OVERVIEW
In a landmark book "The Technology of Orgasm" (1999), Rachel P.
Maines documents the problem of female sexual frustration dating back to
400BC with Hippocrates masturbating women for "hysteria." [4] Maines
recounts
that next to fevers, the greatest part of a physician's caseload consisted
of women suffering from lack of sexual satisfaction. Female orgasm
invoked by treatment modalities like hand massage, hydrotherapy, and
electrotherapy was called "paroxysm" so that women's frustration would not
embarrass men; it was more expedient to burn women as witches than to cope
with them as sexual beings. Maines' chapter 1, "The job nobody wanted,"
documents how weary husbands passed the woman's sex problem on to
physicians,
who passed the job on to midwives. The invention of the vibrator was a
major medical innovation that cut the time
of treatment from an hour to 10 minutes - a practical solution, for
physicians.
WHAT DOES A WOMAN WANT?
In his quest to solve the sex-related problem
of female "hysteria," Sigmund Freud (1925) envisioned
the function of coital orgasm as a regulatory mechanism essential for
mental health. He used the term "actual neurosis" to classify common type
of neuroses caused by frustration from typical "failed" intercourse -- a
problem that could not be solved by psychoanalysis (pp. 25-26). [5] The
etiology of failed intercourse--not clear to Freud--is clearly defined by
historian Rachel Maines, a woman: "[P]enetration unaccompanied by direct
stimulation of the clitoris is an...ineffective way to produce orgasm in
women" (Chapter 5, "Revising the androcentric model", p. 115). [4] That
simple description of coitus in the standard missionary position explains
why Freud's patients never succeeded
at the goal of "vaginal" orgasm.
CONFUSING THE SYMPTOM WITH THE CAUSE?
If classic female sex problems--loosely termed "hysteria" and
"frigidity"--were so widely recognized throughout medical history, how is
it possible that in recent decades the sex problems suddenly "disappeared"
from view? A most common symptom of sexual dissatisfaction
for women has always been DEPRESSION. The May 2003 issue
of "Contemporary Sexuality" (Newsletter of the American Association of Sex
Educators, Counselors and Therapists) contains the article "Medication
induced sexual dysfunctions associated with treatment of depression" that
poses a logical question about the relationship between depression and
sexual dysfunction. [6] Author, Gordon Dickman ponders: "Which came
first? Was the client depressed and that resulted…in sexual concerns…?"
Or, he probes, "were they experiencing [sexual problems] and then became
depressed
as a result of that?"
ANTIDEPRESSANTS - THE UP, AND THE DOWN
Have decades of drug use obscured the origin of the problem? In his
expose "Prozac Backlash," Joseph Glenmullen (2000) [7] recounts that "the
first potent antidepressants of the modern era were cocaine elixirs,
introduced in the late 1800s". They were "prescribed for everything from
depression to shyness, just as the Prozac group are today." Glenmullen
elaborates, "Freud wrote three famous 'cocaine papers' advocating the
drug's use. Since cocaine elixirs, we have had numerous amphetamines,
bromides, barbiturates, narcotics, and tranquilizers, all hailed as
miracle cures until their dangerous side effects emerged" (p. 12).
Beyond describing side effects of Prosac type drugs that characterize
brain damage, Glenmullen challenges the accuracy of data on side effects
presented by pharmaceutical companies -- "While systematic studies have
shown that 60% of patients on serotonin boosters suffer from severe sexual
side effects, Eli Lilly's official figure is just 2-5%"
(p. 22). (Eli Lilly is the manufacturer of Zoloft,
Paxil, and Luvox.)
Dr. Glenmullen cautions, "Future generations
may well look back on the last 150 years as a frightening
human experiment" (p. 24). In 1998 more than 60 million prescriptions for
serotonin booster type antidepressant drugs were written (p. 15).[7]
Newsweek reported the prescription rate was up to 200 million in 2002. [2]
Sex researchers and health providers must now consider that a morbid
syndrome that has been touched off by drug treatment for classic symptoms
of female sexual dissatisfaction.
