Sex, Lies, and Pharmaceuticals. Ray Moynihan

researchers used a questionnaire and a definition of sexual dysfunction derived from an international manual of diseases used in Britain— similar to the American DSM. (A key difference between the British and US definitions is whether or not the woman must experience distress. In the British definition, this requirement is absent.) Unlike other studies of this kind, the British researchers also asked the women directly whether they thought they had any sexual problem, even of a mild nature, and how distressing that problem might be. In addition, the women were asked whether they considered their problem to be a medical one— like arthritis—an emotional one or relationship related—like a lack of time together with a partner. The findings were stunning.

      When the researchers looked at the results from the questionnaire used to assess the women, they found that a whopping 38 per cent might qualify for a doctor’s diagnosis of sexual dysfunction. But that figure then fell to 18 per cent if the woman herself was required to think she had a problem. When it was also required that the woman saw her problem as distressing, the figure fell again—this time to just 6 per cent, a world away from 38 per cent.

      In other words, only a tiny proportion of women who were ‘diagnosed’ with a sexual dysfunction during this study saw themselves as having a sexual problem that distressed them. This is clearly only one small study with an unusual scientific approach, but it raises fascinating questions about the value of the definitions of these conditions. If only a very small number of women labelled as dysfunctional actually see themselves as having distressing sexual problems, what does that say about the definitions of the dysfunction? A major reality check is surely looming.

      As to what the women saw as the origin of their sexual problems, the innovative London study found relationship and emotional issues were the most commonly perceived causes. For almost two-thirds of the women in the study who said they had a problem, difficulty with their relationship was seen as one of the factors. This doesn’t mean those difficulties aren’t genuine, but it does raise doubts about the relevance of drugs in treating them. Echoing the approaches of John Bancroft and Leonore Tiefer, the British researchers concluded that ‘reduced sexual interest or response in women often appears to be an adaptation to stress or an unsatisfactory relationship.

      Many such adaptations may be short term and not classifiable as dysfunction.’ This is a point of view shared by a lot of sex researchers who are uneasy about using the word ‘dysfunction’ to describe common problems.²³ ‘Most women regard their sexual problems as something to do with relationships,’ said Dr Michael King, the professor based at University College who oversaw the London survey and a psychiatrist with an interest in psychosexual medicine who regularly sees both male and female patients. ‘I find very disturbing the drive to find a pill to medicalise everything to do with sex.’²⁴

      Unlike other studies of women’s sexual problems, this British research was entirely free of pharmaceutical industry funding, and none of the researchers had any connections to any company. Michael King is one of the small but most likely growing numbers of doctors around the world who has decided not to accept any more free lunches from companies trying to woo his favour. He avoids financial relationships with them, and he’s banned them from sponsoring meals in his medical school department. ‘I’m not anti-pharmaceutical companies,’ he says. ‘They are incredibly important. I just don’t like researchers getting so close to them.’ While he fully recognises the need for doctors to work with drug companies testing drugs, he’s worried when they join forces to conduct surveys or develop diagnostic tools, because of the potential that the marketing and the science will get mixed up. On a positive note, he argues that with all the attention drugs like Viagra are producing, people are more likely to be open with their doctors, even though they don’t necessarily see their sexual problems as medical ones. Importantly, he points out that ‘they are still afraid to talk to each other’. He is hinting that a frank conversation with one’s sexual partner may often help a lot.

      While Michael King might choose to avoid pharmaceutical companies’ free lunches and financial ties, other researchers, however, very happily continue to work with industry on surveys of this condition. And sometimes the drug companies don’t just fund the studies: they actively initiate them, run them and help write up their results. When sociologist Ed Laumann published the results of a later survey of sexual problems, this time around it was global—and this time it was directly funded by Pfizer.²⁵

      Funding wasn’t where the company’s role ended, either. One of the people who helped analyse and interpret the results was actually a Pfizer employee. And as Laumann explained it, the motivation for the huge international survey actually came from within Pfizer, which orchestrated it and paid for it. ‘It was a marketing effort,’ said Laumann bluntly, to help the drug company ‘gauge the scale of interest’ across the markets of many different nations.²⁶

      That study surveyed close to 30 000 men and women in almost 30 countries. It used similar questions to the ones Laumann had used in his original American survey, although this time round the results were not presented as dysfunctions, but rather as sexual problems. The rates were again extremely high, with findings that in some parts of the world over 40 per cent of women had experienced some problems. As an example, according to the results from countries in Northern Europe, almost 20 per cent of women apparently had the problem of failing to reach orgasm, with that figure rising to over 40 per cent in Southeast Asia. Those statistics sound horrifyingly high, and they give the sense the world is living through a plague of sexual problems. But it is worth taking a closer look at how those figures were calculated.