33 thoughts on “Guest Post: Interview with K on Female Sexual Dysfunction”

1. Really thought provoking! Thank you! “When talking about FSD, I am increasingly frustrated with the lack of participation by women who actually have FSD. I think that having a conversation about women without the actual involvement of the women in question is a real problem. Many of the feminist blog posts I’ve seen about filbanserin over the last few weeks have been posted by people who do not themselves give any indication that they have FSD, and who seem not to have taken a proactive approach to reach out to those who do live with it. I am disinclined to reach out to bloggers who write like this, because I don’t feel safe in their spaces.”
   This needs to change. We need to get off the ace high horse and hand out cake! Or cherry pies :)

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2. A few comments:

   K, you lament that almost all discourse about FSD is done by experts rather than women with FSD, however I suspect that there are systemic reasons for this fundamental for the very concept “FSD.” (A concept that can be usefully contrasted with the concept “asexuality”.) Masters and Johnson proposed a number of sexual dysfunction categories (highlighting the parallels between males and females and making anagous classifications for both), and the DSM relies on a modified version of this proposed by Helen Singer Kaplan. The label FSD (as the New View people like to point out) was introduced in the late 1990’s in conferences funded by the pharmacutical industry, in the wake of finding out how very profitable Viagra was–note that the idea of “FEMALE sexual dysfunction” is in considerable contrast the the DSM’s Masters and Johnson/Kaplan models that played down sex-differences. The concept FSD, by it’s nature, is a concept created by the medical establishment, in which they give themselves the authority to talk about it. This contrasts considerably with asexuality, which is a concept created by the people who identify that way. Asexuality, in contrast to FSD, is a grassroots movement, and the result is that “asexuals” have much more say in how asexuality is talked about than “women with FSD” have about how FSD is talked about. Moreover, a serious question that needs to be asked is why there is barely any FSD community to speak of. For most (serious) disorders, there are forums for people with that condition, as well and family and friends, to come together to talk and to address these issues. Why hasn’t anything like that developed for FSD? I suspect that the reason is that while there are some people very distressed about some FSD category, they may well be in the minority. For whatever reason, it appears that there are a relatively small number of people who find FSD to be a helpful identity (and to become active in advocacy work concerning it.)

   There are also a number of places where you attack straw men.
   The idiocy (itself an ablist term which here implies that anyone who believes in the validity of HSDD is unintelligent, and that is bad and therefore the person is bad,) she is referring to…
   While I would avoid the term “idiocy,” I have my sympathies with what the author is saying. The idea is that seen from a sensible viewpoint (like what the author considers her own viewpoint to be), this conceptualization is absurd/”idiotic”. It does not mean that anyone who accepts this idea is an “idiot.” Very sensible people can believe rather bad ideas–especially if they’re surrounded by other people with those bad ideas.

   Also, it makes little sense to me to consider not being interested in sex a disorder (and adding the requirement that it’s only a disorder if you’re distressed about it doesn’t fix this. I’ll avoid going into the history of that requirement suffice to say that ISD/HSDD has been in the DSM since 1980, and the bit about it only being a disorder if it causes marked distress or interpersonal difficulty was added in 1994 based on a decision by a handful of people, and with no consultation of the people assigned the task of revising the sexual dysfunctions.) However, it makes a great deal of sense to me to regard genital pain as being a disorder (although I agree with the people who think it makes little sense to call it a sexual disorder, and that it would make much more sense to classify it as a pain disorder.) Questioning HSDD does not entail rejecting all of the sexual dysfunction diagnoses.

   I believe that one of the unintended, unfortunate consequences of framing FSD and HSDD as manufactured by modern medicine is that it invalidates the experience of women who live with these conditions. If FSD does not exist, then women who have it must not exist either, and so there is no need to acknowledge women with FSD.
   No. Not even remotely. The social constructionist position (which I am sympathetic to in this case) is that the categories we use to talk about sexual matters are not simply out there in nature waiting to be discovered. At different times and places, people may conceptualize the same “reality” in very different ways (and, they argue, our very conceptualizations are part of reality. Thus, as the conceptualization FSD has been created, it is “real” to the extent that it forms how people think about things, including how they understand themselves.) The idea is that modern medicine created the categories that are used in conceptualizing certain issues as “female sexual dysfunction” rather than a multitude of other ways that the same issues conceivably be conceptualized. They are not claiming that the phenomena that are being labeled as “FSD” didn’t exist before that. Sadly, much social constructionism rhetoric suffers from lack of clarity and often use a term to refer not to what it generally refers to, but to the conceptualization itself, and this leaves many people confused and creates a lot of misunderstanding.

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   • This does skirt the line a bit, but I’m inclined to leave it up for now.

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   • Starting a bit out of order (it flows better this way!):

     However, it makes a great deal of sense to me to regard genital pain as being a disorder (although I agree with the people who think it makes little sense to call it a sexual disorder, and that it would make much more sense to classify it as a pain disorder.) Questioning HSDD does not entail rejecting all of the sexual dysfunction diagnoses.

     Actually there was already some debate between experts about whether or not sexual pain should be considered a pain disorder or a sexual dysfunction. I believe it was Y. Binik who proposed that dyspareunia be classfied as a pain disorder, becuase that’s who the editorial responses were in response to. This took place in 2005…

     And actually, one of the sexologists behind the New View Campaign wrote a letter to the editor in, in favor of leaving sexual pain under the category of “Sexual dysfunction.” Behold: Dyspaerunia is the only valid sexual dysfunction and certainly the only important one.

     You may not be able to see the full text of that article, that’s just the abstract. But I have the article in front of me, so here’ some supporting evidence:

     My criticisms have, however, focused on the universalized notions of desire, arousal, and orgasm in dysfunction nomenclature, and not on the inclusion of dyspareunia and sexual pain. Immeresed in the feminists literature on women’s health, I was more than aware of the disgraceful history of neglect and mishandling of women’s complaints of pelvic pain and thus it seemed that dyspareunia was the only sexual dysfunction with validity in women’s lives.

     It goes on like that in some fashion, though Dr. Tiefer continues to criticize universal norms & boxes to put people in.

     Now to me, this position that pain is a valid “Disorder” rather than a “dysfunction” is inadequate, because it ignores the sexual component of pain. You yourself expicitly said, “Genital pain” is a valid disorder. Yes, genital pain is a pain condition.
     But what about when that pain is present only under certain conditions? Such as during sex? If you have vulvodynia or vestibuiltis, you may (or may not) be able to go about most of your day and non-sexual life with no or very little discomfort. But when you go to have some kind of sex or insert something vaginally, it hurts!
     So when it’s situational, is that still a valid pain condition? Or is it then sexual dysfunction?

     Furthermore I still have not come to terms with why it’s okay to call sexual pain a dysfunction but not someone else’s loss of desire. Why is one recognized but the other is not? Why is my pain more valid and important and a dysfunction but, for another example, problems orgasming are not?

     Also, what to do and what, if anything, do you treat when you have overlap between genital, sexual pain, and some other sexual problem? When I was in the worst state I’ve been in, my libido crashed.

     BUT my position is…
     This doesn’t have to be an either/or thing. Vulvodynia, for example, I think of it as both a sexual dysfunction AND a pain disorder. It’s two things at once, at least for me. For other women for whom sexuality is not a concern, it may be solely a pain disorder.

     There’s something else in that same article that may address another point you bring up… You said:

     note that the idea of “FEMALE sexual dysfunction” is in considerable contrast the the DSM’s Masters and Johnson/Kaplan models that played down sex-differences.

     Just so you know I am already aware of the problematic history of sexual dysfunction. I have read about it and continue to read about it as I go along, so I won’t say I’m an expert in. Nonetheless I remain comfortable with the label today.

