We are living in a time of sexual confusion. Women are liberated and empowered, free to explore desires like never before; sexual education now includes lessons on consent and, even, pleasure; the acronymous roster of sexual rights (LGBTQQIP2SAA) grows ever more unwieldy as it seeks to encompass every nuance of sexual expression; and yet the acceptance of all that is alpha male is such that an American Presidential candidate can boast of sexual assault and still be elected to the White House. What allows for the co-existence of these disparate and contradictory social attitudes is socio-sexual norms.
Norms are the product of continuing historical, geographical, cultural, and sociological changes; socio-sexual attitudes are not static and are shaped, through complex interrelationships, by the sexual culture that surrounds them. The norms of our sexual culture reflect its confusion: hence, consent can be taught to children while an admission of sexual assault is dismissed as jocular banter; behaviour that is shameful promiscuity to women is simply sexual prowess to men; and rights long-held by heterosexuals must be fought for by anyone whose sexuality exists outside of heteronormativity. Yet there is one sexual norm that remains: an assumption that everyone wants to have sex. If they don’t, such is the peculiarity of their lack of desire that it is assumed to have a medical root.
This medicalisation of the (lack of) desire is the focus of my research; specifically, female lack of desire or Female Sexual Dysfunction (FSD). This condition entered the medical lexicon in 1952 when it was listed in the first edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM I) as a psychosexual disorder, replacing hysteria, one of the most frequently diagnosed yet inconsistently defined diseases in medical history.
The definitions, symptoms, and differential diagnoses of FSD were expanded in successive editions of the DSM, but no successful treatments emerged. In March 1998 Viagra, the treatment for Erectile Dysfunction, received Food and Drug Administration (FDA) approval and, detecting a potential market for a female equivalent to the blockbuster drug, pharmaceutical companies began research into what became known as the Pink Viagra. The search continued until August 2015 when, despite a number of FDA Board members’ concerns about its safety and efficacy, the Sprout Pharmaceutical product, Flibanserin (brand name Addyi), received FDA approval. Anticipating booming sales, Valeant Pharmaceuticals bought the drug for $1 billion only to discover one fairly significant flaw: the pill doesn’t work.
Addyi is the treatment for a sexual state, reworked to look like a medical condition. The drug is a flop because not wanting to have sex is as normal as wanting to; it isn’t indicative of sickness and, therefore, is not a symptom to be cured by a pill. Women aren’t taking Addyi, not only because it doesn’t work, but because they know they’re not abnormal and that their reasons for not wanting to have sex are not going to disappear with a little, purple pill. (The pill also comes with a lengthy roster of significant side effects.) Childbirth, menopause, the pressures of day-to-day life, or just not fancying their partner are only some of those reasons.
There is also the nature of the sexual culture in which the condition and its treatment were created. Ours is a culture that positions heterosexuality and its attendant expectations of male dominance and female submission as the norm. The attitudes that accompany this norm impose upon the socio-sexual climate an expectation – even demand – of heterosexuality and of penetrative, penis-in-vagina sex.
My research explores female sexuality as represented in the media coverage of Flibanserin/Addyi. It draws on concepts of the model of ideal sex, sex as the subject of medicalisation and pharmaceuticalisation, and the purpose of medical definitions of sexual normalcy in order to examine women’s sexuality in relation to a drug intended to increase women’s desire for sex. This draws on sex and sexuality in a medicalised context – specifically that created by the construction of Flibanserin/Addyi and FSD as a condition. The existence of both the drug and condition is the result of more than a wish to improve the sex lives of women. It is founded on a desire to maintain heterosexual, penis-in-vagina intercourse as the model of ideal sex to which women should aspire. However, there is room in our sexual culture for a new norm: that of the right to choose one’s own sexual normality.