Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Original Articles and Reviews

Women’s Sexual Desire

Challenging Narratives of “Dysfunction”

Published Online:March 23, 2017https://doi.org/10.1027/1016-9040/a000282

Abstract

Abstract. Recent changes in the classification of female sexual dysfunction in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the US Food and Drug Administration’s (FDA) approval of the first drug to treat low sexual desire in women (flibanserin) have highlighted the intense focus on sexual desire problems in women. We first discuss the rationale for the DSM changes and outline the DSM-5 criteria for Female Sexual Interest/Arousal Disorder. We provide an overview of some of the key events leading up to the approval of flibanserin for the treatment of hypoactive sexual desire disorder in women, including the role of the “Even the Score” advocacy campaign, that accused the FDA of gender bias in not giving women with sexual desire problems access to treatment options. Incorporating narratives from testimonials of female patients attending the 2014 FDA Patient-Focused Drug Development Public Meeting, we examine some of the prevalent beliefs around sexual “normalcy” and the immutability of sexual desire. We critique how the media and pharmaceutical companies depict sexual norms and female sexual desire and how pharmaceutical trials often narrowly define and assess sexual desire and “sex.” We end with some recommendations for how researchers, clinicians, and journalists can better acknowledge that sex and desire have multiple meanings and interpretations with a view to women being offered a truly informed choice when seeking help for sexual problems.

References

  • American Psychiatric Association. (1952). Diagnostic and statistical manual of mental disorders (1st. ed.). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd. ed.). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th. ed.). Arlington, VA: Author. First citation in articleCrossref, Google Scholar

  • Angel, K. (2010). The history of “female sexual dysfunction” as a mental disorder in the 20th Century. Current Opinion in Psychiatry, 23, 536–541. doi: 10.1097/YCO.0b013e32833db7a1 First citation in articleCrossref, Google Scholar

  • Angel, K. (2012). Contested psychiatric ontology and feminist critique: “Female Sexual Dysfunction” and the Diagnostic and Statistical Manual. History of the Human Sciences, 25, 3–24. doi: 10.1177/0952695112456949 First citation in articleCrossref, Google Scholar

  • Attwood, F., Barker, M. J., Boynton, P. & Hancock, J. (2015). Sense about sex: Media, sex advice, education and learning. Sex Education, 15, 528–539. doi: 10.1080/14681811.2015.1057635 First citation in articleCrossref, Google Scholar

  • Bancroft, J. (2002). The medicalization of female sexual dysfunction: The need for caution. Archives of Sexual Behavior, 31, 451–455. doi: 10.1023/A:1019800426980 First citation in articleCrossref, Google Scholar

  • Bancroft, J., Graham, C. A. & McCord, C. (2001). Conceptualizing women’s sexual problems. Journal of Sex & Marital Therapy, 27, 95–103. doi: 10.1080/00926230152051716 First citation in articleCrossref, Google Scholar

  • Basson, R. (2000). The female sexual response: A different model. Journal of Sex & Marital Therapy, 26, 51–64. doi: 10.1080/009262300278641 First citation in articleCrossref, Google Scholar

  • Basson, R., Berman, J., Burnett, A., DeRogatis, L., Ferguson, D., Fourcroy, J., … Whipple, B. (2000). Report of the international consensus development conference on female sexual dysfunction: Definitions and classifications. Journal of Urology, 163, 888–893. doi: 10.1016/S0022-5347(05)67828-7 First citation in articleCrossref, Google Scholar

  • Basson, R., Driscoll, M. & Correia, S. (2015). Flibanserin for low sexual desire in women: A molecule from bench to bed? EBioMedicine, 2, 772–773. doi: 10.1016/j.ebiom.2015.08.009 First citation in articleCrossref, Google Scholar

  • Basson, R., Leiblum, S., Brotto, L., Derogatis, L., Fourcroy, J., Fugl-Meyer, K., … Weijmar Schultz, W. (2003). Definitions of women’s sexual dysfunction reconsidered: Advocating expansion and revision. Journal of Psychosomatic Obstetrics and Gynaecology, 24, 221–229. doi: 10.3109/01674820309074686 First citation in articleCrossref, Google Scholar

  • Basson, R., McInnes, R., Smith, M. D., Hodgson, G. & Koppiker, N. (2002). Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder. Journal of Women’s Health & Gender-Based Medicine, 11, 367–377. doi: 10.1089/152460902317586001 First citation in articleCrossref, Google Scholar

  • Boyle, M. (1994). Gender, science, and sexual dysfunction. In T. R. SarbinJ. I. KituseEds., Constructing the social (pp. 101–118). London, UK: Sage. First citation in articleGoogle Scholar

