Women’s sexual satisfaction has taken center stage, yet quality information about women’s sexuality has received very little attention until recent years. Did you know that the importance of women’s sexual pleasure and displeasure didn’t get serious attention until after Viagra™ exploded onto the market in 1998 and the National Health and Social Life Surveywas published in 1999?

That survey of nearly 2000 women and 1500 men between the ages of 18 and 59 across various social groups had some surprising results. It found that 43 percent of women experience sexual dysfunction, compared to 31 percent of men. In addition, the study found that sexual dysfunction is higher among women and men with poor physical and mental health.

The study was widely publicized, generating a demand for a quick cure, like Viagra™, to alleviate the problem. But medical, psychological, sexologists, and pharmaceutical professionals quickly realized that some major questions about female sexual health would first need to be answered: Was female sexual dysfunction (FSD) a real medical crisis or over excitement? Is there simply a lack of sexual education and understanding of what turns women off and what turns them on? Are women affected with a serious medical disorder or are they dissatisfied with their sexual lives? And if there is a problem, can it be fixed with a miracle drug that will send women orgasming across the nation?

Trying to Define FSD

Medical doctors (urologists and gynecologists), psychologists and sexologists are still debating how to define and treat the complex landscape of women’s sexuality. Currently the International Consensus Development Conference of Female Sexual Dysfunction (ICDCFSD), using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the World Health Organization International Classifications of Diseases (ICD-10), identified four disorders that cause sexual distress among women:

• Desire disorder—a persistent absence of desire for sexual activity
• Arousal disorder—a persistent inability to attain or maintain sufficient sexual excitement
• Orgasm disorder—a persistent difficulty, delay or absence of orgasm after sufficient stimulation
• Pain disorder—a persistent genital pain associated with sexual intercourse or stimulation

The definition provided by the ICDCFSD is a general outline, but isn’t inclusive or official despite using two of the most reputable systems for clinical diagnosis. The outline does provide a clear format of four areas of FSD for a very brief understanding of common issues that can occur among women. It does not provide insight to the multiple reasons for women’s dissatisfaction with state of their sexual lives.

“The trend today, in diagnosing FSD is to ask, ‘Is it a problem for the woman herself? Is it a problem in the relationship?’ A sensitive therapist focuses pleasure rather than performance,” says Dr. Julian Slowinski, a clinical psychologist and sex therapist at the Pennsylvania Hospital and the University of Pennsylvania School of Medicine.

Is It a Physical or a Mental Problem?

Since Viagra™ was such a blockbuster drug, pharmaceutical companies have worked hard to identify mechanical causes for FSD, which can then be treated with pills or devices.

But many researchers are skeptical of these efforts. Dr. Leonore Tiefer, clinical associate professor at the New York University School of Medicine’s Psychiatry Department and campaign coordinator for New View, an organization that raises critical questions about pharmaceutical involvement in sex research, education and treatments says, “The drugs won't work; they'll cause side effects; they'll overly focus on genital aspects of sexual satisfaction; disposal and excretion will interfere with the [vaginal] environment; [and] they'll mislead students, professionals and the public.” 

A study conducted by the Kinsey Institute called “Distress about Sex: A National Survey of Women” took another look in 2002 at women’s sexual dissatisfaction. The study surveyed nearly 1000 heterosexual women over a one-month period finding only 24 percent of women were unhappy with their sexual lives.

"An important lesson we have learned in this study is that the physical issues medical professionals focus on when dealing with 'sexual dysfunction' in women seem, in fact, to be less important than emotional or more subjective aspects of their sexual lives," states John Bancroft, s enior research fellow at the Kinsey Institute.

Dr. Dennis Sugrue, co-author of Sex Matters for Women and clinical associate professor at University of Michigan Health System’s Department of Psychiatry and Gender Services Program, agrees. “The women’s sexual response is a very complex set of factors, culture, family, relationship dynamics and a host of issues of a woman’s ability to feel sexually satisfied. For many women to feel desire they have to feel desirable, which isn’t necessarily true for men,” said Sugrue.

“Women are all over the place regarding arousal, sexual interest," noted Dr. Slowinski. "It’s situation-specific.”

No Quick Fix

Pharmaceutical companies have found it difficult to get a product or drug to the market. Approval of Viagra™ for women’s use was dropped by Pfizer in 2004 after clinical trials consistently proved that the drug didn’t work the same in women as it did in men.

During the same year, Intrinsa®, a patch created to assist women with sexual desire, was rejected by the Food and Drug Administration’s (FDA) Reproductive Health Drugs Committee. At issue was Procter & Gamble’s inability to provide sufficient long-term safety data and the questionable significance of Intrinsa®’s trials.

The only product approved by the FDA to treat women’s sexual dysfunctions is the Eros Clitoral Therapy Device (CTD), a battery-powered soft handheld cup and vacuum devise to assist with drawing blood into the clitoris to help stimulate lubrication in the vagina and relax the vaginal muscles, created by Urometrics. The Eros CTD was approved in 2000 and was immediately available by prescription only for $359, which is reimbursable by Medicare and private insurance companies.

An Ongoing Battle

Women’s sexual dissatisfaction and pleasure will continue to be debated and explored by both medical (urologists and gynecologists) and pharmaceutical companies and psychologists and sexologists as new issues come to light. In the meantime, it’s important for couples and women to work with their doctors and therapists to explore all aspects of the women’s and couple’s lives in order to get at the heart of the sexual issues.

“[It’s] very common for women to have sexual difficulties desire, orgasm, or lack of pleasure during sex,” notes Dr. Sugrue. “Sex is a very important part of [women’s] existence—if they aren’t enjoying their sexual life then they need to talk with their physician or consult a therapist.”

And, what’s the most effective way for couples to handle sexual problems? “Communication is absolutely critical, because by the time that sexual difficulties come to attention, fears and difficulties are amplified,” says Dr. Sugrue. Couples should approach sexual difficulties “[as] a shared experience rather than a source of conflict or barrier in the relationship…respond by saying that we can work on this together for satisfaction in our sexual relationship.”