PHARMACEUTICAL ENGINEERING - A TOXIC SYNDROME?
Historically marriage had been the prescription
for female sex-related problems, but Freud's coauthor Joseph Breuer (1893)
[8] noted that "the great majority of severe neuroses in women have their
origin in the marriage bed"
(p. 246). From that standpoint the following syndrome is evident:
(a) Originally, the most common female neuroses were
caused by the failure of intercourse to provide orgasm
for women (resulting in an incomplete response for men as well). As
stated by Freud (1925), "The symptoms [such as depression]...must be
regarded as direct toxic consequences of disturbed sexual chemical
processes" related to intercourse (p. 26) [5].
(b) Currently, the Prozac type drugs used to treat depression cause
loss of sexual desire.
(c) The loss of sexual desire from antidepressants
has provoked research for new drug solutions, such as
a female-type Viagra to increase sexual arousal. But,
at best, drug induced arousal will enable couples to recommence the sex
act in the same archetypal manner
that has caused depression and other sex-related problems historically.
Finally, in this syndrome the biological regulatory mechanisms of the body
are no longer functioning normally -- pharmaceutical engineering replaces
natural body function.
FREUD'S VISION - "A SPECIFIC...ACTIVITY"
The research finding of a natural physical
alignment that makes female orgasm possible in coitus
--and has resulted in high frequency of simultaneous orgasm--has been
replicated by studies (Pierce, 2000)[9] reporting success in the treatment
of hypoactive sexual desire, a common problem that has dumbfounded sex
therapists [10]. Research on the technique and anatomy of "coital
alignment" (Eichel, et al., 1988) [11] was motivated by
a visionary part of Freud's theorizing that was largely ignored in his
lifetime.
In describing the ideal of coital orgasm, Freud (1894) [12] alluded
to "a SPECIFIC or ADEQUATE ACTIVITY" consisting of "a complicated spinal
reflex act resulting
in relief of the tension at [the] nerve-endings...and in
all the preparatory psychical processes necessary to induce this reflex"
(italics Freud). Freud stressed that the entire process "must absolutely
be carried into operation" (pp. 97-98). He concluded, "[I]n essentials
this formula is applicable also to women..."(p. 98). That formula appears
to be dependent on the specifics of coital alignment, a basic positioning
and the coordination of sexual movement [13]. It requires that men and
women relate. No pharmaceutical treatmentcan substitute for
the human interaction that is necessary.
1. Moynihan R. The making of a disease: female sexual dysfunction.
BMJ 2003; 326:45-47.
2. Veith I. Four Thousand years of hysteria, Chapter 1
in Horowitz M (Ed.). Hysterical personality. New York: Jason Aronson,
1977.
3. Deveny K. No sex, please, we're married: Are stress, kids and
work killing romance? We're not in the mood. Newsweek (USA), 2003 June
30; 40-46.
4. Maines R P. The technology of orgasm: "Hysteria," the vibrator,
and women's sexual satisfaction. Baltimore/London: Johns Hopkins
University Press, 1999.
5. Freud S. An autobiographical study (1925). New York: W.W.
Norton, 1952.
6. Dickman G. "A role for sexologists: Helping manage medication-
induced sexual dysfunctions associated with treatment of depression.
Contemporary Sexuality 2003;
37: i-viii.
7. Glenmullen J. Prozac backlash. New York: Simon & Schuster,
2000.
8. Breuer J and Freud S (Trans. Strachey J). Studies on Hysteria
(1893-1895). New York: Basic Books, 1957.
9. Schover SR, Leiblum SR. Commentary: The stagnation of sex
therapy. J Psychology & Human Sexuality 1994; 6:5-30.
10. Pierce, A P. The coital alignment technique (CAT):
An overview of studies. J Sex Marital Therapy 2000; 26: 257-268.
