Expert answer:Women and Sexuality in the Media
Solved by verified expert:As mentioned in Hilary Howard’s 2011 New York Times article, “Vibrators Carry the Conversation,” (2011), vibrators can now be purchased at mainstream drugstores. Despite the accessibility of vibrators and other sex toys, open discussion of women’s orgasms and sexual pleasure is rare.Here is the article http://www.nytimes.com/2011/04/21/fashion/21VIBRAT…In order to receive full credit, your discussion post MUST Do the following:FIRST –Provide COMPLETE & COMPREHENSIVELY answers to the following questions in relation to the above article and statement on women’s sexual pleasure:Why might this still be the case?How might this relate to the medicalization of women’s sexuality, as discussed in this unit’s lectures and articles? SECOND –Find an example of women’s sexual pleasure in the media, and discuss how it opens/develops the conversation on this topic. THIRD –You MUST USE THREE (3) course materials, in addition Howard’s article, WITHIN THE BODY OF YOUR INITIAL POST. The three course materials can be from any week, but must be relevant to the topic and support your perspective/argument. Therefore, your initial post and works cited/reference should list a total of FOUR course materials.HERE IS ANOTHER SOURCE: https://www.xojane.com/sex/female-ejaculation-stor…FORMALLY CITE YOUR SOURCES WITHIN THE BODY OF YOUR INITIAL POST AND YOUR REFERENCE LIST. THIS MEANS: CHOOSE A FORMAL CITATION STYLE (APA, CHICAGO, MLA, ETC) AND USE IN CORRECTLY AND CONSISTENTLY THROUGHOUT THE BODY OF YOUR INITIAL POST AND YOUR WORKS CITED/REFERENCE LIST.
juffer.pdf
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Citation
Juffer, Jane. (1998). The Mainstreaming of Masturbation? Making
Domestic Space for Women’s Orgasms. In At Home with
Pornography: Women, Sex, and Everyday Life (pp. 6996). New York: New York University Press.
MLA:
Juffer, Jane. At home with pornography: Women, sex, and
everyday life. NYU Press, 1998.
APA:
Juffer, J. (1998). At home with pornography: Women, sex,
and everyday life. NYU Press.
Chicago:
Juffer, Jane. At home with pornography: Women, sex, and
everyday life. NYU Press, 1998.
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Article
Abstract This essay will describe how the success of Viagra
stimulated drug companies to create a women’s sexual condition
comparable to erectile problems in men for which they could
market new sex drugs to women. The heart of the article focuses
on two interrelated aspects of Viagra culture playing out in drug
industry efforts to create and expand a market for sex drugs for
women: (1) the industry’s ‘Hunt for the Pink Viagra’ to treat
the ‘disease’ of female sexual dysfunction (FSD), and (2) the
prescription and promotion of off-label uses of men’s sex drugs
to women. In order to contextualize these two trends, the article
outlines key activities and actions that have enabled the drug
industry to consolidate power and build capacity in this area,
including: mass dissemination of estimates of disease prevalence;
the institutionalization of FSD in academic circles, which
includes strategic revision of disease definitions as well as the
creation of a legitimized infrastructure for dissemination of
supporting research and education; and public-relations
stimulated mainstream media coverage. The article concludes
with a consideration of the ongoing challenges to the
medicalization of women’s sexuality as well as to harmful
corporate practices more broadly.
Keywords female sexual dysfunction (FSD), medicalization,
off-label prescriptions, pharmaceutical industry, Viagra
Heather Hartley
Portland State University, Oregon, USA
The ‘Pinking’ of Viagra Culture: Drug
Industry Efforts to Create and
Repackage Sex Drugs for Women
The year 2003 marked both the 5th anniversary of Viagra’s launch and the
release of two prominent new competitors to Viagra’s multi-billion-dollar
annual market share: Levitra and Cialis. The makers of these products,
Bayer HealthCare Pharmaceuticals/GlaxoSmithKline (Levitra) and Lilly
ICOS (Cialis) promote the ideology that more is better. Both products are
Sexualities
Copyright © 2006 SAGE Publications (London, Thousand Oaks, CA and New Delhi)
Vol 9(3): 363–378 DOI: 10.1177/1363460706065058
http://sex.sagepub.com
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Sexualities 9(3)
advertised as ‘lasting longer’ than Viagra, with Cialis even nicknamed ‘the
weekender’ because of its alleged 36-hour range of effectiveness. In
general, of course, the pharmaceutical industry embraces the philosophy
that ‘more is better’, especially when the topic is profit. The success of the
blockbuster drug Viagra – and the concomitant spread of a ‘Viagra
culture’ – prompted the industry both to develop other drugs to treat
male sexual problems, and served as an incentive for it to espouse a
medical approach to women’s sexual problems and develop new sex drugs
to treat those problems. Just as happened with men’s problems, women’s
sexual problems became increasingly medicalized – defined and understood as a largely physiologically based set of conditions called ‘female
sexual dysfunction’ (FSD).
