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Sex and Medicine: Strange Bedfellows? |
Doctoring Desire Takes Emotion Out of Sexual Behavior
By Jeanie Davis WebMD Medical News
You've seen the ads Click Here for Penis Power,
says one. Embarrassed? Try Laser Vaginal Rejuvenation,
says another. We're a society obsessed with sexual
performance, in ourselves and our partners, trying
Viagra and every medical gimmick out there to get
it right, says a new study.
The problem with this medical approach to sex what's
being referred to as the "medicalization of sexual
behavior" "is that social and interpersonal dynamics
may be ignored," writes Graham Hart, a public health
researcher at the University of Glasgow.
His paper, appearing in the latest issue of the
British Medical Journal, says that for the last
20 years, we've been involved in nothing less than
"mass surveillance" of sexual performance. We're
measuring ourselves and being measured against what
we perceive as norms and standards for sexual performance.
The downside: "Many people feel inadequate when
faced with evidence about extremes of sexual performance,"
Hart says. "This can turn sex into a problem 'Is
this normal, doctor?'"
"Articles peppered with physiological and technical
terms confirm and elaborate on the right way to
perform 'to please him or her,'" he writes. "Viagra
(sildenafil citrate) the first oral drug to treat
impotence, or erectile dysfunction ranks as one
of the greatest success stories in pharmaceutical
history."
Women are part of this picture, too: Studies are
evaluating Viagra's potential in helping women with
arousal problems. And gynecological surgery is being
harnessed to enhance sexual pleasure and improve
aesthetics. The "designer vagina" involves laser
"pruning" of genital warts or an "extra stitch"
to tighten vaginal muscles.
All this focus on performance has led to a prevalence
of sexual dysfunction, Hart writes. "Our obsession
with sexual gratification has undoubtedly increased
people's expectations, and it may have increased
people's feelings of inadequacy," he writes.
"Although many men with erectile dysfunction daily
thank Pfizer for their efforts, others who once
thought their low libido was "normal" and acceptable
now feel dissatisfied with their sexual lives."
"People choose one another for their uniqueness,"
Hart writes. "The last century saw a considerable
increase in acceptance of diversity of sexual expression
it would be a shame if this century saw diversity
replaced by uniform expectations of performance
and desire." There's not really this across-the-board
focus on sexual performance that Hart reports, says
Nadine Kaslow, PhD, professor of psychiatry and
behavioral sciences at Emory University and chief
psychologist at the Grady Health System, both in
Atlanta.
"People simply know there are options to make sex
better," she tells WebMD. "Some people want those
options, some people are confused or ambivalent
about them, and some really don't care."
It's true, Kaslow says, "there's nothing wrong
about choosing those options if it's done in the
context of a relationship. If Viagra makes you enjoy
your partner better, makes the interaction better,
more power to you."
However, "if you feel so insecure, so badly about
yourself, and you don't get any emotional support,
all the Viagra in the world isn't going to make
you feel better. If it's all purely about performance,
if people are so worried they won't be loved if
they can't perform well, that means there's a lot
of stress in the relationship."
Individual or couples counseling are helpful in
resolving sexual and self-esteem issues, she says.
"Unfortunately, people who get prescriptions for
Viagra, who have vaginal surgeries, hardly ever
get counseling. If you have anxiety problems, if
you're angry with your partner, all these medical
treatments aren't going to help you get real pleasure
out of the sex."
Couples involved in fertility treatments have the
same technology/relationship issues, she says. "They
have to have sex at a certain time, they complain
it's not about sex anymore. Couples who handle it
best are the ones who can play with it."
Sexual pressure isn't a latter-day issue, says
Donald Rosenberg, PhD, clinical psychologist and
sex therapy specialist for 30 years in New York.
"It's existed as long as sex has," he tells WebMD.
"Guys are always going to worry about getting an
erection and keeping it and not coming too soon,"
he says. "Women are going to worry about the pressure
they feel, I'm not pleasing you unless I have an
orgasm. These are things that openness and talking
about sex, if anything, would make people solve
the mechanical problems and make [sex] better."
Think back to the years when no one talked about
sex, he says. "Look at the problems, the repression.
Talking is a very positive thing, it opens the door
to intimacy. It's wholesome in all aspects." Anything
that improves sexual functioning "takes the pressure
off," Rosenberg says. "If you don't have to worry
about having the erection, if it's not on your mind,
you can focus on your partner more, her pleasure.
If she doesn't have to worry about having an orgasm,
she can focus on the pleasure of her partner and
their relationship."
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