What made me start blogging?
Five years ago I sat down on a dark November evening and wrote my very first blog entry. It was a bit ranty. I’d been misquoted by a journalist and was anxious it would get me into hot water (again).

I didn’t have a game plan when I started blogging. My partner (who’s way more tech savvy than I am) thought it might be a good way of sharing ideas I was struggling to convey via the mainstream media (I was writing several advice columns in magazines at the time, as well as hosting a regular radio phone in for BBC Five Live).

I approached the blog as a form of therapy. I wanted to work with the media but was getting a lot of stick for it professionally (I’m an academic as well as a sex educator). Having a place to blog would allow me to correct any errors in reporting and disclose bad journalism. I even hoped it it might even let me bring evidence into sex/relationships reporting – and show it was possible to do so without things becoming worthy or dull.

One thing I felt sure of early on was this blog was something I enjoyed writing, but I wanted to be useful, and most importantly to deliver things about sex, relationships, science and journalism that readers wanted to know about. Which is why the blog has always been shaped by things you’ve asked for.

Readers make this blog (or “why don’t you have comments?”)
Last summer I asked regular readers to give me feedback on this blog and got some very helpful responses. It’s taken me a while to implement some of these, but I have now upgraded the blog to include the things you asked for – photos and images to liven things up, a better blogroll, summaries at the start of most entries so you can decide if you wish to read on. And categories. Something I didn’ think about five years ago and really wish I had. I’m now in the process of going back through all the 800+ posts and adding categories to them, which I hope will make this blog a lot more useful to you.

The one thing this blog doesn’t have is comments. I did start off having them, but encountered several problems. As I was offering advice within columns and websites elsewhere I hadn’t planned to also answer problems on this blog. However, not all readers understood this so I frequently found requests for advice on anything from infidelity to penis size included in discussions about blogs relating to research design or journalism ethics. This sometimes led to some readers mocking those asking for advice, which of course is completely unacceptable for me as an educator.

Moreover, I’ve always blogged openly – never behind a pseudonym. I work within the community on sex/relationships projects and educational activities (in the UK and internationally). This meant I was very accessible, and felt vulnerable when those whose comments were deleted or not posted, made very personal threats.

I found moderating the comments was time consuming and took me away from other educational activities which I felt were more worthwhile. So I decided to remove the comments option. When I’ve asked readers if they want them back the general response is ‘no’. That’s mostly from people who feel the blog’s a safe space to get information which they can use as they wish elsewhere.

Of course I strongly welcome respectful email feedback and am always happy to add information or correct errors within the blog. You’re always welcome to start discussions on other forums or your own blog about issues raised here. For now I’ve no plans to reinstate comments, but since I’m occasionally asked why I don’t have them I thought this was a good a time as any to clarify the issue.

Achievements so far
Having read back to 2004 I’m pretty pleased with this little blog. It’s nice to see it’s grown into a resource that people trust and enjoy reading.

The things I’m most proud to have written are activist blogs that highlight medicalisation, exploitation and abuse. These include the debates around female sexual dysfunction, questioning high street stores stocking ‘herbal’ erectile dysfunction drugs (not approved by the FDA), exposing the Advanced Medical Institute’s aggressive sales technique for men affected by premature ejaculation, or highlighting misleading media coverage of the availability of Viagra on the high street.

I initially planned to use the blog to set right bad sex coverage in the media (or occasions where I’d been misquoted). This has been a theme within the blog although I think it’s become more focused over time (although not necessarily less ranty than my very first post). I can’t say whether it’s made much difference to journalists, and I hope it’s not put people off working with the media. I’ve found it helpful to describe poor practice – not least because the general trend for ‘experts’ working with the media is to act grateful for any exposure, not publicly discuss poor experiences or document bad practice. Gems for me include an expose of GMTV sending a cab to my home at 6am on the off chance I might wake up and come to their studio. Or how a TV show wanted to discuss female sexual confidence without mentioning genitals or masturbation. Or some rather nasty experiences with snotty TV producers just after I’d had a baby. Not to mention the hilarious case of the science journalist who really took a dislike to me (and colleagues). Oh, and let’s not forget the journalist who wanted me to recommend them an ‘unethical psychologist’ .

Of course, the past five years have not been spent simply slagging off journalists. No. Sometimes I’ve also turned my gaze to bad science too. Where it’s been depressing to report on a carnival of studies which seem to set us back sexually. Studies complaining women orgasm too easily, or there’s a ‘clitorocentric conspiracy’ against the vagina, how sex with a partner is 400% better than any other kind of sex you might have, and you can tell whether a woman has vaginal orgasms by her walk.

Let’s not forget my other bugbears. The fake formula and shonky surveys and my goodness this blog’s a treasure chest for those. And if I’m not being irritated by that, then there’s always the problem of psychologists talking about celebrities, or the general ethical issues raised by Big Brother for me to moan about.

