women's sexual issues
Post Three in Sexual Dysfunction Series

As a young graduate student, I was required to complete an internship for my masters program in psychology. As fate would have it, I wound up working in a state mental hospital (some of my friends think I should have been there anyway). There, I was responsible for conducting assessments on incoming patients.


 I had to learn how to use the DSM-IV in order to make a diagnosis. Luckily, my supervisor was an experienced clinical psychologist who helped me sort through the frequently confusing world of clinical assessment.

It was tough work. I had to figure out if Joe Blow's decision to burn his house down, rather than pay his rent, was due to schizophrenia or bipolar disorder. And was his cavorting naked in the front yard, singing church hymns, while the place torched an indication of mania, or something else? (This really happened, by the way). I think that's when I began to have some questions about the mental health field's favorite tool - questions that only increased during my stint as a psychotherapist (currently, I teach at the college level).

The DSM-IV is a diagnostic manual that contains every disorder one could possibly imagine. And I have two problems with this system: one, human behavior isn't easily categorized, and two, the DSM-IV is based on a checklist approach that is highly subjective. Which is one the reasons that a person could go to five different psychologists and wind up with five different diagnoses.

It all boils down to interpretation. The disorders themselves are subject to revision, and there is nothing about this that is written in stone. However, I don't think most people get this. In my conversations with the average Joe or Josephine, he or she takes whatever diagnosis that a mental health professional makes as some kind of message from above. If little Johnny is diagnosed with bipolar disorder, by golly, he must have it. But it's not as simple as that.

The DSM is highly influenced by social attitudes and possibly by what's profitable. For instance, the initial diagnostic criteria for female sexual dysfunction in the DSM was developed during a Boston conference in 1998. Eighteen out of nineteen of the authors who developed this criteria had corporate ties to twenty-two pharmaceutical companies.

This is not unusual, or the first time this kind of conflict of interests has occurred. In 2006, researchers Lisa Cosgrove, Sheldon Krimsky, Manisha Vijayaraghavan, and Lisa Schneider wrote a blistering indictment of  DSM advisory panels in Psychotherapy and Psychosomatics. There, they claimed that over 56% of the 170 DSM panel members had financial ties to drug companies. This was particularly true for some diagnoses like mood disorders and psychosis. According to Cosgrove et al:

"...there are strong financial ties between the industry and those who are responsible for developing and modifying the diagnostic criteria for mental illness. The connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders.Full disclosure by DSM panel members of their financial relationships with for-profit entities that manufacture drugs used in the treatment of mental illness is recommended."


Many have argued that the DSM looks at female sexual dysfunction mainly in physical terms that boil down to four things: inability to want sex, get wet enough for sex, get off during sex, or have pain-free sex. Relationship, social, political, or emotional factors are given the short shrift.

Which is why psychologist Dr. Leonore Tiefer and her associates developed an alternative view of women's sexual problems that looks at the issue in context. Such questions as "What kind of relationship does this woman have?", "What does she think of her body?", "What messages did she receive about sex as a child?" are considered hugely important in their system and are not really a part of the standard DSM classification.

You will notice that the New View manifesto refers to women's sexual problems as just that - "problems". They don't use the term "female sexual dysfunction". I personally like this approach a lot better. A "dysfunction" is by definition medical terminology - which simply reinforces the pharmaceutical- friendly view of women's sexual apathy.

There are no doubt medical reasons why some women find sex unsatisfying (and New View takes that into consideration), but for many women, it's not simply a matter of popping a pink pill and hitting the sheets. Here is the New View classification:


The New View Manifesto

A New View of Women's Sexual Problems
by The Working Group on A New View of Women's Sexual Problems. 

Women's Sexual Problems: A New Classification

Sexual problems, which The Working Group on A New View of Women's Sexual Problems defines as discontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience, may arise in one or more of the following interrelated aspects of women's sexual lives.
I. SEXUAL PROBLEMS DUE TO SOCIO-CULTURAL, POLITICAL, OR ECONOMIC FACTORS
A. Ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints:
1. Lack of vocabulary to describe subjective or physical experience.
2. Lack of information about human sexual biology and life-stage changes.
3. Lack of information about how gender roles influence men's and women's sexual expectations, beliefs, and behaviors.
4. Inadequate access to information and services for contraception and abortion, STD prevention and treatment, sexual trauma, and domestic violence.
B. Sexual avoidance or distress due to perceived inability to meet cultural norms regarding correct or ideal sexuality, including:
1. Anxiety or shame about one's body, sexual attractiveness, or sexual responses.
2. Confusion or shame about one's sexual orientation or identity, or about sexual fantasies and desires.
C. Inhibitions due to conflict between the sexual norms of one's subculture or culture of origin and those of the dominant culture.
D. Lack of interest, fatigue, or lack of time due to family and work obligations.

II. SEXUAL PROBLEMS RELATING TO PARTNER AND RELATIONSHIP
A. Inhibition, avoidance, or distress arising from betrayal, dislike, or fear of partner, partner's abuse or couple's unequal power, or arising from partner's negative patterns of communication.
B. Discrepancies in desire for sexual activity or in preferences for various sexual activities.
C. Ignorance or inhibition about communicating preferences or initiating, pacing, or shaping sexual activities.
D. Loss of sexual interest and reciprocity as a result of conflicts over commonplace issues such as money, schedules, or relatives, or resulting from traumatic experiences, e.g., infertility or the death of a child.
E. Inhibitions in arousal or spontaneity due to partner's health status or sexual problems.

III. SEXUAL PROBLEMS DUE TO PSYCHOLOGICAL FACTORS
A. Sexual aversion, mistrust, or inhibition of sexual pleasure due to:
1. Past experiences of physical, sexual, or emotional abuse.
2. General personality problems with attachment, rejection, co-operation, or entitlement.
3. Depression or anxiety.
B. Sexual inhibition due to fear of sexual acts or of their possible consequences, e.g., pain during intercourse, pregnancy, sexually transmitted disease, loss of partner, loss of reputation.
IV. SEXUAL PROBLEMS DUE TO MEDICAL FACTORS
Pain or lack of physical response during sexual activity despite a supportive and safe interpersonal situation, adequate sexual knowledge, and positive sexual attitudes. Such problems can arise from:
A. Numerous local or systemic medical conditions affecting neurological, neurovascular, circulatory, endocrine or other systems of the body;
B. Pregnancy, sexually transmitted diseases, or other sex-related conditions.
C. Side effects of many drugs, medications, or medical treatments.
D. Iatrogenic conditions.



2 comments:

  1. Ruby Ryder on August 26, 2011 at 2:09 AM

    "...there are strong financial ties between the industry and those who are responsible for developing and modifying the diagnostic criteria for mental illness. The connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders.Full disclosure by DSM panel members of their financial relationships with for-profit entities that manufacture drugs used in the treatment of mental illness is recommended."

    I am dismayed...yet not surprised. The drug companies are ubiquitous in their influence...and shockingly unconcerned about anything but the bottom dollar.

     
  2. Lilith on August 26, 2011 at 3:44 PM

    Hi Ruby,

    Yes, it is dismaying. Seriously, doing this research for my PhD has left me more jaded regarding the mental health field and pharmaceutical companies.

    I know many people are confused about what to believe about lot of this stuff. And, truthfully, the more I read the more confusing it becomes. There is so much contradictory information in the literature. That is hard to know what to believe.

     
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About Me
Hi, I am a single, graduate student who is finishing up her doctoral dissertation on the subject of female sexual dysfunction (FSD) and sexual satisfaction.

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