Female sexual dysfunction or not knowing how to ask what feels good?
The recently published Italian study suggesting that women can only have clitoral rather than vaginal orgasms raises important questions about the medicalization of female sexuality and sexual dysfunction.
Many women would be happy to have an orgasm the old fashioned way, as a researcher at the University of Western Sydney Jane Ussher points out, especially those who have sexual difficulties.
It is difficult to write on the subject of female sexuality without using negative language such as “female sexual dysfunction” or “failure” to orgasm.
Much of what has been written about female orgasm is based on phallocentric assumptions, such as women “should” have orgasms through penetrative sex with men. And if they don’t reach an orgasm, there is something wrong with them.
Many women have absorbed these culturally acceptable views and the continued medicalization of female sexuality continually reinforces them.
Definition of “ female sexual dysfunction ”
According to the latest diagnostic and statistical manual of psychiatrists, the DSM-V, a woman suffers from “female orgasmic disorder” if she experiences a “marked delay, marked rarity or absence of orgasm or a decrease in the intensity of orgasmic sensations” in 75 to 100% of sexual intercourse situations. This should last at least six months and be accompanied by clinically significant distress.
Many women of my mother’s generation experienced such absence of orgasms, but without experiencing clinically significant distress as they had no real expectation of receiving sexual satisfaction from their partner. Their main concern was not to “get” pregnant.
The other most common female “dysfunction” is “female sexual interest disorder / arousal dysfunction”. Unlike “female orgasmic disorder”, this has at least one male equivalent: “male hypoactive sexual desire disorder”.
Difficulties with excitement are surprisingly common. A large-scale UK study found that 54% of women (vs. 35% of men) reported some form of sexual problem that lasted more than a month. The main problems encountered by these women were a lack of interest in sex, an inability to orgasm, painful intercourse, or difficulty lubricating.
We know that sexual difficulties have a negative impact on the quality of life of women, their general well-being and their relationship satisfaction.
We also know that only one in three women in the United States who report a distressing sexual problem have already spoken to their doctor about their difficulty. This is mainly due to their discomfort in discussing sexual matters with a doctor. As a result, many clinicians lack experience in diagnosing and treating female sexual difficulties.
The complexity of female sexuality
There is a myth spread in the media sexual spontaneity: satisfying sex occurs spontaneously without the need for communication or negotiation and is mutually satisfying for both partners.
The reality is of course much more complicated. University of Pennsylvania researcher Maureen McHugh described what women really want like:
better and more loving relationships, satisfying consensual sex, more time and energy for expression of sexual desire, acceptance and recognition of female sexual desire, and more sex education.
It is disconcerting to consider that more than one in five women have experienced sexual coercion at some point in their lives. It is hardly surprising, then, that some of these women experience some form of “sexual dysfunction” or difficulty later in life.
The medical model tends to pathologize the complex sexual difficulties of women, which often have relational, cultural and power dimensions. According to the DSM-V:
women differ in the importance of orgasm for their sexual satisfaction. There can be marked socio-cultural and generational differences in the “orgasmic capacity” of women. (my emphasis)
This leads to the question: does women’s ability to have an orgasm vary greatly or does women’s ability to request that their sexual needs be met vary from culture to culture and from culture to culture and culture? one generation to the next?
Empowerment of women
A multinational study demonstrated that the reported prevalence of sexual problems varies by region. For women, lack of interest in sex and inability to reach orgasm were the most common sexual problems in regions of the world, ranging from 26% to 43% and 18% to 41%, respectively. .
Participants described issues such as age, physical health, mental health, and relationship satisfaction as influencing sexual functioning, as well as cultural differences.
We like to think that women are empowered in Australia and yet we are under-represented on boards of directors and in parliament. Women in positions of power still suffer from sexism and misogyny, like then Prime Minister Julia Gillard described in his discourse of misogyny. It resonated with women around the world who unfortunately could relate to his experiences.
Is it any wonder, then, that women find it difficult to negotiate their own sexual satisfaction?
Stanford University clinician and researcher Leah Millheiser has done a lot to promote women’s sexual health, especially for women with cancer. His Youtube video, What Our Mothers Never Taught Us: Lifelong Changes in Female Sexual Function, describes a wide range of treatments available to women to improve their sexual functioning.
These treatments vary from drug therapy to sex therapy, with a wide range in between including the use of vibrators, vaginal lubrication, pelvic floor exercises, and more. Despite the use of medical language, women have the power to gain easy access to the knowledge that they are not alone in experiencing sexual difficulties and that treatment is available.
The future is better
It’s still easy to get the impression from popular culture that women should prioritize their male partner’s sexual satisfaction, above their own. I sincerely hope that this generation of young women know more about how their bodies work and are ready to prioritize their own desire for sexual satisfaction over their partner’s desires.