Healthy Skepticism International News
August 2005
Women and the new sexual politics: Profits versus pleasures. Second New View Campaign Conference, Mo
Abstract:
Table of Contents
Introduction.
Women’s sexuality: Experts then and now.
Lack of appropriate research enables perpetuation of myths.
Viagra downsides revealed in study Down Under.
Sex, Viagra and the senior woman.
Androgens make a Comeback.
Valuing oneself.
Killing Us Softly: Advertising’s image of women.
The hidden hand of Big Pharma.
Comprehensive sexuality education vital for youth health.
Letting experts manage our lives and feelings.
Spreading the New View.
A Postscript about New Directions following the Montreal New View Conference.
A brief report about:
Women and the new sexual politics: Profits versus pleasures. Second New View Campaign Conference.
Montreal, Quebec, Canada
July 9–10, 2005
Introduction
What follows are all-too-brief summaries of the eleven plenary talks, in the order they were given, from the recent New View Conference in Montreal. We hope they will bring back some of the excitement for those who attended, and give a sense of what transpired to those who couldn’t be present.
This report will be circulated to all conference registrants and will be posted on www.fsd-alert.org. We will also be posting an album of photos taken at the conference. The full program and participant list will continue to be posted on the website.
Please read the Postscript to learn of post-conference plans for the New View Campaign.
Women’s sexuality: Experts then and now
“The 70s showed that you can’t leave medical research to medical professionals,” said Barbara Ehrenreich, author, political essayist, and social critic. “We need that again.”
In an historical overview of attitudes toward women’s sexuality, Ehrenreich noted that for centuries Christianity dictated women’s inferior status and proclaimed that education would drain energy from their “private parts.” In the post-Enlightenment era, science continued the theme with medical writing depicting the inquiring female patient as neurotic. “Pseudioscience justified women’s lesser status,” she said.
The second wave of feminism gave women the courage to challenge “medical sexism.” They began meeting around kitchen tables-sharing stories of their treatment at the hands of dismissive and patronizing doctors, their unnecessary surgeries, their experiences with dangerous drugs, and their belief that medicine viewed women’s bodies as imperfect and defective versions of men’s.
“Women got angry,” said Ehrenreich. Their personal stories became important “data” for new ways of thinking. The result was women’s health advocacy organizations, books like Our Bodies, Ourselves, and women’s health services where women were active participants.
Today, much of what women fought for in the women’s health movement has become mainstream, a tribute to its success. “But we have new battles to deal with,” noted Ehrenreich.
Extreme forms of Christianity and Islam are trying to set women back. Hard-fought battles for reproductive choice are in serious jeopardy. We are facing the “Talibanization” of society as pharmacists refuse to fill contraceptive prescriptions and the teaching of evolution disappears.
“But, our feminist history gives me hope,” said Ehrenreich. We will resist these challenges to women’s health as we did before, with grassroots politics and faith in ourselves.
Lack of appropriate research enables perpetuation of myths
The clitoris is smaller than the penis? This was just one of the persistent medical myths that Susan Bennett examined in her overview of women’s sexual anatomy and physiology. Bennett reviewed some of the knowns and unknowns about women’s sexual arousal to show how the perpetuation of misinformation has paved the way for development of inappropriate pharmaceutical therapies.
Bennett, a specialist in internal medicine at Harvard, debunked the clitoris size myth, noting that the visible part of the clitoris is actually comparable to the head of the penis, with a similar erectile structure and “legs” that are not visually apparent. She also debunked the myth that, once lubricated, a woman is ready for intercourse. Not necessarily: Also required for subjective arousal and pleasure are healthy vascular and nervous systems.
Another myth is that vaginal lubrication arises from mucus membranes. In reality, lymphatic fluid forms the lubricant when, during arousal, the sympathetic nervous system stimulates a rise in blood pressure and a greater output of hormones and neurotransmitters. These mechanisms are not well understood, although it’s known that centers in the brain are involved.
Turning specifically to what has been termed FSAD (female sexual arousal disorder), Bennett said that the best research indicates that mental health, physical health, and relationship satisfaction are the crucial factors for women; physiological response alone does not predict sexual comfort or distress.