     Anyway it’s funny (not ha-ha funny though) that you mention this line, about supposed equality of sexual dysfunction between (presumably cis) men and women.
     For you see, in this same article and elsewhere in another one of her books, the same author Dr. Tiefer, she made this point:

     I believe it was a mistake for the American Psychatric Association (1980) to base a normative model for women’s sexuality on psychological research wherein Masters and Johnson (1966) described a universal “human sexual response cycle.” Masters and Johnsonson had used a highly selective sample in their research and in addition had coached their participants. The resulting normative cycle was inconsistent with what decades of feminist resarch had shown to be a highly diverse range of of women’s sexual responses in response to culture and circumstances.

     Basically what she’s saying is that, men and women are sexually socialized differently, so the M&J model that had supposed equality of the sexes in terms of dysfunction – in practice it’s really not that equal at all. Like, they had recruited women who already knew how to orgasm but at that time (and still today no doubt) there’s lots of women who do not orgasm regularly & do not masturbate.

     (in practice I have some issues with the equality of the sexes model with M&J – they had put vaginismus & erectile dysfunction across from each other, for example… but as far as I know, ED doesn’t hurt! Vaginismus can!)

     This contrasts considerably with asexuality, which is a concept created by the people who identify that way. Asexuality, in contrast to FSD, is a grassroots movement, and the result is that “asexuals” have much more say in how asexuality is talked about than “women with FSD” have about how FSD is talked about. Moreover, a serious question that needs to be asked is why there is barely any FSD community to speak of. For most (serious) disorders, there are forums for people with that condition, as well and family and friends, to come together to talk and to address these issues. Why hasn’t anything like that developed for FSD? I suspect that the reason is that while there are some people very distressed about some FSD category, they may well be in the minority. For whatever reason, it appears that there are a relatively small number of people who find FSD to be a helpful identity (and to become active in advocacy work concerning it.)

     I thought I *was* doing grassroots activism with the blogging about female sexual dysfunction.

     The history of FSD is largely in the hands of medical doctors, but why should it remain that way going forward? I am hoping to create a place where women with different kinds of FSD *can* speak about thier problems and maybe learn from each other. The blog Feminists with Disabilities (FWD) went up last year in response to the feminist community’s (mis)handling of disability issues. Some of the disabilities discussed and lived with there have similarly fraught histories.

     Furthermore there are some broken up support communities for sexual dysfunction. Part of the reason may be specialization – FSD is a broad topic. Not sure why you put “Serious” in parenthesis there; sexual dysfunction *is* serious. There are support communities for vulvodynia exclusively and for libido problems, for example, after going off SSRIs.

     Basically just because the commnity does not exist *right now* doesn’t necessarily mean that it *shouldn’t* exist. Philosophically, I see no reason why women with FSD can’t get involved with grassroots activism now. (In practice I see that there may be practical barriers related to accessibility.)

     And the small population of women with FSD does not rule out the *need* for a community. Relatively few women have vulvodynia too. But the vulvodynia communities are fairly active (they go through off-and-on periods as I’m sure many communities do.)

     But I am not presently aware of a unified group that advocates for FSD broadly. (If you know or find one, please point me in that direction.)

     I have a feeling that a big chunk of the reason that support communites are so hard to find and why I haven’t found a unified group yet is because of stigma. FSD is stigmatized from multiple angles. The medical model stigmatizes it too, by saying it’s something wrong with you that needs treatment. But I don’t feel any more comfortable with social construction, either – in practice, I’ve seen individual advocates of the social construction model dismiss women with FSD and make broad, sweeping, often sexist and/or disabilist claims about them. So even though I’m comfortable with that label, a lot of other women probably aren’t because of all the stigma attached to sexual dysfunction.

     While I would avoid the term “idiocy,” I have my sympathies with what the author is saying.
     I’m guessing you probably don’t want to talk about calling out ableist language, but what part of the what the author is saying do you agree with? The part that I brought up here — That was her conclusion, that the existence of flibanserin would lead to women not “Taking control” of their sexuality. That is not only ableist but sexist on top.
     I see absolutely no reason why using sexual medicine and exploring, or as she puts it, “Taking control” of one’s sexuality are mutually exclusive things. You can do both at the same time. And I don’t think that doctors are going to, by and large, go around willy-nilly diagnosing women with HSDD and then prescribing medication… becuase that’s not what I’ve seen happen to the women I’ve been talking with. That’s not how it went down for me… and I’ve got the one problem that even you could consider a valid “Disorder.” HSDD seems to be even more controversial then that.

     The social constructionist position (which I am sympathetic to in this case) is that the categories we use to talk about sexual matters are not simply out there in nature waiting to be discovered. At different times and places, people may conceptualize the same “reality” in very different ways (and, they argue, our very conceptualizations are part of reality. Thus, as the conceptualization FSD has been created, it is “real” to the extent that it forms how people think about things, including how they understand themselves.) … They are not claiming that the phenomena that are being labeled as “FSD” didn’t exist before that.

     I am familiar with this concept, that naming the reality doesn’t just name, but creates the reality.
     But in this case, with FSD – I’m comfortable with the clinical label, because it’s accurate for me. Downgrading what I have a “Sexual problem” does not capture the *Degree* to which this is a problem. So I have serious problems when I see, for example, people calling FSD “Mythical.” That happened recently here, and in this case it encompassed a pain problem.

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     • I had read Binik’s paper and a number of the commentaries, so I am aware of the arguments for different positions. The short version is that I am inclined to agree with Binik (at least at a theoretical level), though I don’t feel too terribly strongly about the matter. (Practically, it makes a difference in terms of who–if anyone–researches the matter, and who people would be referred to for help, and whether those people would be knowledgeable about the matter, especially given that med schools tend to have very little education about sexuality. If you haven’t read it already, I’d definitely recommend the recent Binik and Meana article and commentaries for a good description of the issues sex-therapy is having as a field.)

       I thought I *was* doing grassroots activism with the blogging about female sexual dysfunction.
       You are, but simply in terms of proportions of grass-roots activism vs. experts making authoritative pronouncements, there are clear differences between asexuality and FSD and I think this has to do with the ideological and historical factors involved. I am not making any claims that there shouldn’t be more activism of women with FSD–I suppose that I am expressing skepticism about the viability of such a movement. (I would have no objection should I prove to be totally wrong in this prediction.) People in the asexual community identify as asexual largely because they simply feel that it fits, they feel that it helps them make sense of their experiences. You identify as a woman with FSD because you feel that that label fits. What I remain skeptical about is whether there is an especially large population of people who feel (or would feel) similarly. The question is how much of a demand is there for an FSD community. I’m not thinking here in terms of should or ought as much as wondering out loud about the supply and demand of the situation. (I also suspect that the situation is different for different ones of the current diagnoses.)

       Not sure why you put “Serious” in parenthesis there; sexual dysfunction *is* serious.
       The quotes were used because I am neither claiming that it objectively is or is not serious, but in terms of my above musings, what is most relevant is people’s perception of whether it is serious or not. (If they don’t view it as serious, they’re not going to seek out a community for support.)

       Regarding the “idiocy” comment, I avoid the word “idiocy” because of criticisms of it being abelist, but my point is simply that, at some gut level, I feel sympathetic with applying the term to the idea of calling HSDD a mental disorder. Further, the feeling behind this sense (and what I assume the author meant in saying this) simply does not imply what you said it implies. I’m not entirely sure where you get the “taking control” of their sexuality bit in the post that you quote either, or how that had anything to do with anything I said.

       Going back to something earlier in your reply,
       Furthermore I still have not come to terms with why it’s okay to call sexual pain a dysfunction but not someone else’s loss of desire. Why is one recognized but the other is not? Why is my pain more valid and important and a dysfunction but, for another example, problems orgasming are not?
       The short version is that urogenital pain is, by its very nature, painful. Not being interested in sex is not. For a longer version of my argument of why I don’t think it makes sense to regard HSDD as a disorder see Pathology and Asexual Politics. The argument I make there doesn’t apply to urogenital pain, although it probably contributes to my preference for considering it a pain disorder rather than a sexual disorder.

