Sunday, May 24, 2009

Challenging HSDD

In addressing the questions of whether, why, and how the asexual community should challenge classification of sexual disinterest as a disorder, I think the most basic question is what concern it is of ours. Aren't a lot of sexual people distressed about not being interested in sex? So, isn't it important for them to have access to treatment for that? And doesn't having a diagnosis for sexual disinterest help with that? I think these are valid questions. A 2005 article in Medscape helps address them. The context is the New View of women's sexual dysfunctions and the FDA's decision not to approve Intrinsa, a testosterone patch supposed to increase sexual desire in women who had had both ovaries surgically removed. The title of the article speaks for itself.

Is Lack of Sexual Desire a Disease? Is Testosterone the Cure?

(For some reason, linking to it will ask you for a subscription, but you can read it by googling the title.)
Within my own clinical practice, my patients express a variety of reactions to decreased sexual desire. Some patients...seem bothered by lack of sexual desire and seek treatment from me. Others note their lack of desire with indifference. Or, their concern is not for themselves but for their partners, and the impact their decreased desire has on them. There are those who see lack of sexual desire as a welcome liberation. This is not just true of women. Men have also commented to me on the advantages of lessened sexual desire. One noted: "If I'd had this problem when I was younger, I would have been so much more productive."
He suggests that this diversity in response is the reason that the DSM-IV, the ICD-10 and the American Foundation for Urologic Disease all have some sort of requirement that the person be distressed about lack of sexual desire for it to constitute a diagnosis. (The actual history of the distress criteria are more convoluted than this. When ISD was first included in DSM-III in 1980, there was no distress criterion, quite intentionally, as we will find out later in this series. The distress requirement wasn't included until DSM-IV was published in 1994.)

After discussing some of the controversies surrounding this diagnosis, he raises the role of the pharmaceutical industry.
Roy Moynihan, writing in the British Medical Journal over the past several years, has chronicled how Procter & Gamble (and investigators closely associated with the company) have promoted female sexual dysfunction and Intrinsa to the medical and lay communities.[4] To quote Moynihan:

[Procter & Gamble] sponsored key scientific meetings in sexual medicine, hired leading sex researchers as consultants, funded continuing medical education activities, produced a reporter's guide to testosterone, and created a publicly accessible website. It has worked with agents from three public relations companies and at least one major advertising firm to promote awareness of both the "disease" and the drug.

Even if there are patients who experience distress over lack of sexual desire (as it seems to me there are), will not the very existence of a highly promoted pink-pill–equivalent to the "little blue pill" create its own market? Will not a massive "health education campaign" actually change expectations and create a "dis-ease" in women who would otherwise not experience distress?
This is, perhaps, the main reason I think we should oppose HSDD: the function of the diagnosis to create distress. Communicating to people that not being interested in sex, giving absurdly high figures for the prevalence of this "dysfunction" in the general population, and giving long lists of so-called causes seems to function to create distress where otherwise there wouldn't be any.

In the asexual community, probably the two main ways of working out a solution in sexual/asexual relationships are compromises regarding about sex regarding "How much?" and "What kind?" Anderson concludes the article by nothing how a previous article on the New View suggests referring patients with low sexual desire to The Complete Idiot's Guide to Sensual Massage.
It's probably available at the local library, can't be associated with too many adverse outcomes, and sounds a good deal more inviting than a testosterone patch.
Perhaps asexuals successfully dealing with desire discrepancies isn't all that different from anyone else having to address the same problem?

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