Betty Dodson with Carlin Ross

Better Orgasms. Better World.

 0 items

• Login
• Join

Search this site:

“Is the female sexual response is different to that of the males, and does this affects the perception of dysfunction both in the female herself and in the community. This in turn influences the management of female dysfunction”

1.    Encourage you to think critically of the similarities and differences between the male and female sexual response cycles

“Like personalities and our health status, sexuality is an aspect of being a person that at first glance appears to be anything but socially constructed” (Burr, 2003, pp. 41). Over our lifetime sexuality is continuously associated with our conditioning and forms our perceptive understanding of sexual responses that appear as ‘genetic givens’. Apparently we are driven by our ‘hormones’ and our ‘emotions’, as apposed to our hormones/emotions being driven by our thoughts, and are thus we are considered beyond control and learning. “The subjective feeling that sexuality is a ‘given’ of human nature is endorsed by popular biological and evolutionary theories” (Burr, 2003, pp. 41).

I find it fascinating to read in many of the papers that women’s sexual response and anatomy is regularly described using words like ‘complex’ (Basson, 2005; Leiblum, 2003). This language around women’s sexuality creates a systematic meaning converging language and identity construction into female socialisation.

As language forms culture, this introduces a perception of interpretation, ‘ways of talking’, ‘ways of being’, ‘ways of experiencing’ within an inventory of symbolics and semiotics. The position of ordering, controlling and labeling female sexual response creates a performing gender system and obligates personal constructions of sexuality and gender identity in terms of female norms. As Burr (2003, pp. 124) describes “not only do our subject positions constrain and shape what we do, they are taken on as part of our psychology such that they provide us also with our sense of self, the ideas and metaphors with which we think, and the self narratives we use to talk and think about ourselves”.

Within the scientific/biomedical communities there have been numerous ways to try and label and to concretise the female and male sexual response cycles. These range from the ‘ground breaking’ Masters and Johnson (1966) linear model of mainly physiological responses painting a picture of female and male sexual response as being similar during the process of sexual activity, to Kaplan’s (1979) three phase model which consists of the concept of desire, arousal and orgasm for woman. The three phase model describes that (Meston & Bradford, 2007, p. 236) “desire is assumed to precede arousal and orgasm in a linear, sequential manner. Clinical experience indicates, however that often times arousal precedes desire in women”. This effect is generally considered to be due to intrapersonal issues, past experiences and values and attitudes to sexuality.

Recently the linear concepts have been challenged with the introduction of a new circulatory model by Basson (2005) which proposes the importance of intrapersonal relations and intimacy as the starting point of female sexual response. It is perceived that the linear models are representative of the male sexual response cycle and involve excitement, plateau, orgasm, resolution and refractory (added later) (Masters and Johnson, 1966).

2.    Encourage you to reflect on how differences in the perception of the sexual response could affect the way in which dysfunctions are classified and managed in females.

Perceptions of female and male sexual response I believe can and do underpin our ideas about what it is natural for women and men to desire, how they are aroused and what the limitations of their experience will be. Generally in society what is seen as natural is also seen as ‘normal’. In social sciences, normal simply means ‘typical’, as in the most usual behavioural patterns of a group. However in everyday life these terms carry moral connotations. People have been conditioned to feel they need to behave in ways that are natural and normal and regarding sexuality it appears biological, religious, medical and evolutionary theories are setting the parameters of definition.

If we accept that men, relative to women are still in the positions of power in society, then we can say that prevailing discourses of female sexuality support to uphold the this power inequality. When we construct a version of male sexuality as a genetically driven powerful biological drive that they are essentially victim to, men are seen as having a basic ‘need’ for sex. While the version of female sexuality sees woman as being nurturers using sex to gain ‘emotional intimacy’, which can perform an effect of providing men with a potential source of power using force and lack of ability to control their sexual response thereby negating responsibility, while also giving women a potential power structure through being able to elicit male sexual desire while they maintain total control and publically show lack of desire.

I do not particularly agree with the statement that “The female sexual response is different to that of the males”. I tend to look more from the social constructionist perspective and consider that it is the social scripts that condition women to experience their sexuality in the ways that they commonly do. Because of this many of the illnesses, dysfunctions and treatment plans are created based on the current social beliefs and attitudes rather than from a naturally occurring result of being born female.

In Betty Dodson’s book Sex for One, she discusses the issues regarding gender roles and the impact that has on women’s personal experience of themselves.

”In spite of a sexual revolution, the pill, and the women's movement, the sexual double standard is still alive and well. Men continue to have social approval to be sexually assertive, independent and experienced, while women are expected to be sexually passive, dependent, and inexperienced. Fixed in non-sexuality and a supporting role, most women seek security rather than new experiences and sexual gratification” (1974, p. 46).

