Echoing a wider concern expressed by others, he also criticised the surveys for trying to look at an individual woman’s sexual difficulties in isolation from the context of her relationships. ‘Many studies assessed the prevalence of problems with desire, arousal, orgasm and pain without investigating the nature of the corresponding sexual relationships,’ he wrote in his review. Perhaps most importantly, the sociology professor raised the awkward issue of how to define a sexual problem. He pointed out that what was missing in many studies and surveys was ‘whether the respondent views a particular symptom as a problem’. In other words, leaving aside the inflated estimates of dysfunction, how many of the millions of woman who supposedly have sexual problems—according to these survey findings—are in fact experiencing something they consider to be a genuine problem at all?
This is a question well worth pondering for a moment. When we look behind the claims of high rates of sexual dysfunction— like 43 per cent—it becomes clearer that the studies have actually come up with estimates of the rates of common ‘difficulties’—if they can even be called that. But looking more closely, how many of these common experiences—like a lack of interest in sex, troubles with lubrication, or coming to orgasm too quickly—are even seen as problems by the women experiencing them? And if she does look on them as a problem, does she see them primarily as her own personal problem, or rather something to do with her relationship or her partner? As others have observed, the criteria used by researchers to identify a sexual problem are arbitrary and don’t necessarily relate to the reality of women’s lives.15
The same year Ed Laumann’s paper was published another sex survey was being set up, organised by a team working in Bloomington, Indiana. This time the survey was being run by the Kinsey Institute, the outfit named after the celebrated sex researcher. Continuing the work Kinsey and his colleagues had conducted decades earlier, the Institute’s general approach is to view the inhibition of women’s sexual response as an adaptive mechanism. Under this approach, a woman’s lack of interest in sex may well be an appropriate and understandable reaction to life circumstances—stress, tiredness or threatening patterns of behaviour from a partner—rather than a sign of some medical malfunction.
Smaller than Laumann’s, this next survey involved almost 1000 American women. It was overseen by Kinsey Institute director Dr John Bancroft,16 a respected sex researcher and one of the people who had great concerns about this new claim that 43 per cent of women had a sexual dysfunction. Bancroft believed the term ‘dysfunction’ could be highly misleading, making many women feel they had a malfunction when they did not. As to the figure of 43 per cent, Bancroft felt it was outrageous, and did not stand up scientifically.17 Further, he argued, the statistic was being used wrongly as evidence of a widespread need for medical treatments, including drugs, even though Laumann’s journal article itself had shown that sexual problems were commonly linked to relationship issues and other quality of life concerns. Bancroft was worried that, in the era of Viagra, the complexity of female sexuality might be reduced to narrow questions of how much blood was flowing to a woman’s genitals.
The Kinsey Institute survey asked women a range of questions about their sexuality, their relationships and their physical responses during sex, including questions about lubrication, pain and orgasm. The study found that 24 per cent of women expressed distress about their sexual relationships and/or their own sexuality. Drilling down to what might be causing this widespread dissatisfaction, the survey results suggested the state of a woman’s emotional well-being, and her feelings about her relationship with her partner during sexual activity, were more important determinants of her distress than problems around physical arousal, lubrication or orgasm.
The survey results also indicated that distress about sex did not increase with age, even though interest in sex might decline. This reinforced other evidence suggesting that getting older might bring a slowing of sexual interest or activity, but it also generally means less likelihood of worrying about it.18 Like others, Bancroft was alarmed that portraying common problems as dysfunctions—as he believed the Journal of the American Medical Association article had done—could make many older women think there was something wrong with them when there wasn’t. ‘While it is good to encourage older couples to maintain and foster their sexual intimacy,’ he wrote, ‘should we be encouraging older women to regard themselves as “dysfunctional” because they have less sexual interest than when they were younger?’19
Here is a reaffirmation of Kinsey’s celebration of the enormous variation in human sexuality. It is a call to acknowledge the ebbs and flows of sexual life rather than manufacture new medical conditions where the sexual activity of the young becomes the norm for all, and we label those who don’t measure up as abnormal or dysfunctional. Bancroft’s comments are part of a broader concern that the changes in sexuality that tend to happen naturally as we age are being reframed, or re-imagined, as a health or medical problem requiring treatment.20 Yet, at the same time, his perspective readily accepts that some sexual difficulties can be severe and long lasting, and that a medical approach may sometimes be entirely necessary. Criticising the drug companies for trying to portray common sexual problems as treatable disorders doesn’t mean rejecting the obvious benefits of a medical approach and medicines, when needed. For John Bancroft, himself a medical doctor, some malfunctioning in a woman’s sexual response could occur because of the side-effects of a drug, because she was suffering a disease like cancer or because of some failure of her healthy adaptive mechanisms. In such cases, in his view, the word ‘dysfunction’ may well be appropriate, and treatments valuable, including medicines proven to be safe and effective.21 Like many surveys, the one conducted by the Kinsey Institute was funded by the pharmaceutical industry, and in this case the company—Eli Lilly—had also hired Ban-croft as a consultant.
The journal article based on the results of that survey was published in mid-2003, and by the end of that year Lilly’s sex drug Cialis would be approved for men. Like Viagra, this drug acts by enhancing blood flow to the genitals—a physiological process the industry hoped would help some of the many millions of women said to have this new dysfunction. Yet as the industry was becoming excited by the profitable possibilities, respected voices like Bancroft and Tiefer were raising questions about whether there really was a mass market of women with a medical condition requiring drug treatment. If distressing sexual difficulties were largely caused by relationship and emotional factors, rather than a medical dysfunction of poor blood flow, where on earth was this market for drugs?
John Bancroft was asking two very pointed questions: When might a dysfunction better be called a difficulty? And when was a difficulty better seen as normal life anyway? His journal article analysed the ways in which several other influential surveys had dealt with these awkward questions. He concluded that many of the women supposedly found to have sexual problems through sex surveys often didn’t even regard themselves as having problems or weren’t distressed by them. In other words, surveys were not only confusing difficulties with dysfunctions; they might have even been finding problems where none existed. Which begs another awkward question: to what extent are these surveys, which often generate a lot of coverage in the media, actually helping to paint a picture of a new epidemic of sexual difficulties that may not in fact be there in the first place?
Bancroft went so far as to suggest that until there was an agreed way to accurately define whether a woman had a problem with her sexuality or not, running big surveys to assess how widespread they were was a ‘hazardous’ activity. He also called for a whole new approach to assessing sexual problems, in which a woman’s own description of her experience is seen as more important, ‘rather than her answers to questions based on preconceived concepts of female dysfunction’.
Just a few short months later, that call for a new approach to assessing sexual concerns was heard and heeded on the other side of the Atlantic Ocean. A British team based in London decided to take the radical step of conducting a sex survey that included questions asking women straight up whether they thought they had a sexual problem.22 The plan was to try to find out how many women might end up with a label of dysfunction if their doctors used a standard approach, and compare that with the number of women who actually