Because arousal is so complex and psychosocial, it is not surprising that drugs such as Viagra have been shown to be ineffective. However, after abandoning FSAD, pharmaceutical companies have now moved aggressively to develop medications for low desire. It is likely that the same problems will materialize with these drugs. “Huge placebo effects” in this research should remind everyone that “our brains are in control, not our genitals.”
Viagra downsides revealed in study Down Under
The downsides of sexual pharmaceuticals, vastly underreported and neglected in pharmaceutical and biomedical reports, have been disclosed in a significant independent qualitative study conducted in New Zealand from 2001 to 2004.
The New Zealand study is the first one on the effects of sexual pharmaceuticals not to be affiliated in any way with a pharmaceutical company, explained Professor Annie Potts of the University of Canterbury in Christchurch, New Zealand. Participants were easily recruited after a news story maligned Kiwis (New Zealanders) as being too shy and prudish to want to talk about sex! Qualitative interviews are the way to examine the kinds of complex experiences and marginalized viewpoints about sexual pharmaceuticals, which are not looked at in drug industry quantitative studies.
“The use of Viagra can cause tension and conflict in some relationships. Contrary to the rosy pictures fostered by drug companies, sexual rejuvenation by Viagra can actually precipitate sudden and unwelcome changes, especially if partners had in various ways adjusted to sexual change due to erectile difficulties,” Potts said.
Key effects of Viagra use by male partners that were experienced as stressful by women in the study included changes in frequency, duration, and mode of sex, overt and subtle pressures to have sex, tensions and conflicts within relationships, real and imagined infidelities, pressure to maintain a “youthful” sexuality, and concern for the health of the partner using the drug. “Men don’t want to ‘waste’ a tablet,” she said, “and many women say they put up with sex for the sake of their partner.”
The refashioning of sexuality for older populations, assisted by sexual pharmaceuticals, may sound potentially positive and liberating but in actuality, it compounds sexual pressures on women. “Everyone’s on the defensive in the older group about how often they have sex,” she noted.
It is important to rally against the increasing pathologization of normal events of aging as well as to ensure that non-coital sexual practices and pleasures are promoted as viable and sexy alternatives, she said.
Sex, Viagra and the senior woman
Senior women are using the Viagra phenomenon to advocate for their own sexual views and critique the establishment and status quo, said Meika Loe, a professor at Colgate University in New York. A chapter in her recent book, The Rise of Viagra: How the little blue pill changed sex in America, details her research with senior women.
If you look at letters about Viagra in popular magazines, she said, you will see that “senior women are among the most astute commentators on the Viagra phenomenon.” What’s interesting to sociologists is that these letters go way beyond Viagra. “They raise questions about social conventions on a broad scale, about sexuality, aging, and marriage.” It’s not just commentary on Viagra, but on medical research priorities, constructions of manhood in society, and gender and social expectations.
The Viagra phenomenon directs public attention to problematic relationship and social issues, new sexual pressures, and a quick-fix pill culture, Loe said. Since the arrival of Viagra, hundreds of thousands of women have used editorial spaces in newspapers and magazines to insert themselves into the public discourse on topics such as sexual pleasure, marital obligation, social inequality, and male-dominated medicine.
“Viagra has become an opportunity to discuss larger social phenomena,” she noted. When women say, “Why should the doctor give my husband Viagra when he doesn’t even know anything about foreplay?” they are politicizing Viagra and all it represents.
The new sexual pharmaceuticals revive interest in the second wave feminist position that sex is about both pleasure and danger for women. And while senior women are trying to make their voices heard, for the most part their viewpoints have yet to become part of the mainstream discourse. Qualitative research is necessary to allow these voices to be heard. “Clearly, for senior women to state that they are sexual beings today is no less political than 30 years ago,” Loe said.
