There is nothing quite as unsexy, as unstimulating, as listening to
people talk about sex all day long.
That's what I did, for three days in a row, and the people I listened to were not just people who like to talk about sex. They were some of the most renowned sexperts in the world -- almost 450 of them -- from 19 countries, gathered in a luxurious downtown hotel at a Boston University School of Medicine meeting, "New Perspectives in the Management of Female Sexual Dysfunction." The program promised dozens of presentations with titles like "The Physiology of Sexual Arousal in the Human Female -- A Recreational and Procreational Synthesis" and "Importance of Measuring the Axial Penis Rigidity in Reference to the Resistance of Vaginal Introitus" (that is the official term for "Yeow - that hurts!").
What a difference a century makes. In 1899, a sexually enthusiastic woman
would likely have been pathologized as a "nymphomaniac," and hospitalized for insanity, clitoridectomy or both, and a woman who didn't achieve a "vaginal orgasm" would be labeled psychosexually immature. In 1999, as our century reaches its climax, we have an international medical and scientific effort to encourage female sexuality, to help the more than 40 percent of American women who report one sexual complaint or another, be it lack of desire, difficulty achieving orgasm or excruciating pain instead of pleasure.
And so, for three glorious autumn days last week I sat in a ballroom with heavy drapes and crystal chandeliers and eavesdropped as people with M.D., Ph.D., M.P.H., R.N., FDA and NIH after their names exchanged data, hypotheses, ideas, beliefs, questions, answers, "Grand Master" lectures, podium presentations, poster displays, prize-winning essays and countless PowerPoint presentations, all on the subject of female sexual dysfunction, or "FSD."
It was three days of immersion in the desire/arousal/orgasm/resolution cycle, vasocongestion ("that heavy feeling"), hormones and neurotransmitters; vaginas, lubrication and the clitoris (doesn't rhyme with the name of a Seinfeld date), but none of it was nearly as sexy as five minutes of Barry White.
More than one meeting attendee was heard speculating that if Viagra and its
potential for tapping the other half of the gender market did not exist,
this meeting probably wouldn't have either. And in fact, several large
pharmaceutical companies provided "unrestricted educational grants" for this meeting. One of the largest, at the "Diamond Level," came from Pfizer
Pharmaceuticals Inc., the maker of Viagra. As one speaker put it, "Sex
sells. If you didn't know that before Viagra, you know it now."
I listened to a stunning blond Swedish researcher describe her
experiments with Seldenafil (Viagra's real name) on "rat vaginal smooth
muscle." Another researcher described her Viagra work on the "vaginal
tissue strips" of New Zealand white rabbits; the cute little critters are
"euthanized," their vaginal tissue is removed and cut into small strips,
hung in chambers and bathed in drug solutions. The point, apparently, is
to understand the mechanism that causes an actual woman's vagina to "relax" and "dilate," which is what occurs in sexual arousal, and to determine
whether Viagra and other potential new drugs can help "enhance" that.
I saw pictures of turbocharged vibrators, gizmos for measuring and probing, and women lying on exam tables wearing weird 3-D sense-surround glasses watching Candida Royale erotic videos while a researcher sat at a computer five feet away measuring "pre-stim" and "post-stim" responses.
I saw charts and graphs and color duplex ultrasonograms of blood flow to the clitoris. I saw slides of vaginas turned literally inside-out, hanging
outside the body between the patient's thighs, in a frightening example of
"uterine prolapse."
I got a demonstration (on my inner wrist, alas) of a new device called the
EROS-CTD, a battery-powered vacuum device that looks like a computer mouse with a small, clear, plastic suction cup at the end. The device is turned on and the suction cup is applied directly to the clitoris to "cause clitoral
engorgement." Ah, I thought, finally! A penis pump women can call their
own.
I even heard a few good jokes: (Quick, what's the difference between a golf
ball and a G-spot?)
By far the oddest thing I saw was a French urologist's black-and-white
images of a 30-year-old man and a 27-year-old woman who volunteered to have sexual intercourse in an MRI machine. This doctor admitted he had no
"therapeutic goals" for this project; he had simply become inspired by a
15th century DaVinci drawing of sexual intercourse and felt compelled to
create his own "actual anatomical images" of same. He could find only one
radiologist in all of France willing to join him in this endeavor. If
you've ever been subjected to an MRI, surely you can understand his report
that the male subject's "erection was difficult to maintain during the
required imaging period."
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.
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