In 2008 Alice Dogruyol representing The Spa PR Company wrote to me requesting I plug a new genital cosmetic procedure – the g-shot. It involved injecting collagen into the vaginal wall. And was being spearheaded in the UK by a Professor Phanuel Dartey of Harley Street.

I immediately noticed there seemed to be no robust peer reviewed clinical evidence for the safety and effectiveness of the g-shot procedure. I felt the press release I was sent was so poor and the ‘treatment’ described seemed so bizarre that it was best ignored. I assumed no media outlet would pick up on it.

I was wrong.

Several newspapers including the Sun, Mirror, Telegraph and Mail clearly had been sent the same press release as me. The only difference was they joyfully publicized the g-shot and promoted Prof Dartey’s Harley Street practice. And in the case of the Sun and the Mirror the pieces were written by their Health and Science correspondents. Who really should have known better. Since then many women’s magazines and websites have also described the procedure as a sex life enhancer, promoting both the g-shot and Laser Vaginal Surgery (which Dartey also offered).

I was so concerned I wrote a blog post about the problems I foresaw with the g-shot procedure and subsequent media coverage. I also outlined core questions journalists and the public ought to be asking about it.

A journalist colleague then tried to pitch a story critiquing the g-shot , but they were unsuccessful. Over the past three years I sent my blog post questioning the g-shot to any media outlet I spotted giving it publicity. In most cases I heard nothing back. Occasionally a journalist would politely thank me and tell me they’d consider my opinions if they wrote similar pieces in the future.

In other words they ignored my concerns and questions. Probably because they weren’t as exciting as the sexy ‘science’ of collagen injections, and probably because anyone critiquing their breathy discussions of amazing orgasms through genital enhancement could be dismissed as an anti capitalist/feminist/academic killjoy.

I did not systematically continue to campaign against the g-shot because I reasoned even if the media were occasionally (albeit enthusiastically) covering it, I doubted many women would opt for either the g-shot or Laser Vaginal Surgery.

I was wrong here as well.

Last week Phanuel Dartey was struck off by the General Medical Council (GMC).

This followed complaints from five women. The British Medical Journal (16 November) reports Dartey ‘botched laser operations on four women and left another seriously ill after a termination’ . It goes on to report from the GMC hearing:
“Patient A was said to have suffered visible scarring and asymmetry of her genitals, although she had been told that the incisions would be nearly invisible. Part of her vagina had been “effectively amputated,” and she required revision surgery
Patients B and C were given laser surgery for urinary incontinence, which the GMC’s experts say would have been of “limited value”.
Patient E was in major pain after a labioplasty to reduce the size of her labia minora, which Dr Dartey is said to have “significantly over-reduced.” When she complained of the pain, the GMC alleges that he suggested an injection of absolute alcohol into the area of the labial scar to kill the nerve endings, an intervention that was “inappropriate.”
Patient D travelled from Ireland to the Marie Stopes centre for a termination at 18 weeks’ gestation. Dr Dartey is alleged to have perforated her uterus during the procedure but failed to recognise this.
The GMC alleges that he failed to check that all the products of conception had gone and failed to notice that the fetal thorax had not been removed. When D returned home, she became “extremely ill,” … “She was on the critical list and was in hospital for two months.”
Dr Dartey, who was suspended from practice pending the hearing, is also charged with having no valid medical indemnity insurance when he carried out the termination in February 2006”.

A further report of the hearing, again from the BMJ (6 December), explains why Dartey was struck off:
“Robin Knill-Jones, who chaired the GMC’s fitness to practise panel, said, “In the panel’s judgment there is a continuing risk to patients from the way Dr Dartey conducts his practice. His dishonest actions in relation to professional indemnity were a serious abuse of the trust that his patients and those with whom he worked were entitled to place in him.
“The panel considers that the extent and seriousness of Dr Dartey’s clinical misconduct, the gravity of his dishonesty, and his subsequent lack of insight evidence a harmful attitudinal problem.”
When Dr Dartey carried out the termination in 2006 on a woman who had travelled from Ireland, he perforated her uterus and failed to remove the fetal thorax. When she returned home she became extremely ill and was in hospital for two months, the panel heard.
Dr Dartey’s membership of the Medical Protection Society had lapsed in 2002, and he had no indemnity cover when he performed the abortion. The panel found that a membership certificate he sent to Marie Stopes International purporting to cover 2005-6 was a forgery.
Dr Knill-Jones said, “Each of the five patients with which this inquiry has been concerned has suffered from the events in question. In his written communications to the GMC Dr Dartey has shown little remorse or acknowledgment of, or insight into, his failures.
“He has rather adopted a derogatory attitude towards his patients, accusing one of racism, another of blackmail, a third of causing her own problems by failing to follow his advice, and another of reporting him to the GMC because she wanted free corrective surgery for an unrelated problem. The panel has found no substance in any of these complaints and regards Dr Dartey’s lack of insight as a matter of serious concern.””
The lack of insight comment seems particularly relevant given that during the time the GMC were investigating his case, and while it was being covered in the media, someone claiming to be Professor Dartey appeared to comment at Ghanaweb where he belittled those complaining against him. This comment has not been verified as from Prof Dartey but it seems uncannily similar to the report from the GMC hearing.

This is truly shocking case that raises questions about the conduct and supervision of medics in private practitice. Marie Stopes also undoubtedly need to review procedures for the selection and supervision of staff working at their clinics.

The media also has a role to play here, but this was not (as far as I know) picked up on at the GMC investigation.

The PR company who promoted Dartey and the journalists who covered his g-shot and Laser Vaginal Surgery interventions in uncritical and often glowing terms are, in my opinion, culpable.

We know from research on women seeking cosmetic genital surgery one of the main things that persuades them they need cosmetic procedures is advertising from clinics/consultants. And how better to advertise than via an enthusiastic media endorsement? Even though it is well documented there’s no evidence of effectiveness of cosmetic genital surgery but plenty of evidence of active efforts by medics to promote such practices.

Perhaps unsurprisingly the papers that fawned over the g-shot have been remarkably silent about the GMC hearing. And none have admitted they gave publicity to an untested and dangerous cosmetic intervention.

The only paper who reported in favour of Dartey and also on his striking off was The Daily Mail. They managed an incredible about face with their initial piece ‘I’ve had the G Shot and YES, YES, YES my sex life has never been better!’ promoting the g shot procedure. While Dartey’s GMC investigation was ongoing they were still publishing testimonies in his favour. Finally describing his fall from grace in less than glowing terms. The latter piece, of course, made no reference to the former. (Thanks to @MrNorthice for helping with these links).

This media distancing could be coincidence, or it may be more deliberate. In the Mail’s case it can be seen as deliberate in the way Dartey is talked about. When his g-shot procedures are being lauded he’s a Professor from Harley Street. When his striking off is detailed his qualifications from the Soviet Union and Ghanaian heritage are at the fore. As @PeteDeveson astutely commented on twitter: “on the way up it’s “Hollywood” and “Harley Street”. On the way down it’s “Ghana” and “Soviet””. This xenophobic coverage neatly airbrushes any involvement of the newspaper in promoting Dartey’s practice – and subsequent harm done to his patients.

When I first read the press release about the g-shot it raised not so much a red flag as a string of red bunting. I tried to challenge it where possible with journalists but felt powerless to really get anyone to listen.

