Does female sexuality need to be fixed?

Ian Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him at his website, GoodInBed.

At Good in Bed, many of our experts are buzzing about a new documentary called "Orgasm, Inc." Directed by Liz Canner, the film chronicles the race by pharmaceutical companies to get FDA approval on “pink Viagra”—a pill to help treat female sexual dysfunction, or FSD.

The problem with this approach? As the film demonstrates, there’s no clear definition of FSD, which makes it difficult to determine whether it’s a problem that needs “treatment” or simply an example of the differences between male and female sexuality. The truth is that no one really knows what FSD is: Some people liken it to male sexual dysfunction, but there are major flaws with this comparison. It’s easy to tell when a man has premature ejaculation or erectile dysfunction. Female sexuality is less obvious. Women just don’t show clear-cut physical signals when they’re aroused.

Another reason that FSD is tough to define is because we tend to label men who don’t climax during sex as “dysfunctional.” Yet an estimated 75 percent of women never orgasm from penetrative sex alone—suggesting that this is normal, not problematic. So maybe we shouldn’t be focusing on “fixing” female sexuality, but changing the ways we have sex so that women more consistently orgasm. Even researchers can’t agree: In 2000, the Journal of Urology offered a few definitions on FSD, including:

• Lack of interest in sexual activity
• “Phobic avoidance” of sexual contact with a partner
• Inability to attain or maintain sexual excitement
• Difficulty attaining orgasm
• Genital pain or pain during intercourse

More than a decade later, there’s still no consensus on which, if any, of these definitions is accurate. And experts aren’t the only ones who are confused: Although studies suggest that the drug flibanserin could be the new “female Viagra,” the FDA recently declined to approve its use for FSD. In one 2010 study from the American College of Obstetricians and Gynecologists, researchers found that women with low sexual desire who took the medication for 6 months had an 18 percent improvement in their libido. But the FDA rejected flibanserin just a month later, saying it failed to completely prove efficacy in treating FSD.

Some critics say we shouldn’t be “medicalizing” sex at all and don’t need a pill to treat a condition that may be “all in her head.” After all, lots of women often simply aren’t in the mood for sex, or are distracted by life’s stresses, or just need to start using lubricant. That doesn’t mean they’re dysfunctional. In fact, it may just mean they’re normal: To that end, sex researcher Rosemarie Basson has proposed a new framework for thinking about female sexual response, one that places the importance of emotional intimacy and relationship satisfaction at its center. Basson’s framework contends that female sexual arousal is more complex than a male’s and depends more intensely on factors such as relationship satisfaction, self-esteem, and previous sexual experiences.

To me, the issue of FSD isn’t black and white. Sure, FSD isn’t as physically obvious as male sexual problems: Viagra works by increasing blood flow to the penis, giving a man an erection, while flibanserin appears to affect the neurotransmitters (chemical messengers) in a woman’s brain that influence desire. But that doesn’t mean that FSD doesn’t have a physiological component. Side effects of medications (including some antidepressants, blood pressure drugs, and birth-control pills), shifting levels of hormones, stress and anxiety, obesity, and conditions including diabetes and multiple sclerosis can all lower a woman’s desire. So FSD—if it indeed exists—isn’t simply perception, just as it’s not solely physical. My guess is that’s a combination of brain and body—although whether a drug can effectively treat FSD remains unseen. Emily Nagoski, the author of The Good in Bed Guide to Female Orgasms, says, “There’s no such thing as a sexual dysfunction that’s 'all in your head.' Neither is there a sexual dysfunction that’s 'all in your vagina.' There is only the embodied mind. Thus education and behavioral training change physiology.”

Ladies: 5 ways to feel sexy again

In the meantime, there’s no reason why women who want to want sex should suffer with low desire. Prescription testosterone cream may help boost desire women who have low levels of this important sex hormone, as can devices such as the Eros device, which uses a gentle vaccuum pump to stimulate blood flow to the genitals. And don’t discount all the “natural” ways that both women and men can increase sexual desire, from trying new things between the sheets to increasing intimacy outside the bedroom.