The Year in Clinical Sexuality, 2010

The Year in Clinical Sexuality, 2010

As we get ready to close the books on 2010, I would like to express my gratitude to  family,  friends, and colleagues for your support and encouragement over the past year.   And to all my patients for your trust and confidence.   May we all merit much happiness in 2011. In ending the year,  here’s my rundown of 2010’s most blog-worthy events in the field of clinical sexuality     New Books and Other Happenings Sex at Dawn, the breakout volume by the previously-unknown writing team of Christopher Ryan and Cacilda Jetha, took a sledgehammer to conventional evolutionary sexual psychology  (See my interview with lead author Chris Ryan).   Some thought Sex at Dawn might help promote a more relaxed, European-style attitude towards non-monogamy in America.  In “Will Sex at Dawn influence sex therapy?” I argued that this was probably wishful thinking. This summer,  SEC staffers were caught surfing porn at work. In my blog,  “Men and Their Computers, Alone Together,” I wondered whether the traditional Jewish laws of Yichud might be applicable to whether a man should ever be alone with his computer, unsupervised.  I also contributed a piece to an Italian magazine on workplace infidelity – and how to avoid it. In “Contemporary Sexuality and the Brazilian Wax,” we discussed the modern disappearance of young adult women’s genital hair — and in the process had a dialog with Kinsey researcher Dr Debra Herbenick on the subject. A new book, The Nine Rooms of Happiness, sought to teach women the occult male art of compartmentalization.  I reviewed it, and also briefly interviewed my 9-year-old daughter (she’s since turned 10) on the subject of “What Does a...
Pink Viagra and the Riddle of Female Sexual Desire

Pink Viagra and the Riddle of Female Sexual Desire

Sex Therapy, Flibanserin, and the FDA October 29, 2014.    As many of you know, in 2010 Boehringer Ingelheim failed to win approval from the FDA committee charged with evaluating flibanserin for something called Hypoactive Sexual Desire Disorder (HSDD) in women. At the time, many observers argued that HSDD was a made-up disorder, invented to enrich drug manufacturers.  The FDA’s committee members disagreed.  They concluded that HSDD was real enough, but there wasn’t sufficient proof that flibanserin was effective for it. After the negative FDA committee decision, Boehringer Ingelheim decided to sell its rights to flibanserin to another drug company, Sprout Pharmaceuticals, which plans to re-approach the FDA next year for approval of the drug. It’s surely no coincidence that the FDA scheduled a public meeting this week to discuss issues in the diagnosis, measurement, and treatment of female sexual problems.   As expected, “sexual medicine” advocates such as Even The Score are facing off against grassroots “anti-medicalization” groups led by the New View Campaign at the meeting. There are serious arguments to be made on both sides. As an MD sex therapist, I’m a bit biased. We clinicians all have long lists of patients who haven’t been helped enough by our best current methods.  We’re always in need of innovation. And nowhere is this more true than for sexual desire problems.   The Limits of Sex Therapy You might say, “Don’t we already know what causes women to lose sexual desire?  Isn’t a woman’s loss of sexual desire usually about something particular—such as lack of proper rest, or a husband’s clumsy lovemaking?” Very often, yes.  Very often it’s not a dysfunction at all—just...
Our Sexual Culture and The New York Times

Our Sexual Culture and The New York Times

  Camille Paglia’s editorial in The New York Times, “No Sex Please, We’re Middle Class, ” is a fun read, but she throws a lot of things together that I’m not sure really stick. According to Paglia,  over-education is an important source of diminished sexual desire among the ” anxious, overachieving, white upper middle class, ”  as she calls it.  This is an old myth about sex, going back as far as D. H. Lawrence and probably farther — that too much education separates a person from the raw physical sources of his or her sexuality. There’s not much to support this myth about sexuality and education, and every reason to be suspicious of it.   We don’t really know what goes on in most people’s bedrooms.  A quality US study on sexuality that asked, the National Health and Social Life Survey,  found that frequency of sex didn’t change much with  educational level.  The study did find that highly educated people were having more oral sex, though.    Seems like higher education might give one a taste for more sexual variety — hardly a bad thing. Paglia also contends that if you were unlucky enough to be born after the industrial revolution, then you’ve really missed the boat on  great sex.  As she writes, “The real culprit, originating in the 19th century, is bourgeois propriety. As respectability became the central middle-class value, censorship and repression became the norm. Victorian prudery ended the humorous sexual candor of both men and women during the agrarian era, a ribaldry chronicled from Shakespeare’s plays to the 18th-century novel.”   OK, I get that it would have been a...
Simplicity, Complexity, and the Hunt for Pink Viagra

Simplicity, Complexity, and the Hunt for Pink Viagra

  Oct 27, 2014   Will there ever be a “Viagra for women?”    If so, would it ever make it past the FDA?  And how many would women would really ever want to take it? In 2010, an FDA committee voted not to approve Boehringer-Ingelheim’s  flibanserin — a medication reported to somewhat improve female sexual desire.   The flibanserin hearings were an important battle in the current controversy over whether the so-called “medicalization of sexuality” (think Viagra, etc) is a good thing or not. Proponents of “sexual medicine” have been at odds with a vocal grassroots “anti-medicalization” movement for years on this issue. To call flibanserin “Pink Viagra” makes little sense in reality, since the two drugs have little in common.  Viagra works on arousal, and flibanserin works on desire.  Viagra works on the genitals.  Flibanserin works on the mind.  And it’s likely that flibanserin, if it’s ever approved, will have a much more modest impact on female desire than Viagra has on male erections. So why the repeated references to flibanserin as “Viagra for women” and “Pink Viagra”? Ignorance, for one.  Never bet against ignorance in the field of sexuality.  (More on that later).   And money, certainly.  There’s always someone hoping that a drug for women will make as much money from women as Viagra has from men.   But I think there’s another important factor at work.  Phrases such as “Pink Viagra” refer, however unconsciously, to an important divide between male and female sexuality:  the relative complexity of women’s sexual response, compared to men’s.   Behind the hope for a “Viagra for women” is a wish...