In a survey of 31,581 women across the U.S. ages 18 to 102, 44 percent reported having sexual problems, the most common being low desire for sex. The findings mirrored those of many other surveys — but what sets this one apart is that of those women reporting sexual problems, only 12 percent say they are are actually bothered by it.
The report's lead author, Dr. Jan L. Shifren of Massachusetts General Hospital, says “the reason the study is important is that we read about 30 or 40 percent us — women — experience sexual problems and we confirm that, yes, about 30 percent of women may note low desire, or orgasmic response, but when you ask if it is a distressing problem, that is a much lower percentage of women.”
In fact, suggested Shifren, “you could say that something affecting 40 percent is almost normative and not a medical disorder.”
In an editorial accompanying the published study, Dr. Ingrid Nygaard, a urogynecologist and professor at the University of Utah School of Medicine, told the story of a female patient “who, not bothered herself by her lack of interest but very bothered by her husband’s distress at her lack of interest, asked, “‘Why am I the abnormal one?’”
“What I see on a near daily basis are women of all ages who feel that because their sex drive is less than their partners’, they are inadequate and in the wrong,” Nygaard said in an interview.
But what does “normal” mean? Is it a perception of how one ranks compared to others? Is there some objective measure? And when does a doctor decide to treat?
According to the most widely accepted clinical definition, such problems should cause “distress” before they rise to the level of a treatable dysfunction. The paper’s results would seem to support those who argue that “female sexual dysfunction” has been over medicalized.
One way to approach these issues, Nygaard said, is to “focus on symptoms that are bothersome to the person. A condition is not abnormal until it’s bothersome, and that is a little bit of what the authors of the article did. I think you have to define normal in the context of the society in which we live.”
She was cautious, however, about how perceptions of normal are generated. Pop culture has created widespread sexual anxiety by making us believe that great sex is being had by all.
“I emphatically do not think we should look to those media examples as our norm,” Nygaard says. On the other hand, she said, “you do want to look at the population who has been exposed” to that culture because they may become distressed at not matching up.
This dilemma is one reason why some doctors are bothered by the whole idea of “bother” as a standard of medical dysfunction.
Irwin Goldstein, editor-in-chief of The Journal of Sexual Medicine and the director of the San Diego Sexual Medicine center, shrugs at the seemingly low 12 percent number, pointing out that it translates into millions of women and that if millions of patients were afflicted with a condition labeled with a word besides “sexual,” such as “cancer,” there would be major funding to expand knowledge and treatment.
Once you adopt bother as a barometer, Goldstein said, you risk trivializing.
He said he had one male patient with a skin disorder who had very low sexual desire. “If you just asked him, he would say he was not bothered by his low desire,” Goldstein said. “He would say he does not miss it at all. But he is really bothered by the fact he is going to lose his relationship.” Further inquiry by Goldstein revealed “he is interested in sex, but cannot stand the way he looks. Then you get another glimpse of the problem.”
Goldstein, Shifren and Nygaard all agree that these issues are challenging, especially for couples in which one partner has lost interest and the other has not. Ideally, Nygaard suggested, both partners should be considered. “Treating the unit is the optimal approach,” she said.
“Couples who are unable to be as one suffer a burden,” she said. “If we can intervene in ways to make them able to be as one, then that is a blessing.”
Brian Alexander is the author of the new book “America Unzipped: In Search of Sex and Satisfaction."