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       • Re: the idiocy and not taking control of their sexuality bit–read the last paragraph of RavenScholar’s post again, it’s directly stated:

         How many people will develop actual problems from this idiocy, and how many people will never bother to try and take control of their sexuality and own their bodies because their “problems” can be medicated away?

         Given this, I’m going to agree with K on that. I do think that a person saying something is “idiocy” and then going on to say that people won’t bother to take control of their sexuality and their own bodies does imply that the people “medicating their problems away” are idiots. Plus, the phrase “actual problems” implies that they do not have problems at all, and thus are being duped by Big Pharma into thinking they do. And isn’t it the usual assumption that smart people wouldn’t be duped by advertising etc.?

         Also, I do think you take the “idiocy” comment a bit too literally even without those context clues, as generally speaking more often than not I believe people DO mean to imply that people who buy into what they call “idiocy” actually are idiots. Unless the person specifically clarifies that they do NOT think that way, I would see no reason to interpret it the way that you did.

         Edited to add: One more thing… try flipping RavenScholar’s last paragraph around to be about asexuality instead of HSDD, and replace “medicated away” with something like “ignored because they embraced a label for something that doesn’t exist”—wouldn’t you be offended?

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         • I’m not entirely convinced of your reading of RavenScholar, though I am now less convinced of my own reading as well. Regarding your edit, I’m not sure what relevance it has to suggest that I would be offended if the author said something entirely different from what they actually said. (Granted, I’m skeptical of the whole notion of what it means to “take control of one’s sexuality” and suspect that it’s a phrase very elastic in meaning that can be applied to argue for just about whatever, so I have no intention of defending the idea.) I suggest that we drop the issue of what RavenScholar did or not not mean.

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           • My point about the reversal was that it’s not actually all that different from things I’ve heard said about asexuality, minus that end part. The actual words that she used are certainly not “entirely different,” they are only used in a different context, with a different group of people being othered and belittled for their decisions. (Actually, it pretty much implies that they don’t even make any decisions at all and just go along with whatever people tell them to do, as if they don’t have minds, and don’t even own themselves because of it.) Which is beyond offensive, and I hope you see that.

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       • And I disagree on reclassifying dyspareunia as a pain disorder – at least, as exclusively a pain disorder. On the printout of the page I used to show Tiefer’s position in favor of retaining dyspaerunia as a sexual dysfunction (so long as such a term exists anyway,) there’s another letter to the editor that I can’t properly cite because I don’t have the page that came before it… but it’s a letter from someone who also supports retaining pain like vestibulitis as a sexual dysfunction. Sometimes thats’ the main impetus for seeking treatment in the first place – the pain may be manageable outside of sex, but sex makes it worse and causes more problems.

         In practice, you don’t feel strongly in either direction. I do. Here’s an example of why recognizing pain as FSD matters:

         “Listen, I said, is this a neuroogical problem? It’s as if my vagina can’t process sensation correctly. As if any sensation feels like pain.
         That’s what’s wrong with it, he said.
         Shouldn’t I go to a neurologist? I asked.
         I’ve sent some patients with this to neurologists, and they send them right back. They think it’s gynecological.
         Well, it’s both, isn’t it? I asked.
         Yes, he said, it’s both.”

         This is an interaction described in the memior, The Camera My Mother Gave Me. (location 1937.) The author is talking to her main doctor about all the approaches she’s taken to addressing her vulvovaginal pain.

         The author had been getting bounced around from doctor to doctor when she tried to address her vulvovaginal pain. This really happens. This still happens. That’s why I feel so strongly about recognizing dyspareunia as a form of FSD rather than exclusively a pain disorder. It’ really both.
         If we try to restrict sexual pain to one speciality, in practice I think that’s going to work poorly becuase there’s a pretty good chance that specialists who are used to working with pain in other areas of the body are going to be unprepared to deal with sexual pain. Isn’t that a woman’s issue? Go see your gynecologist, who may think it’s a psychological problem. I have heard from women who have then been referred to sex therapists (who often have some credentals in psychology.) There’s a lot of bouncing around to begin with.

         Likewise, treating dyspareunia as exclusively pain may not address the relationship stress that may be accompanied with sexual pain. It really shook up my conception of what my sex life was going to look like. It’s really strong and a pain doctor may not know what to do with that.

         Though the meaning of the word “Dyspareunia” should probably be expanded to recognize painful non-intercourse sexual activity.

         What I remain skeptical about is whether there is an especially large population of people who feel (or would feel) similarly. The question is how much of a demand is there for an FSD community. I’m not thinking here in terms of should or ought as much as wondering out loud about the supply and demand of the situation. (I also suspect that the situation is different for different ones of the current diagnoses.)
         I think there’s a need for such a community, based on comments I’ve gotten from women who hang around on my blog.
         How much does the size of the demand matter? How much demand is “Enough” to start to work on forming some kind of community? Do I need to be able to quantify the # of women with FSD who feel quite strongly enough about it as being > X? What arbitrary thresh hold do I need to pass to show that this is has merit?

         I see from that sociological images post (You write that?) that the asexual community as we know it is only about 10 years old. Is this correct? So how long does it take for a new community to become respectable? Frustration: How much longer do I gotta keep doing this before people recognize that it is important. I been doin’ this activism thing for like 2 years now.

         The short version is that urogenital pain is, by its very nature, painful. Not being interested in sex is not.
         But there are many disorders which are quite serious and considered mental illness or dysfunction which do *not* involve physical pain. The fact that these disorders do not involve identifiable pain does not in any way diminish the validity of someone’s distress from living with interference caused by such conditions. Distress which may be bad enough to constitute some kind of outside, medical management, either exclusively or better yet in addition to expanding the definition of “Normal” and “health.”

         I’ve read social construction arguments against mental illness, so this is a broad thing not limited to just sexual dysfunction. I think that chewed-up rehashes of such arguments are part of the stimulus behind the formation of FWD; feminists came together in response to disabilism within the feminist community. Disabilism which was not just limited to physical conditions, it also included mental disorders. Any single piece of social construction arguing against mental illness may be valid in and of it itself, but when it’s presented as something new or when all the pieces pile up into a heap of guilt and stigma, then you have yourself quite a big problem.

         Sometimes all the social construction in the world does not address the impairment a person has. The social model of disability recognizes that impairments exist. You can have something going on that’s not quite right. But since it recognizes bodily autonomy, you don’t necessarily need to do anything about it. But if you do choose to manage the symptoms of an impairment, then stigma against having the impairment in the first place just makes management and accessibility so much harder.

         That is why I cannot prioritize pain over all other sexual problems. The distress I felt was bad enough, even though I wasn’t always having sex. Leave my crotch alone, and pain-wise I was… sort of okay… only sort of though since there were other weird sensations and processes going on downstairs.
         But what if I hadn’t had a pain problem. It was relatively easy for me to get a diagnosis, because pain was something that could be proven…
         Except in a strange contradiction, this study excluded pain as sexual dysfunction precisely BECAUSE you needed to have a doctor prove the existence of pain. Hmm… what’s up with that. I am very suspicious of this exclusion.

         But if the distress I had was that bad, what about what other women feel when they cannot ascribe some physical *reason* to a drop or lack of libido? I recognizes that sometimes, low libido in and of itself can be a source of stress. Living in a sex-charged culture doesn’t help, and we can address that at the same time. But I think that sometimes looking at social & cultural problems exclusively is still inadequate.

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         • You write that?
           Yes. I tried to indicate that in the comment where I linked to it.

           But there are many disorders which are quite serious and considered mental illness or dysfunction which do *not* involve physical pain. The fact that these disorders do not involve identifiable pain does not in any way diminish the validity of someone’s distress from living with interference caused by such conditions. Distress which may be bad enough to constitute some kind of outside, medical management, either exclusively or better yet in addition to expanding the definition of “Normal” and “health.”