11. Eichel EW, Eichel JD, Kule S. The technique of coital orgasm
and its relation to female orgasmic response and simultaneous orgasm. J.
Sex Marital Therapy 1988; 14: 129-141.
12. Freud S. The justification for detaching from neurasthenia a
particular syndrome: Anxiety-neurosis (1894). In Freud S. (Trans. Joan
Riviera) Collected Papers, Volume one. London: Hogarth Press, 1950.
13. Eichel EW. Orgasm the natural way: the coital alignment
technique (CAT). Video, version 1.0, 2001. Previewed at 15th World
Congress of Sexology
(Paris, 2001).
Competing interests:
None declared
Competing interests: No competing interests
It is often said in locker rooms that women are much more emotionally
labile and subject to obstructive headaches than men. It is also often
said that women do not withstand the stress of work nearly as well as
men. Whilst some might regard such claims as sexist and mythological there
might be a real organic basis for them, certainly in some women.
It is an established fact that women are thermolabile. Unlike men
whose temprature remains constant their body temperature rises 0.3 to
0.5 degrees Centigade with ovulation and may rise as much as 1.0 degree
after ovulation. In the absence of shivering this is almost certainly due
to uncoupling of oxidative phosphorylation induced by the opening of the
mitochondrial permeability transition pore or an increase in mitochondrial
membrane permeability which uncouples oxidative phosphorylation(1). A
change in temperature of the magnitudes seen with ovulatory cycles might
be sufficient to change mood and/or behaviour in women by inducing or
reversing an inadequacy of mitochondrial oxidative phosphoprylation and
its putative neurochemical sequaelae especially if there is some other
cause for an impairment of oxidative phosphorylation including
psychotropic drugs.
The increase in mitochondrial membrane permeability induced by
thyroid hormones appears to be essential for normal cerebral functioning,
a deficiency in adults hypothetically causing the changes in affect and
behaviour characteristic of myxoedema and in infants causing cretinism
(2). A pyrexia is known to reverse on occasions the schizoid state for
the duration of the fever in patients with chronic schizophrenia, as the
late David Horrobin observed in his recent book "The Madness of Adam and
Eve".
Mitochondrial membrane permeability and hence the metabolic rate and
accompanying generation of heat appears to be extremely labile and easily
influenced by acute changes in hormonal and/or cytokine milieu. If
changes in the hormonal milieu in women have similar effects then they
might perturb mood and behaviour by altering the adequacy of oxidative
phosphorylation and its thermoregulatory and neurohumoral consequences as
argued in a succession of rapid responses to the BMJ (2,3,4,5,6,7,8,9,10).
It has been proposed that an inadequacy of mitochondrial oxidative
phosphorylation might also be a cause of headaches (11). Head trauma,
coronary artery disease, and migraine are present in more patients with
cluster headache more than can be explained by chance alone (12). This is
consistent with the hypothetical role of impaired tissue oxygenation in
these conditions (13). Tobacco use, alcohol consumption, and working
outside of the home are risk factors for cluster headaches.
The relationship between cluster headache and hormonal events is not
strong. Migraines, however, occur more commonly in women than in men (14)
and appear to be influenced by the hormonal changes that occur during
pregancy and after parturition (15). The occurrence of migraines in women
is also associated with the occurrence of strokes (16). These
associations are consistent with the hypothesis that headaches and
particularly migraines may be caused by an inadequacy of cerebral
mitochondrial oxidative phosphorylation.
Viagra may also cause migraines without changes in middle cerebral
artery diameter, suggesting that they too might be metabolic events (17).
The effect of Viagra might be confined to or most marked in those who had
some other cause for an impairment of oxidative phosphorylation, such as
other medications, smoking or alcohol,and other forms of substance abuse
(18). Viagra is phosphodiesterase type 5 inhibitor and , therefore,
increases the levels of cAMP. Stress, which releases catecholamines, has
a similar action which if excessive and especially if in a patient with
other causes of an indaquacy of mitochondrial oxidative phosphoprylation,
might have adverse consequences not only upon mood and behaviour but also
upon cellular function and viability (19).