I still feel powerless about this situation and the countless others like it. Journalists cover stories on sex and health topics that advocate untested treatments, products and procedures. Therapists and practitioners are showcased with no check on their skills, qualifications or professional ethics. Cosmetic genital surgery is increasingly presented as ‘the norm’ and if any criticism is allowed it is always a small voice of dissent in a wider promotion of surgical intervention. While this case concerns surgery performed on women, men’s media is just as problematic when it comes to promoting dodgy sex pills, potions and procedures.

Of course claims that science, medicine and surgery can transform your sex life, give you amazing orgasms, make you more desirable or a better lover are beguiling to both editors and the public.

Sadly these claims are rarely put to the test.

Which allows dangerous practices like those offered by Professor Dartey to go unchecked.

Editors and journalists lack basic skills to evaluate press releases or stories they are sent about sex-related products and procedures. Either because they are busy, seduced by science speak, or unable to critically evaluate medical claims. More importantly editors and journalists do not make enough use of willing qualified individuals and organisations who could help them assess whether claims they’re about to write about are accurate or not (for example using guides like this one created by Dr Jennifer Gunter). Where practitioners try and tell them they could be advocating something that is ineffective at best, life threatening at worst, the media (for the most part) ignores them.

We should be rightly angry with the media and with practitioners who promote untested and unnecessary cosmetic genital surgery.

This will be of little comfort to the five women involved in this case, who will be scarred psychologically and physically for the rest of their lives.

Professor Dartey should be ashamed of his actions, but GMC reports imply this is unlikely.

The journalists who didn’t bother checking a simple press release and promoted his products and services should also be ashamed of their actions. Again, I think this is unlikely.

The Spa PR Company who originally promoted the g-shot and Dartey’s clinic should also take responsibility for their role in this tragedy. I have written to them offering a right to reply which I will post here if they wish me to.

Other media outlets could now write about this case critically, and make a commitment to reporting on sex/science stories ethically and carefully. They could campaign against cosmetic genital surgery or refuse to showcase it in their features or advertising. Here too I expect this is unlikely.

It is easy to forget in stories like this how real lives can be destroyed. My sympathies are with the women affected by Dartey’s professional misconduct. While I find it easy to compile a case against media and medical incompetence, I find I lack the words to adequately express how badly I feel for them.

It’s been a while since I’ve written about medicalisation. Which seems as good an excuse as any to revisit this issue and reflect on some of the developments in this area in healthcare, therapy and media.

A few months ago I took part in the 41st Maudsley Debate entitled ‘Love is a Drug’. Ben Goldacre and I spoke for the motion, Sandy Goldbeck-Wood and John Dean against it.

In fairness the title of the debate ‘This house believes that female sexual arousal disorder is a fabrication’ was somewhat misleading since it could be construed as saying there was no such thing as women having problems with desire and arousal. Obviously that’s a ridiculous idea for anyone to support, so Ben and I kept our focus more on the way female sexual problems have been medicalised, and what implications this can have (particularly in healthcare).

You can hear the debate and subsequent discussion here. Ben and I won the debate, although the discussion certainly indicated this is a complex area and one that is not always fully understood in terms of gender, politics and ‘bad science’. I think Ben’s points about teaching medical students (and healthcare staff more widely) to read and think critically about pharmaceutical research is important – particularly in relation to the area of sexual functioning which is heavily medicalised but often not taken seriously. Because it’s about sex.

Additional reviews of this debate can be found here, here and here.

This event follows a debate last year hosted by the British Medical Association which was also attended by John and Sandy, who discussed issues around female sexual dysfunction with Ray Moynihan (author of Sex, Lies and Pharmaceuticals) and Iona Heath.

Both of these discussions were focused towards a medical audience (with the Maudsley debate particularly aimed at medical students and trainee psychiatrists, and the BMA event at practising clinicians and therapists). While the Maudsley debate was open to the public the BMA event was invitation only, so there is a remaining problem of making discussions around medicalisation open to a wider audience.

One way this is being achieved is through screenings of Liz Canner’s amazing documentary ‘Orgasm Inc’ which have been taking place across the US, Canada and UK. Media coverage of this movie has also helped raise the profile of female sexual problems (examples here, here, here and here). Although unfortunately not all journalists covering this area ‘get’ all the issues surrounding this topic, particularly around medicalisation, evidence based practice, and endorsing largely untrialled/untested interventions).

This leaves us with some stubborn problems which still need tackling. These include:

Critiquing FSD = women don’t have problems
One of the most frustrating aspects of challenging the medicalisation of female sexual problems is the inevitable response from some journalists, medics, researchers and members of the public who interpret what you are actually saying as – ‘women don’t have sexual problems’. Clearly women who are experiencing sexual difficulties don’t want to be told they’re inventing their problems, and do want a solution. Those who are challenging medicalisation of sexual function are not saying women don’t have problems. They’re not saying sex isn’t important. What they are saying is that there are many reasons women experience problems, and an equal number of possible solutions to them (see here for more on this). And that it are the many causes and solutions that require exploring rather than assuming a woman who isn’t desiring sex is ill and requires a clinical solution (we unpack this to some degree in the Maudsley debate podcast linked above).

Discussing women’s problems = denying men have problems
Another real problem around talking about this topic is the focus on women. The media ignored the medicalisation of sex for a long while. Then did a lot to write and broadcast in ways that promoted pharmaceutical company agendas. Some media outlets have more recently decided to focus on the medicalisation problem, but generally in terms of focusing on women. This can partly be attributed to activism in this area, and partly due to rehearsing comfortable stereotypes – that women are not particularly sexual or are more likely to have problems with sex. This has led to criticisms that men’s sexual functioning has been ignored, or is not an issue. In terms of research that’s not really true. The challenging of medicalisation of male sexuality came before campaigns against the medicalisation of female sexual functioning. You can read some examples of that work here, here and here (It’s an area I’ve also researched and published on, as well as given advice to men about e.g. here and here).

What may be a more accurate statement is there is concern over men’s sexual functioning and the medicalisation of men’s sexual lives, but a lack of interest in the mainstream media in really taking this up. Other activist and sceptic groups you’d expect to challenge this problem seem reluctant. Witness the general apathy to helping men affected by the actions of the Advanced Medical Institute as a prime example. It is difficult to get journalists to focus on this in terms of medicalisation of sexual functioning per se, rather than simply seeing it as a ‘woman’s issue’.

Media lack of awareness of/complicity in this area
One of the main issues in this area is the media often doesn’t ‘get’ medicalisation. Indeed promises of wonder drugs that will boost our sex lives attract editors like moths to flames. The result has been uncritical pickup of pharmaceutical research on psychosexual problems, either promoting products that aren’t all that effective, or showcasing drugs that aren’t even available for public use. Even where drugs for desire problems have been identified as ineffective media coverage continues to write about them as if they are – for example with media’s ongoing obsession with testosterone therapy as a sex drive booster for women. This parallels problems within medicine where practitioners simply don’t understand the influence of Big Pharma in this area, can’t access (or understand) the diverse literature about medicalisation and critical sexology, and remain unable to identify and appraise literature on this topic.