           There are two main issues involved, one conceptual and one more practical. Conceptually, the issue is what is a disorder. The DSM’s definition (principally) centers around psychological or behavior conditions that cause distress or impairment. Regarding distress, there is a question of whether it the distress has to be inherent to the condition (i.e. “physical pain” as in pain disorders, or “psychic pain” as in anxiety disorders), or whether it can merely be distress about some trait or behavioral pattern. The author of this definition (Robert Spitzer) has argued that it should only include the former, though the clinical significance criteria seem to suggest thatthe latter is how DSM-IV treats the matter. Permitting distress about a condition to make the condition a disorder leads to the vital question of what conditions that someone can be distressed about should be seen as disorders and which shouldn’t. Clearly it would be inappropriate to list in the DSM anything whatsoever that people can be distressed about. Many people are distressed (feel guilty) about their habits of masturbating. Should masturbation, if it causes distress, be in the DSM (or ICD)? The DSM used to include ego-dystonic homosexuality as a disorder. Should it be added again? If you answer these in the negative, you’ll need to come up with some criteria for why these would be inappropriate to call mental disorders whereas distress about not being interested in sex is appropriately called a mental disorder. You could try to argue that not being interested in sex is a impairment in sexual function (i.e. it is a disability). What you are saying seems to be going in this direction, at times. But if you say this, then there should be no reason for requiring distress. It should be regarded as a disability regardless of whether or not the person is distressed about it. (This is precisely the logic that was used for not requiring distress for ISD in DSM-III.) Would you regard visual impairment, or paraplegia as disabilities only if they cause distress? That would seem to suggest that someone who has come to accept their condition and live a happy and fulfilling life with it should no longer be eligible for accommodations or medical care regarding it.

           The practical issue is that for conditions that are neither impairing nor (inherently) painful, convincing people that it’s not a problem is actually a rather effective solution to the distress. This has been seen a lot in the asexual community, and it has been seen by sex therapists who want to normalize the lower range of sexual desire, calling it still in the normal range. (Because of societal expectations, it is not uncommon for people–especially women–to be distressed about what they believe to be their low sexual desire, when it is statistically “normal” for someone in their position.) This simply isn’t true of pain disorders. Even if someone becomes convinced that there is nothing wrong with their pain, it still hurts.

           Moreover, given that convincing people that there’s nothing wrong with their not being interested in sex has strong anecdotal evidence indicating its effectiveness, labeling lack of sexual interest in sex as a disorder (but only if it causes distress) is likely counter-productive to the goal of reducing distress. It helps to reinforce in the sexually uninterested, in therapists, and in the general public that there is something wrong with not being interested in sex.

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           • Would you regard visual impairment, or paraplegia as disabilities only if they cause distress? That would seem to suggest that someone who has come to accept their condition and live a happy and fulfilling life with it should no longer be eligible for accommodations or medical care regarding it.

             Perhaps you should ask people with disabilities these questions?

             It sounds like you’re looking for an objective standard by which to measure disability. This makes some sense from a diagnostic, scientific viewpoint but in real life, issues of disability aren’t as clear-cut, and there are still questions of what disability is and who lives with it, even within communities of people with disabilites. This is an interesting comment when juxtaposed with a comment below, where Sciatrix asked, “Another clarification: is there a community of women with what we currently call HSDD who are invested in the conceptualization of lack of sexual attraction or desire as a disorder/disability?”

             I think a part of the reason that considering distress is so important, is because sexuality is complex. The existence of FSD and HSDD in no way diminishes or simplifies this complexity, so what feels normal & comfortable for one person, may feel like a shock to another.

             Moreover, given that convincing people that there’s nothing wrong with their not being interested in sex has strong anecdotal evidence indicating its effectiveness, labeling lack of sexual interest in sex as a disorder (but only if it causes distress) is likely counter-productive to the goal of reducing distress. It helps to reinforce in the sexually uninterested, in therapists, and in the general public that there is something wrong with not being interested in sex.

             Not necessarily. There are disability activists who argue that there is nothing inhernetly wrong with being disabled, with having an impairment. But the impairment itself and lack of understanding broadly can nonetheless present obstacles.

             And you can do both at the same time – You can recognize disabilities and impairments and stress that accompanies them as valid, while still working for greater acceptance and questioning what normal really is.

             I am not convinced that the existence of sexual dysfunction as a disorder is entirely to blame for creating sexual anxiety. We can look at the medical model of sexual dysfunction and labels. But I think we also need to look at some unfortunate, probably unforseen side effects of the sexual revolution: “There is a generation of women getting older who started the sexual revolution… They bought vibrators, read the Kama Sutra and when their sex lives aren’t good they get pissed off about it.”

             Dr. Marty Klein is a sex therapist, who’s been practicing for decades. About ten years ago, he and Riki Robbins wrote Let me count the ways, which is a book which encourages readers to re-frame the way they think about sex and sexual problems. Is what you have a problem, and if you think so, why? Think about things differently, think about who gets to define what “Normal” is, take away the social pressures to perform.
             Nonetheless, earlier this year, he wrote, “Western psychologists have known for a century that sexuality is a complex and subtle combination of biological, psychological, and social components. And so all competent therapists use a ‘comprehensive approach’ to sexual issues. And we encourage other therapists to use it as well. But here’s the unfortunate truth of American psychotherapy, marriage counseling, and clinical sexology: this ‘comprehensive approach’ isn’t nearly as effective as we or our patients would like. In fact, inhibited desire in both men and women is the sexual issue with which therapists have the least success.”
             That’s a big concern for me. I’m fine with letting people know that it is okay to have low desire, to consider asexuality, or to think about what’s considered low libido in the first place. I’m fine with letting people know that it’s also okay to have a disability or to have a sexual dysfunction.
             What happens when that comprehensive approach doesn’t do the trick? What do you do when all the social construction in the world is not enough to put your mind at ease. My distress (and the physical symptoms) eased up only after a doctor recognized what I was going through & I started getting treatment. My pain is better-managed now, but I’m still real stressed out.

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3. I found this very interesting reading, and will try to keep some of the points you have in mind. Outside of the issue of Flibanserin, were there any recurring issues with respect to the asexuality community that you found alienating? You mentioned not feeling safe in asexual spaces earlier, and I’d like clarification on that so that I can make sure not to do it myself on my own blog.

   Another clarification: is there a community of women with what we currently call HSDD who are invested in the conceptualization of lack of sexual attraction or desire as a disorder/disability? I don’t think that within the specifically asexual community any other sexual dysfunctions are generally viewed as problematic. In fact, I often see only lifelong HSDD classified as problematic, not the temporary form.

   One of the things I did have concern with regarding the idea of women with low libido self-identifying as disabled is that lack of attraction/libido is not a piece of cake in this culture. I think that, from my perspective as an asexual blogger, saying that whether to define lack of attraction/libido as a disability is a personal choice is very much an upsetting concept for me. Partly this is because conceptualizing lack of sexual desire as a disability is not actually a purely personal thing. When we conceptualize things as disabilities, we say that they limit us in life. I can see conceptualizing genital pain like vulvodynia or sexual dysfunctions PAST the issue of desire and attraction as disabilities, because they prevent you from doing something you otherwise want to do. But conceptualizing the very lack of sexual attraction/desire as a disability is very problematic, I feel, because rather than preventing one from doing something, one is being prevented from wanting it in the first place.

   (There’s also the problem raised that if we’re going to medicalize a condition, it’s probably not a good idea to make it so subjective that a diagnostic criterion is whether you identify as disabled because of that condition. That’s me approaching the matter from a purely scientific/administrative framework, not an ethical or disability-centered one.)

   Moreover, it’s possible–and actually, in my experience, quite common–for someone in the asexual community to come in, say, “I think I’m asexual. And this SUCKS, I don’t want to be asexual!” And I think the reason for that is not that asexuality is inherently a source of distress, but rather that having a marginalized sexual orientation is a fairly nasty place to be in, particularly if you have a romantic orientation that does not match up to your sexual orientation.