  • Brotto, L. (2010). The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Archives of Sexual Behavior, 39, 221–239. doi: 10.1007/s10508-009-9543-1 First citation in articleCrossref, Google Scholar

  • Brotto, L. A., Basson, R., Chivers, M. L., Graham, C. A., Pollock, P. & Stephenson, K. (2016). Challenges in designing psychological treatment studies for sexual dysfunction. Journal of Sex and Marital Therapy, . doi: 10.1080/0092623X.2016.1212294 First citation in articleCrossref, Google Scholar

  • Brotto, L. A., Graham, C. A., Paterson, L. Q., Yule, M. & Zucker, K. J. (2015). Women’s endorsement of different models of sexual functioning supports polythetic criteria of Female Sexual Interest/Arousal Disorder in DSM-5. Journal of Sexual Medicine, 12, 1978–1981. doi: 10.1111/jsm.12965 First citation in articleCrossref, Google Scholar

  • Cacchioni, T. (2015). Big pharma, women, and the labour of love. Toronto, Ontario: University of Toronto Press. First citation in articleCrossref, Google Scholar

  • Carpenter, L. M. (2001). The ambiguity of “having sex”: The subjective experience of virginity loss in the United States. Journal of Sex Research, 38, 127–139. First citation in articleCrossref, Google Scholar

  • Chivers, M. L. & Brotto, L. A. (2017). Controversies in women’s sexual arousal and desire. European Psychologist, 22. doi: 10.1027/1016-9040/a000275 First citation in articleLink, Google Scholar

  • Clayton, A. H., Althof, S. E., Kingsberg, S., DeRogatis, L. R., Kroll, R., Goldstein, I., … Portman, D. J. (2016). Bremelanotide for female sexual dysfunctions in premenopausal women: A randomized, placebo-controlled dose-finding trial. Women’s Health, 12, 325–327. doi: 10.2217/whe-2016-0018 First citation in articleCrossref, Google Scholar

  • Connaughton, C., McCabe, M. & Karantzas, G. (2016). Conceptualization of the sexual response models in men: Are there differences between sexually functional and dysfunctional men? Journal of Sexual Medicine, 13, 453–463. doi: 10.1016/j.jsxm.2015.12.032 First citation in articleCrossref, Google Scholar

  • DeRogatis, L. R., Clayton, A. H., Rosen, R. C., Sand, M. & Pyke, R. E. (2011). Should sexual desire and arousal disorders in women be merged? [Letter to the Editor]. Archives of Sexual Behavior, 2, 217–219. doi: 10.1007/s10508-010-9677-1 First citation in articleCrossref, Google Scholar

  • Farmer, M., Yoon, H. & Goldstein, I. (2016). Future targets for female sexual dysfunction. Journal of Sexual Medicine, 13, 1147–1165. doi: 10.1016/j.jsxm.2016.05.016 First citation in articleCrossref, Google Scholar

  • Fishman, J. R. & Mamo, L. (2002). What’s in a disorder: A cultural analysis of medical and pharmaceutical constructions of male and female sexual dysfunction. Women and Therapy, 24, 179–193. doi: 10.1300/J015v24n01_20 First citation in articleCrossref, Google Scholar

  • Frith, H. (2015). Orgasmic bodies. Basingstoke, UK: Palgrave MacMillan. First citation in articleCrossref, Google Scholar

  • Gao, Z., Yang, D., Yu, L. & Cui, Y. (2015). Efficacy and safety of flibanserin in women with Hypoactive Sexual Desire Disorder: A systematic review and meta-analysis. Journal of Sexual Medicine, 12, 2095–2104. doi: 10.1111/jsm.13037 First citation in articleCrossref, Google Scholar

  • Gellad, W. F., Flynn, K. E. & Alexander, G. C. (2015). Evaluation of flibanserin: Science and advocacy at the FDA. Journal of the American Medical Association, 314, 869–870. doi: 10.1001/jama.2015.8405 First citation in articleCrossref, Google Scholar

  • Giles, K. R. & McCabe, M. P. (2009). Conceptualizing women’s sexual function: Linear vs. circular models of sexual response. Journal of Sexual Medicine, 6, 2761–2771. doi: 10.1111/j.1743-6109.2009.01425.x First citation in articleCrossref, Google Scholar

  • Giraldi, A., Kristensen, E. & Sand, M. (2015). Endorsement of models describing sexual response of men and women with a sexual partner: An online survey in a population sample of Danish adults ages 20–65 years. Journal of Sexual Medicine, 12, 116–128. doi: 10.1111/jsm.12720 First citation in articleCrossref, Google Scholar

