There are two types of ads for sexual dysfunction. For males (here, here and here) the images are of horses running, a man driving a truck pulling a trailer, or men with women in bathtubs, playing sports, having drinks, walking on the beach or boating on the ocean, sails at full mast. In each case the pitch is: take this pill and you will be ready to perform…and your partner will be ecstatic. Meanwhile, for women the images are of women walking around semi-naked (by themselves), getting relaxed and ready, and telling the audience with a smile “sex shouldn’t have to hurt.”

Those ads send a very specific message: Men must be able to perform. Their capacity to become erect makes their women happy. Women must receive, it is their duty, sex might not give them any joy, but at least it won't hurt as much.

Houston, we have a problem.

As humans age, our interest in engaging in sexual activity wanes, for females more so than for males (on average). No biggie, just part of the human experience, right? Wrong. Our society leans towards a view of sex as a responsibility of partnering, for heterosexual couples this results in an emphasis on males’ capacity to penetrate females and females’ capacity to endure it.

 If there is no joy, should there be sex?

Conflicts arise when females experience more of a decline in sexual interest than males. Some have argued that this is because of a human nature where men always want lots of sex and females just want high quality partners… but substantial research debunks that simplistic explanation. Human sexuality is very, very complex (peruse the many posts on Psychology Today on the topic). The connections between desire, aging, health, stress, social expectations and patterns of sexual activity are no exception.  Stacey Lindau and colleagues examined over 3000 adults in the USA.  They found that the most prevalent reported sexual issues among women were low desire (43%), difficulty with vaginal lubrication (39%), and inability to climax (34%). Among men, the most prevalent sexual problems were erectile difficulties (37%). Many studies have demonstrated similar numbers.

For women, low desire, physical discomfort or pain with sex, and difficulty enjoying sex enough to climax are intricately associated with their decrease in sexual interest. For men it’s often the challenge of getting an erection. How does society deal with this complex and important topic?  Not well. We classify women as deeply disordered and men as in need of chemical assistance. 

That’s not right.

Hypoactive sexual desire disorder” (HSDD) has been called the most common sexual “disorder” in women. HSDD in women is a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. One of the main reasons that it causes this distress or interpersonal difficulty is that socially we expect women to be willing, and ready, for sex as much as, and in the same ways as, men are. While there is a lot of overlap across individuals, genders and sexualities, differences are also very common. Anyone who has spent any time around males and females of any society, age, and sexuality realizes there is no simple answer to why, how and when we have sex.

There are many reasons why women’s sexual desire tends to decrease with age. Menstrual cycles, hormonal contraceptives, birth and lactation, hysterectomy, health conditions, general stress, societal expectations, lifestyle changes, and a range of physiological and psychological issues associated with perimenopausal and postmenopausal states all can affect sexual desire and arousal. Many studies also demonstrate that women become less sexually aroused/attracted to their partners over the course of long term relationships (esp. marriages). Changes in sexual desire are not necessarily a disorder. They mostly emerge as a common part of the complexities of being a human female in the modern world.

HSDD is also found in men, although at a lower rate than women, and is also often associated with age. Male HSDD is often misdiagnosed as erectile dysfunction because of the common misconception that all men desire sex all the time. Erectile dysfunction (ED) is the inability of a man to get and keep an erection firm enough for sex. There are many, many reasons why this could happen: aging, hormone levels, social and others stressors, lack of arousal or desire for sex partner(s), circulatory problems, shifting sexualities, and a range of other influences can impact a human male’s ability to achieve and maintain an erection.

Society’s answer to these issues?  Pills.

There is now a multi-billion dollar industry around the pharmaceuticals Tadalafil (Cialis), Vardenafil (Levitra), and Sildenafil (Viagra) which are oral remedies for ED.  Each of these alter the body’s systems such that blood flow to the penis can be free from the constraints noted above (stress, hormone levels, circulatory issues, attraction, etc…). Side effects include a range of blood pressure and cardiac issues, headaches, blurry vision, digestive tract problems and multi-hour erections. Just what we need.

Recently, our friends in the pharmaceutical world have developed Osphena (Ospemephine) which purports to help peri- and post-menopausal women vaginally lubricate (so sex does not hurt so much), and Addyi (Flibanserin) which is supposed to add to sexual desire and decrease emotional stress in women with HSDD. Unlike the male targeted drugs, Addyi works more like an anti-depressant, largely on the assumptions that women are not interested in having sex with their male partners due to their neurotransmitters being out of whack. Basically, assuming that not wanting to have sex is a form of neuropsychological disorder: women must be out of their minds not to want to have sex with men. Especially now that the men can have hard-ons all the time. Side effects include fainting, sleepiness, dizziness, nausea, and alcohol consumption is forbidden when on it. Ooh, sexy. 

More than half a million men got prescriptions for Viagra in its first month on the market in 1998. The number of prescriptions for Addyi in its first few weeks of release in 2015? 227.  There is no pill for human complexity.

Now don’t get me wrong, sex and sexuality are wonderful and central parts of being human, but they are neither simple, nor can they only be about male gratification. If we want to enable human sexual lives to flourish, we have to remember that it takes two to tango. In the dance of human sexuality both partners need to participate fully, freely and with a desire to enjoy being with one another. There is much more to sex than penetration, and much more to sexuality that the capacity for lubrication or erection. Rather than asking so many women to suffer out of a sense of duty or responsibility, we should seek to discover what kinds of intimate interactions might give all involved pleasure. The answers (and there will be many) will benefit us all a heck of a lot more than a drug that might make us dizzy, nauseous, headachy and produce men wandering the streets with four hour erections. 

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