   I’ve said in the past that my main problem with HSDD–even with the discomfort clause in place–is that it approaches a person who does not experience sexual attraction or sexual desire and is unhappy with this because it sucks as a thing to change about that person. Rather than approaching the problem with an attitude of “how do we make the world easier for people like you to navigate,” the conceptualization of HSDD instead replies “You’re right, that’s a terrible thing to be. We’d better fix you to make you like everyone else.”

   My personal background with disability is the neurodiversity movement, which is centered around the idea that the answer to questions like “it’s difficult to be myself, because the world is not set up for people like me” should be much closer to the first answer than the second. So I find it a little strange that “fix the difference” should be a more preferable solution to the problem than “fix the structural problems making this an issue in the first place.”

   Which is not to say that I don’t think that the voices of women with FSD or what we now call HSDD should be heard. Is there an existing support network of bloggers with FSD or a sexual-dysfunction support group where these kinds of discussions are going on? If we’re going to create safe spaces for women with sexual dysfunctions within asexuality spaces, it would be nice to hear lots of women talk about their experiences.

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   • And you know, I just realized that that last paragraph sounds suspiciously like “educate me! I don’t want to do the work of looking on my own!” So I am going to go click links on your blogroll and possibly make friends with Google. K, If you feel up to linking to something specific to HSDD/low desire or attraction within FSD and conceptualization as a disability, that would be awesome. If you don’t, feel free to not bother.

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     • This isn’t about low desire/HSDD as disability but I found this a few weeks ago and I’ve been wanting to share. Here’s something I found that may be relevant to what you’re looking for: in Google Books about vaginismus…

       What’s very interesting to me is the rest of the book it’s a part of. Illness in the Academy: A collection of pathologizes by academics.

       “Given my later training in gender studies, ti became tempting to try to believe that this wasn’t a “problem” or “dysfunction”; it was simple a “diference.” But given the imperative we receive in our culture to express our sexual beings, the messages we’re sent that suggest we’re incomplete, uptight, wound-up, or repressed if we can’t or don’tl it doesn’t feel like merely a diference; it feels like a defecit. It alsod oesn’t feel like just a difference when the desire is there, but the measn of expression are not.”

       Then later, “Is it wrong to want my vagina to open?”

       Vaginismus… illness… pathology… illness.. included in the same place as things that are more readily recognized as illness… cancer, pain, disabled identity, diabetes, pain… personal narratives. Vaginismus. What does this mean. I am not used to seeing such a thing.

       I haven’t quite worked out how I feel about this essay but I think it does lend some support to FSD as disability. Like, this + my own feelings on how I can’t prioritize pain above all others.

       Otherwise I’m still working on it… it might, in the end, not work out at all to include HSDD as disability. It might, it might not. I think I need more feedback.

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       • What’s interesting to me about that passage you quoted is that it really sounds like something that tends to come up in the asexual community a lot. From the discussions I’ve read about this, I suspect there would be several people who read that and think, “So why not change society instead of trying to change the individual?” and probably would go on to argue that saying that HSDD constitutes a disability (or even a disorder) would inherently be putting a judgment on the individual with HSDD/low sexual desire/interest that they are somehow broken, which contributes to the sense a person has that it’s a deficit. I do think that’s ignoring the pain of not being able to express the desire that is there, though. The value judgment thing, on the other hand, is something I don’t think I can answer. Is it inherently stigmatizing to even fit in a category of having a disorder/disability? Or is the social stigma separable from the words? Is this just a chicken-and-egg issue?

         I’m not too familiar with disability discourse in general, so perhaps this is something that you’ve seen some insightful thoughts about that I haven’t been exposed to yet.

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       • Oh, thank you very much for that! I found it extremely powerful as well as interesting to read.

         I honestly can’t see any issue with defining FSD more generally, especially aspects like vulvodynia or vaginismus, as a form of disability. After all, those are dysfunctions which can prevent a woman (or biologically female person) from doing something she does want to do, which is engage in a particular form of sexual activity. Or, you know, from going about life pain free. In particular for vulvar pain which is not situationally confined, how could that be any different from any other chronic pain disorder? Pain is pain, sexual pain or no. And if you want to do something, and your body prevents you, how could that not be a form of disability?

         In the linked passage, the author very much came across to me as wanting to engage in PIV sex, but her vaginismus prevented her from doing so. And she had a lot of unpleasant baggage that developed as a result of that. It struck me as wanting but unable to do, which to me is not the same as not wanting.

         (I also thought her linkage of heterosexual but unable to participate in PIV to queerness and transness was really interesting, actually. Particularly since the act of PIV sex is so very tied to the concept of what it means to be heterosexual.)

         It’s the pathologization of lack of desire inherent in the structure of what is now called HSDD that bothers me. Especially, again, lifelong HSDD–I don’t know how familiar you are with the asexual community, but asexuals tend to emphasize that if you’ve just experienced a sudden drop in libido or have suddenly stopped experiencing sexual attraction, this is often a worrying thing that you should investigate further just in case something is wrong.

         To reference Elizabeth’s above comment, I’m very much one of the people who goes “well, if the social stigma is the root of the problem, maybe changing the social stigma is more useful than changing the person themselves to avoid the stigma.” And at the same time, I really want to support people who are upset, and who do want to be “normal” at the same time. But I don’t think that making disability our most common framework for thinking about pervasive lack of attraction or primary sexual desire is going to do anything to remove those societal issues. I think that framing that particular issue as disability actually serves to add to stigma, and while part of it is just the general shitty stigma disability of any sort brings to the table, I think part of it is also imbedded in what disability actually is. That is–is not being sexually attracted to others really something which restricts our ability to do what we want to?

         (I should note also that my perspective is also a little bit, ah, not as pressured about sex? Because I don’t really seem to experience romantic interest in others as such, which means that a lot of the specific problems inherent to women who don’t desire sex but do desire monogamous romantic relationships don’t apply to me. So on this particular situation, I maybe experience some privilege about my asexuality that maybe romantic asexuals don’t have.)

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         • [This comment deleted because K had replied to the wrong thread. Its contents were reposted here. -Elizabeth]

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           • Okay actually you know what,

             Outside of the issue of Flibanserin, were there any recurring issues with respect to the asexuality community that you found alienating? You mentioned not feeling safe in asexual spaces earlier, and I’d like clarification on that so that I can make sure not to do it myself on my own blog.

             then:

             My gut inclination is to relate people who want a cure for low desire to the “ex-gay” movement and to things like reparative therapy. And to the autistic people I’ve talked to who want a cure for autism. And, well, that idea makes my skin crawl, but then I happen to have a lot of baggage surrounding the concept of “cures” for things like that, for a lot of reasons surrounding my personal history. It smells to me like a form of self-hatred.

             okay you know what…
             Case in point with the alienation thing. Okay so I’m not comfortable with the word “Cure” but I do recognize that some folks with low libido may want to address that somehow. Because it in and of itself may be a source of stress in some people. Who are a diverse bunch & that includes individuals with fsd.

             How is that like a hateful bigoted group?

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         • Thanks, Elizabeth.

           Okay here’s what I *should* have posted in response to this specific comment.

           I honestly can’t see any issue with defining FSD more generally, especially aspects like vulvodynia or vaginismus, as a form of disability. After all, those are dysfunctions which can prevent a woman (or biologically female person) from doing something she does want to do, which is engage in a particular form of sexual activity. Or, you know, from going about life pain free. In particular for vulvar pain which is not situationally confined, how could that be any different from any other chronic pain disorder? Pain is pain, sexual pain or no. And if you want to do something, and your body prevents you, how could that not be a form of disability?

           You’re open to the idea of painful genitals or painful sex as a valid pain condition or a disability. So okay, under this view my vulvodynia and maybe the vaginismus is enough to contitute disability. Which, I would agree with since it’s getting in my way and making life hard and I really need some help with this.
           But to me to ignore the sexual component, the sexual dysfunction, is missing out on, what for many folks, obviously not all folks, is a big component of life with such pain.