  • Goldfischer, E. R., Breaux, J., Katz, M., Kaufman, J., Smith, W. B., Kimura, T., … Pyke, R. (2011). Continued efficacy and safety of libanserin in premenopausal women with Hypoactive Sexual Desire Disorder (HSDD): Results from a randomized withdrawal trial. Journal of Sexual Medicine, 8, 3160–3170. doi: 10.1111/j.1743-6109.2011.02458.x First citation in articleCrossref, Google Scholar

  • Goldstein, S. W. (2009). My turn… finally. The Journal of Sexual Medicine, 6, 301–302. doi: 10.1111/j.1743-6109.2008.01147.x First citation in articleCrossref, Google Scholar

  • Graham, C. A. (2010). The DSM diagnostic criteria for female sexual arousal disorder. Archives of Sexual Behavior, 39, 240–255. doi: 10.1007/s10508-009-9535-1 First citation in articleCrossref, Google Scholar

  • Graham, C. A. (2016). Reconceptualising women’s sexual desire and arousal in DSM-5. Psychology & Sexuality, 7, 34–47. doi: 10.1080/19419899.2015.1024469 First citation in articleCrossref, Google Scholar

  • Graham, C. A., Brotto, L. A. & Zucker, K. J. (2014). A response to Balon and Clayton (2013): Female Sexual Interest/Arousal Disorder: A diagnosis more on firm ground than thin air. Archives of Sexual Behavior, 43, 1231–1234. doi: 10.1007/s10508-013-0248-0 First citation in articleCrossref, Google Scholar

  • Hall, L. (2003). Eyes tightly shut, lying rigidly still and thinking of England? British women and sex from Marie Stopes to Hite. In M. MartinC. NelsonEds., Sexual Pedagogies: Teaching Sex in America, Britain, and Australia, 1879–2000 (pp. 53–71). Basingstoke, UK: Palgrave MacMillan. First citation in articleGoogle Scholar

  • Harris, G. (2004). Pfizer gives up testing Viagra in women. New York Times. February 28, 2004. http://www.nytimes.com/2004/02/28/business/pfizer-gives-up-testing-viagra-on-women.html?_r=0 First citation in articleGoogle Scholar

  • Hayes, R. D., Dennerstein, L., Bennett, C. M. & Fairley, C. K. (2008). What is the “true” prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact? Journal of Sexual Medicine, 5, 777–787. doi: 10.1111/j.1743-6109.2007.00768.x First citation in articleCrossref, Google Scholar

  • IsHak, W. W. & Tobia, G. (2013). DSM-5 changes in diagnostic criteria of sexual dysfunctions. Reproductive System & Sexual Disorders, 2, 122. doi: 10.4172/2161-038X.1000122 First citation in articleCrossref, Google Scholar

  • Jaspers, L., Feys, F., Bramer, W. M., Franco, O. H., Leusink, P. & Laan, E. T. M. (2016). Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: A systematic review and meta-analysis. JAMA Internal Medicine, 176, 453–462. doi: 10.1001.jamainternmed.2015.8565 First citation in articleCrossref, Google Scholar

  • Jutel, A. (2010). Framing disease: The example of female hypoactive sexual desire disorder. Social Science and Medicine, 70, 1084–1090. doi: 10.4172/2161-038X.1000122 First citation in articleCrossref, Google Scholar

  • Kaplan, H. S. (1974). The new sex therapy. New York, NY: Brunner/Mazel. First citation in articleGoogle Scholar

  • E. KaschakL. Tiefer (2001). A new view of women’s sexual problems. New York, NY: Haworth Press. First citation in articleGoogle Scholar

  • Katz, M., DeRogatis, L. R., Ackerman, R., Hedges, P., Lesko, L., Garcia, M. & Sand, M. (2013). Efficacy of flibanserin in women with Hypoactive Sexual Desire Disorder: Results from the BEGONIA trial. Journal of Sexual Medicine, 10, 1807–1815. doi: 10.1111/jsm.12189 First citation in articleCrossref, Google Scholar

  • Laan, E. & Both, S. (2008). What makes women experience desire? Feminism & Psychology, 18, 505–514. doi: 10.1177/0959353508095533 First citation in articleCrossref, Google Scholar

  • Laan, E. & Janssen, E. (2007). How do men and women feel? Determinants of subjective experience of sexual arousal. In E. JanssenEd., The psychophysiology of sex (pp. 278–290). Bloomington, IN: Indiana University Press. First citation in articleGoogle Scholar