That the annual market for medical treatments for women’s sexual
woes is estimated at about $1.7 billion creates tremendous incentives for
pharmaceutical companies to develop a specific, FDA-approved ‘Viagra
for women’ (Leland, 2000). At the time of writing (January 2006),
despite a huge outlay of expense and effort, there is no drug approved
for FSD – currently, the only FDA-approved prescription treatment is a
mechanical clitoris-stimulator called EROS-CTD. Proctor and Gamble’s
testosterone patch, Intrinsa, was the first (and so far, only) drug to be
considered by the FDA, and it did not receive FDA-approval. But a
variety of other products for women – pills, patches, creams, sprays – are
being developed and tested by over a dozen pharmaceutical companies
(Enserik, 2005).
The heart of this article focuses on two interrelated aspects of Viagra
culture playing out in drug industry efforts to create and expand a market
for sex drugs for women. These industry efforts concentrate along two
main strategies: (1) a ‘hunt for the Pink Viagra’ to treat the ‘disease’ of
FSD, the chronology of which involved an almost unnoticed shift from
development of products to treat arousal problems to those intended for
desire problems, and (2) the increasing promotion and normalization of
off-label uses of men’s sex drugs for women.
Since the late 1990s, the drug industry has increased its power to shape
definitions of women’s sexual problems and has built institutional capacity
enabling it to develop and promote sex drugs for women. Events and
activities of particular significance include the mass dissemination of estimates of disease prevalence; the institutionalization of FSD in academic
circles; and public-relations stimulated mainstream media coverage.
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Hartley The ‘Pinking’ of Viagra Culture
Industry consolidation of power and building of
capacity
Inflated epidemiology promotes a medicalized view of women’s
sexuality
No accounting of drug industry interest in FSD would be complete
without reference to the ‘43–31’ study, shorthand for the widely-cited
study published in JAMA (Journal of the American Medical Association)
that concluded that more than 4 out of 10 women (43%) have sexual
problems, a rate of sexual dysfunction higher than that of men (31%)
(Laumann et al., 1999). The critiques of this statistic are widespread (see
Moynihan, 2003a), and even Laumann himself has gone on record saying
his findings were appropriated to promote the medicalization of sexual
problems (O’Connor, 2005), yet both mass media and professional literature constantly cite this figure. The pharmaceutical industry in particular
has used this ‘inflated epidemiology’ to expand a medicalized perspective
on women’s sexual problems (Tiefer, 2002). Subsequent studies indicating lower prevalence rates and supporting social-psychological rather than
physical factors as primary determinants of women’s sexual problems (e.g.
Bancroft, 2002; Bancroft et al., 2003) receive almost no media attention.
The institutionalization of FSD
FSD has become institutionalized in academic circles in a manner that solidifies pharma-medical control over the naming and treatment of women’s
sexual problems. Key milestones in the institutionalization process include:
development of systems of disease classification amenable to medical
approaches; creation of a legitimized infrastructure for disseminating
supporting research and education; formation of an attendant professional
organization; and establishment of an appropriate medical specialty.
The American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders (DSM) is the most widely used system for
classifying women’s sexual problems, specifying four categories: lack of
desire, lack of arousal, pain during intercourse, and lack of orgasm (APA,
1994; see Tiefer, 2004 for a critique). In 1998, a consensus conference,
consisting of a group of 19 sexuality researchers and clinicians (18 of
whom had financial ties to the pharmaceutical industry) was convened to
revise the DSM nomenclature. Ultimately, the system was revised in a
manner that facilitates a platform for a new area of physical medicine (for
details, see Basson et al., 2000; Tiefer, 2000b).
An annual continuing medical education (CME) conference sponsored
by the Boston University School of Medicine (Department of Urology)
from 1999 to 2001 played a key role in institutionalizing the medicallyoriented perspective on FSD (Moynihan, 2003a). The CME context
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provided a legitimized infrastructure for the dissemination of research
and education that, in general, promoted a biomedical perspective on
sexual problems (Hartley and Tiefer, 2003; for critique of the increasing
role of the pharmaceutical industry in medical research and education,
see Abramson, 2004; Angell, 2000a, 2000b, 2004; Bodenheimer, 2000;
Kassirer, 2005; Moynihan, 2003a; Relman, 2001; Tiefer 2000a). These
first three Boston meetings inaugurated an annual conference that
soon became international (the conference convened in Canada in 2002,
the Netherlands in 2003, the USA in 2004 and 2005, and Portugal in
2006). And it was at these first Boston meetings that participants voted
to establish a professional organization, first called the Female Sexual
Function Forum (FSFF) in 2000, and renamed the International
Society for the Study of Women’s Sexual Health (ISSWSH) in 2001
(Hartley, 2003).
