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“Women with low libidos ‘have different brains’”

October 29th, 2010

Dr Petra

naughty brain *

If you ever wanted to see how the media simultaneously loves and destroys stories on sex and science, this week we had a classic example of truly bad sex coverage. All based on a conference presentation that suggested low libido in women could be detected through brain scanning.

I’ll move on to the research itself in a second, but first let’s look at some of the media coverage this study generated. Women with low libidos ‘have different brains’ yelled the Telegraph’s MEDICAL CORRESPONDENT (although let’s be fair they probably didn’t pen the headline). The BBC went with a similar angle (and equally daft headline) ‘Libido problems ‘brain not mind”. The carnival of largely poor and uncritical coverage can be found here.

From the press coverage you’d be forgiven from thinking there’d been a massive new scientific breakthrough here. The brainz/sex/laydees combo is a heady mix for journalists – and probably why this conference presentation at the Annual Meeting of the Society for Reproductive Medicine was probably selected for press release. The abstract for this presentation can be found here (although I’ve taken the liberty of printing it in full below)

[O-199] CEREBRAL ACTIVATION PATTERNS IN WOMEN WITH HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) VERSUS WOMEN WITH NORMAL SEXUAL FUNCTION.

T. L. Woodard, N. T. Nowak, S. D. Moffat, M. P. Diamond, M. E. Tancer, R. Balon Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Psychology, Behavioral and Cognitive Neuroscience, Wayne State University, Detroit, MI; Department of Psychiatry, Wayne State University School of Medicine, Detroit, MI

OBJECTIVE: To identify and compare cerebral activation patterns of premenopausal women with acquired HSDD versus those with normal sexual function during viewing of sexually explicit film clips.
DESIGN: Prospective Cohort Study.
MATERIALS AND METHODS: After IRB approval, 19 premenopausal women with HSDD and 7 women with normal sexual function were recruited to participate in the study. The diagnosis of HSDD was confirmed using the Sexual Function Questionnaire (SFQ), Female Sexual Distress Scale (FSDS) and a clinical interview. Functional neuroimaging was performed on a 4 T Siemens Bruker Hybrid Scanner while participants viewed three categories of video stimuli (solid blue screen, neutral videos, and sexually explicit videos), which alternated every 60 seconds for 32 minutes in a block design. Data were analyzed using Statistical Parametric Mapping 2 (SPM2).
RESULTS: When cerebral activation patterns associated with viewing sexually-explicit videos in normal women was compared to that of women with HSDD, women with normal sexual function had greater activation in superior frontal and supramarginal gyri. Women with HSDD exhibited greater activation in the inferior frontal, primary motor, and insular cortices. Additionally, normal women had greater activation in the posterior cingulate cortex while women with HSDD appeared to recruit the midcingulate region.
CONCLUSION: Cerebral activation patterns in women with HSDD differs from those in women with normal sexual function and may reflect differences in how they interpret sexual stimuli.
Supported by: Wayne State University Departments of Psychiatry and Obstetrics and Gynecology.

Tuesday, October 26, 2010 5:15 PM

Oral Presentation: Sexuality Special Interest Group

So this is the presentation that spawned massive global coverage. A conference presentation based on an exploratory study of 19 women with self identified sexual problems and 7 ‘normal’ controls (whatever that means). This is a very small sample, and is not from a peer reviewed publication, and it makes grand claims about neurological activity and sexual functioning which may not be as exciting as they first appear. Without access to a paper to judge, however, we really don’t have much more to go on.

Fortunately a few smart bloggers who know their stuff about neurology and sex have done a very good job in critiquing the study based on what they can tell from the abstract. These include:
Cory Silverberg on why ‘Sex Researchers Want Your B-R-A-I-N-S’
The Neurocritic explaining ‘Media HSDD: ‘Hyperactive Sexual Disorder Detection’
Neuroskeptic also explores the research in their post ‘Brain Scans Prove That The Brain Does Stuff’

I’ve been bothered on two levels about this research. Firstly, the generalisations about neurology/sexual functioning, which the bloggers linked to above do a far better job than I could in dismantling. I’ve no doubt there are interesting things to explore in relation to brain/behaviour and sex, but am not convinced studies like this are really adding to our understanding of sexual functioning.

