Leonore Tiefer is Clinical Associate Professor of Psychiatry at the New York University School of Medicine and Albert Einstein College of Medicine with an international reputation as a lecturer, author, activist and theorist in the field of sexuality. She has written widely about the medicalization of female sexuality and heads up the New View Campaign, which is a grassroots network challenging the distorted and oversimplified understanding of sexuality promoted by the pharmaceutical industry as a means to profit. In this interview she talks about her work and the race to produce a 'female Viagra.'
What is the objective of the New View Campaign?
The campaign began ten years ago to protest and challenge the medicalization of women's sexuality that came about after the approval of Viagra and the subsequent rapid incursion of the pharmaceutical industry on sex research, sex education and professional education. We are focused on the pharmaceutical industry, its advertising and direct-to-consumer advertising. Our main activities at this time are the listserv, our annual public demonstrations, and we give presentations across the world – my last talk was at the Lewis & Clark symposium – The Science Of Gender And Sex.
How do you see the pharmaceutical industry working to medicalize women's sexuality?
The pharmaceutical industry is infiltrating the professional venues wherein disorders are defined and studied. The industry also influences journalists to promote a view of female sexuality that is biased towards a high, inappropriate standard of normality and an enlarged standard of disorder.
There has been publicity recently around the preliminary definitions of sexual disorders that will be included in the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), which is the Psychiatric Association's classification textbook. These decisions about what counts as a sexual disorder are formed by people who are unduly influenced by publications and research that have been commandeered or hijacked by the pharmaceutical industry. They are not interested in de-medicalized texts or anthropological perspectives. The questionnaires used for research are very superficial and narrow, omitting more than they include. The way they are written, everyone would understand themselves as having a disorder.
What is the 'norm' for female sexuality which the pharmaceutical industry is promoting?
There is a very narrow, uniform standard that says nothing about change over the lifetime, change in relationships, or variation due to mood or what's happening in your life. The norms are very rigid. Desire, arousal, orgasm - if you don't have those in regular, routine fashion you are considered to have a disorder. In the way people write about this topic there's too much gender polarization. I don't subscribe to men and women having different sexualities – I don't think there is a uniform sexuality for women or men, there are many variations.
How is a sexual disorder generally defined?
Disorders are presented as interferences of any sort to desire, arousal and orgasm. Interferences are called problems. If you don't have an orgasm or an erection - it's a problem. Not having an orgasm is a problem as opposed to the alternative, as opposed to the many ways a person can be sexual.
What happened when Viagra was approved, how did that impact the pharmaceutical industry?
It wasn't initially clear to Pfizer how the release of Viagra was going to work out. They thought it could be viewed as pornography to promote this drug, that journalists would not be able to write about it. But they met no resistance. It was front page news, people joked about it on television. They changed their marketing plan to fit, once they realized there would be no legal or media resistance to the advertising.
A 'female Viagra' drug, Flibanserin, is currently awaiting FDA approval. They have released the clinical trial information, but they have not released the measures used to make their assessments. So, they are saying that the drug was successful in producing the desired effect but not how they ascertained this success, by what measurements. If there was an increase in 'satisfactory' sexual experiences - then how was this measured and by what standards?
In the case of Intrinsa - the 'female Viagra' patch created by Proctor & Gamble - the FDA rejected it in 2004 with reservations as to not only how safe it was for women to use, but how effective it truly was. For Intrinsa, and for Viagra, the placebo has shown to be extremely effective in clinical trials. The placebo provides a 40% improvement. The drug itself showed an improvement higher than this, but not significantly. The pharmaceutical companies do not make direct comparison, because, as they say, they're not marketing the placebo.
What topics are being discussed currently on the New View Campaign Listserv?
Recent debates have centered on cosmetic genital surgery - labiaplasty and clitoral hood surgery. Another example of the push to create a single 'norm' when in reality there is so much diversity.