Monday, December 20, 2010

More on SIAD

The DSM-5 Sexual Dysfunctions Subworkgroup is currently proposing to merge (Female) Hypoactive Sexual Desire Disorder (HSDD) and (Female) Sexual Arousal Disorder, and make a new diagnosis, Sexual Interest/Arousal Disorder (SIAD). I have previously reported on this and on commentary and criticisms on this proposal (here, here, and here). A couple months ago, another commentary was published in Archives of Sexual Behavior: Should Sexual Desire and Arousal Disorders in Women Be Merged? (So far, ASB has published a number of commentaries on proposed changes to the paraphilias and at least one about proposed changes to Gender Identity Disorder, but this is the only one about the sexual dysfunctions, presumably because a number of commentaries have been published in the Journal of Sexual Medicine.)

Recently, a response has been published--Should Sexual Desire and Arousal Disorders in Women Be Merged? A Response to DeRogatis, Clayton, Rosen, Sand, and Pyke (2010) by Lori A. Brotto, Cynthia A. Graham, Yitzchak M. Binik, R. Taylor Segraves and Kenneth J. Zucker--that I wanted to draw interested readers' attention to.

In reading the commentaries about this proposal a curious observation that I couldn't help but make is that there appears to be a rather strong correlation between supporting the merger and lack of pharmaceutical connections. It troubles me, but it's hard not to notice.

Brotto et al. address a criticism that the new proposal is based on expert consensus rather than data:
There is simply no justification for asserting that the proposal for Sexual Interest/Arousal Disorder was based on‘‘theoretical speculations or expert opinion.’’ Comprehensive and critical reviews of the empirical literature were undertaken (Brotto, 2010;Graham, 2010)and these formed the basis for the proposals. It should also be noted that the DSMIV-TR diagnoses of HSDD and FSAD were not based on any systematically collected body of data. The diagnosis of HSDD was the result of the expert opinion of Helen Singer Kaplan and Harold Lief: FSAD appears to have initially resulted from the early theorizing concerning the human sexual response cycle by Masters and Johnson and was probably saved from extinction by the hope that PDE-5 inhibitors would be effective for women.

They then make a not-so-subtle suggestion of industry based motivation for criticism:
In their letter, DeRogatis et al. reported on data from two nontreatment studies funded by Boehringer Ingelheim (BI).
and then later
Similarly, in DeRogatis et al.’s analysis of baseline data fromthreeBI-funded clinical trials of flibanserin

I counted no few that 5 references to BI having funded relevant studies.

And then their ending:
The basic pre-requisites for any clinical category include demonstrations of diagnostic reliability and construct validity. In fact, there are no published reliability studies for either HSDD or FSAD. We doubt that either diagnosis could withstand a serious reliability check. Considering that both of these diagnoses were created on the basis of expert opinion, have no efficacious treatments, and cannot be differentiated by current psychometrics suggests lack of validity. Other than habit, the motivation to preserve unreliable and invalid diagnostic categories escapes us. On the other hand, there is significant empirical evidence and theory, which we have reviewed, suggesting the overlap between current conceptualizations of desire and arousal. This evidence and theory has motivated our new diagnostic proposal to merge HSDD and FSAD. We hope that the clearly specified criteria for SIAD will motivate definitive studies to address this important diagnostic issue.

The Plan B ad ordeal--now things are getting weird

As many readers already know, there's been a recent stir in the asexual community regarding an advertising campaign for the contraceptive Plan B Onestep. Using the slogan Get a Real Plan, they had two youtube videos, one of which involved a white female character who had recently had sex with a male whose condom somehow-or-other fell off during sex, and she is worried about becoming pregnant. In the video, Sexy Lingerie, the female character promises that if she isn't pregnant, then she vows to become "asexual, asocial, a-everything."

Along with that were some pictures (which seem to have been taken down, although there were independently captured by at least two people.) As many have noted, the colors--purple and gray against a white background--bear an uncanny resemblance to the recently adopted asexual flag.

The matter has been much discussed after a thread about it was started on AVEN: Plan B ad - Offensive?. There have now been threads on Apositive about it, been subject of discussion and outrage on Tumbler, Twitter, and generally blogged about. A lot of people sent it letters and people are thinking about getting a conference call together to talk about what to do. Those who wrote in letters have gotten a response (it seems that everyone got the same email):

Thank you for reaching out to us about Teva Women’s Health “Get A Real Plan” YouTube campaign. We appreciate you bringing to our attention the unintended misrepresentation of the word “asexual” and want to alert you that new content is being developed that will address your concern. It was never our intention to offend any individual or community of individuals. The purpose of the campaign is to educate viewers about what can be done after an act of unprotected sex or contraceptive failure. We believe that contraception is a serious topic and want to ensure that women have the facts they need about emergency contraception, as not all options are the same.

Again, thanks for bringing this to our attention - we should have the updated video posted very soon.

Just before someone posted one of these letters, I was doing some research on the word "asexual" and was then about the look into "asocial" on the The Corpus of Historical American English, and discovered a passage from the novel Big Sur by Jack Kerouac, published in the early 1960s. It is written in first person, from the perspective of a character who has had a fair amount of wine and wonders if they have been drugged as well:
Romana is handing me a bite and I take it from her big brown hands and chew... She's wearing purple panties and purple bras, nothing else, just for fun, Dave's slappin her on the can joyfully as he cooks the supper, it's some big erotic natural thing to do for Romana, she believes in showing her beautiful big body anyway - In fact at one point when Billie's up leaning over a chair Dave goes behind Billie and playfully touches her and winks at me, but I'm not of all this like a moron and we could all be having fun such as soldiers dream the day away imagining, dammit - But the venoms in the blood are asexual as well as asocial and a-everything -Billie's so nice and thin, like I'm used to Romana maybe I should switch around here for variety, " says Dave

It would seem very curious that a cultural reference to a 1960s novel would be used in an advertisement aimed at teens and twenty-somethings, and yet this appears to be what is going on here. No doubt, we haven't heard the last of this recent episode, but as I stated in the title of this things are getting weird.