This week, Time magazine published an article on genital cosmetic surgery,
“Plastic Surgery Below the Belt,” focused on women getting procedures such as labiaplasty, vaginoplasty, and “G-spot enhancement.” It notes that the American College of Obstetricians and Gynecologists issued a statement that these procedures may lead to “scarring, chronic pain, obstetric risks or reduced sexual pleasure,” and that many are calling for more research on the procedures. In fact, ACOG noted this very problem in their statement, explaining that “No adequate studies have been published assessing the long-term satisfaction, safety, and complication rates for these procedures.”

Featured in the article are protests from the New View Campaign, which has at its goal to “to expose biased research and promotional methods that serve corporate profit rather than people’s pleasure and satisfaction. The Campaign challenges all views that reduce sexual experience to genital biology and thereby ignore the many dimensions of real life” and in general to “limit the medicalization of sexuality.” The group protested New York City’s Manhattan Center for Vaginal Surgery on Monday. Time reports that some attendees held signs referencing the normal variation in female anatomy that read “No two alike;” a visit to the group’s website reveals other messages as well, such as “stop marketing discontent.”

The piece also covers the (mis)conception that cosmetic surgery is an adequate solution to relationship or self-esteem problems. LeLaina Romero of the New View Campaign noted that, “Promoting a very narrow definition of what women’s genitals ought to look like — even for those women who don’t want surgery, it harms them.” Similarly, last year’s statement from ACOG suggested “a frank discussion of the wide range of normal genitalia” and “exploration of nonsurgical interventions, including counseling.”

Along these same lines, I just recently learned via a post at Mom’s Tinfoil Hat about the “MENding Monologues,” an all-male performance inspired by the Vagina Monologues conceived as “a love letter to women, a healing for men, and a call to end violence in all its forms.” One of the monologues is a somewhat humorous character, “Dr. Vaginsky,” who challenges the idea that women aren’t fine just the way they are.

For related OBOS content, see Female Sexual Dysfunction: A Feminist View as well as our previous blog posts, Marketing Female Sexual Dysfunction: The Search for the Pink Viagra and Selling Women Unsupported Health Messages and Insecurity about Their Vaginas.

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.”

Beyond Rape – A Survivor’s Journey: Cleveland Plain Dealer reporter Joanna Connors has written a five-part story about being raped 24 years ago when she was on assignment for the paper.

The story is notable not only for Connors’ reach in describing how her life (and by extension her husband and children) was affected by the rape, but she also sets out to learn more about her rapist — and in doing so peels back the layers on a family trapped in a cycle of violence and abuse toward women. While exploring the related race and class issues, Connors raises many questions as she sets about trying to answer them.

All the sections to the series are available here, along with an introduction by the paper’s editor and resources for victims of rape.

Plus: Editor & Publisher looks at responses to Joanna Connors’ story.

Are Doctors Shilling for Drug Companies on Public Radio?: Check this out — as Shannon Brownlee and Jeanne Lenzer write at Slate:

A few weeks ago, devoted listeners of public radio* were treated to an episode of the award-winning radio series The Infinite Mind called “Prozac Nation: Revisited.” The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.

The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of Mental Health, interviewed three prominent guests, and any radio producer would be hard-pressed to find a more seemingly credible quartet. Credible, that is, except for a crucial detail that was never revealed to listeners: All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the “unrestricted grants” that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac.

Continue reading ….

For Prospective Moms, Biology and Culture Clash: Just before Mother’s Day, NPR’s “Morning Edition” looks at the rising age of first-time mothers and the “clash” between culture and biology.

The average age of first-time mothers in the United States has been rising steadily over the past four decades — up from 21.4 in 1970 to a little over 25 in 2005, the National Center for Health Statistics reports. [...]

“Women are no longer marrying the boy they met in high school,” [Rutgers anthropologist Helen] Fisher says. “They’re concerned with getting a career before they marry. This takes time.”

But this is time on the biological clock that cannot be recaptured. …

I appreciate that the story includes a couple sharing household duties while both work, and Fisher notes that businesses are recognizing women want to keep their careers, but there’s still a tone of women should know better — and should get on with making babies.

A story on, say, the glacial speed of government and business to provide adequate paternity and maternity leave and to accommodate breastfeeding moms returning to work — along with the lack of access to quality childcare and the advocacy work of groups like Moms Rising — would be a more welcome and appreciated “Mother’s Day” story.

