November 10, 2008

When is Sex a Problem?

A recent issue of the journal Obstetrics & Gynecology includes an article reporting on a survey of more than 31,000 U.S. women on “sexual problems and distress,” including “low arousal,” “low desire,” and “orgasm difficulties.” Slightly more than 44 percent of the women reported at least one of these “problems,” although only 12 percent reported any “sexually related personal distress.”

As I read the study, I was bothered by the assessment mechanism, such as asking women, “How often do you desire to engage in sexual activity?” Those who reported “never” or “rarely” were categorized as having a sexual problem, but it seems clear that not all of the 38.7 percent of women who responded this way were distressed about it. If they’re not bothered, I wondered, why then is it classified as a “problem?”

In an editorial responding to the study (available only by subscription or payment), Dr. Ingrid Nygaard expresses a similar sentiment:

“It isn’t that I believe that changes in sexual function don’t create substantial distress for some women, but ever since an oft-quoted 1999 study concluded that a whopping 43% of U.S. women between ages 18 and 59 years have sexual dysfunction, I have been suspicious that variations of the norm were morphing into diseases.

…One obvious question was raised by a patient recently, who, not bothered herself by her lack of interest but very bothered by her husband’s distress at her lack of interest, asked, ‘Why am I the abnormal one?’”

Nygaard goes on to urge caution when approaching the issue of sexual dysfunction:

“What’s to be gained by overinflating rates and turning symptoms into diseases? Lots — market shares, provider income, grant support, and so on — that is, fame and fortune. What’s lost is less tangible: an increasing sense held by Americans that no one is actually normal, or entirely healthy, or just fine; and, of course, enormous economic cost to the health care system and to society at large.”

The study’s authors acknowledge that their results show that “sexual problems associated with personal distress” are “much less common than previously published and widely quoted prevalence estimates of about 40% for sexual problems (with unknown presence of distress).”

In her editorial, Nygaard goes on to ask how much of this distress may be related to media depictions of sex, asking “I wonder, at what point does sexual dysfunction represent a societal dysfunction rather than a personal health dysfunction?”

Nygaard concludes: “Balancing the daily media barrage of glamorous, stress-free sex with a realistic message about sexual problems and the potential for treatment will help to decrease the burden experienced by couples who are unable to be ‘as one.’ This article importantly sets the stage for such a conversation.”

While it’s important to not pathologize variations in sexuality, it’s also important to avoid minimizing or ignoring women who DO experience distress about their sexual issues, as 12 percent of the women surveyed did. Nygaard expresses similar concerns, noting that, “These one in eight women who feel stress, frustration, worry, anger, embarrassment, or unhappiness about their lack of sexual interest or enjoyment do indeed meet the criteria of a problem: a source of perplexity, distress, or vexation.”

Likewise, the authors note that existing medical conditions, including depression, thyroid problems, anxiety, and urinary incontinence, may be associated with distress for some these women.

For more information on how the medicalization of sexuality can harm women, see the OBOS article “Female Sexual Dysfunction: A Feminist View.”


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