Prior stimulation of cellular activity by cAMP might be beneficial
for it may upregulate enzymatic pathways involved in ATP resynthesis by
oxidative phosphorylation as occurs in skeletal muscle during the
training of athletes. Viagra is also known to protect the heart from
ischaemia-reperfusion injury by preconditioning (20). Preconditoning of
the heart by Viagra may, however, be partly or wholly induced through an
inducible nitric oxide synthase-dependent pathway. This preconditioning
might be due to the opening of the mitcohondrial ATP-dependent K+
membrane channels.
The withdrawal of trophic substances, such as sex hormones, induces
apoptosis in target organs. Hence the involution of these organs in these
circumstances. Presumably it does so by impairing mitochondrial oxidative
phosphorylation for this appears to be the common denominator initiating
apoptosis. If so the sudden withdrawal of sex hormonal influences might
be the most important cause of mood and behavioural changes in women who
do not have any other reason for an impairment of cerebral mitochondrial
function (21). Being pressured to take Viagra might do more than just
cause offense (22). It might cause real organic changes and headaches
especially if taken with regularity.
Greater understanding of the humoral and other factors that regulate
the openess of the permeability transition pore and mitochondrial membrane
permeability in general and to K+ in particular is needed to define the
causes of mood and behavioural changes in women. It is also importance to
have a greater understanding of all the other factors that might cause
mitochondrial dysfunction and deplete the adenine nucleotide pools. Just
knowing that there are organic causes, be they endogenous or exogenous
such as the birthcontrol pill or Viagra, would be a relief to many
women. Being able to provide a simple and safe solution to the problem,
such as dietry supplementation with omega 3 fatty acids, or thyroid or
even Coenzyme Q10 supplements, would be a boon.
1.Does pyrexia improve outcome? Richard G Fiddian-Green (5 April
2003) . Rapid response to: Maintaining perioperative normothermia
Christopher Mark Harper, Thomas McNicholas, and S Gowrie-Mohan BMJ 2003;
326: 721-722
2. Madness, hyperhomocysteinemia, metabolic rate and body temperature
Richard G Fiddian-Green
bmj.com/cgi/eletters/325/7378/1433#28469, 6 Jan 2003
3. Schizophrenia, and adverse effects of its treatments on mitochondrial
metabolism Richard G Fiddian-Green
bmj.com/cgi/eletters/325/7358/243#29601, 12 Feb 2003
4. Re: Preventing closed minds Richard G Fiddian-Green
bmj.com/cgi/eletters/325/7375/1255#27528, 2 Dec 2002
5. The pooped-out syndrome, ATP stores and hypothyroidism Richard G
Fiddian-Green bmj.com/cgi/eletters/326/7384/295#30166, 4 Mar 2003
6. Depression: a metabolic perspective. Richard G Fiddian-Green
bmj.com/cgi/eletters/325/7370/934#26529, 26 Oct 2002
7. Flying blind in managing endogenous depression Richard G Fiddian-Green
bmj.com/cgi/eletters/326/7384/338#29603, 12 Feb 2003
8. MTHFR gene mutation, methylmalonic acidosis, and exercise. Richard G
Fiddian-Green
bmj.com/cgi/eletters/325/7374/1202#28757, 14 Jan 2003
9. Neuropsychiatric disorders in porphyria and methylmalonic acidosis
Richard G Fiddian-Green
bmj.com/cgi/eletters/320/7250/1647#28812, 16 Jan 2003
10. MMR, IBD, autism and methylmalonic acidosisRichard G Fiddian-Green
bmj.com/cgi/eletters/326/7391/718#30820, 29 Mar 2003
11. Headaches and cerebral tissue oxygenation Richard G Fiddian-Green
bmj.com/cgi/eletters/325/7369/881#26368, 18 Oct 2002
12. Finkel AG. Epidemiology of cluster headache. Curr Pain Headache Rep.
2003 Apr;7(2):144-9. Review.
13. Re: Preventing closed minds Richard G Fiddian-Green
bmj.com/cgi/eletters/325/7375/1255#27528, 2 Dec 2002
14. Lipton RB, Stewart WF, Scher AI. Epidemiology and economic impact of
migraine.
