what we should be asking, instead of asking if the FDA is sexist (which it isn't)

I’m not sure why journalists take it seriously, the assertion that the FDA is sexist. It’s a narrative invented by a PR firm for a drug company that has a massive profit motive for getting their drug approved. It is a very *clever *narrative, that feeds into cultural fears of government control of our bodies, and it cleverly coopts the language of “choice” and “women’s autonomy” for the purpose of making a drug company money.

But, as Amanda Marcotte writes, “the reality is so much more complicated, and important to understand, than that.”

I think, too, that it wastes everyone’s time and distracts from the real issue:

 

Women are struggling. How can we help them?

 

And there is a Catch-22 in this question.

Sexual responsiveness is sensitive to CONTEXT – the person’s external circumstances and their internal state. Like tickling, right? A stimulus in a great, sex positive context may turn you on, while that same stimulus in a negative context won’t do anything but shut you down.

And part of the context by which sexual responsiveness is influenced is the set of cultural rules that shape our expectations about how sex “should” work. When our sexualities match the “should,” that’s a sex positive context; when we don’t match the “should,” that’s a context where we’re more likely to judge or criticize ourselves and feel ashamed of our sexuality, which will do nothing but shut us down.

That means that one of the ways that we can help women who are struggling is to change the context – change the set of “shoulds” that they hear from doctors and the media and other cultural influences.

So when we let the PR firm for the drug company hijack the narrative, when we let it be about how sick and broken women are and how sexist the FDA is, stopping women from having access to a drug to cure them, we create a context that normalizes the idea that women are diseased, that they need help – help that only a prescription can bring. Furthermore, we reinforce a context where women feel dismissed if someone says, “You don’t need a drug. You’re not even broken.”

As far as she’s concerned, she is broken, because she doesn’t match the cultural “should.” You can’t take away her belief that she’s broken unless you replace the “should” with something different.

 

This is how medicalization works, and why it’s a problem.

 

Let’s think through an example:

Bobbi goes to the doctor because she hasn’t been experiencing spontaneous desire for sex. She did before, but hasn’t for a long while. So she asks her doctors about her low desire.

 

SCENARIO A: NONMEDICALIZATION

The doctor asks her if she experiences pleasure on those occasions when she does have sex with her partner. Bobbi says yes, though before the sex she’s always worried about whether or not she will and if she’ll have an orgasm and sometimes feels resentful about feeling so pressured to want and have sex.

So the doctor suggests she might be experiencing responsive desire, which is both very common and a normal variation on sexual desire, such that her interest emerges only once a sexual scenario has begun. The doctor offers her a book – maybe like this one or like this one –  on different ways women experience desire.

“it’s a myth that sexual desire is ‘supposed’ to just be there all the time,” says the doctor. “In reality, sexual interest is like curiosity: it comes and goes, depending on the situation. And there are things you can do to influence the situation to maximize curiosity.”

How does Bobbi feel when she leaves the doctor’s office? What does she do next?

 

 

SCENARIO B: MEDICALIZATION

The doctor says, “You meet the diagnostic criteria for low desire, but there are currently no FDA approved treatment for low sexual desire in women. I can write you this script for an antidepressant, which will help you feel less depressed about lacking sexual desire.”

How does Bobbi feel when she leaves the doctor’s office? What does she do next?

There is no denying that being able to take a pill that generates desire for sex would be simpler than teaching everyone skills for making responsive desire work in their relationship, when they’ve always been taught to expect spontaneous desire.

And there is no denying that teaching everyone about responsive desire is ALL THE MORE DIFFICULT because so many physicians don’t know about it and therefore treat lack of spontaneous desire as a disease.

We might argue that the notion that “responsive desire” is a disease requiring medical treatment is, itself, the more sexist part of this equation.

 

But that is what we should be talking about. Not “Is the FDA sexist?” but “How can we help women?”

I’m a sex educator, so of course my first response is, “We can help women by educating them – and their partners – about what the real ‘shoulds’ are, what the science tells us they can expect from their sexuality: arousal nonconcordance, the brakes and accelerator, responsive desire, and context sensitivity.”

When we teach the real “shoulds” (which aren’t “shoulds” at all), we change the context.

And the new context, in turn, increases women’s sexual pleasure.

Don’t let the marketing ploys distract you from what really matters.