Female orgasms not always on the menu

I worked with a woman once who casually dropped this bomb over lunch: she said she could have orgasms at one touch, and have two or three right on top of each other. I also know women who have had lots of sex but not one orgasm, and a few who don't care whether they have one or not.

Although most women fit somewhere between these extremes, prepare to feel inadequate. In the wake of Viagra's phenomenal success, pharmaceutical companies such as Pfizer are rushing to bring to market a female equivalent: gels, pills, and patches to enhance libido or heighten sensitivity.

Many experts argue that women's sexual health is too complex to address with a drug; others say that drug companies are just creating one more "illness" that needs curing. A Montreal conference in July, sponsored by more than a dozen Canadian and U.S. women's-health groups, will address industry efforts to find a female market for what they say are unnecessary, and possibly unsafe, sexual-enhancement drugs.

The theory behind a Viagra-like drug for women is that by increasing blood flow to the genital area, the pill will improve sexual response. But a 2000 randomized study sponsored by Pfizer-involving 577 women who reported at least six months' lack of arousal, pain during intercourse, or vaginal dryness-didn't give the company the results it had hoped for. That's because 45 to 50 percent of study participants said they felt improved sexual function using a placebo, or fake pill.

The study's lead author, Rosemary Basson-sexual functioning guru and consultant at the BC Centre for Sexual Medicine at Vancouver General Hospital-told Reuters at the time that the results confirmed that "sexual difficulties in women are very complex", much more complex, in fact, than inadequate blood flow to the genital area.

But the complexities haven't stopped the medical establishment from trying to make a distinction between normal female sex?uality and sexual dysfunction, as though there's a clear line between the two. According to a January 2003 article in the British Medical Journal, the first international conference to develop a consensus on female sexual dysfunction was held in 1998 in Boston. Eighteen of the 19 authors of the new definition of FSD that emerged from the conference had close ties to a total of 22 drug companies. By 2000, the newly formed Female Sexual Function Forum began hosting annual conferences with Pfizer as key sponsor, and over 20 other pharmaceutical firms as cosponsors.

The group brought this new disorder to public attention in a 1999 article in the Journal of the American Medical Association, which cited a study that suggested 43 percent of women between 18 and 59 suffer from this condition. Although the mainstream media still happily cite this number, it has since been widely questioned by experts. Among them is Lori Brotto, assistant professor and researcher in UBC's department of obstetrics and gynecology.

In a recent interview from her home in Vancouver, she pointed out that the methodology of the study is now considered flawed. The 43-percent stat was based on a survey involving 1,500 women, who were asked questions about seven symptoms, such as a lack of sexual desire and anxiety about sexual performance, that they may have had over the previous two months. However, they weren't asked whether their problems were severe enough to cause personal distress. Experts have also suggested that the time frame surveyed is problematic, as results possibly represented only a temporary response to illness or other stress.

Brotto is currently working to develop treatments for sexual dysfunction in ovarian- and cervical-cancer survivors; they often suffer sexual problems as a result of the inevitable hormonal loss caused by radiation therapy.

She told the Straight that trying to define female sexual dysfunction is a lot like trying to nail Jell-O to a wall. "There are so many subtleties involved. In otherwise healthy women, there's only a tiny subset whose sexual problems are purely physiological, who would respond to a Viagra-like drug."

For the rest, "normal" is a crafty shape shifter, which constitutes one thing to one woman and something entirely different to another. For example, Brotto says that according to evolutionary scientists, orgasm in women is necessary for reproduction because it helps retain sperm by creating suction in the uterus. To advocates of the theory, inability to have an orgasm is a dysfunction. But Brotto says she sees a lot of women through her research who are not orgasmic but who say they enjoy sex with their partners anyway. "They say it doesn't interfere with the relationship, so why fix something that's not broken?"

To Brotto, the one defining feature of sexual dysfunction is the level of interference it causes. If lack of desire or inability to orgasm interferes in a woman's life, distresses her, or creates a burden on her relationship with her partner, then it could do with some fixing. If it doesn't, then leave well enough alone.

Sometimes, there's nothing to treat except a woman's perceptions about what's normal. Our culture is already suffused with images of women in the throes of orgasm, when in fact, lots of women don't routinely have them, says Brotto. Add to that the noise currently being generated by the pharmaceutical industry over FSD and before you know it, you've got a problem where once there wasn't one, and a lucrative one at that.

So before reaching for that blister-pack of female sexual enhancers, consider this-you might not need fixing at all.