Curr Med Res Opin. 2001;17 Suppl 1:s4-12. Review.
15. Marcus DA, Scharff L, Turk D.Longitudinal prospective study of
headache during pregnancy and postpartum. Headache. 1999 Oct;39(9):625-32.
16. Schwaag S, Nabavi DG, Frese A, Husstedt IW, Evers S. The association
between migraine and juvenile stroke: a case-control study. Headache. 2003
Feb;43(2):90-5.
17. Kruuse C, Thomsen LL, Birk S, Olesen J. Migraine can be induced by
sildenafil without changes in middle cerebral artery diameter. Brain. 2003
Jan;126(Pt 1):241-7.
18. The real danger is in the mixing? Richard G Fiddian-Green
bmj.com/cgi/eletters/325/7367/736/c#26113, 7 Oct 2002
19. Stress: the spice of life Richard G Fiddian-Green (1 April 2003)
Rapid response to: Stress: defining the personal equation Roy Menninger
BMJ 2003; 326: 107S
20. Salloum F, Yin C, Xi L, Kukreja RC. Sildenafil Induces Delayed
Preconditioning Through Inducible Nitric Oxide Synthase-Dependent Pathway
in Mouse Heart. Circ Res. 2003 Mar 13
21. The making of a disease: female sexual dysfunction Ray Moynihan BMJ
2003; 326: 45-47
22. Sick doctors need evidence-based care Richard G Fiddian-Green (31
March 2003) Rapid response to: How many doctors are sick? Judith Stanton
and Woody Caan BMJ 2003; 326: 97Sa
Competing interests:
None declared
Competing interests: No competing interests
Ray Moynihan points out that the corporate sponsored definitions of
"female sexual dysfunction" are being criticised as misleading and
potentially dangerous. He also states that the "role of drug companies in
the construction of new conditions, disorders and diseases needs more
public scrutiny". I would like to offer a new name for these medicalised
new diseases. Let's call the process NOSOPLASIA and the company or doctor
involved in the process NOSOPLASTER. The Greek words: nosos=disease and
plasis=creation, accurately define the process of making a disease and are
familiar to doctors. The new words may not carry the sinister meaning of
the words neoplasia or dysplasia, but surely no doctor would like to be
called a nosoplaster.
John Halazonetis, retired private practitioner
20 M. Botsari, Filothei 152 37, Greece
johnhal@otenet.gr
Competing interests:
None declared
Competing interests: No competing interests
Ray Moynihan's expose "The Making of a Disease: female sexual
dysfunction" in the British Medical Journal [1] makes it clear that the
pharmaceutical companies biased the series of conferences held to "update"
the definition of female sexual dysfunction. The goal to make billions
from a Viagra type pill for women's sexual problems was undoubtedly an
incentive for drug companies. But that is only half the story. Has human
sexuality sailed into the perfect storm? Is there a hidden agenda in
sexology to disenfranchise intercourse as normal sex? Is that another
reason why breakthrough research on the nature of the sex act--sexual
intercourse--was excluded from conferences to update the definition of
female sexual dysfunction? [2]
The BMJ by article by Moynihan cites Dr. John Bancroft and Dr.
Leonore Tiefer as dissenters against the "medicalization" of female sexual
dysfunction. What, then, might such dissenters provide to remedy
desecration of the Oath of Hippocrates?