Androgens make a Comeback
Testosterone Dreams, the title of his new book, is how John Hoberman, University of Texas, Austin, refers to “fantasies about exploiting the therapeutic potential of androgenic drugs.” Male (androgenic) hormones, which include testosterone and anabolic steroids, have taken center stage in their newest incarnation as the magic elixir for women suffering from “female sexual dysfunction” or FSD.
Hoberman pointed out that such androgen promotion isn’t new. Since the 1930s, marketing to doctors and the public claimed that taking these hormones helped to “deepen human experience” if not to “prolong life itself.” However, he said, androgens became “demonized” in the 1980s in reaction to “media discomfort with freakish bodybuilders and steroid-boosted [Olympic] athletes” and, even more recently, anabolic steroids became a threat to the integrity of professional sports like the Tour de France and American baseball. Hoberman said that elite athletes may become the “last officially mandated pharmacological virgins,” since athletes are forbidden these drugs at the same time as they are marketed to midlife men and women for sexuality and vitality.
Drug companies in the 1940s and early 1950s promoted synthetic androgens and estrogens for “male menopause” and male sexual function. Recent campaigns have fused “therapeutic and cosmetic” goals. Anabolic steroids are promoted to combat wasting in AIDS patients, and at the same time, to boost sexual appeal through accentuated muscular development in healthy men. High steroid use has been documented in police officers, prison guards, firefighters, and soldiers who all want greater “physical self-assertion and self-confidence,” said Hoberman.
Hoberman wondered if the “socially sanctioned return of testosterone for women” was grounded in both the growing acceptance of hormone replacement as an anti-aging therapy and a new social “entitlement for lifelong sex.” There seems to be no “cultural restraint to oppose testosterone therapy for FSD,” he said. He felt only the “social conservatism of American physicians and of society as a whole” had delayed the promotion of testosterone as a “female aphrodisiac” in earlier years.
Valuing oneself
Let us examine “who is persuading whom of what and what are their means of persuasion” began Judy Segal, English professor at the University of British Columbia, in her discussion of the rhetoric around FSD. “Values underlie persuasion, even when they are not evident,” she said, adding that “teasing them out is critical.”
Segal described how the commercial, medical, public, and literary realms each have a set of values. In commercial discourse, for example, ads for anxiety drugs endorse the values of being social and authentic (as a reason to take medication), and disvalue being solitary and unproductive (which you’ll be when unmedicated and suffering anxiety).
How is pleasure, especially sexual pleasure, dealt with in these various domains? What kinds of pleasure are positively valued, and what kinds are either neglected or explicitly devalued?
In medical discourse, for example, being normal is highly valued, along with being a good patient and having a “real” disorder. Thus, women with sexual problems are encouraged to focus on specific and functional problems, the “real” ones, and keep hidden other sexual feelings and concerns. Pleasure “can’t be measured” and is “irrelevant to health,” so you rarely see pleasure mentioned at sex research conferences.
In the public discourse around sex and sexuality, Segal described how advice gurus, like Dr. Laura Shlesinger, turn sex into “women’s social work” to ensure happy families. Sex becomes “a loving obligation of marriage,” not a source of personal pleasure. Women’s pleasure becomes “a collateral effect.”
Literary discourses fall short as well. The typical news story about a woman suffering from a sexual problem is so predictable and conventional, it’s “as if it were written by a software program.” Journalists use scripted phrases and images, not “words put together from scratch.” Every story starts with a suffering woman, who has “tried everything” but still has sexual problems. It’s never her “fault”-her problem is always “very common,” she always “suffers in silence,” and she is saved by a new product. The article always insists that she is “not alone” and that her “pain is real.” The use of such tropes [i.e., familiar figures of speech] to talk about sexual experiences prevents us from understanding that there is no one authentic story about sex and sexuality.
Segal concluded that there is not much information or originality in the discussion of women’s pleasure and sex. We not only must take apart the messages we hear, but value unique experiences and strive to develop a world of multiple stories.
Killing Us Softly: Advertising’s image of women
The unattainable image of ideal beauty presented in advertising produces a toxic cultural environment that constantly sacrifices women’s health and sense of wellbeing for the sake of corporate profit, said Jean Kilbourne, author and expert on gender issues and the media. Kilbourne is also the award-winning filmmaker behind the Killing Us Softly documentary series.
