Feminist Sex Therapy: A New View of Women's Sexuality

Some foundational ideas:

• There are no magic bullets for the socio-cultural, political, psychological, social or relational bases of women’s sexual problems.
• There is no one-size-fits-all, normal sexual pattern or response. Problems can arise in many different ways, and can be due, in order of likelihood, to social, relational, psychological and/or physical causes.
• A fundamental barrier to understanding women’s sexuality is the medical classification scheme in current use in the Diagnostic and Statistical Manual of Disorders (DSM). The DSM divides sexual problems into four categories of sexual “dysfunction”: desire disorders, arousal disorders, orgasmic disorders, and pain disorders.
• The DSM promotes a false notion of sexual equivalency between men and women. Women and men don’t experience or describe their symptoms in the same way! According to research, for example, women generally do not separate issues of “desire” from those of “arousal.”
• The emphasis on genital and physiological similarities between men and women in the DSM ignores the implications of gender inequalities related to social class, ethnicity, sexual orientation, etc. Social, political, and economic conditions, including widespread sexual violence, limit women’s access to sexual health, pleasure, and satisfaction in many parts of the world.
• The DSM approach bypasses the relational aspects of women’s sexuality, which often lie at the root of sexual satisfactions and problems–e.g., desires for intimacy, wishes to please a partner, or, in some cases, wishes to avoid offending, losing, or angering a partner.
• The DSM takes an exclusively individual approach to sex, and assumes that if the sexual parts work, there is no problem; and if the parts don’t work, there is a problem. The DSM’s reduction of “normal sexual function” to physiology implies, incorrectly, that one can measure and treat genital and physical difficulties without regard to the relationship.
• ll women are not the same, and their sexual needs, satisfactions, and problems do not fit neatly into categories of desire, arousal, orgasm, or pain. Women differ in their values, approaches to sexuality, social and cultural backgrounds, and current situations, and these differences cannot be smoothed over into an identical notion of “dysfunction”–or an identical, one-size-fits-all treatment.
• The medical model of sexual dysfunction distorts women’s sexual problems, ignores sexual individuality and cultural variations, minimizes the impact of relationship quality, feelings and learning and is promoted by Big Pharma overtly and covertly.
• exual dissatisfaction results from anxiety, harassment, abuse in the family, relationship or culture; fatigue, grief or stress because of work, family, money or health problems; worries about pregnancy, pain, stress, STDs, or loss of reputation; and lack of sexual knowledge; relationship insecurities; fantasy expectations and displaced conflicts.
• Effective clinical work, using an alternative framework, focuses not on symptom removal, but rather adopts the humanistic psychology goals of empowerment, self and cultural understanding, individual goal-setting, and the development of appropriate skills.
• An alternative clinical approach to the evaluation and treatment of intimacy disorders or desire begins with the classification of a woman’s sexual concerns based on a wide variety of factors, rather than just the physical operation of her reproductive organs.
• For effective clinical treatment of women’s sexual concerns clinicians must listen to and educate women about their bodies, minds and relationships. It is also imperative that clinicians normalize variations in desire, rather than pathologize them.