Of course, it’s not all been bad news. Anyone would think this blog is only about gripes and grumbles. I’ve always wanted to showcase a variety of sexual experiences within this blog and not just think about sex just for a Western audience. I’ll continue to discuss issues relating to sex and seniors; teenagers; disability; transsexuality; lesbian, gay and bi issues; open relationships; BDSM; sexual health; contraception; prostitution; pornography; reproductive health; pleasure; desire; asexuality; dating; psychosexual problems; showcasing great sex pioneers; talking about safer sex; and as many other topics as I can find for you to read about.

Where to next?
Unlike five years ago, I’m now thinking strategically about this blog – who it’s for, what it does, and seeking to find ways to assess any impact it may have. I’ve noticed over the years it sometimes deviates into areas that interest me, but may not appeal to all readers. So my aim is to ensure the focus of the blog remains around the core things you’re most interested in when you visit – sex, science, and media.

I’m currently involved in overhauling the site so in the new year I hope to have far more open access materials available for you – relationships and sex guides, information about sexual and reproductive health, more advice and links to sources of help, along with practical information for journalists, healthcare professionals, parents, teens and teachers.

I’ve been asked by many readers for more information about how to become an agony aunt/media sex educator, so I’ll be blogging about this – as well as how to write a sex blog – in the not too distant future.

I’ll also be making use of twitter soon, as sometimes I blog about issues people need to hear about fast (particularly developments in science/health), so hopefully that will make messages more accessible. I’ll let you know once I’ve sorted it.

Obviously I’d like to hear what you’d like to see. How would you like this blog to develop over the next year (or five!). Are there any particular things you’d like to see more/less of? Topics you want covered? People you’d like me to interview for the ‘quickies’ section of the blog? Campaigns you want covered? Let me know what your vision is for this blog.

So, happy fifth birthday blog. Big birthday kisses to those of you who’ve been with me from the beginning. For those of you who’ve only recently found this blog I hope you like it enough to stick around for the next half decade. I notice one of my favourite other blogs Mind Hacks has also celebrated it’s fifth birthday too, so congratulations to them.

Time to blow out the candles and make a wish. Of course, I can’t tell you what it is. You’ll have to come back in five years to find out if it’s come true.

Brief background – female sexual dysfunction

Over the past 10 years the race has been on with pharmaceutical companies to find the ‘female Viagra’ – a drug to treat female sexual dysfunction (FSD).

At the same time, concern has been growing within healthcare, therapy and education about the medicalisation of sexual functioning. FSD in particular is a diagnosis with a controversial heritage, with concerns expressed that common (but often upsetting) female problems around lack of desire and difficulty experiencing orgasm have been repackaged within a illness-based model.

[You might also find this discussion held a couple of years ago on Woman's Hour that addressed FSD useful (includes links to support organisations relating to sexual difficulties). Plus this special issue of the journal Sexualities tackles the problem of medicalising sex for women and men, and Liz Canner's amazing documentary Orgasm Inc provides a thorough backdrop to the topic]

Over the years several drugs have been developed, although many did not get past early trial stages. Of those that did, testosterone patch Intrinsa was heralded as being the answer to lack of sexual desire in women, although was later found not to be clinically effective (and was never approved for use in the US). Another drug – PT141 – aimed at boosting desire (and aimed at men and women) also failed to meet safety standards and wasn’t developed further (although that wasn’t before the media promoted it as the sex wonder-drug of the future). Alongside these promised medications there’s been a whole slew of herbal products and ‘super foods’ (usually fruits, seeds and berries) promoted in the media and all guaranteed to boost desire or enhance orgasms.

Latest trials – Flibanserin
Flibanserin is a centrally acting anti-depressant type drug made by Boehringer-Ingelheim who have been developing it over the past few years. It is aimed at a condition referred to as Hypoactive Sexual Desire Disorder (HSDD) – or a lack of/no desire for sex in lay terms. Reports suggest the latest trials of the drug are about to be announced, and it’s likely the product will be promoted for public use within the six to eighteen months (pending FDA and EMEA approval). Early trials claim the drug boosts sexual desire, but (as with other SSRIs) this drug must be taken every day for 3-6 weeks before any effects will be noticed and continuously thereafter.

What’s interesting about this drug is it indicates a shift around how we conceptualise and ‘cure’ female sexual problems. Previously the message from drug companies was FSD was a hormonal problem and could be managed with additional testosterone. Flibanserin reframes FSD as a ‘desire is in your head’ model, working on neurotransmitters to increase libido. Moreover, previous drugs tended to focus on women who were approaching or had gone through the menopause (naturally or surgically). Flibanserin is being targeted at all women (so a far larger market share than products just for post menopausal women).

Aside from the wider worries about medicalising female sexual problems (which are caused by numerous factors), critics of Flibanserin question how an antidepressant can boost desire given a common side effect of such drugs are to reduce desire. There are also worries from healthcare workers and therapists around the long term safety of using such drugs and potential problems with withdrawal.