  • Laumann, E. O., Paik, A. & Rosen, R. C. (1999). Sexual dysfunctions in the United States: Prevalence and predictors. Journal of the American Medical Association, 281, 537–544. doi: 10.1001/jama.281.6.537 First citation in articleCrossref, Google Scholar

  • T. LueR. BassonR. RosenF. GiulanoS. KhouryF. Montorsi (2004). Sexual medicine: Sexual dysfunctions in men and women. Paris, UK: Health Publications. First citation in articleGoogle Scholar

  • Masters, W. H. & Johnson, V. E. (1966). Human sexual response. Boston, MD: Little, Brown. First citation in articleGoogle Scholar

  • Mayor, S. (2004). Pfizer will not apply for a license for sildenafil for women. British Medical Journal, 328, 542. doi: 10.1136/bmj.328.7439.542 First citation in articleCrossref, Google Scholar

  • Meana, M. (2010). Elucidating women’s (hetero)sexual desire: Definitional challenges and content expansion. Journal of Sex Research, 47, 104–122. doi: 10.1080/00224490903402546 First citation in articleCrossref, Google Scholar

  • Mercer, C. H., Fenton, K. A., Johnson, A. M., Wellings, K., Macdowall, W., McManus, S., … Erens, B. (2003). Sexual function problems and help seeking behaviour in Britain: National probability sample survey. British Medical Journal, 327, 426–427. doi: 110.1136/bmj.327.7412.426 First citation in articleCrossref, Google Scholar

  • Mitchell, K. & Graham, C. A. (2008). Two challenges for the classification of sexual dysfunction. Journal of Sexual Medicine, 5, 1552–1558. doi: 10.1111/j.1743-6109.2008.00846.x First citation in articleCrossref, Google Scholar

  • Mitchell, K. R., Jones, K. G., Wellings, K., Johnson, A. M., Graham, C. A., Datta, J., … Mercer, C. H. (2016). Estimating the prevalence of sexual function problems: The impact of morbidity criteria. Journal of Sex Research, 53, 955–967. doi: 10.1080/00224499.2015.1089214 First citation in articleCrossref, Google Scholar

  • Mitchell, K. R., Mercer, C. H., Ploubidis, G. B., Jones, K. G., Datta, J., Field, J., … Wellings, K. (2013). Sexual function in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). The Lancet, 382, 1817–1829. doi: 10.1016/ S0140-6736(13)62366-1 First citation in articleCrossref, Google Scholar

  • Moynihan, R. (2003). The making of a disease: Female sexual dysfunction. British Medical Journal, 326, 45–47. doi: 10.1136/bmj.326.7379.45 First citation in articleCrossref, Google Scholar

  • Moynihan, R. (2005). The marketing of a disease: Female sexual dysfunction. British Medical Journal, 330, 192–194. doi: 10.1136/bmj.330.7484.192 First citation in articleCrossref, Google Scholar

  • Moynihan, R. & Mintzes, B. (2010). Sex, lies and pharmaceuticals: how drug companies plan to profit from female sexual dysfunction. Vancouver: Greystone. First citation in articleGoogle Scholar

  • Nappi, R. E., Martini, E., Terreno, E., Albani, F., Santamaria, V., Tonani, S., … Polatti, F. (2010). Management of hypoactive sexual desire disorder in women: Current and emerging therapies. International Journal of Women’s Health, 2, 167–175. doi: 10.2147/IJWH.S7578 First citation in articleCrossref, Google Scholar

  • Nazareth, I., Boynton, P. & King, M. (2003). Problems with sexual function in people attending London general practitioners: Cross sectional study. British Medicine Journal, 327, 423–426. doi: 10.1136/bmj.327.7412.423 First citation in articleCrossref, Google Scholar

  • Oberg, K., Fugl-Meyer, A. R. & Fugl-Meyer, K. S. (2004). On categorization and quantification of women’s sexual dysfunctions: An epidemiological approach. International Journal of Impotence Research, 16, 261–269. doi: 10.1038/sj.ijir.3901151 First citation in articleCrossref, Google Scholar

  • Pitts, M. & Rahman, Q. (2001). Which behaviors constitute “having sex” among university students in the UK? Archives of Sexual Behavior, 30, 169–176. doi: 10.1023/A:1002777201416 First citation in articleCrossref, Google Scholar

  • Sand, M. & Fisher, W. A. (2007). Women’s endorsement of models of female sexual response: The nurses’ sexuality study. Journal of Sexual Medicine, 4, 708–719. doi: 10.1111/j.1743-6109.2007.00496.x First citation in articleCrossref, Google Scholar

