Female Sexual Dysfunction or "Creeping Medicalization"?

When a woman with a sex problem sits down with a doctor or sex expert, they're up against centuries of sexist stereotypes—and a raging debate about how to undo those stereotypes.

Uneven diagnosis and treatment is still a problem: While a man with a sexual dysfunction is likely to be taken seriously and given treatment by his doctor, women are likely to be told to "relax," according to sexual medicine experts and frustrated patients alike, suggesting the problem may be "all in her head."

But does this mean that "female sexual dysfunction" is underdiagnosed? Or are some doctors going overboard, slapping the word dysfunction on anything that doesn't fit within a narrow definition of normal? The debate continues, with profound effects on women's sexual health and health care.

What's normal?
According to a widely cited 1999 analysis published in the Journal of the American Medical Association, 43% of all women (and 31% of men) surveyed reported experiencing an episode of a sexual problem, such as lack of interest in sex, difficulties with orgasm or erection, or finding sex painful. Such troubles were labeled "sexual dysfunction," and researchers said it's a "significant public health concern." Treatments must be found, they said—especially for women.

But is it really dysfunction if it's happening to almost half of all women? Or is it actually normal? "We can't as physicians tell people what is normal," says Irwin Goldstein, MD, director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine. Yet sex drives and sexual response that falls short of that nonexistent "normal" have spawned a lucrative industry of sex-related pharmaceuticals and sexual health centers, like the one Dr. Goldstein himself runs.