           I’m relatively loose with FSD – I’m not saying that all people who have a sex problem have it. There’s lots of sex problems that never pass someone’s thresh hold to become significant enough to warrant looking at it as a sexual dysfunction. Besides, I really don’t like to go around slapping labels on people.

           But what I can’t come to terms with, is recognizing something like pain as a valid disability, or as a valid dysfunction (as shown in an above quote,) is that it creates this, artificial hiearchy of disability and dysfunction. My physical pain is valid and warrants treatment, yours doesn’t. My pain is real, because it’s physical, yours isn’t becuase your pain is psychological. Or else we’re pretty sure it’s psychological pain because we can’t find any physical impairments using the measures we currently have available. I can prove my disability and certainly my sexual dysfunction in one way or another; you aren’t disabled or dysfunctional enough.

           In the linked passage, the author very much came across to me as wanting to engage in PIV sex, but her vaginismus prevented her from doing so. And she had a lot of unpleasant baggage that developed as a result of that. It struck me as wanting but unable to do, which to me is not the same as not wanting.
           With a number of the women I’ve been in contact with, it’s very similar, if not the same, when there’s low libido. Someone in a comment thread at a Feministe post, I remember described it as a feeling like, a disconnection between what the body and brain want. There’s a want there – but for some reason the right conditions aren’t being met. The want is there, somewhere… Sometimes, it’s missed dearly. But the drive to act that I feel now, doesn’t show for a long time.

           Especially, again, lifelong HSDD–I don’t know how familiar you are with the asexual community, but asexuals tend to emphasize that if you’ve just experienced a sudden drop in libido or have suddenly stopped experiencing sexual attraction, this is often a worrying thing that you should investigate further just in case something is wrong.
           See this is actually I think, the first time that someone from within the asexual community has said this to me. I’m seeing a lot of focus on people with lifelong low libido. (I could go on a tangent here about how we’re defining lifelong but this might work better on a dedicated post.)
           There’s intersectionality things to consider too – if you get a physical problem like pain under control, and/or every other potential social problem is addressed, but your low libido which used to be comfortable does not rebound, what then? Then is it okay to consider medication? Not that that question probably matters much right now since there’s still not a readily available medication for HSDD anyway. There’s that Intrinsia patch but it’s only in Europe and I don’t know how all well it’s working out over there yet.

           But I don’t think that making disability our most common framework for thinking about pervasive lack of attraction or primary sexual desire is going to do anything to remove those societal issues…. That is–is not being sexually attracted to others really something which restricts our ability to do what we want to?
           It’s not just the low libido in and of itself though – I’m worried about the distress that sometimes accompanies it. In that case, the sexual attraction is there. But it’s so hard to sync up with it when you want to. Which doesn’t accompany it all the time. But when it does and it’s serious enough to get in the way – then I think you may have something there that warrants further investigation.

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   • Another clarification: is there a community of women with what we currently call HSDD who are invested in the conceptualization of lack of sexual attraction or desire as a disorder/disability?
     Not that I am currently aware of however this does not mean that such a community does not exist. I haven’t found one yet.
     There’s a couple of medical-oriented websites run by clinics & doctors that have forums attached to them. Does that count? I think that’s primarily for advice, which is something I try *not* to give. Like with His and her boards. It’s not so much about steering the conversation…

     Not saying such a place doesn’t exist though so if you find one, plz point it out to me. My google-fu is weak; it comes up with stuff with alterior motives.

     I actually do get a lot of where the reluctance to classify FSD and HSDD as disability comes from. When I was thinking about FSD as disability, you can still see this in the text of the post, I was feeling like, Well maybe it’s not fair to classify low desire in and of itself as a disability because you know there really IS a lot of bullshit in sexual culture… it was easier for me to think of it as *part* of disability when accompanied by something else. Like pain or as a side effect of medication.
     Then I saw the comments about flibanserin and I was like “wooooooah” and totally changed my mind.

     My understanding of the social model of disability though, is that, just becuase you have a disability, that doens’t necessarily mean you gotta *do* anything about it.

     Like, it isn’t just the disability in and of itself that limits life. If culture did a better job of making life more accessible, if needs were not “Special” then in practice some impairments would not be as disabling as they are. So in this case if (Western, I live in the US) culture wasn’t so contradictory and pushy about what sex is supposed to be like then where would distress about low desire even come from? Maybe a lot of it wouldn’t even be there.

     It’s possible to medicate to manage symptoms and to look at, try to change, the broader culture at the same time. I think in some cases that’s totally appropriate; use whatever means necessary to manage your impairment or symptoms, what’s causing you distress. Social change takes a long, long time and some of us can’t wait that long for the change to happen.

     But at the same time I think it’s okay to try to put the information out there that says, *not* treating is also an option. There’s a long history of forced medication on people with disabilities & it seems like a lot of the resistance against HSDD comes from a similar vein. A lot of women with what might be considered low libido (there’s questions about how do we even measure such a thing) do not need any medicine.

     But then I’ve also heard from women who are so frustrated with a low libido that they are open to medicine. The culture sucks but that doens’t necessarily mean they don’t have some kind of impairment going on, either. It can be both.

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     • I noticed a lot of rather iffy-looking websites too when I tried googling for HSDD support groups and related terms. One in particular appeared to be almost entirely around marketing products, especially drugs of various types to women with HSDD. With no apparent discussion of any possible side effects. I will probably try again in a week or so, though–normally my Google-fu isn’t so bad, but right now I’m up to my ears in a bunch of other things. I will make sure to come by your blog and let you know if I do find something interesting.

       If I remember correctly that’s the social model of disability? Which… I can agree on a lot of aspects of that, but if the disability is purely social in nature–if there are no inherent difficulties entailed but its social stigma–I think that is a model of disability that is a little bit too broad. After all, if that is inclusive in the definition, ANY marginalized group counts as disabled. Too much melanin in one’s skin would qualify as a disability, for example. Or I could take the obvious route and bring up homosexuality. Lifelong HSDD has always reminded me very much of the old diagnosis of ego-dystonic homosexuality.

       I admit, I was not paying much attention to the Flibanserin discussion when it happened. I was really low on resources at the time, and I was withdrawing from a lot of different things in order to recover. (I’d also had a panic attack related to being invisibled like hell in a Psychology of Women course which was discussing sexual dysfunction disorders in the week prior to the Flibanserin discussion. So I was really not interested in engaging with that topic at that time.) Everything I am coming across it now is largely after-the-fact, and often a long time after the fact. I do want to make that clear, and I want to make it clear that the linked discussions I am finding really horrify me with the ableism displayed against women with FSD.

       I think that looking at the ways in which societal structures which add to the difficulty experienced by disabled people is really important to discuss, but I think the societal structures encouraging that marginalization cannot be the whole of what it means to be disabled. I mean, I’m in the US as well. And I’m on the autism spectrum. And even if society was perfectly set up to accommodate my particular issues–even if there was no stigma to being autistic, even if all spaces were set up with things like quiet rooms where you could go away, I’d still experience dealing with things like sensory issues to certain stimuli. I happen to think it’s worth it and wouldn’t be cured even if I could be (see below), but I don’t think that the particular issues I deal with would go away with enough accommodation. They’d be easier, but not perfect.

       In a way, saying that kyriarchy is the source of disability implies that if society were perfect, disability would not exist–and I think that attitude leads you right back to the societal construction attitude towards things like vaginismus. Which I agree with you seems to be very flawed to me, as well as simplifying what is probably a very complex issue and leading nicely into a bunch of different ways to marginalize women with FSD.

       (My bias is that I think most things like that probably include both a biological and a psychological component. I am very much not a fan of the nature/nurture dichotomy, and what I have picked up about the social construction theory of vaginismus is that it seems to be all about the nurture. Which doesn’t fit, particularly given that not all women who are anxious/afraid of sex/have issues surrounding sex experience vaginismus, and that not all women who experience vaginismus have that particular mindset.)