Those defending Flibanserin (and drugs like it) argue that therapists are only criticising the products as they want to promote talking cures over medical ones (and thus have a conflict of interest). They also have reappropriated feminist discourse to talk about women being left out or needing the same access to sex drugs as men (although the products available for men are actually limited and mostly only for erectile dysfunction).

The difficulty with discussing this area is that women do experience sexual problems for a variety of reasons. Many of these can be helped with education, better contraception, improving (or leaving) a difficult relationship, therapy, addressing psychological or physical health problems, or better sexual communication between a woman and her partner. These issues should be tackled as a first port of call, rather than recommending a pill or patch. However, given the embarrassment women experience over sex problems, plus additional pressures from the media and partners to be good in bed (and a desire for pleasure and intimacy), it’s easy to see why someone would prefer a magic bullet than having to work through what’s causing their problems.

Sadly drug companies (and practitioners allied to them) exploit this by making out anyone who questions the FSD diagnosis is anti-women or out to stop women enjoying sex.

What you can expect from media coverage
At each stage of development Flibanserin has already been promoted via the media as a forthcoming drug that will transform women’s sex lives. No doubt coverage over latest research on the drug will follow this format. It’s a dream for health writers and particularly glossy men and women’s magazines as you can discuss sex (and the stereotypical ‘women don’t like it’ angle) with a mix of science and the promise women who’re not sexy enough can be fixed.

You can expect plenty of headlines promoting a wonder drug to boost sex – and reinforcing the idea that women’s sex problems are ‘all in her head’.

What you won’t see is questioning about the drug, safety and long term effects. Nor will you see any critical reflection on the construction of FSD as a medical condition, nor any practical advice on the many reasons women may not experience the sex life they expect – and what they might do about this.

What journalists probably don’t know – behind the scenes of marketing Flibanserin
While Flibanserin has been developed, there has also been a systematic approach from Boehringer-Ingelheim to promote the product before it has been developed. In 2008/9 I’ve had two invitations to attend two two-day long ‘training days’ at top London hotels (with an honorarium of £1000 per session). This invitation has been extended to other practitioners within sexual health.

My understanding of the aim of these events were to highlight FSD (or more specifically Hypoactive Sexual Desire Disorder) as a problem and inform practitioners about treatment approaches. From that, key advisors who’d attended training days could speak further and influence colleagues to also promote FSD as a problem and recommend future treatments as they came on board. Here’s a copy of the agenda for one of the events to give you an idea about what was covered.

I did not attend these events. However, this did not prevent Boehringer-Ingelheim from trying to engage me in other ways. On 1 April this year I was sent an unsolicited invitation to write a paper for their journal British Journal of Sexual Medicine. You’ll see from both the letter and instructions for writing the paper that they had clear instructions about what they wanted me to say and how this would set the scene that HSDD was a prevalent and distressing problem doctors ought to be aware of – presumably so they could be alerted to a problem and be more willing to prescribe a pill when said medication became available.

This may not seem like a major issue, but it’s worth noting that such activity is frowned upon by reputable academics as really all you are doing is marketing a product, not engaging in true peer reviewed science. So obviously I didn’t accept this offer either.

[Since writing this Boehringer Ingelheim's Medical and Scientific Affairs Manager contacted me and requested a right to reply. You can read their response here].

I’m raising this here as journalists and the public need to know this may be considered a case where the market for the product is being worked upon at the same time the product is being developed.

Nobody is denying women have problems, but there are many ways to approach these without slapping a clinical diagnosis on women who don’t feel sexy.

Questions you should be asking about FSD and sex drugs
If you’re a journalist, healthcare provider or member of the public you should think about what may cause women’s problems with sex and solutions to those. Question whether a clinical intervention is the best option, and research how the category of FSD (and related diagnoses like HSDD) have been created (and who by). In particular you should ask the question whether taking SSRIs on a long term basis is the best answer to women who aren’t feeling desire.

Update 16/11/09
The press release for Flibanserin is now available. If you’re a journalist covering this story you may want to ask questions about efficacy, safety and medicalisation (as outlined above). You may also want the drug company to clarify exactly how many ‘satisfying sexual events’ (their term) were classed as significant as compared with placebo. The press release states a significance, but in lay terms how much more satisfying sex per month can a woman expect if she’s taking her daily dose of Flibanserin?

Update 17/11/09
Cory Silverberg has a clear and thoughtful analysis of the Flibanserin studies, reflecting particularly on how sexual experiences were measured. This blog highlights how Flibanserin is still an experimental drug (not quite how the media are reporting it). Also, it’s worth noting from Cory’s appraisal of the research how not all women in the study did experience significantly better ‘satisfying sexual events’ compared with placebo. Well worth a read for an appraisal of both the research and marketing approaches from Boehringer-Ingelheim.

Also, Neuroskeptic has a fantastic blog that tackles in depth the trials for Flibanserin and the interpretation of the findings.