WAKING UP TO THE MEDICALIZATION OF SEX
AN ESSAY BY LEONORE TIEFER
Most feminists agree, that despite the prevailing contemporary rhetoric of women’s sexual empowerment and choice, women’s sexual experiences are regulated for them by others in a patriarchal society. Today the popular script claims that the sexual double standard is dead and women are sexually emancipated, at least in countries not dominated by religious orthodoxy. However, this empowerment claim is contradicted by numerous memoirs and studies by and about ethnic women, disabled women, teen women, college women, dating women, married women, old women, and others. The personal stories of sexual life that emerge from such research identify numerous areas of insecurity, distress, and outright subjection that emphasize how disappointment, shame, and lack of joy and confidence are a big part of the standard story of women’s sexual lives.
Accepting that we dance to a patriarchal tune when it comes to sexuality is not to deny that many women feel physical pleasure, emotional intimacy, and psychological power in flirting, masturbating, or engaging in partnered sexual activities, at least some of the time. Rather, it is to emphasise that these experiences of pleasure, intimacy and power occur within a framework of limits and rules dictated by the corporate, media, and educational institutions of our patriarchal society. Thus, from feminist point of view, sexual emancipation remains remote.
One prime source of the limits and rules that regulate sexuality in contemporary liberal society arises from commercial interests and governmental policies that shape a discourse of “sex as health” as the principal sexual metaphor. Not “sex as hobby,” “sex as expression of emotion,” “sex as learned behaviour,” “sex as transcendence,” “sex as complex psychophysical activity,” or “sex as collection of widely diverse cultural displays,” but, rather, “sex as genitally focussed universal evolutionary behaviour and need,” akin to respiration, digestion, or sleep. Within this framework a life or marriage without sex is not healthy, sex must include genital activities, orgasm is the high point of sex, too little sex is not normal, sex contributes to well-being and longevity, etc etc.
This construction places sexuality into a discourse of biological health, and authorises arbiters of normal and abnormal function such as doctors and psychotherapists to explain and advise the public about sex. These people have become the designated sexuality experts of our society.
Anthropologists and sociologists call this framing “medicalization,” and they have tracked the growth of medicalization throughout the 20th century as it totally transformed public and professional understanding of many aspects of everyday life such as mood, sleep, appetite, emotions, alcohol use, activity level, weight, aging, pregnancy, menstruation, drug use, mental state, social behaviour, and more. These all became aspects of health (and illness), and any deviations from social norms became identified as signs and symptoms of medical or mental health conditions. Given the moralistic perspective on sexual life resulting from thousands of years of patriarchal religious dictates, and the super-moralized place of women’s sexuality within those teachings and practices, it made sense to me to understand the medicalization of sex as a shift “from sin to sickness” but not a shift from regulation to emancipation.
The medicalization of sexuality began to interest me as a feminist as I watched the growth of a new specialty called “sexual medicine” in the 1980s and 1990s. It was a field devoted to treating, helping, and otherwise fixing women whose sexual interests and experiences deviated from social norms. However, this new sexual medicine for women was not devoted, as similar developments had been in the past, to curing lesbians or taming nymphomaniacs, but to jazzing up the lackluster levels of coital interest displayed by many married women. It seemed noteworthy that efforts to “help” these women emerged just as Viagra and other erectile function enhancers appeared, and as men were being encouraged by advertisements to look forward to drug-assisted lifelong capacities for penetrative intercourse and orgasm.
Pharmaceutical companies began to hunt for a “Pink Viagra” for women that would have a rate of return comparable to that of Viagra’s annual multi-billion dollar/pound/euro bounty. A desire/arousal medicine for women was promoted, of course, not as something that was largely of interest to multinational corporations and advertising agencies, but as something women themselves needed and wanted due to their alleged widespread inadequate sexual function and distress.
This hunt has gone on for years and years, despite extensive research literature showing that women’s sexual problems and dissatisfactions are most often the result of a long laundry list (the word is chosen intentionally) of social and interpersonal causes. It is only because numerous attempts have failed to produce definitive clinical trials that no medication for “female sexual dysfunction” has yet been approved in the U.S. It is only a matter of time until one drug or another will pass muster, however, and then the advertising industry will take over and publicise the “good news” far and wide through every form of communications media and some not even yet invented!
My activist and academic work over the past two decades has focussed on exposing the evolving system and network behind the medicalization of sex. The major challenge was overcoming my initial limited training as a research and clinical psychologist and broadening my knowledge to include areas such as critical public health and social studies of medicine. Feminism offered me a basic standpoint – sex is better understood as a matter of cultural arrangements than as an element of biomedical health – but it has taken far longer to understand how professional and business elements interact on the global stage to produce and promote an ever-expanding clinical framework of sexual research, diagnoses, and treatments.
Overall, I have come to understand the situation this way: Sex has become a commodity in a consumer world. “Health” is the overall consumer category where reigning authorities locate sex. Clinicians are considered the designated sex experts and act to preserve their authority and economic opportunities while engaging in self-justification about the social value of their work. Healthy sex life, a constantly changing category of age-related specifics, has become an unquestioned right and social necessity. Most people receive no sexual instruction, so the reality of their sex lives inevitably falls short of their expectations. People fail to understand that their disappointment is socially caused, however, and feel defective and inadequate, rendering them vulnerable to clinical formulations, surveillances and interventions. The media are captive to the same assumptions and trumpet new discoveries that are little more than press releases. Thus the medicalization of sex goes on.
Artwork © ZAHRA LUENGO