       I… hm. My gut inclination is to relate people who want a cure for low desire to the “ex-gay” movement and to things like reparative therapy. And to the autistic people I’ve talked to who want a cure for autism. And, well, that idea makes my skin crawl, but then I happen to have a lot of baggage surrounding the concept of “cures” for things like that, for a lot of reasons surrounding my personal history. It smells to me like a form of self-hatred.

       And yet… I want people to do the best with what they have. I think that that particular form of cure-seeking isn’t the best method to do that, and I think that it encourages more self-hatred, but I do not want to further marginalize people trying to do the best they can in a fucked-up world either. So I don’t know. I think my response to the question of medication for low libido/lack of primary sexual desire comes down to “I would not do that, and I will fight against people without this experience telling you that you should do that, but I am not going to condemn you personally for any choices you decide to make.”

       I’m actually working on a piece about ableism and asexuality for a zine called Asexual Feminism at the moment, so I’ve been thinking a lot about this particular intersection a lot from my perspective lately. (Speaking of which, you might or might not be interested in talking to the publisher–she’s said this issue’s theme is meant to be “the medicalization of asexual bodies.” It might be really good to have a perspective from your viewpoint in that zine, and she’s explicitly welcomed nonasexual writers to contribute.) My focus in that piece is on how the marginalization of disabled people and asexual people is related, not so much concerning HSDD except as an aside, but it has been doing a good job of making me think. So has this discussion.

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       • Okay can we pretend like my comments up here : comment 687 are actually down here.

         (Elizabeth I don’t suppose you could move the text around in the dashboard if it didn’t already get replies?)

         Because I replied to wrong thread.

         [Okay, copy-pasting previous comment below. -Elizabeth]

         If I remember correctly that’s the social model of disability? Which… I can agree on a lot of aspects of that, but if the disability is purely social in nature–if there are no inherent difficulties entailed but its social stigma–I think that is a model of disability that is a little bit too broad. After all, if that is inclusive in the definition, ANY marginalized group counts as disabled. Too much melanin in one’s skin would qualify as a disability, for example. Or I could take the obvious route and bring up homosexuality. Lifelong HSDD has always reminded me very much of the old diagnosis of ego-dystonic homosexuality.

         It’s not 100% like that though. But there are activists who do advocate for a broader definition.

         Some ways look at disability & non-disability came up almost a year ago on FWD. Disability Is …? Here’s on way of looking at it:

         Informed by the social model, “disability” becomes a marker not for condition (mental or physical) — not for “what I feel inside, what I experience inside” — but instead for the fact that our condition is maligned or neglected (or both) by the rest of society.

         Disability is not a matter of my condition, but a matter of the group I am assigned because of that condition.

         Perhaps it could be said as such: Disability is not a condition, it is a status.

         The author, amandaw, goes on with this nuanced discussion of disability – the word itself, it isn’t perfect either. Here’s another one of her points: The word “disability,” in the disability movement right now, already refers to a great variety of individual conditions, abilities, approaches…

         She went on to include a quote by another author, Joel, who looked at disability from the perspective of an autistic person and talked about strengths & weakenesses:

         Yes, that’s right, you’re DISABLED. Yep, you can pick that word apart and tell me why you aren’t, but, trust me, you are. And, no, I don’t mean that you are less or more functional than anyone else. I mean that you are part of a community defined by society’s institutions and programs, a community formed because of our minority status and the fact that society expects certain strengths and weaknesses, and anyone who doesn’t have that same pattern of strengths and weaknesses is going to have trouble in this society.

         And talking about queer as a disability is actually a poor analogy and one which I think you should think about re-examining, for reasons described in this post: Why Queerness is Not a Disability (As if you Thought It Was…)
         Of course you can be queer and disabled at the same time. But the two are not, and should not be, viewed as the one & the same. K.C. Jones’ arguement is more similar to what you’re trying to say, that it’s the culture’s views that are all screwed up, not someone’s sexuality.

         (I’d also had a panic attack related to being invisibled like hell in a Psychology of Women course which was discussing sexual dysfunction disorders in the week prior to the Flibanserin discussion. So I was really not interested in engaging with that topic at that time.)
         Well that certainly is one thing we have in common. The reaction, if not the reasons behind it.

         My gut inclination is to relate people who want a cure for low desire to the “ex-gay” movement and to things like reparative therapy. And to the autistic people I’ve talked to who want a cure for autism. And, well, that idea makes my skin crawl, but then I happen to have a lot of baggage surrounding the concept of “cures” for things like that, for a lot of reasons surrounding my personal history. It smells to me like a form of self-hatred.
         Okay that’s really upsetting for me, it’s too much like the “You just need to learn to love your body” square on the recent bingo board. As though people with low libido must not already love themselves, yet still feel in some way hindered. You know it can be both things at the same time. I am not suggesting that anyone change their sexual orientation or that there is a reason to because some such orientation is inherently abhorrent. To state it clearly: There’s nothing abhorrent about asexuality, and there’s nothing abhorrent about sexual dysfunction including low libido.

         However from my point of view, low libido may not even be curable. I actually oppose using the word “Cure” in relation to FSD because I just don’t think it’s a realisitic standard. If you’re “Cured,” then it’s like whatever was bothering you was never there in the first place, right? You didn’t just get over the infection you had, you took something and cured it. Didn’t happen with me. Cures are pretty unusual, I think. Even after I started getting treatment for my pain, I am not and do not expect to be “Cured.” You may be able to treat the symptoms or address the distress that comes along with the symptoms. But a cure? Not for me. If you’ve lived with lifelong low libido, I honestly can’t imagine anything that would come out that would completely reverse that and make it as though it never existed in the first place. This is a problem probably stemming moreso from the medical model of FSD; one of my specialists explicitly told me I’d be “Cured” after the surgery. (Luckily, I didn’t believe the surgeon – I knew ‘treated’ was the more likely outcome.)
         Now that treatment for me was surgery; for someone else it may’ve been oral medication; for someone else entirely, sex and talk therapy alone may be appropriate without medical intervention.

         Also, there was a piece on asexuality and disability on FWD also last year that you may want to think about for your own piece. Guest post: Disability and Asexuality

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       • Okay, this:

         I… hm. My gut inclination is to relate people who want a cure for low desire to the “ex-gay” movement and to things like reparative therapy. And to the autistic people I’ve talked to who want a cure for autism. And, well, that idea makes my skin crawl, but then I happen to have a lot of baggage surrounding the concept of “cures” for things like that, for a lot of reasons surrounding my personal history. It smells to me like a form of self-hatred.

         Yeah, let’s think about what you just said. First of all, what is asexuality? Lack of attraction, right? Not lack of desire, necessarily. Not even necessarily lack of sexual interest more broadly defined (which, let’s keep in mind that HSDD’s proposed name change is to Sexual Interest/Aversion Disorder). There are asexuals (like me) who don’t experience sexual attraction but can experience some form of desire/interest/etc. (and this does not even put us in the gray area). The reverse is also true: there are people who experience sexual attraction but lack the ability to act on it. These people want to have sex, or perhaps more accurately, they want to want. These are not asexual people, they are sexual, remember. They do experience sexual attraction. Is it, then, denying their sexual identity/orientation for them to seek treatment for HSDD? Is that really a form of self-hatred?

         And then, to liken those people to the ex-gay movement also assumes that these people would go around telling everybody else (presumably asexuals) that they need to be “cured” as well—which, okay, maybe SOME of them might say something like that. I personally haven’t ever met anybody who does that (although I guess I did once see a blog post by a gay man who once falsely identified himself as asexual and then after realizing he wasn’t went on to proclaim the entire orientation non-existent, though it’s not quite the same thing). But even so, aren’t they doing this erroneously, if they go around telling asexuals that’s what’s wrong with them? Isn’t it just the same as any other sexual who assumes that asexuality is about a lack of desire or interest rather than a lack of sexual attraction?