Where to next?
The problem of medicalisation and poor media coverage of sexual problems is not going away. So encouraging and recognising good quality reporting in this area is vital. Supporting screenings and discussions of documentaries like Orgasm Inc can help, as can more public events tackling this topic. Moving away from a debate style format (i.e. do problems exist or not) would also allow for perhaps a more nuanced discussion on medicalisation, how it happens, and how to recognise and respond to it. Focusing on this as an issue affecting cis and trans women and men, as well as different sexualities is important. As is reflecting on how we view psychosexual issues for different age groups (and what age groups, genders, sexualities do we seem most keen to pathologize). Helping medics, therapists, journalists and the public to understand core issues around medicalisation as well as critiquing research on treatments in this area would also be useful. As would challenging any suggestion that critiquing medicalisation equals denying people have psychosexual problems.

You may also be interested in responding to the classifications of psychosexual issues in the revised DSM (deadline 15 June), or learning more about the Medicalisation of Sex from this recent conference in Vancouver.

You may remember my previous post on the revisions being made to the DSM (Diagnostic and Statistical Manual of Mental Disorders). Over the past few years the existing DSM (IV) has been revised and the public invited to consult on its content. The DSM covers a range of mental health issues, which other bloggers and activists have been reflecting on. For the purpose of this blog I’ve focused on how the DSM will be approaching psychosexual issues – although it is worth noting concerns have been raised about how gender will also be approached (particularly around transgender issues).

The provisional DSM-V is now available for public comment, you have until June 15 to read, critique, question and add your views. Information about how to do this can be found via the DSM-V website .

To help us reflect on the psychosexual aspects of the provisional DSM-V I’ll draw your attention to the thoughts of the indomitable Leonore Tiefer who has shared these thoughts:

7) When you write to the DSM-V, don’t go on and on (the way I have here!!), but pick one point and make a strong argument. Maybe 200 words. Pick a dysfunction that you feel strongly about E.g., are you glad to see the disappearance of vaginismus and dyspareunia in favor of Genito-pelvic pain/penetration disorder? Do you think the changes in the orgasm category encourage hypervigilance? Do you think combining arousal and desire makes sense? Do you like the new modifiers/qualifiers or do you think they are window-dressing? Have they left anything out you wish were there (e.g., Male romance disorder)? etc.”

Tiefer makes some important points here about how psychosexual disorder is being characterised within the proposed DSM-V but you may also have your own thoughts about the way sex/relationships/intimacy is being constructed/pathologised when you read through the DSM-V draft.

Do please add your thoughts, send in your observations and particularly record any concerns that you have. It’s important we all try and do this if we are worried about medicalisation, commercialisation and sex. Many of the discussions on this topic have focused on female sexual functioning/medicalisation, but it’s important to note the DSM-V is also focusing on how male sexual problems are viewed, so focus your critiques here also. This is particularly important given how often male psychosexual issues and the manipulation of male anxieties around premature ejaculation and erectile dysfunction are ignored.

If you’re a journalist you may also want to use the pointers above to think critically about the provisional DSM-V, or more widely about how we conceptualise sex, gender and relationships.

Remember you’ve until June 15 to do this so get lobbying, write about this on blogs, share on twitter and where possible within the mainstream media and healthcare settings.

Last summer myself and several other sex educators, therapists and reproductive healthcare staff were approached by researchers from Betty TV working on a new programme commissioned by Channel 4 called ‘The Joy of Teen Sex’. The show was described as a cross between the established (and popular) Embarrassing Teenage Bodies and The Sex Education Show. The Joy of Teen Sex would be set in a mock clinic where young people who had sex and relationships questions could get advice. The TV company was looking for people to appear as experts on the series (who’d play the role of ‘clinic staff’), and/or to refer them young people for possible inclusion.

After friends and family the media is often one of our main sources of sex information (acting as a ‘super peer’ – who doesn’t always have the right answers). Young people particularly appreciate sex and relationships advice from broadcast and online media. Providing sex information via the mainstream media is not new and has been well received by young people, parents, educators and healthcare staff (a classic example can be found here, see also here).

I am very much in favour of using the media to share information on sex and relationships (and other health topics). But I had reservations from the outset about this particular series. All of which I shared with the researchers at the time, and I’ll repeat now.

The series was billed as being a ‘youth’ programme. Although that doesn’t necessarily mean young people were actively involved in its creation. The title ‘The Joy of Teen Sex’ sounded like something by an adult trying to impress the kids rather than generated by a youth audience.

As I heard more about the planned content of the series it seemed profoundly out of touch with the title. The title implied an attempt at celebrating sex, while the calls for participants suggested it was mostly negative and problematising sex (more on this later). The proposed content did not match the kind of things I’ve noted young people are worried about (through my research and work over the past decade as an agony aunt; and from listening to parents, sex educators and healthcare staff).

Given both Embarrassing Teenage Bodies and The Sex Education Show had received some criticism for their approach to sex-related topics , I was concerned that merging them for a new format without learning from the feedback for existing programmes was not good practice. When I shared these worries with the researcher from Betty TV they did not appear interested.

Setting up a ‘pretend clinic’ was also perhaps unhelpful as it may give an inaccurate impression to young people of what sexual health services are like. If the mock clinic appears off-putting to an audience it may also discourage them from attending a sexual or reproductive health clinic in real life (for more ideas on what a ‘real’ GU clinic is like click here).

The ‘clinic’ setting also framed sex and relationships issues within a health or medical format. Which may be appropriate for tackling the treatment of STIs or contraception, but given this programme was also being presented as providing advice about relationships was a medical tone the best to use? After all, do you head to your GP when you want tips to spice things up sexually? Given the wider concerns about medicalisation and sex, presenting young people with the idea sex and relationships are a primarily medical issue (as opposed to social or cultural) is unhelpful.

Those worries, however, were insignificant compared to my anxiety when I received the advert the company wanted me to pass on to young people, which read:

SO YOU THINK YOU KNOW IT ALL WHEN IT COMES TO SEX?

(The above advert was also posted here with other casting calls can be found here and here)

Let’s unpack this advert.

First of all the programme starts with a challenge – asking if young people know it all. None of us ‘know it all’ when it comes to sex. Such an approach runs counter to working with young people on sensitive issues, where the aim is usually to create a safe space where people can ask questions or debate issues with confidence, rather than feeling judged, silenced or challenged.

‘Sex’ is not transparently defined. Discussions with the TV researchers making the programme indicated they understood ‘sex’ as penis in vagina intercourse (or anal sex in the case of young gay men). This is an extremely limited view of ‘sex’, the meaning of which has been explored in depth here.

Yet ‘sex’ and relationships are constructed in a particular way by this advert. For young people the advert focuses on ‘sex’ as whether or not they know much about infections, problematising porn, ‘losing’ virginity, and young women’s orgasmic difficulties. That leaves out a whole range of other issues young people may wish to talk about while reinforcing many gender and sexual behaviour stereotypes.

When it gets to the parent section of the advert it becomes even more judgemental. Here we see ‘sex’ categorised with more mentions of porn, a brief nod to sexuality, value judgements about ‘sleeping around’, and the setting up of girls as victims, boys as predators. There is nothing positive for parents. Only a list of potentially scary issues a parent might get in touch with. Indeed sex is stated as ‘the biggest worry for parents’.

Is that true? Are parents not also worried about their child’s future? Their academic progress? Their friendship groups? Risk of violent crime? Their health and wellbeing? Financial worries? Some parents may well be anxious about their child’s sexual development, but I’m confident most parents will have additional, and equally pressing, concerns. Realistically if sex really is your prime concern as a parent is television the best place to get support? Particularly if your worries are linked to the motional or physical safety of your child. This is not to say parents should not want advice, just that framing conversations with young people about relationships in purely negative ways is unhelpful.

