I need you all to know ahead of time that I frickin’ LOVE Marty Klein. You may not think so by the end of this post, but it’s true.
That doesn’t mean he ain’t wrong.
In a post titled, “Flibanserin Defeated; What Is Accomplished?” he says that we, the anti-flibbers, have been accomplished four things – four bad things, obviously:
* The further public confusion of desire and arousal. People everywhere are referring to “pink Viagra,” which is a fundamental error.
Viagra addresses arousal, not desire. Flibanserin addresses desire (albeit imperfectly), not arousal.
(Technically, according to the FDA, Flibby doesn’t address desire “imperfectly” so much as it addresses desire not at all – or not enough to countervail the harmful side effects.)
It could be true that the anti-flibbers have confused people – I don’t know. I do know that I seem to spend every other post writing about arousal and desire, so I don’t feel like I personally am contributing to any confusion. (NB: desire can be responsive rather than spontaneous and still be healthy! Arousal is women is not necessarily related to desire or even PERCEIVED arousal! Okay? Okay!)
So me, I’m not contributing the confusion. But the anti-flibbers in general? Well, this is an empirical question. I’m open to evidence. Is there evidence? Dr Klein doesn’t cite any evidence. Can anyone find any evidence?
Also, am I wrong in thinking that the anti-flibbers are not the source of “pink Viagra” but rather the media started the term? Again, I could be wrong. Anyone know?
Either way, if the “pink Viagra” term has confused people, unconfusing them should be a priority. That will, of course, require teaching people about women’s sexuality, which is more complex than mens. Which brings me to…
* Reinforcing the myth that women’s sexuality, especially desire, is more complicated than men’s.
No, no, no. Eroticism in adults is complicated, and it insults both genders to suggest that only women have emotions around sexuality. Professionals don’t understand why men don’t desire women they love any more than we understand why women don’t desire men they love.
Most men are not heartless machines eager to screw anything with a heartbeat, any more than most women are frigid creatures who only acquiesce to sex out of duty.
Women’s sexuality IS more complicated than men’s – as evinced, for example, by the fact that a hydraulics-related solution like Viagra improves men’s arousal but not women’s – but that IN NO WAY implies that “only women have emotions around sexuality” that men will “screw anything with a heartbeat.” No one is saying that and it’s slightly horrifying that Dr Klein could seriously think that someone is. How is a smart dude like Dr Klein lulled into such an obvious trap of thinking that if I say “women are more complicated” then I must mean “men are NOT complicated”? Ick. And duh.
* Denigrating the idea that some women (and their relationships) really do suffer from low sexual desire even when the emotional and relational conditions are supportive.
It’s accurate, of course, to say that there isn’t a single level of desire that’s “normal.” But women who experience dramatic drops in their desire know there’s something wrong. And isn’t it obvious that one definition of “healthy adult” is the experience of sexual desire when the conditions are right?
Again, no one is saying this. Indeed, we anti-flibbers are distressed when low-desire women misconstrue our message. A woman with low desire spoke at the FDA hearing, saying that people who were against Flibby and HSDD were saying she was imagining her problem, so I sense this is widespread misunderstanding.
And we anti-flibbers do need to do something about this. I don’t know what we should do about it, but it’s a problem that our pro-woman cause is being misconstrued as anti-woman.
Here’s a summary of my pro-woman perspective: I think – and I suppose this is opinion more than fact – but I think that saying that MOST women are healthy and living in a fucked up culture and that that’s why their desire is low is SUPPORTIVE of women. SOME women have flatlining desire and are miserable because of it and won’t feel “treated’ until their desire level reaches some tolerable threshold (a threshold determined not by any clinical or medical standards but by sociocultural standards – no less real, but it’s important to note), and I wish there were a treatment for that. There isn’t one (I doubt there will ever be a medical one), and that sucks.
Also: NO DUDE, it’s NOT obvious that the definition of a healthy adult necessarily includes experiencing sexual desire under the right conditions. Meet the asexuals, friend.
(Dear asexuals, ya’ll have come up a lot lately. Much are you maligned! I appreciate your struggles! I try to give you your propers! Love, Emily)
But suppose Dr Klein meant “most healthy adults,” then yes. In that case let’s talk about what “the conditions are right” means. Camille Paglia wrote a NYT op ed about this in fact. Our culture doesn’t give much scope for “the right conditions” for women – and women are more context-dependent than men are (not to say men aren’t context dependent, just NOT AS MUCH). It’s the CULTURE that is the target of the “comprehensive approach” discussed later.
* Knocking down the straw man that “women’s sexuality is so simple it can be fixed with a pill.”
C’mon, no one—certainly not the drug company—has suggested this. Flibanserin is proposed for women whose reduced desire can’t be explained by a dozen other factors, including well-known desire killers such as ambivalence about the relationship, sexual trauma, and husbands who don’t bathe.
Yeah – NO ONE has suggested this. Where is this coming from? Who said the pharma folks are saying women’s sexuality is so simple it can be fixed with a pill? I’m literally asking – I haven’t heard anyone claim this.
But maybe I missed something – could well be. Maybe someone is saying this. Given evidence, I would change my mind. Um… anyone got any evidence?
So. Yeah. Those are the four things he says the anti-flibbers have accomplished. My responses, in summary: (1) have you any evidence of that? because I have evidence to the contrary in my blog; (2) anti-flibbers don’t think men are sexual robots and it’s disappointing to hear you say so; (3) we anti-flibbers aren’t disparaging any women, but I recognize that we need to do something about the misunderstanding of our view as dismissive of the suffering of women with low desire – I don’t grant that we’ve been disparaging, but I grant that it’s the perception; and (4) who thinks big pharma is saying women’s sexuality is simple? Again, just lookin’ fer evidence.
