Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance

T he creation and promotion of " female sexual dysfunction " (FSD) is a textbook case of disease mongering by the pharmaceutical industry and by other agents of medicalization, such as health and science journalists, healthcare professionals, public relations and advertising fi rms, contract research organizations, and others in the " medicalization industry. " Whether one relies on Lynn Payer's original defi nition of disease mongering (" trying to convince essentially well people that they are sick, or slightly sick people that they are very ill " [1]), her checklist (Box 1), or the analysis of our pill-popping society that was recently offered by Greg Critser [2], the sequence of events and cast of participants involved in FSD matches the classic disease-mongering tactics [1,2]. Each physical condition or life event that has been subject to disease-mongering tactics has its own unique history. Sexual life has become vulnerable to disease mongering for two main reasons. First, a long history of social and political control of sexual expression created reservoirs of shame and ignorance that make it diffi cult for many people to understand sexual satisfaction or cope with sexual problems in rational ways. Second, popular culture has greatly infl ated public expectations about sexual function and the importance of sex to personal and relationship satisfaction. Thus the public is led to want and expect high rewards from sexual life without having tools to achieve these rewards. People fed a myth that sex is " natural " —that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, are likely to look for simple solutions. This sets the stage for disease mongering, a process that encourages the conversion of socially created anxiety into medical diagnoses suitable for pharmacological treatment. In this essay, I begin by examining sexual attitudes in the 20th century that were crucial in setting the scene for the creation of FSD. I then highlight key steps in the history of FSD and of the campaign to challenge its reductionist approach to women's sexual problems. In the early 20th century, sexual life and interest were stimulated by intensive urbanization and immigration that disrupted old community-based patterns of sexual regulation [3,4]. Sexual choices and expectations, however, were still largely governed by traditional religion and a double standard. Public discourse around sex was moralistic, and sex-education materials were limited and …