The advert does indicate what the aim of the series might be. Rather than an opportunity to empower parents or listen to young people, it seems to be designed for the viewer to judge the wayward teen or hapless parent. Previous programmes and wider media coverage about young people’s sexual behaviour have been criticised for creating a format which slut shames young women, makes young men appear to be perverts, presents a heteronormative tone (while pretending to be right on about sexuality), and generally suggests sex is a scary issue – for both young people and their parents. It harks back to an old fashioned view (explored in depth here) that if we had to deliver sex education we might as well make it as offputting as possible to dissuade young people from considering trying it. Aside from this being limited, it is also disempowering. And it shifts topics that young people may not necessarily be seeing as a negative, into a problem. Although in this case dressing it up as a ‘sex positive’ series.

The phrase that put me off supporting the programme most was ‘Sex is the most important thing in a teenager’s life’. It may surprise you, but I profoundly disagree. ‘Sex’ may be important to some teens some of the time, but not to all teens all the time. For many young people the most important thing in their lives may be their friends, their schooling, hobbies or sports, their pets, their faith, music or a whole slew of other stuff I’m probably to old and boring to know about.

Indeed when you talk to young people, often what they are interested in is being in a relationship, being close to someone (either in the short or long term). They may certainly have questions about ‘sex’, and have a range of feelings attached to it – curiosity, anxiety, and excitement. But they will also have other questions that go beyond the mechanics of intercourse.

The majority of young people (2/3 of the UK population) do not have ‘sex’ (at least defined as penis in vagina intercourse) until they are 16 or over (the UK’s age of consent). Many young people aged under 18 have not have sex or a relationship. Those having sex at a very young age tend to be more vulnerable due to numerous reasons (covered here) and are of particular concern to educators, healthcare staff and youth workers.

When you talk to people who deliver sex and relationships education via schools or youth groups, those who are working ethically and appropriately are not trying to convince young people sex is the most important thing in their lives. Indeed, they are usually stressing to young people the importance of having many interests, and encouraging them to delay sex. Alongside tackling wider problems or opportunities facing young people (like schooling, home issues etc). Critics of sex education often argue that talking about sex encourages early experimentation, which is not accurate. However, you can see why critics get worried when young people are being encouraged to view sex as the cornerstone of their entire lives, when for many it isn’t (at least not all the time).

From the calls for respondents the programme ‘teen’ has been defined as young people aged 16+ (or in some cases 18-20). Meaning the focus of the series is better described as being aimed at ‘young adults’.

Setting up a post watershed series (screened at 10pm) aimed at ‘teens’ but really meaning over 16s raises issues over what topics will be covered. Working with young people on sex and relationships issues reveals lots of diversity. You may find a nine year old asks a question that seems very ‘adult’ while a fourteen year old wants to know something that you’d expect a much younger child to be aware of. Part of the skill in working with young people (as it is with adults) is pitching what is discussed at their level, within their comfort zone. Not talking about issues they are not yet confident to understand, or that may be beyond their comprehension or are age inappropriate.

There is always a dilemma in education and advice giving about to provide information that does not patronise young people nor decide for them what they ‘ought’ to know. Young people have a right to sex and relationships education, but when television programmes muddled entertainment and advice (ignoring the latter for the sake of the former) this can mean young people either get information that is not useful, or are presented with concepts that may not be appropriate to their needs.

My worry with this programme is the topics selected for the series were chosen to attract an older audience, rather than truly deliver sex information to teens based on issues young people really want answers to.

It is important to stress I only had involvement at the early stages of development, when practitioners were being approached to be part of the series or find potential participants. I don’t know whether the focus of the programme has altered since, but reading pre-reviews of the series suggests concerns myself and others had with the series have not been resolved.

According to press coverage, in the first show we will meet a woman called Michelle whose 17-year-old daughter Rachel got pregnant last year, is sexually active, but ‘refuses’ to go on the pill. Already we can see the cards being stacked against the mother and the daughter. The danger of such programming is it becomes an opportunity for audiences to judge others who are not fitting particular expected roles. Worryingly there is often a class and race based subtext to this kind of media coverage where audiences are invited to judge chavvy youth or those from ethnic minorities or different faiths.

Other press discussions of what we can expect from the programme, from sex tips to ideas about techniques suggests the focus is a primarily adult one – but one that is also problematic. Adult sex advice (from the media and self help market) is preoccupied with positions and performance. Where ‘perfect’ sex is something to continually aspire to, is measured by how much you do it (not what you do), and where orgasms are something you ‘achieve’ not ‘experience’. It is a space where relationships are usually defined as monogamous (usually heterosexual but sometimes lesbian or gay sexuality is acknowledged). It is not a place where diverse sexualities are talked about in depth – or if any kink or alternative sexualities are focused on it is usually in a fairly sanitised or problematised way.

Sex for grownups (in the mainstream media and popular culture) excludes those who can’t fit into size 10 sexy lingerie, afford the latest sex toy, or whose bodies can’t mould themselves into 101 different positions. It is not a place for people with disabilities to have a voice, nor for those who are Trans, queer or asexual to speak out. If you are single you are allowed to be sexual so long as you can talk (albeit not very explicitly) about friends with benefits, or better still indicate you are trying your hardest to get into a relationship.

Many researchers, therapists and sex educators feel the stifling mainstream depictions of sex and lack of adventure and exploration – and absence of focus on communication – is a problem for adults who want to experience enjoyable sexual encounters or relationships. As a result, the aim of teaching young people to view sex and relationships in more diverse ways is to overcome many of the bad advice aimed at adults, or at least develop the critical thinking and life skills to see through the commercialised, pressurised and frequently unrealistic versions of sex currently on offer in mainstream popular culture.

It is therefore worrying the ‘The Joy of Teen Sex’, rather than tackling what ‘sex’ might be and how young people may look forward to experiencing it, may just serve up a predictable platter of Cosmo-esque sex tips. This is not what youth-focused sex and relationships education should be.

The media frequently distorts the teaching of sex and relationships. This can frighten parents and disempower teachers. Yet with programmes that provide unrealistic ideas about advice giving for young people this could easily give parents the wrong impression, suggesting as the norm activities that are not considered appropriate within school based or healthcare settings. It would be damaging if a programme that misrepresented both sex education and sexual health care contributed to a backlash against supporting parents, schools and healthcare providers from giving relationships information to young people.

Parents already worry about tackling sex and relationships issues with young people although they play a fundamental role in educating children. Media coverage that exaggerates the concerns of young people, presents an overly sexualised focus, or does not tackle the more mundane (and less ‘sexy’) questions young people may have can do two things. Firstly it can suggest to parents they need to be fearful for their child (and their potential sexual interests), and secondly imply the issues their child wants to know about are completely outside a parent’s ability to tackle. Neither are empowering for parents or young people. It is perhaps for this reason parents have already started speaking out about the programme.

What is not clear is why young people and parents wanted to participate in The Joy of Teen Sex. Were they seeking attention or fame? Or did they need advice? If it’s the latter it would be useful to know what led them to get this through a television programme rather than existing services – particularly if people had encountered barriers with existing education or healthcare on sex and relationships issues. Were people unaware of, or unable to access existing sources of free help and information? What about the participants in the programme? How representative are they of young people generally – and how many would-be participants for the show were not included? Why was that? It would be interesting to see journalists follow up on these questions, rather than just inviting us to gawp at and judge the participants in this series.

