Female sexual dysfunction is an umbrella term which encompasses a really broad range of symptoms and conditions such as, lack of sexual desire, an inability to enjoy sex, painful sex, insufficient vaginal lubrication, or failure to achieve an orgasm (anorgasmia). Causes can be physical or psychological. Physical causes may include conditions like diabetes, heart disease, nerve disorders or hormone problems. Psychological causes may include work-related stress, anxiety, trauma, relationship difficulties and even a lack of sex education, and some drugs such as anti-depressants are thought to interfere with sexual desire and function in 50-70% of women.
Women with specific problems such as pain, sexually transmitted infections, thrush or other health problems should always consult a doctor. A GUM clinic can help with many of sexual issues but more complex problems require specialist help. The Jane Wadsworth Clinic at Saint Mary’s hospital in London takes an integrated approach tackling both the physical and the mental causes simultaneously. Lifestyle changes and talking therapies such as MCBT can also help enormously.
Gynaecological issues such as pelvic pain, painful intercourse or cramp at orgasm can destroy a woman’s quality of life and even her relationship but because they are not generally life-threatening, limited NHS budgets often restrict the number of investigative procedures carried out. As a result, finding the underlying cause, or achieving a definitive diagnosis can take years. According to a survey carried out in 2005 by the Endometriosis All Party Parliamentary Group with Endometriosis UK, the average time between presenting at a GP’s surgery with symptoms and a confirmed diagnosis of endometriosis is eight years.
That women are ostrich-like when it comes to sexual and gynaecological issues doesn’t help. Figures from the NHS Cancer Screening Programme show that between 1995 and 2006 the number of women aged 25 to 29 who had taken a smear test had fallen 10 per cent. That’s really disappointing when you consider that in 1988 when the screening programme was first introduced, the death rate from cervical cancer in women under 35 was among the highest in the developed world and now, more than 1,000 lives are saved each year.
At the end of the day we can hardly expect these issues to be a priority in the healthcare system if we don’t prioritise them ourselves.
Prospect Magazine: Female Viagra just isn’t sexy
SUZI GODSON 20th October 2010 — Issue 176
Distrust of big pharma is stifling research into the real problem of female sexual dysfunction
Female sexual dysfunction (FSD)—a condition which can involve physical pain during sex, loss of desire or failure to reach orgasm—is a disorder invented by pharmaceutical companies intent on selling women drugs they don’t need, according to a new book, Sex Lies and Pharmaceuticals, by Ray Moynihan, a health lecturer at Australia’s Newcastle University.
This story has made headlines around the world, yet it is not new. Last year the award-winning American documentary-maker Liz Canner released Orgasm Inc, her ten-year exposé of the billion-dollar race to find a drug to treat FSD. And for at least a decade prior to that, sexologist and campaigner Leonore Tiefer has been criticising “disease-mongering” trends in the management of women’s sexual problems. As she told me eight years ago: “FSD is a contrived diagnosis foisted on the public by those interested in selling women a pharmaceutical cure.”
The hunt for a cure for FSD had begun in earnest about four years before my conversation with Tiefer. A survey by sociologist Edward O Laumann, of the University of Chicago, had established that 43 per cent of women suffered from some form of FSD. Ordinarily that information would not have merited a second glance, but this was 1998—and a small blue diamond-shaped pill had just become the fastest- selling drug of all time. In the wake of Viagra’s success, it was inevitable that drug companies would throw money at any product that could enhance the sexual function of nearly half the female population. Fast-forward 12 years, however, and male sexual dysfunction drugs, including Viagra, Cialis and Levitra, are racking up combined annual sales of $4.4bn (£2.8bn), yet the pink cash cow remains elusive.
Why is FSD proving such a hard nut to crack? Largely because drug companies have been searching for a one-size-fits-all solution to what is, in essence, a spectrum of different and complex problems. Take a closer look at Laumann’s figure of 43 per cent and you find that it is made up of 14 per cent of women who had difficulty becoming physically aroused, 7 per cent who experienced pain or physical discomfort during intercourse and 22 per cent who were suffering from low sexual desire. But how do you define low sexual desire? It’s not a dysfunction; it’s a non-specific complaint that often has nothing to do with a woman’s physical health and everything to do with her relationship, her age, the size of her arse, her mortgage, or even her partner’s wedding tackle. No pill is ever going to solve all those issues.
The right drug, however, might be able to help the 15.6 per cent of women who suffer from clinical conditions that make sex difficult or impossible. That smaller figure comes from the respected British National Survey of Sexual Attitudes and Lifestyles, published in 2000 and, while not such a headline-grabber, this is the percentage of women who have suffered from persistent sexual problems for six months or longer.
David Goldmeier, a doctor who specialises in sexual dysfunction, treats patients at the Jane Wadsworth Clinic at St Mary’s hospital in London. His male patients have a raft of pills and pumps and pessaries to choose from, but there is no comparable or universally effective treatment for women. Understandably, women who find sex painful, or unachievable, are distressed by their condition and acutely aware of the negative impact it has on their relationships. If Pfizer or GlaxoSmithKline or any of the other pharma giants managed to come up with a product that actually worked, they would strike gold—but they would also, more importantly, improve the quality of life of more than one in ten women.
So while it is popular to demonise big pharma, let’s bear in mind that it costs about $1bn to develop a new drug with no guarantee of approval by the authorities. With those odds, it is inevitable that companies will try to recoup their investment by targeting every possible big market for new products. And if we are mistaken in thinking that a “cure” for FSD will change the lives of nearly half the female population, improving the lives of 15 per cent of women is still a worthwhile goal.
“Female sexual dysfunction” is indeed an unsatisfactory umbrella term for a range of problems. But to claim it does not exist, or to assume that women are incapable of differentiating between a marketing ploy and a condition that severely impairs the quality of their relationships, is obviously wrong. And as Goldmeier warns, claiming that female sexual problems are fictitious only marginalises women who already are often highly embarrassed to talk about, or seek help for, such issues.
Worryingly, the recent negative publicity surrounding FSD is now diminishing the appeal of continued research. This is dismaying, because there is still so much to learn about female sexual function. The full length of the clitoris (3.5 inches) was only discovered in 1998 and, despite decades of investigation, experts have consistently failed to establish whether the G-spot actually exists. If scientists can’t even agree on basic female anatomy, what hope is there for women suffering sexual dysfunction?