IE 11 is not supported. For an optimal experience visit our site on another browser.

The many mysteries of the female orgasm

Medical researchers do not often speak or write with exclamation points, but then most medical researchers don’t spend much time trying to figure out why some women are sexually unhappy.
F. Birchman /
/ Source: contributor

Medical researchers do not often speak or write with exclamation points, but then most medical researchers don’t spend much time trying to figure out why some women are sexually unhappy.

Dr. Susan Davis, however, does just that, and she’s annoyed. “Women’s sexual health has been very trivialized and neglected,” Davis argues. “If a man has a problem with sexual function, he is seen to have a biological problem. If a woman has a problem with sexual function, it is first considered psychological!”

Davis is correct. A 1977 review of “marital sexual dysfunctions” in the prestigious journal Annals of Internal Medicine declared: “For classification purposes, the three basic physiologic deficits — excitement phase dysfunction, orgasmic phase dysfunction and vaginismus — are subdivided into primary and secondary types. Primary dysfunctions represent long-standing developmental problems and are usually purely psychological in origin. Secondary dysfunctions occur after a period of normal sexual functioning and may be organic or psychological in origin.”

That dogma has held back research into female sexual function to the point that science still knows little about it. Davis, an M.D. and scientist at Australia’s Monash Medical School in Victoria can testify to the challenge. In a paper published in the Journal of the American Medical Association (JAMA) this week her team found that no single measurement of androgen hormones, like testosterone, could predict low desire.

As faithful readers of Sexploration know, there has been hope that treatment with testosterone can reignite passion, but Davis’ work shows that things may be more complicated. Some women with low testosterone did not have low desire, while some women with normal levels did.

A tool belt of sex drugs for men
So now we have just one more mystery about women’s sexual health and that’s what I found so fascinating. The new JAMA paper arrives shortly after a study showing that men who are too quick on the draw can be helped by a drug called dapoxetine. The drug, which is now being considered for approval by the Food and Drug Administration, may be good news for men with premature ejaculation.

Those who read the FDA tea leaves say a decision ought to come (sorry, I couldn’t help that) late in 2005 or early 2006.

So among our three choices (Viagra, Cialis and Levitra) to help us get and keep a stiffy, and maybe a drug to give us a more leisurely trip to Nirvana, we men are developing a tool belt of sex drugs. Look out, baby.

Meanwhile, women have … um … lemme think. Well, actually, I couldn’t think of much, so I went looking, and here’s what I found in the research: “lack of knowledge,” “additional studies needed,” “there have been limited anatomic and physiological investigations,” “information about the sexual health care needs for midlife women is limited.”

Though the situation is improving, science knows far too little about how women’s parts work. And government is mounting precious few studies to find out. When I looked for clinical trials related to female sexuality being sponsored by the National Institutes of Health, I found exactly two and they were related to the effects of cancer treatment.

And yet, according to a recent study by researchers at Yale School of Medicine and Albert Einstein College of Medicine, nearly half of all women suffer from some sexual problem. Many suffer from more than one.

Medicalizing nature?
Scientists like Davis are trying to change this and in so doing they have walked into something of a controversy. Last year, when Procter and Gamble was trying to win FDA approval for their female testosterone patch, which the company claimed could help women boost their sexual desire, some critics argued that drug companies were medicalizing nature, creating a new disease or syndrome in order to then sell a drug to treat it.

Davis has no patience for that argument. “There is a very loud lobby group that says this field of research is being driven by industry,” she says. But, she insists, “this is a real quality of life issue for a lot of people. When a disparity exists between sexual desire in a couple, it puts huge stresses on the relationship and in turn the family unit. Women want to be proactive in changing this and they have a right to be proactive if they choose … They are saddened that they have lost the desire for intimacy, which is such an important human emotion and they want to do something about it.”

“Industry,” she insists, “has not ‘created’ a health issue, it already exists.”

There’s no question that industry will be happy to capitalize; that’s what industry does. And with the success of the male sex drugs, it doesn’t take a business genius to realize what the payoff might be if you provided for the other half of the world’s population.

And business certainly is trying. In 2000, the FDA approved a clitoral suction device called Eros. Some studies have shown it increases blood flow to the clitoris and may enhance lubrication and satisfaction.

A New Jersey drug company called Palatin Technologies, which specializes in the brain — the main sex organ, is studying a nasal spray called P-141 in women with low desire (and in men with impotence).

And of course, there’s Intrinsa, the P&G testosterone patch, and a testosterone gel called Libigel from BioSante. They may or may not receive FDA approval, but both are far along the development path.

May never be a magic bullet
As this week's study shows, however, the link between hormone levels and sexual desire is still murky and it’s possible there won’t be a one-shot drug fix for the sex doldrums. In some cases, psychology may indeed be involved. Quality relationships are important, too. It all gets complicated.

Which brings me back to my point. Nobody really seems to know what’s what. This may be partly the fault of women themselves. Surveys show that most women hardly ever discuss sex with their doctors. But Davis attributes the new corporate interest to those women who do. “The surge of interest is very much being driven by the women in the community who are now being far more open about their sexual concerns," she says. "Women need to let it be known that they want more research into women’s sexual health.”

So women — and the men who love them — can affect change. Talk to your doctors and don’t spare the nitty gritty. If you aren’t getting lubricated, say so. If your lover is doing aerobics in bed to please you but you’d really rather switch on Leno, say so. If it hurts, say so.

Good sex is one of those things that makes life worth living so tell that doctor you want to shiver and shake like a Pentecostal at a revival meeting.

Nobody ever got answers by being shy.

Brian Alexander is a California-based writer who covers sex, relationships and health. He is a contributing editor at Glamour and the author of "Rapture: How Biotech Became the New Religion" (Basic Books).

Sexploration appears every other Thursday.