Female Sexual Dysfunction -- Medical Fiction?

VIDEO: Wake Forest Us Dr. Ryan Terlecki says its real and its treatable.
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Many doctors have critiqued the over-medicalization of female sexual dysfunction by the pharmaceutical industry, but journalist Ray Moynihan, author of "Sex, Drugs, and Pharmaceuticals", goes so far as to argue that drug-makers helped to create the disorder.

"It has become clear that drug companies have not simply sponsored the science of this new condition; on occasions they have helped to construct it," he writes in an article published Thursday in the British Medical Journal.

Between industry-sponsored research that puts female sexual dysfunction (FSD) at epidemic proportions and industry-developed diagnostics that teach physicians how to make five-minute diagnoses, Moynihan argues that drug marketing has merged with medical science, influencing and even guiding medical perception of female sexual dysfunction.

"They did it for social anxiety disorder and for erectile dysfunction," says Dr. Marcia Angell, who teaches social medicine at Harvard Medical School. "They create a lot of buzz, and all of a sudden there's an under-treated epidemic -- and they have a ready-made market for what they turn out."

But would this supposed "creation" of disease by drug makers suggest that female sexual dysfunction, as a diagnosable medical disorder, doesn't really exist?

Some doctors would say so, arguing that the novelty of much of the medical discussion of FSD lends credence to the fact that it's predominantly an invention of the industry.

Sexual therapists and their patients, on the other hand, beg to differ.

The "argument that female sexual dysfunction is an illness constructed by pathologizing doctors under the influence of drug companies will fail to convince clinicians who see women with sexual dysfunction, or their patients," writes Dr. Sandy Goldbeck-Wood, a U.K. associate specialist in psychosexual medicine in an accompanying response to Moynihan's article.

Though the pharmaceutical industry's over-involvement in much of the research on the subject should certainly be called into question, she adds, the reality of these disorders and the distress they cause, should not.

Sexual Dysfunction: Myth or Medicine?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) IV classifies six different sexual disorders that plague women, including those affecting arousal, orgasm and pelvic pain, all of which fall under the banner of female sexual dysfunction.

Insofar as FSD is included in the DSM IV, "it is as real as any other DSM psychiatric diagnosis," says Sheryl Kingsberg, chief of the division of behavioral medicine at University Hospitals Case Medical Center in Cleveland.

But, the industry hype surrounding FSD has led some to criticize the extent or even the existence of these disorders, warning that doctors may be pathologizing normal ups and downs of libido in response to the industry's illusion of epidemic.

"There are probably women who don't fully function sexually, but that's very different from saying it's a diagnosable medical condition," Angell says. "That's a giant leap ... that presupposes we have more knowledge than we do."

Kingsberg counters that "any diagnosis is developed because there's enough evidence to show there is a syndrome," adding that in 20 years of personal experience, she has seen hundreds of women who would classify for the DSM's diagnosis.

"By not legitimizing it with a label, that's doing these women a disservice," she adds.

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