         The degree to which ex-gays go around preaching hate also should be considered, here. It’s one thing to tell another person, “Oh, I had something like that once, this is what happened to me,” and a completely different thing to make it your entire goal in life that people renounce their “sinful, evil” selves and go around spewing hatred, trying to create discriminatory public policies, etc. Why assume that people who have undergone treatment for HSDD would react with the latter? It’s a very extreme comparison, so naturally it’s going to be very upsetting for people who have or would seek treatment for HSDD to hear, whether or not their goal is to be cured.

         I let the comment through because you seemed earnestly clueless that it was hurtful, and you said it’s a gut reaction, so probably it was just an emotional reaction talking, untempered by reason. The idea of a cure for asexuality (or autism) is abhorrent to you, and I totally understand that. I don’t want anybody to try to “cure” me either… but that’s not what anyone here is suggesting. I know that other people do suggest that. But is seeking treatment for HSDD something that automatically means those people would, or something that automatically means people are denying their sexual orientation and thus engaging in self-hatred? I don’t think so.

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         • You’re absolutely right, it was a gut reaction I had not held up under the light of serious analysis. One which I ought not to have posted, in hindsight.

           When I made the analogy to the ex-gay movement, I wasn’t thinking about the movement as a whole; I was thinking of an individual person who decides to seek treatment for homosexuality. You are absolutely right about the level of vitriol involved in the ex-gay movement, and I do not think anything even remotely close to that is involved in the current conception of HSDD.

           I don’t think there’s anything like the public face of the ex-gay movement with respect to “ex-asexuals” telling asexual people they need a cure, either. Again, that aspect of the analogy is wrong. Really wrong. The only equivalent that I can consider is the broader culture of invisibility surrounding both all forms of FSD and asexuality, and that’s not so much bigotry as ignorance. (Most of the time.) Certainly nothing approaching that level of vitriol, again.

           So I apologize, both to you and to K, for an analogy which was extremely poorly-thought out. In a way, I was working through my initial thoughts on the subject in a forum which was not the appropriate place to do so, and I apologize for that as well.

           When I say “primary sexual desire,” what I’m meaning is essentially the same as sexual attraction, and I’m not making that clear and that’s my fault. (I honestly have not come across a better description of sexual attraction than primary sexual desire as used in Rabger’s definition: the desire to have sex with someone purely for its own sake.)

           The idea of someone who experiences sexual attraction but at the same time has a lifelong lack of libido is, I must admit, very foreign to me. I’m trying to make it clear that the “lifelong” type of HSDD is what bothers me, but I have not been using my terms consistently and again that’s my fault. You are right also in pointing out that someone who experiences sexual attraction but for whatever reason has a drastically reduced or nonfunctional libido would be quite
           right in trying to remedy this situation. (The current diagnostic criteria of HSDD are really unclear on this sort of thing; but that’s a problem with the diagnosis, not the rest of it.)

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     • First, I wanted to let you know that I apologized for that passage below Elizabeth’s comment. It’s an apology meant to you, also, and I wanted to make sure you saw it. I fucked up there, and I fucked up badly. I was working through initial reactions out loud in a space where I should not have been working through them, and I knew it was not a reaction devoid of issues on its own even when I put it down, as I hope was at least somewhat evident in the paragraph directly below it. (It may not have been. Call that a compounded fuck-up on my part. And triply because I ought to have known better than to post anything like that I had even the slightest reservations about.)

       I also wanted to add to that here that about your contention that that paragraph implies that women with low libidos ought to just “love themselves more,” and that would make their problems go away… Damn, I hope I didn’t imply that. Or I wish I hadn’t, because the only thing shifting your conceptualization of life-without-primary-sexual-desire from disability to queerness is the framework. The problems remain; it’s just that the way of thinking about them changes somewhat.

       And talking about queer as a disability is actually a poor analogy and one which I think you should think about re-examining, for reasons described in this post: Why Queerness is Not a Disability (As if you Thought It Was…)
       Of course you can be queer and disabled at the same time. But the two are not, and should not be, viewed as the one & the same. K.C. Jones’ arguement is more similar to what you’re trying to say, that it’s the culture’s views that are all screwed up, not someone’s sexuality.

       I’m sorry, I really was not trying to compare queerness to disability there–my point in that analogy was an attempt to say it is not the same thing, and an attempt to explain why I thought that particular model as I understood it was flawed. Clearly I didn’t understand the model as well as I thought I did. Your explanation of how it actually works makes a lot more sense and also invalidates a lot of my original point.

       Right now, as HSDD stands, it encompasses asexual people who feel distressed about their orientation as well as people who experience sexual attraction but have libidos lower than they would like. And I think asexuality is a form of queerness. So part of my problem with it is that it seems very much to me as though the current conception of HSDD, as it stands (and I do not think the proposed changes are doing much to fix this), is that it does seem to be conflating a form of queerness with a disability in at least some cases. Which is the point I was trying to make earlier, and failed at.

       I’ve actually read that piece many times, and it was one of the impetuses for me to start thinking about that particular intersection in the first place. But thank you for linking me.

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       • Right now, as HSDD stands, it encompasses asexual people who feel distressed about their orientation as well as people who experience sexual attraction but have libidos lower than they would like. And I think asexuality is a form of queerness. So part of my problem with it is that it seems very much to me as though the current conception of HSDD, as it stands (and I do not think the proposed changes are doing much to fix this), is that it does seem to be conflating a form of queerness with a disability in at least some cases. Which is the point I was trying to make earlier, and failed at.

         Okay, that I can see that, with the diagnostic criteria.

         I agree that asexuality falls onto the queer spectrum. Queer is not a disability – there is nothing wrong.

         In reality, if you have had lifelong low or absent sexual libido, that may very well be just a part of your personality or your sexual orientation. I’m a bit of a dark & gloomy person in general, but that does not mean I am currently in a state of depression.

         But then it’s like, what if you don’t know that you’re asexual yet. My understanding is that the population of asexual folks is small – small enough to get frequently overlooked – or when it is acknowledged, it gets sensationalized in the media. So I get that concern.

         I’m not certain what the best, fastest way to separate HSDD and asexuality is. To me they’re different. It sounds like one of the important questions is where, exactly the personal distress is coming from, from cultural pressures or from within. One of the sex therapists blogged something that said, “Millions of women (and their partners) know their lack of sexual desire causes suffering.” So, to these women, it is something from within. The social construction model looks at what comes from without. You’d think that there could be some kind of balance struck between them but a lot of what I’ve read pits the two against each other.

         I’m sure that better education, less sensationalism will help but it will take a long time to implement, and then there’s still professionals who dismiss asexuality as a valid orientation. I’ve seen that too.

         I’m inclined to leave HSDD as a valid diagnosis, but I can see where you’re coming from too. There’s some problems that need addressing without sacrificing people with it and without it.

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4. Yay sciatrix! I second your thoughts!

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5. Pingback: Guest blogging: Reaching out to the asexual community « Feminists with Female Sexual Dysfunction

6. By the way, I suppose I should mention this here. I’m writing a guest post for K’s blog as well which is going to be in the same interview format, on the other side of the same topic. So far, there are only a few questions for it, so I’m wondering if there are any questions that people want me to address? The questions for K were brainstormed by a group of asexuals rather than just one single individual, so maybe this would be a good strategy to employ for this one as well.

   This is also the reason why I’m mostly stepping back and just facilitating this conversation right now.

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7. Pingback: Interesting posts, some time in October « Feminists with Female Sexual Dysfunction

8. Pingback: “Blue Balls,” Sexual Pain Disorders, and “The Point of No Return” | epochryphal

9. Pingback: Blog Rants: The Early Ace Blogosphere | The Asexual Agenda

10. Pingback: Blog Rants: The Early Ace Blogosphere | Prismatic Entanglements

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