  • Sanders, M. (2016). Sex, drugs, and advisory committees: An analysis of pharmaceutical industry manipulation of FDA vulnerability to sociopolitical influences on matters of women’s health. Columbia Human Rights Law Review, 48, 2016–2017. First citation in articleGoogle Scholar

  • Sanders, S. A., Hill, B. J., Yarber, W. L., Graham, C. A., Crosby, R. A. & Milhausen, R. R. (2010). Misclassification bias: Diversity in conceptualisations about having “had” sex. Sexual Health, 7, 31–34. doi: 10.1071/SH09068 First citation in articleCrossref, Google Scholar

  • Sanders, S. A. & Reinisch, J. M. (1999). Would you say you had sex if…? Journal of the American Medical Association, 281, 275–277. doi: 10.1001/jama.281.3.275 First citation in articleCrossref, Google Scholar

  • Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A. & Johannes, C. B. (2008). Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics & Gynecology, 112, 970–978. doi: 10.1001/jama.281.3.275 First citation in articleCrossref, Google Scholar

  • Simon, J. A., Kingsberg, S. A., Shumel, B., Hanes, V., Garcia, M. & Sand, M. (2014). Efficacy and safety of flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the SNOWDROP trial. Menopause, 21, 633–640. doi: 10.1097/GME.0000000000000134 First citation in articleCrossref, Google Scholar

  • Snabes, M. C. & Simes, S. M. (2009). Commentary: Approved hormonal treatments for HSDD: An unmet medical need. The Journal of Sexual Medicine, 6, 1846–1849. doi: 10.1111/j.1743-6109.2009.01294.x First citation in articleCrossref, Google Scholar

  • Spurgas, A. K. (2016). Solving desire. The New Inquiry, March 9, 2016. First citation in articleGoogle Scholar

  • Tiefer, L. (1991). Historical, scientific, clinical, and feminist criticisms of “the human sexual response cycle” model. Annual Review of Sex Research, 2, 1–23. First citation in articleGoogle Scholar

  • Tiefer, L. (2001). Arriving at a “New View” of women’s sexual problems: Background, theory, and activism. In E. KaschakL. TieferEds., A new view of women’s sexual problems (pp. 63–98). New York, NY: Haworth Press. First citation in articleGoogle Scholar

  • Tiefer, L. (2006). Female sexual dysfunction: A case study of disease mongering and activist resistance. PLoS Medicine, 3, 3178. doi: 10.1111/j.1743-6109.2009.01294.x First citation in articleCrossref, Google Scholar

  • Tiefer, L., Laan, E. & Basson, R. (2015). Missed opportunities in the Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction held at the FDA, October 2014. Journal of Sex Research, 52, 601–603. doi: 10.1080/00224499.2014.1003362 First citation in articleCrossref, Google Scholar

  • van Rooij, K., Poels, S., Worst, P., Bloemers, J., Koppeschaar, H., Goldstein, A., … Tuiten, A. (2015). Efficacy of testosterone combined with a PDE5 inhibitor and testosterone combined with a serotonin 1A receptor agonist in women with SSRI-induced sexual dysfunction. A preliminary study. European Journal of Pharmacology, 753, 246–251. doi: 10.1016/j.ejphar.2014.10.061 First citation in articleCrossref, Google Scholar

  • Waldman, T., Shufelt, C. L. & Braunstein, G. D. (2012). Safety and efficacy of transdermal testosterone for treatment of hypoactive sexual desire disorder. Clinical Investigation, 2, 423–432. doi: 10.4155/cli.12.18 First citation in articleCrossref, Google Scholar

  • Witting, K., Santtila, P., Varjonen, M., Jern, P., Johansson, A., von der Pahlen, B. & Sandnabba, K. (2008). Female sexual dysfunction, sexual distress, and compatibility with partner. Journal of Sexual Medicine, 5, 2587–2599. doi: 10.1111/j.1743-6109.2008.00984.x First citation in articleCrossref, Google Scholar

  • Woloshin, S. & Schwartz, L. M. (2016). US Food and Drug Administration approval of flibanserin: Even the Score does not add up. JAMA Internal Medicine, 176, 439–442. doi: 10.1001/jamainternmed.2016.0073 First citation in articleCrossref, Google Scholar

  • Wood, J., Mansfield, P. & Koch, P. (2007). Negotiating sexual agency: Postmenopausal women’s meaning and experience of sexual desire. Qualitative Health Research, 17, 189–200. doi: 10.1177/1049732306297415 First citation in articleCrossref, Google Scholar