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The debate reaches a climax Jan 17th, 2003 An unacknowledged alliance between drug companies and the pornography industry is returning women's sexuality to the dark ages, according to Shere Hite, the American cultural historian best known for her ground-breaking Hite Report on Female Sexuality, first published in 1976. A report accusing drug companies, including Pfizer, the maker of Viagra, of creating a disease then offering a treatment for it - simply to make money - has turned the clock back half a century for Hite. "In the 1950s and 1960s, the idea penetrated society that women were neurotic, and they were seen in negative terms that came out of the Freudian tradition," she says. "If they did not have an orgasm during coitus, women were apt to think they had a problem. The general stereotype of what sex is has not changed since then and that lack of change has been bolstered by the pornography industry, which is wedded to old stereotypes and has re-ignited in people the idea that women experience sex like men." The recent report in the British Medical Journal, by Australian journalist Ray Moynihan, accused drug companies of sponsoring the creation of female sexual dysfunction to profit from supplying the female equivalent of Viagra. His argument is that because research is so heavily sponsored by drug companies, there is a risk "the complex social, personal, and physical causes of sexual difficulties, and the range of solutions to them, will be swept away in the rush to diagnose, label, and prescribe". Dr Hite's response is unequivocal. "We need to redefine sex, not medicalise women," she tells The Herald in an exclusive interview before her views are published next week. She says she's been aware of this since she questioned women 27 years ago for The Hite Report. "The results were published around the world in many languages, so I was surprised recently to see that some drug companies were pursuing the will-o-the-wisp of pushing women to have orgasm during coitus." The position of the pharmaceutical industry and some doctors is that the treatment of female sexual dysfunction is 15 years behind the treatment for men. Pfizer, whose sales of Viagra are now worth £1bn a year, is accused of trying to create a similarly lucrative market for treating so-called disorders in women such as lack of desire, lack of arousal, pain during intercourse, and lack of orgasm. However, doctors and psychologists point out that only lack of arousal - suffered by 20% of women complaining of sexual dysfunction - is likely to be helped by a drug similar to Viagra. "Of course the drug industry can make money if it wants to make women try to conform to stereotypes," says Hite. "Even if women are receptive to the drug, it still does not mean they are going to have an orgasm during coitus. A drug that gets more blood into the genital area is not necessarily going to produce an orgasm, but the drug companies will make money for a couple of years until word gets out." Although Moynihan saw the making of female sexual dysfunction as the "freshest, clearest example we have of the corporate-sponsored creation of a disease", for feminist writers, including Hite, the idea of such a condition is an old one. "It is common knowledge and has been for two centuries that women 'have a problem' having orgasm during simple coitus. Yet, as long as female orgasm was not considered as important as male orgasm, this was not much discussed," she says. Hite sees the need for a cultural rather than a medical revolution. "Women need to have autonomy over their bodies in order to create a new and interactive kind of physical intimacy with their partners. The assurance that there is nothing wrong with clitoral stimulation to orgasm is one of the most important statements we can make. "In short, I think that trying to force women's bodies to adapt so they have orgasm during coitus 'like a man does' distorts female sexual identity (and pressures them to fake orgasm). Sex can be equally beautiful, if not more so, when an honest and erotic interchange takes place between both people." She adds: "Sex is a cultural rather than a biological institution; our society's idea of sex is formulated to suit reproductive needs, not instinctive ones, and so can change. Will women now redefine sexuality? Women are making many changes in how they see and practise intimate physical relations - how they express and share their bodies. Though the choices are theirs, it can still take some time to wake up and see that one is free, in charge of one's life, that all decisions are possible. Like Sleeping Beauty waking up after 2000 years of misinformation, women need a little time to begin thinking clearly. "In reality, being active in sex has a different meaning for women, a meaning that is only beginning to unfold. The semi-pornographic images of women visible on so many advertising posters and in television commercials do not represent who women are sexually, but rather the use and selling of women's bodies by a double-standard tradition. It is no wonder, with female sexuality equated with what is shown in many ads, that some women today recoil, deciding 'the old ways were best', imagining that women were more respected then - whether or not this is historically accurate. "One of the keys to female sexuality during the next 100 years, I am sure, will be that women will begin initiating a new type of sexuality - something that will cause a true revolution in sexuality, one that has as yet barely begun. Women have hardly begun to show who they are sexually." Dr Hite, who will comment on the BMJ article in next week's edition of Nature, is by training a historian who wanted to understand why we'd reached the point we are at - how just wasn't good enough. Now she is visiting professor of gender and culture at Nihon University in Japan. She says: "In my research, I found that 72% of women did not regularly have orgasm during coitus, yet 93% could reach orgasm easily and pleasurably with self-stimulation that was dissimilar to the stimulation received during coitus. Thus I concluded that women do not have a problem; it is society that has a problem with its definition of sex that should be changed to include the stimulation women need." The Hite Report, re-published in the UK in 2000 and published in China for the first time this year, has never been replicated. According to its author, this is because sufficient steps have not been taken to assure people responding that they are anonymous and because surveys covering the same gound have failed to be precise. "They ask questions such as whether women are satisfied or dissatisfied, which could be taken to mean whether or not they experienced orgasm, but, of course, they are not synonymous." There remains, however, a deep division among women and doctors dealing with sex-related problems. Moynihan's original article provoked a spirited response from both camps, including patients who say they are delighted the problem is at last being taken seriously. While psychologists and psychiatrists have been questioning the basis of the drug industry's approach - that 43% of women suffer from sexual dysfunction, a figure that carried a health warning when it was first extrapolated - the Impotence Association is in the process of changing its name to the Sexual Dysfunction Association, because every time it is publicised it is inundated with calls from women. Dr Hite is not alone in the opinion that female sexual dysfunction could become a disease with no basis. George Dodds, a consultant psychiatrist at Falkirk Royal Infirmary, responded to Moynihan's article by suggesting it may already be too late to stop female sexual dysfunction being made a disease. "We already have post-traumatic stress disorder(PTSD) firmly established, although it was essentially created in the 1970s by politically astute military veterans and lawyers as a more attractive option to the mixed anxiety and depressive disorder that it is. "Worse, Munchausen's disorder and its offspring, Munchausen's by proxy, are now accepted but are not diseases; they are behavioural disturbances that society would prefer to be dealt with (poorly as it happens) by psychiatrists rather than criminal justice systems. "Female sexual dysfunction is not a disease but a disorder, and may have a number of causes. The result of uncritical medical thinking up against a pushy medical and drug industry is to disempower people and lead them to become dependent and truly ill rather than healthy," he says. -Jan 17th
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