I have not seen the programme, so I my concerns could be completely misplaced. I will watch it and see if it manages to provide accurate and empowering information. I sincerely hope it does, but I am not confident this will happen. As a supporter of mediated sex advice it infuriates me programmes continue to be made where experts are ignored, where unethical practice is permitted, where young people are not involved, and where the end result does not educate but may well disempower parents, teachers and young people. It represents an endless stream of programming that wastes time, money and opportunities to share accurate advice people so desperately want.

I am always happy to support programmes that cover sex and relationships in an affirmative and diverse way, that move beyond ‘sex’ as intercourse, positions, techniques or infections to answer the questions young people really have in a sensitive way.

I did not feel The Joy of Teen Sex was offering this (although as already mentioned I am happy to be proved wrong). When I was asked to participate as a presenter and to refer young people to the researchers I refused. I felt the TV researchers were not listening to the feedback I shared on how they might make this programme more accurate and empowering, or my concerns about the wellbeing of young people and parents.

Equally worryingly the researchers warned me and other educators not to criticise or question them in public (i.e. on Twitter) or share our concerns about the series.

When a TV company commissioned to make a youth focused programme tells practitioners concerned about young people to keep silent, you really have to wonder who they are trying to benefit.

The Joy of Teen Sex is on Channel 4 tonight at 10pm (GMT)

It’s nearly Christmas and you may have already got gifts for friends and family. But if you’re still wondering what last minute goodies to buy, or can stretch to one more present, then here’s a few suggestions for charities and organisations who could do with your support.

These are all programmes I feel are often not given much publicity and may not fit in the usual ‘good gift’ type Christmas promotions, but nevertheless do amazing work all year round and deserve our support.

I’ve picked 6 charities/groups who represent various different activities around sex, relationships and health. Some are faith based, some secular. Some are specifically focused to one region or country, others are international. You may want to support the one you feel most impressed by – or perhaps give a small amount to several of these very good causes.

As well as financial support there are also other ways to help these organisations so do read up on any that interest you and see if you can help them as a volunteer in the new year.

Hesperian Foundation
Hesperian is a non-profit publisher of books and newsletters for community-based health care. It produces free resources in various different languages on topics such as Where There Is No Doctor, Disabled Village Children and Helping Health Workers Learn.

Here are ways you can get involved, which don’t just involve financial donations – you can also volunteer, translate and review books, and let other people know about the work Hesperian are doing.

Jabulani Rural Health Foundation
Jabulani is a non-profit organisation that supports Zithulele Hospital and its surrounding community. Zithulele Village is situated in a remote part of the Wild Coast (Eastern Cape Province, SA). Founded in 2007 by four Christian doctors, our focus is on healthcare, education, poverty relief, environmental issues and care for those affected by HIV/AIDS.

Practitioners at Zithulele have introduced a number of innovative programmes for rural health which have been reported in The Lancet and SAMJ and include nutrition, maternal health, occupational therapy and education projects.

A short film about the hospital can be found here:

Donation information can be found here
Become a friend of Zithulele here

Scarleteen
Scarleteen is an independent, grassroots sexuality education and support organization and website. Founded in 1998, Scarleteen.com is visited by around three-quarters of a million diverse people each month worldwide, most between the ages of 15 and 25. It is the highest-ranked website for sex education and sexuality advice online and has held that rank through most of its tenure.

More info here

Donate here

Outsiders
Outsiders is a community for people with physical and social disabilities that enables people to meet, make friends, overcome isolation and form relationships. It coordinates local meet ups, provides advice and hosts numerous events to raise funds for greater advocacy for people with disabilities. It also operates a peer support network, lobbies for greater rights for disabled people, and informs health and social care practice around sex, relationships and disability.

As well as providing financial assistance there are other ways you can help Outsiders including lobbying on issues around disability rights, and assisting the organisation with research, advocacy and resources. More information on how to give here

Education for Choice
Education For Choice is the only UK-based educational charity dedicated to enabling young people to make informed choices about pregnancy and abortion.

When young people have opportunities to explore the decisions that can lead to and result from pregnancy they are better able to:
Protect themselves from sexually transmitted infections and unintended pregnancy
Make informed choices
Access appropriate services to support their choices.
Education For Choice’s work is focused on the word choice. Whilst we concentrate on the issue of abortion, as it is the issue that receives least attention, we believe that work with young people should value all pregnancy choices equally.
Our ethos is that the best outcomes of unintended pregnancy occur when the woman involved has been able to make her own informed choice.

Donate here

The New View Campaign
The New View Campaign was formed in 2000 as a grassroots network to challenge the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs.
The pharmaceutical industry wants people to think that sexual problems are simple medical matters, and it offers drugs as expensive magic fixes. But sexual problems are complicated, sexuality is diverse, and no drug is without side effects.

The goal of the New View Campaign is to expose biased research and promotional methods that serve corporate profit rather than people’s pleasure and satisfaction. The Campaign challenges all views that reduce sexual experience to genital biology and thereby ignore the many dimensions of real life.

The New View Campaign is devoted to education, activism, and empowerment. We invite you to benefit from the information on this website, and we invite your support and participation.

More information on donating and volunteering for the New View, as well as implementing its ideas into policy and practice can be found here

I hope you are able to support one or more of these charities/organisations financially or in some other way.

Thanks for your continued support for this blog. Your feedback, suggestions and ideas for content (and how to improve the blog) is always very welcome.

Wishing you a very Merry Christmas and all the best for a happy and healthy New Year.

To get people in the Christmas spirit – and the mood for giving, I’ll be sharing carols, seasonal songs and a few sketches on twitter between 1-4pm on 22nd December (GMT) on the hashtag #PsXmasCharityConcert.

If you missed it, here’s the concert in full – please consider giving to one or more of the charities/organisations listed above while you tune in!

We opened with Mariah Carey’s All I Want For Christmas Is You

Followed by Meryn Cadell’s The Cat Carol which you can listen to here. [Not really suitable for young children, anyone who feels a bit hormonal, or people who like cats]

Then it was time for a bit of reading, with the fabulous Joyce Grenfell’s Nursery School Nativity Play And George, Wise Men never do that…

I bet you’ve never heard a better (or madder) version of The Little Drummer Boy than this one by The Klezmonauts.

It’s a Christmas tradition in our house that my dad reads King John’s Christmas as part of our family concert (he does it beautifully). So it felt apt to include it in my virtual Christmas Concert.

Next it was time for some Christmas kitsch – and it doesn’t get much kitscher than Eddie Dunstedter and his organ. I feel like I need a pair of heels, a cocktail and a Christmas pinny to really get into this one…

And if that wasn’t camp enough, it was time for some innuendo with Larry Grayson asking ‘Who’s stuffing your turkey this Christmas?’ (Go on, you can tell me!)

Do you believe in reindeer and the magic of Christmas? Of course you do! It’s only those pesky physicists who try and spoil things with all their logical explanations. Bah humbug!

Another song due after that, and it was over to Si Cranstoun and a very jolly Miss Santa Claus (he’s part of the Dualers – who are fab!)

What could be more seasonal than a song about an Angel Gabriel by LAMB?
I can fly
But I want his wings
I can shine even in the darkness
But I crave the light that he brings

Hoping you have someone in your life who make you feel this way.

