Boston Globe - Little heed to women's sexual problems
December 7, 1998
By Alisa ValdÉS-Rodr Iguez, Globe Staff, 12/07/98
For Bonnie Myers, 41, Viagra is the miracle drug that rescued her
libido. No, her husband Russell doesn't swallow the blue pills. Bonnie
does. And for the first time in 10 years, the Maryland day-care worker is
having orgasms.
Preliminary studies, including one at Boston University, show Viagra can
affect sexual response in women much the same way it affects men. Spurred
by requests from women for the drug, scientists said they have come up with
a Viagra-like topical gel for women.
While these efforts represent a beginning in addressing female sexual
dysfunction, they are just that, and no product is likely to get FDA approval
before 2002. Even though drug companies and medical device makers have
worked for years to devise ways to treat male impotence, female sexual
dysfunction is only now being seen as a medical and not just emotional
problem.
It is emblematic of medicine's neglect of female sexual dysfunction that an
October conference on the subject that the Boston University School of
Medicine sponsored was the first of its kind ever.
Dr. Irwin Goldstein, the Boston University urology professor who led
development of the gel, said that women's sexual dysfuntion is ''an immature
field. A naive field. Not because women don't have these problems, but
because medicine has not addressed their issues.''
It was not until the October meeting that the medical community even
reached consensus on what female sexual dysfunction is. Now there are
several new classifications, including one called sexual arousal disorder,
caused by hysterectomy, menopause, and vascular disorders like diabetes;
this is the condition apparently aided by Viagra.
Specialists in women's health, sexuality, and history say the ignorance of
female sexual dysfunction stems from a long history of fear, denial, and
misunderstanding of women's sexuality and anatomy.
''Our understanding of female sexual anatomy and physiology has really
lagged behind that of the male,'' said Dr. Jennifer Berman, a urologist at BU
Medical Center. Berman and her sister Laura, a sex therapist, teach at BU
and are leading one of the first studies of women and Viagra.
Said Jennifer Berman, ''There has been very little support for research from
universities and foundations. The reason is probably multifaceted, but stems
from social taboos about women's sexuality, and the myth that female sexual
dysfunction is an emotional issue rather than a physical problem.''
Even though women also become ''erect'' when sexually aroused, that fact is
less known, even by women themselves, according to Carol Queen, a San
Francisco author who has written about culture and sex and has taken
Viagra.
''Women's sexuality is less culturally important,'' Queen said. ''A woman can
have sex and procreate without being turned on. She might not like it, but it's
possible. Male sexual arousal, on the other hand, is quite obvious.''
Queen pointed out that the majority of men getting Viagra prescriptions do it
not to reproduce, but rather ''to have a good time.'' Queen doubted HMOs
would be as willing to pay for ''pleasure drugs'' for women, and said their
reluctance to cover birth control medication demonstrated her point.
The FDA took six months to approve Viagra for men. But a lack of basic
sexual dysfunction research in women means the FDA will not be in a
position to begin considering Viagra for women until 2001 or 2002, say
Goldstein and the Bermans.
Once Viagra for men was approved by the FDA, many insurance
companies sped through the approval process to pay for it. Tufts Health
Plan, for instance, took only one month to decide to cover Viagra for men,
citing demand as the reason. The usual drug approval time for the HMO is
three to six months.
But a spokeswoman for the HMO said it would likely take longer to
approve coverage for women, because of the lack of documented research.
The basic problem, the Bermans and others said, is that so little work has
been done on the physiology of female sexual response and orgasm.
''Most research on women's sexual dysfunction has been done in the field of
psychology,'' Jennifer Berman said. ''The thought of having women stimulate
themselves in a clinical setting has been very disturbing to people when
we've applied for grants.''
The reason such a prospect is disquieting to people is a cultural tradition of
desexualizing women, according to Mary Daly, a feminist author and
assistant professor of theology at Boston College.
Goldstein dismissed this view as ''a bunch of feminists making statements,''
saying most research in sexuality was done on women in the 1960s and
1970s. The focus shifted to male sexuality, he said, only with the advent of
the penile implant.
But Jennifer and Laura Berman agreed with Daly, saying modern attitudes
about women's sexuality date from the Victorian era.
The Bermans, Queen, and Daly said that when the topic of Viagra for
women has been discussed by the media, Victorian notions of women's
sexuality have surfaced with an obvious taboo surrounding the clitoris.
The clitoris, the external organ responsible for female orgasm, contains the
same number of nerve endings as the penis and also becomes erect with
arousal. In utero, the penis and clitoris form from the same tissue.
The Bermans have found in their research that Viagra makes orgasm easier
for women by increasing blood flow to the pelvic area, as it does in men,
and specifically by causing the clitoris to become erect, as well as by causing
other reactions.
But the Bermans say they have been forbidden to use the word in many
television interviews, including recent ones with network anchors Dan Rather
and Peter Jennings. They say they are annoyed that many print articles dance
around the scientific facts by using vague descriptions of women's sexual
response, while specifics about the penis seem to be fine.
''It's frustrating and difficult to speak about a medical topic without being
able to speak clinically and anatomically,'' said Jennifer Berman.
''There is a long history of the clitoris being despised,'' Daly said, noting that
forced removal of the organ is common practice in much of Africa and the
Mideast.
An estimated 130 million women alive today have experienced the removal
of their clitoris in a procedure its proponents liken to circumcision, but its
critics say is more analogous to castration.
Daly said, ''What not many people know is that an English gynecologist
named Isaac Baker Brown invented the clitoridectomy in 1858, as a cure for
female masturbation.'' The procedure was common in the United States and
England until the early 1900s.
''We're up against centuries of misinformation,'' said Jennifer Berman, adding
that the open discussion of women's sexuality is ''the final frontier feminism
has yet to cross.''
''But that's what's really exciting about the hype around Viagra,'' she said.
''It's opening up lines of communication. If nothing else, we're talking about it
now.''
This story ran on page E01 of the Boston Globe on 12/07/98.
© Copyright 1998 Globe Newspaper Company.
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