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Medicalising sexual behaviour – some interesting stories in the news

September 1st, 2008

Dr Petra

There are two interesting stories doing the rounds at the moment that concern the medicalisation of sexual behaviour – sex addiction and lack of sexual desire.

Sex addiction has become a media favourite this week after actor David Duchovny has admitted himself to a clinic for treatment of sex addiction. As you may expect press coverage has ranged from a snigger at the star’s expense through to discussing sex addiction as a clinical condition requiring in-patient treatment. Which is a problem because most respected clinicians, therapists and educators working from an evidence based background do not accept the concept of sex addiction. Instead most practitioners agree that people can have problems within their relationships and may act in ways that are sexually damaging or compulsive, but this is not the same as an addiction. Concerns over the sex addiction industry include promoting unproven or even dangerous therapies, and allow for sex negative views to be promoted.

Website The Frisky has a great piece about sex addiction and links to a number of useful sites that address sexual problems while clarifying why the addiction label is problematic. It includes a link to a previous blog I wrote where I discovered I was a sex addict (something of a feat given I had a new baby at the time). I’ve recently retested myself and I am still an addict, although I’m still struggling to work out how this might be.

Meanwhile over at Susie Bright’s blog she tackles ‘Sex Addiction: the big con’ with an amazing interview with Professor Leonore Tiefer who clearly and humourously takes apart how problematic sexual behaviour has been medicalised into a clinical condition.

Because we’re used to hearing about sex addiction nowadays, criticising it can be difficult. After all doctors are telling us we have it, the media talks about it a lot, and it sounds very serious. To question it surely means denying people have problems or perhaps allowing dangerous health problems to run unchecked? Well, no. We do need to question the idea of medicalising sexual behaviour – particularly when ‘treatments’ offered are frequently endorsed by people without adequate training, supervision, or awareness of the wider scientific literature on this issue.

Let’s be clear. Some people do behave in sexually risky ways. They don’t practice safer sex, they cheat on partners, they fail to control impulses or experience sex as a form of compulsive behaviour, or they use sex to make themselves feel better while inside they feel sad, lonely or angry. This is a problem and something that therapy can definitely tackle. But it doesn’t mean people who are acting in this way are ‘sick’. Rather than slapping an addiction label on them we need to work with them to identify what is driving problems within their lives or relationships. And we need to get away from the idea that looking at porn, masturbating, enjoying (safer and consensual) sex with multiple partners, having pre marital sex, or being homosexual is a sign of sex addiction.

At the opposite end of the spectrum there’s the problem of sexual dysfunction – or more specifically a lack of sexual desire. Since when we’re not saying those who seem to like sex a lot are addicts, we’re happy to suggest those who don’t enjoy sex or desire it much are also ill and require a cure. In today’s Guardian newspaper Ben Goldacre has an excerpt from his new book Bad Science that includes a discussion of how female sexual dysfunction has moved from being a personal problem with numerous social, cultural, physical or emotional routes to a full blown clinical condition by the pharmaceutical industry. The book excerpt is accompanied by a science podcast and both are worth your consideration as they tackle wider issues of media health reporting. You can order Ben’s book here.

The media in particular love to reinforce the idea of female sexual dysfunction with promises of new wonder drugs on the horizon, hormonal treatments or just a simple fruit smoothie will all make you want to have sex again. Stories about why you may not want to have sex, or whether you even have a ‘problem’ with desire are absent.

What’s interesting about these two stories is although they appear poles apart they both operate within the media on the same level. They allow for us to judge, to mock, and to endorse home grown ‘therapies’ and medical interventions. The encourage us to avoid the wider social, political or personal causes of our problems – or give us any practical life skills to enable to sort things out for ourselves.

These issues are typically gendered. It’s usually men who are described as being the addicts in need of control – men who are cheaters, habitual porn users, frequenters of prostitutes and unwholesome onanists who need to be reigned in by talking therapies, lie detectors or prayer. Sexual desire problems are the domain of women where its usually presented as normal but unfortunate that women go off sex. A range of interventions from buying new panties to placing scented candles around the bedroom are usually recommended, although hormones, genital surgery or private prescriptions of medications made for men can also be suggested.

People do have problems with not wanting sex or feeling out of control in relation to their sexual behaviours. It’s common for the media and practitioners in favour of medicalising sexual functioning to claim anyone questioning sex addiction or desire disorders are denying people have any sex problems. Which is an effective way of silencing more sensible views and encouraging widespread scaremongering.

Whether you’re being told that wanting sex a lot or not desiring it at all is a problem, you need to question who is telling you this information, what evidence are they basing their ideas upon, does the wider scientific community agree with these ideas, and who is benefiting from sharing this message?

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