Research by Geer and Robertson (2004), shows that women have much higher negative attitudes to sexuality than men do.  In a study conducted by Fisher et al. (1988) they suggest that this gender difference is a learned disposition based on their exposure to sex related restrictiveness and punishment during socialisation. Therefore it would be expected that women, because they are exposed to a more negative sex culture than men, would be more restrained in sexual behaviour and interests which, in turn would be reflected in increased levels of automatic or implicit negative attitudes.

Going by this it would make sense that if women are conditioned from a young age to have greater implicit and explicit negative attitudes to sexuality that this would impact on their subjective experience and societies view the female sexual response cycle and how to classify and manage the dysfunction. Society’s view is also steered by medical-industrial complex, an enormously important but barely discussed power nexus that now controls a billion-pound transnational business supplying drugs and equipment” (Salvage, 2002). Medical opinion is without doubt an influential source of dominant social attitudes, inheriting from religion its role as the most powerful guardian of ideology.  Medical ideas are central to expectations about the ‘normal’ condition of people” (Scrutton, 1992, p.17)

A survey that reported 43% of American women experience sexual concerns (Laumann et al 1994. In Meston & Bradford, 2007, p.234), attracted criticisms as it labelled the ‘sexual problems’ as ‘sexual dysfunctions’, with the “concern being that the high prevalence statistic would contribute to the medicalisation of women’s sexuality and lead to an over prescribing of drugs to treat psychosocial issues” (Meston & Bradford, 2007, p.234).

On a physical level I see more similarities than differences between the male and female cycles. Yes men get erections that are obvious, however women also get erections, their clitoris, men ejaculate so do women. However we do live in a patriarchal society were we generally find that the “perception of women’s sexuality is seen as less powerful, compelling, and profound than that of men” (Chalker, 2002, p. 21). Women’s bodies with their not so obvious genitals, softer flesh and ‘socially constructed’ slower sexual response are viewed as imperfect and certainly ‘complex’.

Even to this day there is still controversy over what actually constitutes a woman’s genital anatomy. This is despite the fact that we live in a world of abundant information. We have at our fingertips loads of scientific knowledge about gynaecological functions but are also privy to ‘useful’ advertising that tells us how to keep the vagina sanitary, how and when to get it tested for diseases and lumps and bumps, how to rid it of odours, how to stay safe from STDs, and what the perfect vulva looks like. In a study conducted on women and their personal discovery their clitoris it was frequently found that they did not acquire any information in primary or secondary school, “there was a curricular omission” about the parts and the functions of their genitalia (Waskul et al, 2007, p. 157). The female genitals are imprecisely defined with many parts of the anatomy missing from medical, dictionary and slang definitions (Braun and Kitzinger, 2001, p. 155). Studies show that women holding negative attitudes about their genitals and about how they function directly impacts on their body image and how they experience sexual pleasure (Schooler et al. 2005. pp. 325). Surely this must impact on the perception of how to classify and manage the dysfunction.

3. Consider the range of options available for the management of female sexual dysfunction.

“In defining health, it is not sufficient to consider only the health of the individual. If health is defined only in individuals terms, then issues of power and control, and the unequal access to life chances because of socioeconomic status, ethnicity and gender, for example, are easily ignored” (Talbot & Verrinder, 2006, p. 37).

When a woman presents to a practitioner with a sexuality issue, the prescribed treatment plan seems to include detailed psychosocial and medical history, evaluation of the woman and of her partner, referral for a physical examination that includes hormonal and blood testing. The push to focus on female sexual response issues to be perceived as sexual dysfunctions by drug companies as a way to sell their products has lead to a ‘pathologisation’ of what is quite possibly a healthy sexual response or a simple sexual issue for a woman needs to be taken in to consideration when performing a client consultation.

“If a hormonal problem is suspected, assays for prolactin, total testosterone, free testosterone, sex hormone–binding globulin, dihydroepiandrosterone, arogens, and cortisol may be warranted to rule out endocrine disorders. Although diagnostic laboratories routinely provide reference values for these hormones, there is controversy as to what differentiates “normal,” “low,” and “deficient” hormonal states” (Guay & Spark 2006. In Meston & Bradford, 2007, p.241).

There are a wide array of topical lotions, medications, hormonal therapies and surgical procedures to treat cosmetic concerns, pelvic floor tightening, clitoral vascularity devices, vaginal spacers etc.

For treatment of psychological issues emphasises the communication and active listening skills, sexuality education and sensate-focus exercises. Cognitive-behavioural techniques are effective are also beneficial (Basson 2006). “These therapies are distinguished in large part by cognitive techniques used to challenge beliefs that undermine sexual desire and arousal, such as unrealistic expectations of performance, self-consciousness, and even the notion that one is innately dysfunctional” (Meston & Bradford, 2007, p.241) .