Dr. Bancroft, current director of the Kinsey Institute, has defended
the late Alfred C. Kinsey's use of pedophile data to define child sexual
development. In Tim Tate's Yorkshire Television Production "Secret
History: Kinsey's Pedophiles" (1998), Bancroft pleads, "Consider the cost
of remaining ignorant. The less we know about these behaviors, we'll be
in a much worse position than if we have more information about them." [3]
It was Dr. Bancroft who acknowledged that Kinsey had presented the
pedophile data as coming from several pedophiles--rather than one--to make
the "research" look more "objective." That was academic fraud. [4]
In his Journal of Sex Research article "Sexual science in the 21st
century: Where are we going? A personal note," Dr. Bancroft states
"[W]ith the exception of the many excellent gay, lesbian, and feminist
scholars who have been focusing on sexual issues in recent years, there is
a reluctance for the brighter, straight young academics to enter the
field, particularly men. The academic world actively discourages them
from doing so." [5]
As a heterosexual who has done ground-breaking research on the nature
of the sex act--resulting in frequency of female orgasm and simultaneous
orgasm--I allege that the part of the "academic world" suppressing that
research is a network of Kinsey disciples. Dr. John Bancroft has known
about the coital alignment technique (CAT) since the International
Conference "Love and Attraction" held in Swansea, Wales back in 1977. In
spite of the fact that the CAT research has been successfully replicated
in several published controlled studies [6], Bancroft does not seem
worried that much of the public and many professionals remain ignorant of
the research. Paraphrasing his words I must assert, "[T]he less we know"
about what most people regard as normal sex, we'll obviously be in a worse
situation "than if we have more information." In the era of AIDS,
anything that helps couples attain sexual fulfillment in monogamous
relationships would seem a high priority.
For the future Dr. Bancroft envisions, "We see a move toward the
'pure' relationship founded on the ongoing benefits of the two individuals
concerned, whatever their gender...." [7] Has the discovery of a natural
anatomic design that facilitates female coital orgasm, and synchronizes
female and male sexual responses, interfered with an agenda for a new
world order? Is such research not relevant to an understanding of sexual
health, and thereby for the defining and treatment of "female sexual
dysfunction"?
Having been trained in the ideology of what Kinsey's coauthor and
biographer Wardell Pomeroy termed the Kinsey "grand scheme [8]," I later
coauthored an expose titled "Kinsey Sex and Fraud" (1990) that documents
my experience in the New York University (NYU) human sexuality program.[9]
One of our guest lecturers in an international health seminar in Holland
was Dr. Theo Sandfort who has expressed his concern--in relation to coitus
--that "paedosexual [pedophile] contacts are [regarded as] importantly
different from contacts between adults and are of much less value.... It
is possible that the overvaluation of heterosexual coitus is linked to the
negative type-casting of other forms of contact." [10]
And what does Dr. Leonore Tiefer, another authority cited by Moynihan
as expressing a concern about the medicalization of sexuality, offer from
her perspective as a feminist and social constructionist? In her book
"Sex is not a natural act," Dr. Tiefer advocates that "like Jell-O" human
sexuality can be molded by "social forces." [11] As an example of using
social construction to advantage, Tiefer cites Theo Sandfort's "study of
the relationships of twenty-five Dutch boys, all ten to sixteen years
old...with men twenty-six to sixty-six years old" (p 62): Sandfort [10]
states, "Instead of speaking in terms of 'victims,' 'offenders,' and
sexual assaults...this research approaches pedophile relationships as
simply another form of relationship children can have" (p 180). It is
noteworthy that a few years after my attending the NYU "health" seminar in
Holland (1983) the Dutch lowered the age to twelve for a consenting child
in a pedophile relationship.
Is there, then, a hidden agenda in sexology that is invested in the
failure of coitus, and the alienation it causes between men and women?
Has the CAT model provided a natural solution to sex problems that cannot
be solved by drugs? The finding of a basic coital alignment--a biological
optimum for orgasm--means that man and woman are meant to relate - they
are interdependent for the highest level of sexual function. Will
scientific research that has revealed the nature of the sex act prevail
over financially exploitive goals and/or pathological political agendas in
sexology? S.O.S.