Plus: This Wall Street Journal’s Heath Matters column focuses on unplanned pregnancies later in life. Close to 40 percent of pregnancies among women over 40 are unplanned, according to a 2001 survey by the National Center for Health Statistics in Atlanta, the most recent data available.

Public Citizen Calls on FDA To Withdraw Ortho Evra Patch From Market: Public Citizen’s Health Research Group called on the FDA this week to withdraw the birth control patch Ortho Evra from the market, citing studies that found an increased risk of dangerous blood clots, reports Reuters.

“The considerable safety concern of high-dose, variable estrogen exposure tips the balance of risks and benefits against the availability of Ortho-Evra as a contraceptive,” wrote Sidney Wolfe, head of the research group.

A Better Method for Handling Rape Kit Evidence: Jessica Voorhees Norris, a Ph.D. candidate in forensic chemistry at University of Virginia, has created a method for handling rape kit evidence that reduces part of the DNA analysis time from 24 hours to as little as 30 to 45 minutes and improves the sperm cell recovery rate by 100 percent, according to this university release.

If her method was to be adopted by forensic labs — and the results accepted by courts — the backlog could potentially be reduced within months.

“There is an overwhelming demand for DNA analysis of sexual assault evidence, but laboratories have neither the funding nor the manpower to handle the caseload in a timely manner,” Norris said. “Juries have come to expect DNA evidence in sexual assault cases, but forensic labs are not able to perform in a timely and efficient manner due to limitations in the currently used technologies.”

“Homosexuality,” “Sexually Explicit” Most Common Reasons for Challenging Books: For the second year in a row, “And Tango makes Three,” a children’s story by Justin Richardson and Peter Parnell about two male penguins caring for an orphaned egg, was the most “challenged” book in U.S. public schools and libraries, according to the American Library Association.

Other books in the top 10 cited as “sexually explicit” include “The Color Purple” by Alice Walker; “It’s Perfectly Normal,” by Robie Harris; and “The Chocolate War,” by Robert Cormier.

“Overall, the number of reported library challenges dropped from 546 in 2006 to 420 last year, well below the mid-1990s, when complaints topped 750,” reports the Associated Press. “For every challenge listed, about four to five go unreported, the library association estimates.”

National Women’s Health Week: We here at OBOS like to think of every week as Women’s Health Week, but next week it’s official: National Women’s Health Week runs May 11 – May 17, and the push this year is to encourage women to make their health a top priority and take simple steps for a longer, healthier and happier life.

As we approach the 10th anniversary of FDA approval of Viagra — a moment of silence, please, in memory of Viagra-free email, commercials and Bob Dole — the search for a woman’s version of Viagra continues.

Even the most optimistic researchers believe that a “pink Viagra” is still about five years away, according to the Washington Post. But the race is on.

As David Segal writes, “Though it’s unclear exactly how many women would ask for a prescription, no one doubts that the first company that gets to market a remedy for female sexual dysfunction, as it’s formally known, will earn a fortune.”

Maybe it’s time to consider a different, some would say New View:

“Drug companies want to say to women, ‘You don’t need to know anything; you can have the satisfying sex life that you seek — people dancing on TV, the whole bit — without knowing anything. Just ask your doctor,’” says Leonore Tiefer, a psychotherapist and clinical associate professor at New York University, who has long decried what she calls “the medicalization of women’s sexuality.”

“I resent that, because there are specific harms that come from being ignorant and dependent in the world we live in,” adds Tiefer. “There may be lots of people who aren’t interested in sex, but is there a medical reason for that, and do we diagnose that?”

The Post’s Segal adds:

Tiefer’s critique centers, in part, on the way that pink Viagra is sure to be marketed — with ads day and night, suggesting that women who aren’t feeling frisky have a medical problem. She and her allies — organized as the New View Campaign — are also galled that so much money and media attention are heaped on the lust drug, even before it exists, when for many women the solution to their libido problems isn’t that exotic.

Maybe they have a partner who hasn’t a clue about technique. Maybe they’re stressed out. Maybe they can’t possibly get in the mood because they’re so busy raising children. Therapy, counseling, even free day care, says the New View Campaign, might do more for women’s sex lives than any drug company ever could.

The story is well worth a read for the science behind the search for a female aphrodisiac and a good discussion of the potential stigmatization of women who aren’t as interested in sex. For more reading, “Our Bodies Ourselves” has a whole section on the feminist view on female sexual dysfunction.