4. Critically evaluate the evidence base for the effectiveness and acceptability of on these options for the management of female sexual dysfunction.

Successful treatment of female sexual concerns needs to be viewed holistically, placing the woman’s subjective experience, psychological responses and socialisation as important factors in her sexual response. Biological factors need also need to be addressed while keeping in mind the over use of pathologisation with regards to the sexual concern.

The problem that comes with the medicalisation include “mind-body compartmentalisation, generalisations about human function and experience, and focus on the individual, all of which create a universalised, function-focused sexuality in which physiology dictates sexual conduct” (Boyle, 1994: Tiefer, 1995, 1996, 1999. In Tiefer, 2001, p. 89). Whilst this approach may be appropriate for some particular actual sexual dysfunctions it surely cannot effectively manage all female sexual concerns. We must maintain awareness that as a society we take our past with us, so therefore we need to understand and acknowledge religions and culture have impacted on our perceptions and behaviours both with sexuality and intrapersonal relations “This model has probably allowed at least some sex education and research in a culture still paralysed by its history of prudery and hypocrisy in which embarrassment and value conflicts about sex remain pervasive” (Money, 1985; Reiss, 1990. In Tiefer, 2001, p. 89).

The Western Socratic method of thinking always places our thinking to have to “establish standards and fixed definitions” (De Bono, 1995, p. 12). This framework for thought has brought about a way in which  “medicalisation offers a vocabulary of biological innocence – the kneebone is connected to the ankle bone – to purge the lubriciousness from any discussion of sexuality, and there may have been an advantage to that in the past” (Tiefer, 2001, p. 89). However, the health of individuals is strongly influenced by the social and physical environments and it can never fully considered outside of that context.

References:

Basson,R. (2005): Women’s Sexual dysfunction: revised and expanded definitions. Review Synthese.

Basson, R. (2006): Sexual Desire and Arousal Disorders in Women New England Journal of Medicine, vol. 354;(14)

Braun, V., Kitzinger, C. (2001): Snatch , Hole, or Honey Pot? Semantic Categories and the Problem of Nonspecificity in female genital slang. The Journal of Sex Research, vol. 38; (2): pp. 146 - 159

Burr, V. (2003): Social Constructionism, Routledge.

Chalker, R. (2002): The Clitoral Truth: the secret world at your finger tips. Seven Stories Press, New York, NY.

De Bono, E. (1995): Parallel Thinking: from Socratic to De Bono Thinking. Penguin Books, England.

Dodson, B. (1974): Sex for One: The Joy of Self Loving: Three Rivers Press, New York, USA.

Fisher, W., Byrne, D., White, L., & Kelley, K. (1988): Erotophobia– erotophilia as a dimension of personality. Journal of Sex Research, 25, 123–151.

Geer, J. & Robertson, G. (2005): Implicit Attitudes in Sexuality: Gender Differences. Archives of Sexual Behavior, Vol. 34, No. 6, December 2005, pp. 671–677

Kaplan, HS. (1979): Disorders of Sexual Desire. New York: Brunner/Mazel

Leiblum, S. (2003: Arousal disorders in women: complaints and complexities, vol. 178; (638 – 640)

Masters, WH. & Johnson, VE. (1966): Human Sexual Response. Boston, MA: Little, Brown

Meston, C. & Bradford, A. (2007): Sexual Dysfunction in Women (ed.) Department of Psychology, University of Texas at Austin, Austin, Texas

Salvage, J. (2003): Rethinking Professionalism: the first step for patient focused care? University of Sheffield, UK.

Scrutton, S. (1992): Medical ageism: Expectations of health in old age. Ageing healthy and in control: An alternative approach to maintaining the health of older people.  London, Chapman & Hall.

Deborah, S., Monique, W., Merriwether; A., Caruthers, A. (2005): Cycles of Shame: Menstrual Shame, Body Shame, and Sexual Decision-Making. The Journal of Sex Research; Nov 2005; 42, 4; Academic Research Library, pg. 324.

Talbot, L. & Verrinder, G. (2006): Promoting Health: The Primary Health Care Approach. Elsevier Australia 3rd Edition 2006

Tiefer, L. (2001): A New View of Women’s Sexual Problems: Why New? Why Not? New York University School of Medicine. The Journal of Sex Research, vol. 38; (2), pp. 89 – 96.

Waskul, D., Vannini, P., Wiesen, D. (2007): Women and Their Clitoris: Personal Discovery,
Signification, and Use. Symbolic Interaction, Vol. 30, Issue 2, pp. 151–174