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There were, to be sure, some take-home headlines from this meeting, including a new, more woman-friendly way of defining FSD. It includes, for the first time, the requirement that a woman's sexuality be considered "dysfunctional" only if it causes her "personal distress." In other words, these sexologists are now willing to concede that it is up to the woman herself -- not her partner, not her doctor -- to determine whether her lack of desire, lack of arousal, degree of pain or difficulty with orgasm is sufficiently troublesome to warrant diagnosis and/or treatment. You've come a long way, baby?

There was also a "buzz" about the various Viagra studies on rats, rabbits and even real women that, while small and preliminary, did seem to suggest some real promise in treating some women with arousal difficulties. However, FDA approval for Viagra for women seems several placebo-controlled, double-blind studies away.

In a provocative lecture titled "The Sexual Pain Disorders: Is the Pain Sexual or Is the Sex Painful?" a prominent researcher advocated that pain and discomfort associated with sexual activities be reconceptualized, treated not as sexual disorders, but as pain disorders, with the focus on the pain, not the sex. As he explained, when a back injury keeps a worker off the job, it's not treated as a work problem, it's treated as a pain problem. Why should pain during sex be any different?

Anthropologist Helen Fisher spoke of the three brain systems for love: lust, attraction and attachment. There were important presentations as well about sexuality for women after a breast cancer diagnosis, diabetes or hypertension; sexuality for women with spinal cord injuries; sex during pregnancy; sex after menopause; and new ways to think about a woman's cycle of desire, arousal and satisfaction.

Lesbians and lesbian sexuality were almost invisible at this conference, with the exception of one presentation about treating "Inhibited and Discrepant Desire in Lesbian Couples" (aka Lesbian Bed Death), and some scattered efforts to eliminate the emphasis on sexual intercourse when talking about what real women actually do. However, for the most part, this conference placed the heterosexual woman who has intercourse in a stable partnership front and center.

There was also a good old-fashioned feminist controversy, made all the more poignant because Boston is hallowed ground: home base for the collective that publishes the groundbreaking 1970s self-help book for women, "Our Bodies, Ourselves."

Even before the conference began, a New York psychologist and sex therapist, Dr. Leonore Tiefer, got scared. She firmly believes this conference represents a watershed event in the history of women and the history of sex. She sees only danger in a medical approach to women's sexuality, and accuses the medical establishment and pharmaceutical companies of aggressively trying to define, control and profit from women's sexual satisfaction. "We are watching the calculated invention of a new disorder [for women] that serves many financial and professional constituencies -- but not necessarily the interests of women," she says.

Tiefer was outraged that the organizers recruited hundreds of people from many health-care disciplines to this event, most of whom she says are "oblivious to the politics of gender," but invited almost no one who studies sexuality from a social, cultural or psychological perspective.

From the podium, Tiefer accused her colleagues of "careerism uninformed by women's larger social predicaments," and challenged them to resist "the temptation to promote simplistic models and solutions for women's complex sexuality." She reminded them that eroticism, personal longings, fear and the need for intimacy and power are not found in any lab. She implored them not to try to measure and standardize that which is spontaneous.

It was a brave thing Tiefer did -- "I would have felt like complete and total shit if I hadn't done it," she says -- especially to this crowd, so giddy in its echo chamber of professional success and stature. Her talk was politely applauded, but her politics predictably rejected and denounced by many at this conference, including two angry women who took to the microphones and called her "reactionary," "archaic," "intense," even (gasp) "anti-feminist" for wanting to preserve a lower-tech, non-medical approach to women's sex lives.

"Women should have choices. Not every woman wants psychotherapy, not every couple wants couples therapy," was the reaction from Dr. Sandra Leiblum, a leading authority in the field of sex therapy. "Pharmacological options are a choice women should have. It would be like saying women can only have vaginal deliveries without any kind of sedative or epidural for pain."

I couldn't help but notice that this meeting was a managed-care efficiency expert's wet dream. The program book listed precise times for each event -- for example, "2:01-2:11 p.m.: Decreased Testosterone in Regularly Menstruating Women With Decreased Libido: A Clinical Observation." The longest anybody got to speak, even though he or she may have come thousands of miles to do it, was 20 minutes, and these were the so-called "Grand Master" lectures -- so authoritative, apparently, that no questions were allowed afterwards.

There was also a rat-a-tat-tat procession of six-minute presentations with precisely four minutes of questions no longer than 30 seconds apiece. At one point, as yet another researcher raced through his latest laboratory triumph, the woman next to me muttered, "Leave it to men to rush through sex."

Here's what I want to know: How come doctors, who, in my experience, are constitutionally incapable of ever seeing any patient on time, can run their conferences like clockwork? I propose a placebo-controlled double-blind study on that.

But let it not be said that the world's greatest sexologists are all work and no play. On Saturday night, those willing to pay $85 apiece (on top of the $495 registration fee) were treated to a clambake and lobster dinner aboard a yacht circling Boston Harbor in the moonlight. They told (preferably dirty) jokes for drink tickets; they chose "You Make Me Feel Like a Natural Woman" as the FSD theme song; and, through a chain of events that nobody seemed quite able to recall the next morning, about 20 of these high-powered medical men stripped off their shirts, danced bare-chested to Motown oldies and posed for a team photo in a kick line.

Oh, and, in case you were wondering, the answer is: A man will spend 20 minutes looking for his golf ball.
salon.com | Oct. 28, 1999

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