But what worried me more is the way the media responded to this story. The conference presentation was distributed to the media over the weekend, which is when journalists first alerted me to it. That means (at least some) journalists had a couple of days at least to research and write this story. It also means that a fair number of journalists were talking to academics like me (or other therapists/activists) who were telling them to find out….

- Who funded this research? (That’s important given the influence of the pharmaceutical industry in this area, particularly with their role in medicalising HSDD)
- The problem with the very small sample size
- The issue that this study was only appearing in the form of a conference presentation and had not been submitted to peer review for a journal, nor published in a format people could read to form conclusions about the robustness of the research
- How sexual dysfunction and ‘normal’ were measured and how women were assigned to these categories
- What measures were used to test arousal, and did those seem reasonable in terms of producing similar responses in participants
- Whether the research made any sense to neurologists, and particularly to talk to neurologists and get them to give their view (and to use this to interpret the research when writing it up)
- Where this work fits within the wider context of HSDD – not least given it’s very recent history with the ‘desire drug’ Flibanserin being abandoned by the drug company who created it, the British Medical Journal debating the problem of medicalisation of female sexual functioning, and Ray Moynihan’s groundbreaking expose on the disease mongering of HSDD in his book Sex, Lies and Pharmaceuticals.

It was, after all, only a couple of weeks ago the press were telling us HSDD doesn’t exist. But two weeks isn’t long in media land and certainly nobody seemed to do any searching to highlight this in the pieces they were writing.

In fact the main format for these stories was to rehash the research uncritically, talk in an alarmist manner about the prevalence of women’s problems but explain their lack of sex drive was ‘in the brain’. With a couple of therapists or medics quoted cautioning about overgeneralising on HSDD – but nobody specifically taking on the research. That remains a common problem with all coverage of this kind. A token spokesperson’s required to give ‘balance’ but that usually still approaches the original research as though it’s robust enough to pin a story on – rather than the research itself that requires a thorough appraisal.

Remember many journalists reporting on this story were MEDICAL or HEALTH or SCIENCE correspondents, many of whom were actually at the conference. So they could, and should, have asked questions about the study based on the things I’ve listed above. If you’re a journalist specialising in health/science these should not be particularly difficult things to ask. In fact it should be the first things you question on. A basic search around recent coverage on HSDD should also have alerted any journalist (regardless of speciality) that this is a controversial area full of problems with funding, bias and spin.

Some of the journalists I heard from decided, after reflecting on the study, simply not to report on it. Fair enough you may think, they decided it wasn’t that robust and wasn’t worth writing about. However this is as problematic as writing about the study uncritically. If you don’t talk about a study because you don’t give it much credit the public won’t know why you’ve got a problem with it.

A far more appropriate response from the media should have been to take the story but ask questions about the findings, put them in context, and talk to the public about what kind of things can cause lack of desire, why it’s a problem to medicalise these factors, and where scientists are trying to do this (as may have happened here).

Even if all your competitors are gushing over a small sample conference presentation that sounds sciencey but actually isn’t that informative, if you’re the only person who tackles the problems with the science and the wider social ramifications then you have an exclusive. Again, many journalists were given the opportunity to do this but they chose either to report the study uncritically, or not cover it at all.

The problem we have at the moment is the mainstream media appear incapable of understanding or accurately reporting sex science stories – even when they are given information to enable them to do this. And while we are rightly complaining about the activities of the pharmaceutical industry, the problems of medicalisation and the poor research that accompanies this, we also need to note the media are a major cause in the misrepresentation of HSDD to the public.

Perhaps it might be more accurate to say (in the words of blogger and consultant @mngreenall) ‘hacks have “different brains” that “light up” when there’s guff to be written about sex’. Certainly it seems if there’s a sex science story that promises a whacking gender difference and an oversimplistic answer to a complex problem the media are guaranteed to give it coverage. No matter how weak the research may be, nor how serious the repercussions can be to the public who desperately need quality information to reassure them about their sexual anxieties.

It’s so depressing to see stories unfold like this, and at such times it’s always good to fall back on ‘women know your limits’ for a more biting and ironic take on womenz brainz….

* Image source here

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