1. Moynihan R. The making of a disease: female sexual dysfunction.
BMJ 2003; 326:45-47.
2. Eichel EW, Ablin RJ. Breakthrough research excluded from
international consensus on female sexual dysfunction. BMJ website,
January 8, 2003. Rapid response to Moynihan R. The making of a disease:
female sexual dysfunction. BMJ 2003; 326:45-47.
3. Tate T. Secret History: Kinsey's pedophiles. Yorkshire Television
Productions (for Channel 4, U.K.), aired August 10, 1998.
4. Bancroft J. Kinsey's Conclusions. Letter to the editor. In The
Washington Post, December 28, 1995 (p A22).
5. Bancroft J. Sexual science in the 21st Century: Where are we
going? A Personal Note. Journal of Sex Research 1999; 36:226-229.
6. Pierce, AP. The coital alignment technique (CAT): An overview of
studies. J Sex Marital Therapy 2000; 26:257-268.
7. Bancroft J. Director's Column. Kinsey Today. Spring/Summer 2000,
Volume 4, Number 1.
8. Pomeroy WB . Dr. Kinsey and the Institute for Sex Research. New
York: Harper and Row, 1972:55.
9. Reisman J, Eichel E. Eds: Court J. Muir G. Kinsey, sex and fraud:
The indoctrination of a people. Louisiana: Lochinvar-Huntington House,
1990.
10. Sandfort T. The sexual aspect of paedophile relations: The
experience of twenty-five boys. Amsterdam: Pan/Spartacus, 1982:53.
11. Tiefer L. Sex is not a natural act and other essays. Boulder, CO:
Westview Press, 1995:62-64.
Competing interests:
None declared
Competing interests: No competing interests
Sir,
P. Boynton's observation that my letter did not have anything to do with
the title demonstrates that the very point I was trying to make has been
missed by her. Women whose symptoms did not fit either a known or
acceptable diagnosis have been labelled as 'mad' or 'neurotic' for
hundreds of years, and my reading of Ray Moynihan's article was that he
had been guilty of exactly the same crime by implication. The content and
tone of my letter should have been clear to P. Boynton as it has been to
others who have read it, and consequently her response to my letter was
quite inappropriate. The title implied sarcasm for the contents of
Moynihan's article, which should not have to be spelt out.
Competing interests:
None declared
Competing interests: No competing interests
Would Jay Khastgir care to explain why their response to Moynihan's
article is entitled 'The scientific basis of mad women'? Is Khastgir
using the title to suggest women with a sexual problem are also 'mentally
ill'? Or rather,should we infer that women who do not want to be labelled
as 'dysfunctional', can have their views dismissed as 'madness'? The
title appears to have little to do with the rest of Khastgir's letter, so
why use it? There is a long and unhappy tradition of labelling (and
treating) women as 'mad' where they do not fit the views and ideals of the
medical profession(1,2). In the light of this it is surprising the BMJ
found it acceptable to print the letter using this title.
1. Segal,L. Straight Sex: The Politics of Pleasure. Virago. 1994.
2. Ussher, J. The Psychology of the Female Body. Routledge. 1989.
Competing interests:
None declared
Competing interests: No competing interests
Revisiting Ray Moynihan
Ray Moynihan's 2003 article instilled healthy skepticism in me as I began my PhD research on female sexual dysfunction in 2014. However, after performing a systematic review and meta-analysis of 135 publications from 41 countries, we found - similarly to Laumann et al. - that 41% of women do report female sexual dysfunction. Furthermore, we were able to show that across all sexual disorders that we analyzed, studies with pharmaceutical funding had consistently lower meta-analytical prevalence estimates than those without pharmaceutical funding.
The full commentary published in the Journal of Sexual Medicine (Dec 2017) can be found here: https://authors.elsevier.com/a/1W8uD6CSsvw16B
Competing interests: No competing interests