“The message from advertising is that the way to be happy, to find satisfaction - including sexual satisfaction - is through the consumption of products,” she said. But try as women and girls may to achieve this ideal, failure is inevitable, because the ideal is based on absolute flawlessness.
She noted that 20 years ago, the average female model weighed eight per cent less than the average woman, but now weighs 23 per cent less than the average women. The body type portrayed in advertising is a combination of special genetic heritage and plastic surgery. Moreover, all advertising images are digitally altered and body doubles are widely used in movies and ads for movies, so the public actually has no idea what models, movie stars, and celebrities look like in real life.
Not meeting this impossible standard affects female self-esteem. “In terms of sexuality, it makes women hate their bodies, which makes it rather hard to feel sexy and engage fully in sex,” Kilbourne said dryly, noting that in a breakout session the day before her talk, Deborah Nedelman and Leah Kliger had reported that 51 per cent of older women interviewed cited dissatisfaction in body image as the primary factor in their loss of sexual desire.
If women are experiencing loss of desire, it is imperative to look at the conditions of their lives and the quality of their emotional and sexual relationships, rather than looking toward medication, she said. “This is a really a public health problem, and public health problems can be solved only by changing the environment.”
The propaganda barrage begins with ads aimed at girls, where they are portrayed as both innocent and sexy, virginal and experienced-all, confusingly, at the same time. Girls’ power is trivialized, as when it is turned into products such as “Curl power” or “Revolt jeans.” Likewise, women’s political commitments are co-opted by ads. “If you were any more satisfied, you’d blush,” is an ad line for yogurt. “We are encouraged to feel passion for products, not people,” Kilbourne suggested.
Citizen advocacy, patient awareness, and media literacy are key to countering the harmful effects of advertising images, she concluded. “The advertising industry has an enormous amount of money and power but we can use their very images against them to educate about their real messages and redefine the concepts of love, sexuality, and freedom that advertising has corrupted.”
The hidden hand of Big Pharma
From classical medicinal practitioners to modern pharmaceutical companies, there has long been an exploitation of the demand for medical cures, said medical investigative journalist Jeanne Lenzer, whose articles have appeared in the British Medical Journal, New York Times, USA Today, and Mother Jones, among many other media outlets.
Earlier this year, she broke the news story that officials at Eli Lilly had long been aware that their product fluoxetine (Prozac) had troubling side effects including suicide attempts and violence. The pharmaceutical company has since spent close to $1 million on public relations trying to undo the “damage” that ensued from the article.
“The biggest problem is controlling the message, and pharmaceutical companies control their scientific messages to doctors and their messages to the media,” Lenzer said. The public may think companies are competing with each other to sell their products, but secret agreements reduce both competition and accurate information to the public.
Referring to a study published in the London Journal in 2000 showing that people who took Vioxx had a heart attack rate four times higher than average, Lenzer said that Merck, the manufacturer, immediately launched a massive publicity campaign and Vioxx sales actually skyrocketed over the next year. It was “one of the great miracles of marketing,” she said, and it would be four years before the product would be pulled by the FDA.
“Clearly, marketing trumped science,” Lenzer said. “How do companies fool us?” Pharmaceutical companies “hide their data in plain sight,” she explained, using Marcia Angell’s phrase. One common tactic is to use combination endpoints. When a company says a drug will “reduce stroke, death and nonfatal heart attacks,” Lenzer explained, in fact the word “and” actually means “and/or.” Thus stroke and death may not actually be reduced, but since nonfatal heart attacks were reduced, they can use the combination phrase. Endpoints are combined to create the illusion of multiple benefits to a drug, when benefits are actually minimal and the product may actually be accompanied by serious side effects.
Lenzer listed many other tricks and tactics, from underpowered clinical trials to hiding trial data, to multiplying endpoints so something will work out. The problem is, she concluded, US healthcare priorities must be examined and reworked. “You can’t keep coming up with global breakthroughs like penicillin and insulin,” she noted. The public needs changes at the FDA, the NIH, in universities and journals, and the public needs the scientific literacy to see through industry scams.