A couple other things. He says:
The vociferous righteousness about this drug is terribly reminiscent of the hysteria over other sex-related drugs such as Plan B, RU486, and gardasil. Historically, conservatives have always attacked any technology designed or used to support sexual expression. But getting this resistance from progressives who care about women is new.
This isn’t “wrong” per se, I just REALLY disagree. A couple of people have said on my blog that they think my objections to flibanserin are “denying women choice” or “disrespecting women.” Indeed, Dr Klein’s comment could almost have been written by a friend of mine who kinda yelled at me for blogging about being glad flibby was not approved. He said that women with low desire thought I sounded “cruel.” But it makes no more sense coming from the inimitable Dr Klein than from my friend. Lemmee ‘splain:
The hysteria around all three of those drugs ran along the lines of, “IF YOU PUT THESE ON THE MARKET GIRLS WILL GO AROUND HAVING SEEEEEEEEEEEEEXXXXX!!!! AAAAAIIIIIGHHH!” Which is not only demonstrably untrue but also unjustified by three decades of behavioral research on harm reduction interventions.
Our “hysteria” (ugh – that WORD!) around flibby is not about what women might do – making women have too much sex or making them WANT too much sex or even making them believe their sexuality could or should conform to some medically-defined range of “normal.” Women ALREADY believe their sexuality could or should conform to some normal range – we can’t blame that on a drug.
No, this “hysteria” is about a corporation making a profit by lying to women, telling them they’re broken and need to be fixed with a drug, when really what they need is a different culture.
We’re not concerned that women will start wanting or enjoying sex; we’re concerned that they WON’T – they’ll take a drug, believing (falsely) that it will make them the sexual creatures they believe they should be, and they’ll be taking on harmful side effects in the process. They’ll buy the cultural party line that desire is amenable to medication and then they’ll feel EVEN MORE BROKEN when the drug doesn’t help. Of course, the drug company’s profits are the same, regardless of whether or not it works for a woman who fills the Rx.
The fact that it IS progressives who care about women should be a clue that our response DIFFERENT – even if your ears are tuned to hear objections to sex meds coming from the Right, the fact that it’s coming from the left means you can’t just say, “Ugh! Objection to sex meds! Must be some anti-sex freaknuts who think men are just penises with bodies!” The fact that we DO care about women are WANT sex to be good means that you might consider the possibility that we really are trying to create positive change for women.
Finally: Dr Klein goes on to disparage the New View’s options in lieu of a drug:
The suggestion of a “comprehensive approach” as if it’s some wonderful and effective new technology is troubling. Western psychologists have known for a century that sexuality is a complex and subtle combination of biological, psychological, and social components. And so all competent therapists use a “comprehensive approach” to sexual issues. And we encourage other therapists to use it as well.
And, he says, it doesn’t really work.
He’s right about therapy not helping desire – Julie Heiman wrote a review article of effective sex therapies maybe 10 years ago, and she noted that she wouldn’t even include therapy for desire because there was no evidence that therapy could increase desire per se.
What therapy DOES give couples, as he indeed says, is better communication skills, an untangling of the knots around initiation, and makes orgasms more reliable (in women). And it helps people to understand and embrace their own sexualities, rather than seeing the ways it varies from the cultural narrative around sexuality.
Women, varying from each other so much more than man (ahem, women are more complex) need this self-acceptance even more than men do; there is only one big ol’ cultural narrative and a quingigillion women’s sexualities (as opposed to merely bajillions of men’s sexualities).
So what “comprehensive approach” means from MY point of view (as an educator, not a therapist) is, well, EDUCATION. Education both in and outside of therapy. Education about non-concordance, responsive desire, and the other aspects of women’s sexuality that make it so crucially different from (and yes, more complex than) men’s. If women understand their sexuality in its normal, healthy state, they’ll experience less distress when it just does its thing – and women’s sexuality’s “thing” includes, for 90% of women, shutting down in response to depression, which is more common in women than in men, and for 80% of women, shutting down in response to anxiety, also more common in women than in men.
YOU know these things already because you read the blog – and thanks for reading because CHRIST ON A BIKE do I spend a lot of time writing all this stuff. It’s nice to know some folks are learning something. But lots and lots of people think a woman is supposed to be like a man. And she’s not.
To conclude the longest post so far on the blog (and hopefully the longest ever), I want to mention a way in which I differ from the larger New View view:
We all know that drug companies will keep looking for a sex drug for women, but if they ever do find one that works (they won’t), as I’ve said before, I’d sing its praises.
Because despite all the reinforcement of cultural myths around women’s sexuality, all the manipulation the marketing division would inevitably try, there are women who feel really bad about having no desire and their distress won’t be allayed through reframing or education or better communication with their partner.
But there won’t be a drug because women’s sexuality IS more complex than men’s. There can be no female equivalent because of the arousal non-concordance I keep banging on about and because of the predominantly responsive nature of women’s sexual desire.
Globally speaking, it’s not women’s DESIRE that’s broken, it’s the culture that shapes both women’s desires and their perceptions of that desire (“enough” desire, “too much,” “too little”). What needs to be fixed is the CULTURE. You can’t medicate a culture. You can change it gradually through education and various reform efforts.
Because women’s sexuality is what it is – variable on a galactic scale, changing across a woman’s menstrual cycle and reproductive lifespan, as well as varying hugely from woman to woman, and disruptable by more factors than we know about, in ways we don’t yet understand – it’s not amenable to medical interventions as science currently construes that term.
Public health interventions, maybe. Therapy, that too, in an indirect way.
Education. Education. Education. I only wish Dr Klein had included, in his list of our accomplishments, the creation of a teachable moment for women to learn about their own sexualities.