On a lighter note I asked if people were familiar with the term Camp As Christmas? You will be after watching Bearforce 1 and ‘Christmas is here’ (which frankly ought to be the Christmas number one IMHO)

Next it was time for an activity for all the family – and kids of all ages. The Santa Application form (which I use in teaching questionnaire design – only at Christmas obviously). Still time to get your application written!

Obviously it wouldn’t be Christmas without a bit of Judy Garland, and the tearjerker anthem Have yourself a merry little Christmas

Last up in the virtual concert was my favourite carol In The Bleak Mid Winter which has the most beautiful words written by Christina Rossetti. I have a bad habit of ruining carol services by blubbing my way through the final verse of this.

Thanks for joining in my charity concert – either here or on twitter, and remember this was all for the good causes listed above, so please give them your money or your time if you are able.

Merry Christmas!

Fans of the movie Anchorman will no doubt be familiar with the men’s fragrance ‘Sex Panther’. If you hadn’t heard of it before, here’s your introduction…

The fantastic line ‘they’ve done studies you know. 60% of the time it works every time’ has become a well known catchphrase. But I think it deserves far wider use and so I’ve appropriated it to highlight dubious sex research claims.

Last week a Dallas TV station didn’t disappoint with an amazing Sex Panther statistic of their own, claiming ’80% of women have an enlarged labia’. You can see the coverage of the story here.

Even with my dubious maths skills this doesn’t make sense. Because if such a large majority of women report large labia then presumably this becomes ‘the norm’ rather than ‘a problem’.

Using a standard Sex Panther approach we’re told nothing about the origins of this statistic. Merely an assumption that science has shown us 80% of women have larger labia. So we don’t know how many women were studied to make up this figure, who they were, when they were studied, or whether they actually considered themselves to have a problem. We don’t know who did the research, or whether it was even published. We’re given no clue about how ‘enlarged’ labia must be before they become unwieldy. The statistic becomes even more ludicrous if we’re assuming ‘enlarged’ to mean ‘larger than average’. In which case we seem to be being told that 80% of women have larger than average labia.

And that’s before we get on to the problem of the programme makers not being able to differentiate between the vagina and labia.

Of course the piece is really only an advertorial for a “misses only makeover” and sadly amidst the coy references from the anchorwomen we see absolutely no investigative journalism to assess whether cosmetic surgery for well women is needed or to interrogate the concept of ‘enlarged labia’ and who is problematising our vulva shapes and sizes.

Had any research been undertaken the journalists may have learned there is no clear evidence for the effectiveness of cosmetic genital surgery in well women, but there is a growing trend within the cosmetic surgery industry to pathologise the female body as a means to creating a wider market in ‘enhancement’.

Although uncritical media reporting on genital surgery is not unusual there is fortunately an antidote.

THE NEW VIEW CAMPAIGN announces its THIRD Conference, to be held at the University of Nevada, Las Vegas, on Sunday, September 26, 2010.

FRAMING THE VULVA: GENITAL COSMETIC SURGERY AND GENITAL DIVERSITY

While the vulva surgeons are holding a conference on the Las Vegas strip, the New View, in collaboration with the UNLV Women’s Studies Department and Petals, will hold a counter-conference to examine the
personal and political complexities of the new female genital cosmetic surgeries.

Our one-day event will include a morning plenary session on the emerging issues in genital scholarship, activism, and art, and an afternoon of experiential and discussion workshops for participants to share strategies and build connections. The event will conclude with an evening reception, photography and craft exhibition, and film showing at the Erotic Heritage Museum.

Areas covered will include:
• Cosmetogynecology and the new genital perfectability industries
• The rhetoric vs. the realities of Western genital surgeries vs. “FGM”
• Collaborative models of activism
• The revival of “cunt art” in craft, film, photography and painting
• Sex education and feminist-owned sex shops
• The latest body modification trends, from Vajazzling to Vatooing
• Disease-mongering, marketing, and body surveillance
• Critical health studies perspectives on cosmetic genital surgery

Confirmed plenary speakers include:
• Virginia Braun, University of Auckland, New Zealand
• Leonore Tiefer, NYU Medical School, NYC
• Vanessa Schick, Indiana University, Bloomington
• Lynn Comella, UNLV, Las Vegas

Full registration, hotel, and contact information here.

Please share information widely and if you’re a health worker, activist, therapist or sex educator do try and support the event if you can – either by attending the conference or donating to the New View Campaign. Journalists may particularly want to attend to learn more about celebrating women’s bodies and accurate reporting on the growing trend for medicalisation.

In the meantime go on – love your labia! Or love someone else’s. And if a journalist tells you there’s something wrong with your genitals without explaining the science behind their statements be assured they’re simply selling you Sex Panther Statistics.

Tomorrow sees the FDA Committee Hearing on Flibanserin, the drug created by Boehringer Ingelheim (BI) to address ‘hypoactive sexual desire disorder in women’. In advance of the meeting you can see the hearing’s list of materials here, BI’s submission of their research on Flibanserin to the FDA here, and my summary of the story/science of this case to date here.

For the past few years while BI have been developing Flibanserin there have been numerous concerns raised by scientists, therapists, educators and activists. Their concerns have included the measures used to assess sexual satisfaction, the trials undertaken to assess the product, safety/efficacy questions, marketing strategies aimed at practitioners and the public, and the fact the research has not been made available within a peer reviewed journal.

It is now possible to review the research (see above) and, as critics have already indicated, it seems there are problems with the method and measures used and particularly issues around side effects and the effectiveness of the drug.

These issues are part of a wider anxiety over the increasing medicalisation of reduced female sexual desire and have been discussed in advance of the FDA hearing by Leonore Tiefer and Liz Canner and challenged via groups such as the New View Campaign.

Over recent months press coverage has not been particularly critical. Numerous stories have run about the promised ‘Pink Viagra’, despite practitioners like myself consistently urging journalists to check the science, the ethics of marketing and the general backplot on medicalisation.

However, with the release of data by BI for the FDA hearing the press have become more critical of the research and finally have begun to raise questions about ethics, science and marketing. Some example coverage includes:
FDA Staff question female sex drive pill (Reuters)
Flibanserin Failure: Female Viagra Drug Disappoints (US News)
Female Viagra fails in clinical trials, or so male partners claim (TrueSlant)
Push to market pill stirs debate on sexual desire (New York Times)

Overall the media coverage is reporting the FDA as raising issues about the safety and efficacy of Flibanserin. Fewer discussions have focused on the equally troublesome aspect of the marketing of the product, though after the hearing tomorrow this may be raised.

It is a pity that journalists covering this story could not have perhaps applied a more critical lens when the story was being flagged up back in April/May. Particularly since they were actively advised by practitioners to ask core questions which have now been raised by the FDA.

More positively, it is worth noting that at least the media have kept up with this story and followed up discussions of the hearing and the drug. Previously when the drug Intrinsa (Proctor and Gamble) was being assessed by the FDA the media applied little critical coverage to the event and failed to follow up what happened at the FDA hearing – despite being encouraged to do so.

Certainly the role of blogs, twitter, and activists challenging poor science and misleading media coverage have undoubtedly ensured core questions that should have been asked about the drug have been addressed somewhere – even if not always in the mainstream media.

So, what may the hearing decide? It’s hard to tell. Previously with the Intrinsa hearing it was assumed they would approve the drug, but this didn’t happen. Early indications seem to be suggesting the FDA won’t approve Flibanserin but we cannot assume this just yet. Even if the FDA do turn it down we can expect BI to then approach the European Medicines Association (EMEA) for approval (as happened with Intrinsa).

