There are so many things that make up our sexuality. If I think back over my life, I know that my family's disapproval of certain things, the message that I got from the church, comments from my friends, things I saw on soap operas and movies, and the measly sex ed I got in sixth grade all combined to shape my early idea of what sex was, and what I thought it should and shouldn't be. Luckily, I was a bit of a bookworm, and so I checked out every book I could get my hands on that talked about sex and pregnancy (an alternative route to talking about sexuality). That certainly helped to add to the ideas already formed in my head about sex and sexuality. Even though I think that I was fairly open-minded about sex, loved to talk about it with my friends, and had good first experiences, those things did not prevent me from having some difficulties with sexuality later in life.

Now that I am an MD, psychiatrist, and sex therapist, I can look back to recognize that I had periods of time where my sexuality and sexual desire were affected by such varied things as anger, stress, fatigue, anxiety, self-image, and side-effects from different medications and/or products. Had I not become a psychiatrist, I might not have recognized the different ways these factors were negatively affecting my life and may have not sought to resolve them as I have. Now I don't usually talk about myself personally, but I felt that it was through personal experience and knowledge that I was best suited to comment on how the treatment of women's (and men's) sexual functioning, or dysfunction, is evolving at the hands the medical and the pharmaceutical industry.

Let's get one thing straight. The pharmaceutical industry is interested in making money. By extension, if the medical community can use pharmaceuticals to enhance their patient visits, and therefore income, they will prescribe them. How many medical professionals are hired, and paid very handsomely, each year by the pharmaceutical companies to push their products?

Obviously, advances in medical science have certainly improved our quality of life and life expectancy overall. And this is a welcome advantage of medicine and medications in general. But it seems that, as our society moves more in the direction of instant gratification and desire for quick-fixes, the less people want to take responsibility for their own lives, and the less effort they are willing to put into their lives to make positive, healthy changes. This is a score for the pharmaceutical companies because people continue to be in a condition to ask for, or require, medications. The cycle continues and the more medications they sell.

Now after the great financial success of Viagra, the pharmaceutical and medical industries have been on a campaign to define female sexual dysfunction as a disease or medical condition. In effect, they are discarding all of the personal, interpersonal, emotional, and environmental factors that can negatively impact a woman's sexuality, and instead focusing on the physical symptoms that result in order to label it as "an illness." This is a gross oversimplification and denial of what may really be happening to a woman to cause such a response.

By accepting the disease definition of sexual difficulties, a person is less likely to examine what areas of their life or lifestyle are contributing to their sexual dysfunction, and then work on these. It's easier to just take a pill. After all, your doctor told you that was the thing to do. Funny how nobody talks about the positive response from the placebo effect, which accounts for roughly 30% of response to medications (yes, a sugar pill). That demonstrates that your psychology can trump your biology, but it doesn't sell very many medications.

I love medical science and the practice of medicine, and I do prescribe medications. But I chose to be a sex therapist in order to have a holistic approach to my patients. I have seen the power of the mind to both make us sick and heal us. And when it comes to human sexuality, our mind is the major determining factor in our arousal, our sexual response, and our sexual satisfaction. Recognizing that anxiety and anger account for upwards of 80% of the patients who present with sexual complaints, I am worried about the medicalization of sexual dysfunction. Some have called it disease mongering on the part of the medical and pharmaceutical industry.

I believe that the flip side of that is the denial of responsibility by the patient, because this would suggest some effort and change required of them. Oftentimes, the healthiest thing to do is recognize what is harming you in life and move to change this for the better. Those professionals that have worked in sex therapy with patients understand the role that all of these factors play. They also have first hand experience at helping patients overcome these difficulties, many times without the need for medications and their side effects. I encourage everyone to put medicine in perspective and seek true balance and health, not just a band-aid approach to the complexity of our sexuality.

When it comes to sexual dysfunction, medications can be very efficacious and necessary at times. But this should never overshadow a comprehensive exploration and treatment of all the elements contributing to a person's complaints. Sexual dysfunction is not a disease.


By Madeleine M. Castellanos, MD