Female Sexual Dysfunction -- Medical Fiction?


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.

"Pharma can't invent something that has no resonance with people. They have to be responding to a need," says Pepper Schwartz, a sex expert and professor of sociology at the University of Washington.

"It's obvious that it exists," she adds, but that doesn't mean there's risk of women interpreting what is a normal cycle of sexual health, such as lulls in libido following pregnancy, as a pathological disorder.

And that doesn't mean that it afflicts women at epidemic proportions, with one in three or one in four women a victim of it, as some industry-funded surveys say.

Treating the Patient, Not the Diagnosis

There's an "improperly intimate research relationship between industry and clinicians," Goldbeck-Wood writes in her commentary, that casts doubt on some of the existing evidence on the subject.

But faced with patients who are suffering, sex experts point out, the prevalence can be beside the point.

"From my point of view and that of many doctors working in health, we don't know the exact number, but we know from our clinical practice that these are real patients consulting real doctors in real distress," Goldbeck-Wood says.

A Middle Ground: Integrating Techniques

The myriad issues in female sexual health are too complicated to be reduced to a quickie diagnosis or a magic pill, sex experts warn. Putting prescription power in the hands of a physician who has only a few minutes to diagnose is a dangerous prospect, warns Aline Zoldbrod, a Boston-based sex therapist.

"It takes sex therapists hours to tease out information from a woman and determine what's going on. You need to look at her marriage, how much stress she has in her life, whether she's depressed, whether she's ever enjoyed sex. It's not like doing a blood test," she says.

It's an unfortunate reality that if the pharmaceutical industry advertises a pill that's going to offer a simple solution to women's complex sexual problems, a lot of women are going to go for it, she adds, but that doesn't mean that that will be effective or appropriate treatment.

While the long hoped-for "female Viagra" might one day offer a pharmacological solution for many women's sexual woes, experts admit, the bottom line is that treatment of FSD needs to be nuanced and tailored to the woman's needs, whether that's through counseling, lifestyle changes, or medication.

"We should be asking ourselves: How can we help in an evidence-based way instead of just reaching for the prescription pad?" Goldbeck-Wood says.

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