The media often tends to suffer with memory loss on such cases so it’s very important if the FDA do not approve Flibanserin that journalists remember this. Because if BI then goes for EMEA approval and relaunches their ‘Pink Viagra’ PR drive journalists need to remember the problems already highlighted with the drug.

You can keep up with the discussions at the FDA tomorrow by following The New View Campaign on Twitter who will be tweeting live from the event. Do follow them and keep watching and asking questions about science and medicalisation. Tomorrow is a very important day for the future of women’s sexual wellbeing, but the quest to find a pill to fix our sexual problems without looking at wider social/cultural issues is not going to end there.

On June 18th pharmaceutical company Boehringer Ingelheim will be seeking approval from the Food and Drug Administration (FDA) for their drug Flibanserin (which may be traded under the names of Ectris and/or Girosa).

This is an antidepressant style drug which Boehringer Ingelheim claim is a treatment for low/lack of sexual desire in women (aka Hypoactive Sexual Desire Disorder or HSDD). It must be taken every day and for up to a month before any benefits may be noticed. How long it should be taken for after that is not clear.

It has been difficult to judge the efficacy/effectiveness of this drug because to date no trial data has been published in a peer reviewed journal. Instead data was presented at a conference last November based on combined data from a number of trials. This combined data indicated a significant difference between the drug and placebo although it was only one more sexually satisfying experience per month on Flibanserin as compared with placebo. There is little information available about how long the drug must be taken for, potential side effects and what happens during/after withdrawal. A summary of activity on this product to date can be found here.

Despite a lack of clear data about the product, its effectiveness or how it has been evaluated, Boehringer Ingelheim has already focused on marketing to the public with activities including a glossy website aimed at women called Sex Brain Body. Messages outlining the prevalence of HSDD and related issues are also shared frequently via @SexBrainBody on Twitter. They have also been approaching practitioners to put their name to pre-written pieces to go into journals. These detail the prevalence of HSDD to be aimed at GPs and other healthcare staff along with hosting numerous ‘training events’ (described as ‘round table discussions’) for practitioners to learn more about HSDD and CME activities for medics such as “Female Sexual Health: Recognizing the Impact of FSDs on Patient and Partner and Implementing Clinical Strategies for Overcoming Communication Barriers”. In addition for the last 12 months the company has also paid a number of sexologists to design marketing materials.

What is HSDD and does it exist?
Women do experience psychosexual problems, as well as relationships difficulties or dissatisfaction with sex/relationships. You can see these summarised in an answer I recently wrote for NHS Choices.

Obviously with many potential causes of problems there are many potential solutions/responses. This might include basic health information, adequate reproductive health care, improved communication with a partner, healthcare for other problems or relationships counselling.

Concerns have been raised by the suggestion that not wanting sex or experiencing low sexual desire is a clinical problem requiring a pharmaceutical solution as a first port of call.

It was all about your hormones, now it’s all in your head
In the past five years we’ve seen some interesting (and worrying) developments in the area of drug development for HSDD. For several years the general view was women’s lack of desire was linked to hormonal deficits (specifically Testosterone) with hormonal patches designed to ‘treat’ the problem. These performed poorly at trial and were not approved by the FDA (although did get approval for use in Europe). A systematic review of all trial data indicated the Intrinsa patch was not effective at dealing with low desire in women.

The focus has now shifted to seeing women’s lack of desire as a neurological problem, with Flibanserin working in a similar way to an antidepressant (indeed it was developed as an antidepressant but was not fit for purpose). The naming of the promotional site as ‘Sex. Brain. Body’ particularly shifts attention towards female desire problems as being psychological, complex and emotional.

Intrinsa was only designed for women who had low desire following surgical menopause, whereas Flibanserin can be taken by any woman diagnosed with low sexual desire. Already we have seen practitioners associated with Boehringer Ingelheim working on Flibanserin also suggesting the contraceptive pill reduces desire which is one market which may benefit from having a pill to boost arousal.

Challenging the medicalisation of female sexual problems
There have been a number of efforts to challenge the medicalisation of female sexual dysfunction and to ask questions about Flibanserin. These include the New View Campaign, journalist Ray Moynihan’s forthcoming book Sex, Lies and Pharmaceuticals and Liz Canner’s documentary Orgasm Inc. While Paul Joannides has used humour to focus on problematic aspects of the drug.

The response by the Boehringer Ingelheim has been to focus on presenting high levels of female sexual dysfunction to practitioners and the media, and reinforcing the message HSDD is extremely prevalent and highly distressing. Those who have criticised the company or the drug have been accused of ignoring women’s plight or dismissing problems.

This is unfair and inaccurate. It is perfectly reasonable to question any drug that is being marketed, particularly in terms of its effectiveness, safety, marketing and purpose. Rather than denying women’s problems those questioning Boehringer Ingelheim are mostly long term activists for women’s health and sexual wellbeing.

What can you do?
Write to the FDA
This needs to be done by 3 June (can do this via email or fax). Contact details are:
Kalyani Bhatt
Center for Drug Evaluation and Research (HFD-21)
Food and Drug Administration
5600 Fishers Lane (for express delivery, 5630 Fishers Lane, Rm. 1093)
Rockville, MD 20857
Phone: 301-827-7001
Fax: 301-827-6776
E-mail: Kalyani.Bhatt@fda.hhs.gov

In particular you may wish to focus on the following in your feedback via the New View Campaign
“Please write to the FDA before June 3 about Flibanserin. All the information you need is on the FDA website. Write about side effects worries, poor efficacy in the trials, your concerns about the target population of young women, the outrageous marketing campaigns now underway with actress Lisa Rinna and others, the poor efficacy in the European trials that is never mentioned, the emphasis on HSDD (a soon to be extinct designation), etc. Be specific and be personal!!”

Sign the petition
The petition against Flibanserin and the medicalisation of female sexual functioning is hosted at Change.org. Please share this widely on twitter, your blog, forums, through health groups and listserves. It will be presented to the FDA at the hearing on the 18th June.

Encourage the media to focus on this as a women’s health issue, rather than a pro/con debate on whether HSDD exists or whether women should/shouldn’t get help.

If you work within healthcare encourage colleagues to look critically at this drug, ask questions about why trial data hasn’t been published/subjected to peer review, and consider wider ways we can enable women and their partners.

This is a very important issue in sexual and reproductive health. It is extremely worrying the FDA are being asked to approve a drug which has not performed particularly well at trial, and which has not been published in any peer reviewed journal to allow the scientific community to investigate it. It is also concerning that female sexual responses which may be distressing are being reclassified into a clinical condition.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification system created by the American Psychiatric Association to enable those working in healthcare to research, diagnose and treat mental health problems. It is not without controversy with critics arguing over each iteration of the manual more and more behaviours are medicalised and the DSM is tainted by the influence of drug companies with a vested interest in creating disorders in order to provide treatments. Supporters argue having a system of managing our understanding of mental disorders improves our approaches to research and care for those experiencing mental distress.

Today sees the launch of the draft version of the latest incarnation of the manual – the DSM5. It’s been worked on over the last decade and you can now see how mental disorders are being conceptualised (including what disorders have been amended, removed or added to). The whole draft is available here although I am most interested in how sexual functioning, gender identity and paraphilias are being approached.