Dr Irwin Goldstein chaired the three Boston meetings, and his high
profile at these events helped him to secure funds (and legitimacy) to open
the nation’s first academic sexual medicine department in Fall 2002 at
Boston University, where the research focused heavily on FSD. Goldstein
left Boston University in May 2005, and at the time of writing is ‘currently
in the process of seeking a new location for his sexual medicine practice’.1
He is still the editor of the Journal of Sexual Medicine, and this position
has afforded him continued power to shape discussion on FSD. For
example, an article in the July 2004 issue, which he edited, included new
FSD guidelines based on work at a critical 2003 FSD conference in Paris.
Even though a ‘progress report’ at that conference had noted the lack of
scientific data supporting the utility of drug-treatment regimens for FSD,
the article explicitly endorsed investigational use of Viagra-type and testosterone products for this purpose (O’Connor, 2005).
Strategy I: Securing FDA approval for a woman’s
sex drug
Pfizer determined that clinical trials of Viagra in women showed that it is
no more effective than a placebo, and the company stopped the trials in
February 2004 (Harris, 2004). While some drug companies are still
developing products that follow a ‘Viagra model’ by targeting genital
blood flow (e.g. alprostadil), and others are developing products like
PT-141 that aim to augment dopamine-like brain chemicals (Enserik,
2005), arguably the main focus in drug development now is on products
specifically intended to enhance sexual desire, mainly through the
administration of testosterone. At least seven drug companies are developing testosterone products for women (NAMS, 2005).
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Hartley The ‘Pinking’ of Viagra Culture
When Viagra was being tested in women, the targeted condition was
‘female sexual arousal disorder’ (FSAD). When these trials came up empty,
not only did the focus in drug development shift to testosterone but also
the intended targeted condition changed to ‘hypoactive sexual desire
disorder’ (HSDD). Just months after Pfizer pulled the plug on the Viagra
trials because the drug did not enhance arousal, Proctor and Gamble
(P&G) announced plans to seek FDA approval later that year for its
Intrinsa testosterone patch to treat desire problems. This shift from FSD
‘being about’ an arousal problem to FSD ‘being about’ a desire problem
seems to have gone largely unnoticed by most cultural commentators. Yet
the shift in focus from FSAD to HSDD is a dramatic illustration of active
drug industry ‘disease mongering’ tactics (Payer, 1992; Tiefer, 2006) –
the change seems to indicate an effort to match up some drug (any drug?)
with some subcomponent (any subcomponent?) of the DSM classification.
Did women’s problems with arousal suddenly go away? Of course not,
but mainstream media, following the P&G marketing spin, proclaimed
the failure of the Viagra trials to be evidence of women’s ‘more complex’
sexuality, and they moved on to the ‘next big thing’.
The ‘hormone of desire’
And the ‘next big thing’ was the focus on testosterone as the ‘hormone
of desire’. A dominant medical explanation for ‘hypoactive sexual desire
disorder’ (HSDD) is that it is a product of ‘androgen insufficiency
syndrome’ (Fishman, 2004). This linkage has fueled development and
promotion of androgen replacement therapies for women’s sexual
problems – primarily prescription-only testosterone and over-the-counter
dehydroepiandrosterone (DHEA) treatments (see Hartley, 2003). In spite
of the known risks of such therapies (Basson et al., 2001; Fourcroy, 2001),
the paucity of data on the efficacy of such treatments, and even prominent articles that demonstrate no linkage between low sexual desire and
low testosterone levels (Davis et al., 2005), drug development efforts
increasingly concentrate in this area and growing numbers of physicians
are prescribing testosterone off-label to women.
With hopes of being the first to win FDA approval (key to dominating
the market), P&G sought approval for its Intrinsa testosterone patch in
December 2004. The FDA advisory committee determined that the
benefit of the drug (an average of one additional sex act per month) was
overshadowed by the patch’s potential health risks. The recent drug safety
scandals surrounding Vioxx and hormone replacement therapy (HRT)
likely influenced the FDA advisors to be more risk-adverse than in the
past, and they unanimously voted against approval of Intrinsa. Critics
were also particularly concerned that were Intrinsa approved for its target
population – surgically menopausal women also taking estrogen – that
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Sexualities 9(3)
marketing surrounding the drug would also target and drive up off-label
prescriptions for women outside that main group.2 Ironically, P&G tried
to use the existence of off-label prescribing of testosterone to its advantage. Especially for prescription testosterone products, determining offlabel dosage for women is a guessing game, and P&G has argued that its
patch would insure more consistent and accurate dosage (Neff, 2003).