Comprehensive sexuality education vital for youth health
Young people today are coming of age in societies that are increasingly urban, industrialized, and media-saturated-a new global reality that poses many challenges relating to youth sexual health, said Barbara Huberman, Director of Education at the US-based NGO, Advocates for Youth.
The US leads the world in unplanned pregnancy by teenagers, more than nine times higher than the rate in the Netherlands, nearly four times higher than that of France, and nearly five times higher than that of Germany. What is Europe doing that the US is not?
Since 1998, Advocates for Youth has studied the approaches to sexuality education for youth taken by these four countries. “In European countries, research is the basis for public policies to reduce teen pregnancy, abortions, and sexually transmitted diseases,” Huberman said. “Political and religious interest groups have very little influence in public health policy.” Marriage is not considered the criterion for intimate sexual relationships.
In contrast, the US currently spends $1 billion on “abstinence until marriage” programs, in which educators are allowed to teach only about the failure of condoms and contraception and not their success, she said. Meanwhile, 50 per cent of new HIV infection cases in the US are occurring in young people under the age of 24. Youth in the US are inundated with highly sexualized media images while public health policy communicates a single “just say no” message. It’s contradictory and hypocritical.
In the 1970s, European countries faced decisions about the decriminalization of abortion with positive government policies. In the 1980s, European countries faced the challenges of HIV/AIDS with massive public education campaigns to renormalize condom use. By contrast, Huberman told about how in 2005, with abortion under threat and sex education nonexistent, US pharmacists are refusing to fill contraceptive prescriptions “for religious reasons” and abstinence-only messages are playing on prime time TV.
Advocates for Youth has distilled the lessons from the European successes into “the three Rs-rights, respect, and responsibility. “Young people need to be given the right to information, knowledge, and access to services related to sexual and reproductive health, in order to protect themselves,” she said. “When young people are given rights and respect, public health data shows that they act responsibly.”
Huberman concluded that families, educators, and healthcare providers must all take responsibility for making sure that young people receive accurate and comprehensive sexuality education and services. She showed video clips from public service announcements that her organization is developing to contrast the US and European messages.
Letting experts manage our lives and feelings
Carl Elliott, non-practicing physician and philosophy professor from the University of Minnesota’s Center for Bioethics, offered the audience a parable for his talk about expertise-a true story about a fraudulent psychiatry resident named Shoemaker who managed to pass undetected for almost an entire year. His “lousy character and third-rate morals” didn’t tip his teachers off because nowadays we mainly look for technical competence in our physicians. Shoemaker behaved like a psychiatrist, and no one thought to check his credentials. “How do we sort out the Shoemakers from the genuine article?” Elliott asked. “How do we know who really is an expert?
This is a particularly serious problem in a culture that depends so heavily on experts. As people have come to measure “the success or failure of a human life on a yardstick of individual psychological wellbeing,” we have turned to what Walker Percy called “experts of the self” to set the yardsticks. What, rhetorically asked Elliott, have we wrought?
Nathaniel West’s 1933 novel, Miss Lonelyhearts, tells of an ordinary journalist abruptly assigned the advice column in his paper. Despite a complete lack of training or even life experience, he, too, is given the mantle of authority by readers who rely on him for advice with their desperate situations.
There are many conflicting opinions about psychological happiness and wellbeing (and sexuality). Such an environment of uncertainty breeds many “authorities.” But, which experts can you trust? How is one to sort out authentic answers and advice when so-called experts such as doctors, drug company researchers, journalists, and patient groups all offer “expert” opinions? And when all these groups are revealed to be on the pharmaceutical industry payroll, what do we do, then?
Elliott suggested that there are “real dangers” to routinely turning to such experts-any experts-for advice on everyday experiences such as raising children or having a good relationship. These days, he said, “expert mediators stand between you and your life,” and we all give up some of our humanity when we become “consumers of experiences” depending on experts to tell us how to manage our lives.