In particular hypersexuality appears to be moving towards supporting diagnostics around sexually addictive/compulsive behaviours, which requires close attention as we already know this is one area full of very poor science, political and faith based ideology and a whole slew of homespun (but largely unevaluated) therapies.

If this is to be included in the DSM5 there needs to be a strong evidence base underpinning anything we want to label as ‘hypersexuality’ and robust reflections on how we classify problematic behaviour to ensure we don’t pathologise certain forms of sexuality (ie adultery, masturbation or alternative relationships) that particular faith based and neo conservative groups/professionals disapprove of.

The classifications around gender identity have proved controversial with critics questioning whether such guidance should be developed – particularly given a weak evidence base in this area. You can see how it is being approached in children here (approaches for adults also outlined in this part of the DSM5 draft). Mainly the debates around the classification in children have focused less on the issue of identifying problems and more about evidence based evaluations of treatment interventions for young people.

Sexual interest/arousal disorder in women is also an issue requiring close attention as we know this is an area where there’s been an ongoing issue about medicalising female sexual behaviour, suggesting women who don’t want sex for practical, relationship or health based reasons require hormonal or SSRI-type interventions.

You can expect to see discussions of this particular classification on sex blogs in the coming weeks, although it’s worth also looking at the additional classification aimed at men, and compare how these are new classifications as distinct from existing categories of orgasmic disorder aimed in women and men.

The existing DSM classifies difficulties in experiencing orgasm as a dysfunction, while the proposed new version would add to this lacking in desire for sex. Some people will welcome this seeing the lack of desire as the barrier to orgasm, others may conclude that there are many reasons women and men don’t feel desire or experience orgasm and classifying them as a mental disorder may be overmedicalising a range of normal human sexual responses.

If you’re interested in how we understand sexuality and human sexual behaviour I’d recommend reading through the entire list but focus your attention particularly on what’s being proposed as now needing classification, what’s being subsumed into existing categories and what established diagnostics look set to remain.

From this you should consider the evidence (shown by each category) and see whether you feel this is fair, balanced and whether it comes with any conflict of interest (you may need to track down the cited papers to do this). You could also reflect on what categories are being added, who is suggesting them and who might benefit or face discrimination from them should they be classed as a mental disorder. You may also want to think about what happens if any categories are added to or removed from the DSM – in terms of how we’ll be approaching research, therapy, drug treatments or surgery for sexual dysfunctions, and gender identity disorders and how those plus legal sanctions may be applied to the classification of paraphilias.

I’m not arguing here that all the items listed in the ‘sexual and gender identity disorders’ aspect of the DSM should be overlooked (for example nobody’s going to dispute paedophilia is a problem, although we need to be sure the way we classify this means those anxious about being potential abusers can get help and treatment). Yet we do need to cast a critical eye over some of the definitions activities that might come under the umbrella of fetish and kink, and also problematise those who apparently have too much or too little sex (or interest in sex).

No doubt colleagues far better versed in understanding mental health classification will be discussing the ramifications of the DSM5 draft in the coming weeks and I’ll add their reports to this blog.

In the meantime you have until 20 April 2010 to respond to this or any other aspect of the DSM5 draft. I would recommend we all do this as individuals or collective groups of practitioners or activists as this process will be used to inform how we define, research and treat mental disorders. If you feel there are particular areas which should be included or excluded from the DSM now is the time to have your say.

This week BBC2′s Horizon series continues with ‘Pill Poppers’, an investigation into our use of drugs. From the programme’s website

Over your lifetime you are likely to be prescribed more than 14,000 pills. Antibiotics, cholesterol lowering tablets, anti-depressants, painkillers, even tablets to extend your youth and improve your performance in bed… These drugs perform minor miracles day after day, but how much do we really know about them?

Drug discovery often owes as much to serendipity as to science, and that means we learn much about how these medicines work, or even what they can do, when we take them. By investigating some of the most popular pills we pop Horizon asks – how much can we trust them to do what they are supposed to?

I was invited to participate in the programme to discuss sex drugs and the medicalisation of sexuality. This covers a wide area, not all of which was possible to cover in the programme, so here’s an overview of this issue.

Medicalisation of sex has a long history – explained thoroughly here, and while we undoubtedly welcome the benefits of antibiotics for sexually transmitted infections, the more recent phenomena of medicalising sexual functioning is more worrying.

The best known sex drug is, of course, Viagra. Aimed at tackling erectile dysfunction in men it has morphed from a drug for a chronic clinical condition to a ‘lifestyle drug’ often wrongly understood to be an aphrodisiac. Other drugs for ED soon followed – Cialis and Levitra, with more in development. A discussion of the 10 year history of Viagra can be found here.

Given the huge profit made from erectile dysfunction drugs, the race was on to find additional sex drugs and over the past few years we’ve seen a lot of hype about sprays that would boost desire, Viagra’s use in women, and testosterone treatments for women. Which either did not proceed past trial stage (in the case of the first two examples), or was licenced for public use but not found to be clinically effective (in the case of the latter example). There’s also the growing market of herbal sex products mostly sold online but also stocked in high street stores. Not to mention the private clinics using bullying tactics to persuade men to buy their ‘cure’ for premature ejaculation.

Over the past 15 years there’s also been a major shift to categorise a lack of desire in women as a clinical disorder requiring medical treatment, the most recent development being the ‘desire drug’ Flibanserin.

For Horizon’s ‘Pill Poppers’ I was keen to outline how some sex drugs (such as the contraceptive pill or antibiotics for sexually transmitted infections) have undoubtedly enhanced our lives. But the medicalisation of sexual behaviour is another matter. While I agree men with chronic erectile dysfunction as a result of a health problem such as MS or diabetes benefit from an erectile dysfunction drug, attempts to classify a lack of desire have proved highly problematic.

There are many things that can cause sexual problems for women and men (gay or straight), including:
- Physical or mental health problems (such as diabetes, heart disease or depression, cancer)
- Gynaecological or urinary problems (including thrush, cystitis, sexually transmitted infections)
- Relationship problems (such as arguments, jealousy or communication difficulties)
- Stress (from too much work or workplace problems, being overloaded with housework, a lack of partner support, or financial worries)
- Not knowing or being able to effectively explore or communicate what turns you on
- Lack of privacy for sex
- Concerns over pregnancy (worries about getting or not getting pregnant)
- Past or current physical, emotional or sexual abuse
- Body image or confidence issues
- Lack of sex education or holding negative beliefs about sex

These can be short or long term problems and may resolve themselves or require the assistance of a therapist or healthcare practitioner. The idea that a lack of interest in sex should be immediately approached with a pill means the multiple contributory factors to sexual problems may well be missed – resulting in any medication being largely ineffective.

It’s worth noting, as Pill Poppers airs, that despite the media hype we only currently have drugs legally available to treat erectile problems. Although from the media hype around drugs in the pipeline (at trial stage) you’d be forgiven for thinking there’s more products available. You’d also be forgiven for thinking no drugs means no support or help for psychosexual problems, which isn’t true. Therapy and other healthcare interventions can do a lot to help.

So my advice is if you are worried about your sex life, identify what the cause of any problems might be before thinking you’ve a clinical condition. Of course if you’re in pain or distress you should speak to a doctor or therapist, but it may well be that while you have a problem it isn’t necessarily one a pill would fix.

After all they’ve yet to make a pill that makes your partner romantic, or keen to share all the household chores.

Link to Pill Poppers, BBC2, 21.00 (GMT). Available on iplayer via link.