Strategy II (the new game): Off-label prescribing of
men’s sex drugs to women
The two erectile dysfunction drugs approved in the US after Viagra,
Levitra and Cialis, represent only the tip of the iceberg, as a wide variety
of other products are in development for men, including drugs for
premature ejaculation and PT-141, a nasal spray intended to act as an
aphrodisiac. Additionally, testosterone replacement products such as
AndroGel and Testim are increasingly promoted as treatments for men’s
sexual problems. While none of these drugs approved for use in men –
Viagra, Levitra, Cialis, AndroGel, and Testim – has been sufficiently tested
or proven for use in women, increasingly, when women discuss their
sexual problems with their doctors, they are given ‘off-label’ prescriptions
for one or another of these products. Testosterone researcher Dr Jan
Shifren estimates that one-fifth of all the prescriptions of testosterone
products approved for men are actually written (off-label) for women
(Kantrowitz and Wingert, 2005).
The Federal Drug Administration Modernization Act (FDAMA) of 1997
loosened the restrictions on the type of information that drug companies
could share with physicians regarding off-label uses for their drugs (Conrad
and Leiter, 2004), thus facilitating a general growth in off-label prescribing. Although drug companies are not allowed officially to market drugs
for off-label uses, the companies are largely able to circumvent this law by
‘merely informing’ doctors of these uses at ‘educational’ CME conferences
(Angell, 2004). A key reason why numbers of physicians are writing these
off-label prescriptions for women is their exposure to presentations at CME
conferences on FSD (such as those hosted by ISSWSH) that have promoted
a biomedical perspective on sexual problems, conceptualized women’s
sexual problems as largely based in ‘androgen deficiencies,’ and reported
‘anecdotal’ stories of success in treating female patients with testosterone
(Fishman, 2004; Hartley, 2003; Hartley and Tiefer, 2003; Loe, 2004).
Such off-label prescribing is also becoming increasingly normalized in
mainstream media accounts of FSD. For example, the 3 May 2004 CBS
Evening News ran a segment showing two women being treated with testosterone for their libido problems (CBSNEWS, 2004).
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Hartley The ‘Pinking’ of Viagra Culture
Five years ago, it seemed that such off-label prescribing practices represented a ‘side game’ in the larger effort to pharmacologically manage
women’s sexual problems – a way to prescribe a little something to women
until they got their own FDA-approved ‘Pink Viagra’. Today, however, it
is becoming increasingly clear that off-label prescribing represents something much larger: a way to circumvent the FDA-approval process
altogether in some cases. Why bother to conduct expensive clinical trials
and risk having a drug denied approval in the end? The story of the media
celebrity Berman sisters dramatically illustrates the importance of off-label
prescribing, as an even cursory look at their advice and treatment practices reveals an infrastructure largely built on off-label prescriptions.
Working the lay audience
The Bermans: Leaving evidence-based practice for the big money
No successful campaign of medicalization would be complete without
active advocates dedicated to the shaping of consumer opinion. On this
count, two ‘sexperts’ have risen to particular prominence in mainstream
media coverage of FSD: Laura Berman, PhD (a sex therapist) and Jennifer
Berman, MD (a urologist). This sister team was originally trained at the
Boston University Urology Department by Irwin Goldstein. They left
Boston University in 2001 to co-direct the UCLA Female Sexual
Medicine Center (FSMC) in Los Angeles. In 2004, Laura Berman left
UCLA and used venture capital to open the Berman Center, a treatment
clinic in Chicago. In 2005, Jennifer Berman also left UCLA to relocate
in the private sector, opening a sexual medicine practice at the Rodeo
Drive Women’s Health Center in Beverly Hills (O’Connor, 2005). The
shift of the Bermans’ practices from academic centers to the explicitly forprofit commercial sector speaks volumes about the new ‘Viagra culture’.
It is important to point out that the Berman sisters’ crossover appeal to
mainstream and academic audiences has garnered them significant power
to shape discussion about FSD. Women in search of solutions to their
sexual problems often turn to mass media resources such as popular magazines or television talk shows, where the Berman sisters have high levels
of visibility. The sisters have been featured in numerous popular publications (such as Cosmopolitan, Discover, Marie Claire, Fitness, Redbook,
Magazine, Ladies Home Journal, Vogue, an …
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