Female Sexual Dysfunction Diagnosis Questioned

(WOMENSENEWS)–“I knew something had changed dramatically when I had my daughter,” says Lillian Arleque
of her 1975 childbirth. “There was no sexual desire. No sexual response and, prior to that, things were great.”

When Arleque, a motivational speaker, approached doctors for help, she was told that her regular periods and normal physical exams meant her problems were psychological. She disagreed.

“When Viagra came out I thought, good, now in a few years they’ll take a look at women,” she recalls. Last year Arleque saw sexual medicine specialist Dr. Irwin Goldstein from the Boston University School of Medicine, who diagnosed her as low in hormones DHEA (dehydroepiandrosterone) and testosterone. Treatment with DHEA supplements and testosterone gel brought a “70 percent improvement,” says a grateful Arleque.

Although women like Arleque are finding help in physical cures, some doctors and health advocates say such products help only a minority of women with sexual complaints. They add that the treatments have a downside: They medicate and make pathological normal female sexual responses. These critics also charge drug and medical-device makers with promoting the creation of a new medical diagnosis, Female Sexual Dysfunction, in order to plan Viagra-like direct marketing campaigns to women.

Female Sexual Dysfunction was defined by 19 urologists at four meetings starting in 1997 to include difficulties with desire, arousal, pain and orgasm. The diagnosis doesn’t describe what causes such problems.

Once physicians name and define a new medical diagnosis, such as Female Sexual Dysfunction, also known as “FSD,” drug companies are allowed to begin drug trials and seek Food and Drug Agency approval for potential remedies for the newly defined illness.

Critics of the Female Sexual Dysfunction diagnosis, such as medical journalist Ray Moynihan, point to pharmaceutical sponsorship of the meetings, noting 18 of 19 participants had financial relationships with a total of 22 drug companies. In an article in January’s British Medical Journal, Moynihan argues that with drug companies dominating research trials in search of profitable remedies, the tail may be wagging the diagnosis.

Pfizer’s Viagra (sildenafil), introduced in 1998 as a remedy for male impotence or erectile dysfunction, has reached annual sales in excess of $1 billion.

Better Surgical Techniques May Be More Important Than Developing Drugs

Hormones weren’t Lisa M.’s problem (last name withheld by request). The healthcare worker in her 40s says after hysterectomy her orgasms took longer to occur and were less intense. Lisa’s research led her also to Goldstein, who diagnosed nerve damage from the surgery.

Although Viagra “helped some,” Lisa says, she didn’t want to take medicine, so Goldstein suggested the EROS-CTD (trademark) device, an FDA-approved prescription-only vacuum pump for clitoral stimulation, which Lisa says has helped her.

The most common surgical cause of nerve injury like Lisa M.’s is abdominal hysterectomy. When the nerves are stretched or compressed, they may heal; but if cut, nerves must be surgically re-attached. Such nerve injury is a known complication of abdominal, pelvic and hip operations.

“How to do better surgery is not what the pharmaceutical industry is interested in,” says psychologist and sexual therapist Leonore Tiefer, professor at New York University School of Medicine and Albert Einstein College of Medicine. “For every basic science study that’s coming out, 50 drug trials are coming.”

She believes the new diagnosis of Female Sexual Dysfunction is a rush to medicalize women’s sexual problems, to exaggerate the physical component and minimize the non-physical component. “I’m in favor of prevention,” Tiefer says. “Don’t go to a doctor; go to a bookstore. We know most of the problems are related to relationship issues and sexuality knowledge issues.”

Tiefer says even women changed by childbirth and surgery can still have satisfactory sexual relations given enough time, tender partners and new techniques.

“The Eros is a vibrator,” says Tiefer. “It costs $359. You can buy a vibrator for much less money.” She adds the medical relief for men may not be all it has seemed. “After a year or two, men find Viagra is not effective,” Tiefer says. “I want to know what the problem was in the first place.”

Tiefer also says that post-menopausal women may not want “young” sex. “Suddenly, aging is illegal; you’re supposed to have the same vaginal lubrication, the same intensity of orgasm, as when you were 20 or 30, and you’re not supposed to change.”

Questioning the Impact of Pharmaceutical Funding

Dr. Irwin Goldstein has a different view. He believes that creating a formal diagnosis helps women. Goldstein is a leader in defining Female Sexual Dysfunction. He is the director of the Institute for Sexual Medicine and professor of urology and gynecology at Boston University School of Medicine, which has treated men since 1978 and women since 1998.

“Erectile dysfunction is a medical condition. You need to have women’s sex problems in some context,” Goldstein says, adding patients at his clinic first see a psychologist.

“The pharmaceutical industry was not involved in the defining” of Female Sexual Dysfunction, says Goldstein, he says. “I was co-chair of the meeting set up by the American Foundation for Urologic Disease, which put the firewall up. It provided an unrestricted educational grant. Not one drug person was in the room.”

Judy Norsigian, executive director of Our Bodies, Ourselves and a founder of the Boston Women’s Health Collective, however, says Goldstein is “naive or disingenuous if he thinks he’s immune to the funding from drug industries. There’s a pattern that emerges over years that proves the point.”

“For device or drug makers, they’re going to try to expand the market for the product by having more and more women think of themselves as sexually dysfunctional in a way for which a drug or device is the solution,” says Norsigian, predicting ad claims as broad as once made for hormone replacement therapy.

Suzanne Batchelor has written for the national science series “Earth and Sky” and on health and medicine for Medscape, CBS Healthwatch, WebMD and the Texas Medical Association’s “Healthline Texas.”