Relying on experts, people become insecure even about basic feelings. It is inevitable, then, said Elliott, that “we experience anxiety when our lives don’t match the textbook description. Most of the time,” he concluded, we don’t even realize what we’ve lost.”
Spreading the New View
The New View Campaign has come a long way and it’s time to spread the “new view,” said Leonore Tiefer, Campaign Coordinator, and New York University Medical School psychologist.
She stressed that The New View Campaign has had two equally important parts. It is both “a feminist conceptual challenge to the medical model of sexual problems (The Manifesto)” and a five-year grassroots political “Pharma Watchdog campaign.”
In 2000, Tiefer convened a small group of feminists to challenge the medicalization of women’s sexuality in the wake of Viagramania. The explosive success of Viagra threatened healthcare politics and gender politics and called for an organized feminist response.
The Manifesto has by now been translated, published, and disseminated widely, and could make a difference in sexuality education, clinical work, and research. It is adaptable to men, women of varying ages and social classes, and queer communities. It is based in social constructionist theory and the politics of human rights.
The campaign’s activist work has mostly taken the form of influencing the health and science media concerned with the new sexual pharmaceuticals. As companies issued press releases and clinical studies, the New View Campaign offered a critical voice on methods, marketing, and the very meaning of sexual “dysfunction.” Its greatest triumph and publicity came in December 2004, with the defeat of Proctor and Gamble’s application to the US FDA for approval of the hormone drug Intrinsa.
The Campaign is clearly part of the “New Public Health Advocacy Social Movement” that documents the harms to health from corporate ads, public relations, lobbying, biased science, and damaging products. The Campaign can continue its watchdog role as part of this new social movement.
But the New View must also work for comprehensive sexuality education for children and adults. This will help prevent sexual problems and make people wiser consumers. The public also needs advocates for independent sex research funding, organizations, publications, and media. Tiefer called for “non-industry sex drug research” that would study “placebo effects and mechanisms, adverse drug effects, the many impacts of taking sex drugs, and the reasons people resist taking sex drugs.”
Tiefer concluded with her “top ten” suggestions for spreading the New View, which included the following:
•Don’t be intimidated by technobiobabble (“There are no norms for anything in the female sexual work-up.”)
•For every new book you read, re-read an old one. (“Much of what we need to know is in the older gems.”)
•Understand the power and complexity of Big Pharma. (“These people are working night and day.”)
•Bloom where you are planted. Everyone can do something!
A Postscript about New Directions following the Montreal New View Conference
“Many a slip twixt the cup and the lip,” as they say.
Although we announced ahead of time that the Montreal New View Conference would mark the conclusion of the New View Campaign, that’s not going to happen.
The Conference revealed that the New View is alive and growing-pedagogically, clinically, in terms of research, and, of course, politically. It turns out that there are all sorts of international uses of the New View because its message of empowerment and its corporate critique resonate with so many women. It turns out that older women are finding strength in the New View message of resistance and woman-centerd pleasure. It turns out that queering the New View works well, and it even turns out that some men are finding the New View a haven from robotic sexual performance pressures.
More specifically, people suggested the following New Directions:
•A New View listserv;
•An edited journal issue focusing on selected papers from the conference and/or older women and/or international issues and/or clinical uses of the New View;
•An article using the New View Campaign and Conference as an example of collective feminist work without university or corporate funding;
•An article about how feminists are getting non-medical-model ideas into the media;
•More New View CME courses for physicians and nurses;
•A New View-based college-level Human Sexuality course;
•More varied uses of the website and a new webmaster;
•Autobiographically flavored accounts from those involved from the early days of the New View Campaign on how it has affected their teaching, research, and careers;
•Radio show programming on New View themes;
•New View based peer sexuality education on college campuses;
•A New View performance piece à la “Vagina Monologues”; and
•A New View consciousness raising guide for women over 50.
Leonore Tiefer, who has been the New View point person for the past five years, plans to step back. This Conference begins a transition to a new structure and leadership.
All conference attendees and New View Advisors will shortly receive information about a new New View listserv. This will become the forum for discussing issues of future program and structure.
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