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Sex and Medicine: Strange Bedfellows?

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WebMD Health News
Reviewed by Gary D. Vogin, MD

April 11, 2002 -- You've seen the ads -- Click Here for Penis Power, says one. Embarrassed? Try Laser Vaginal Rejuvenation, says another. We're a society obsessed with sexual performance, in ourselves and our partners, trying Viagra and every medical gimmick out there to get it right, says a new study.

The problem with this medical approach to sex -- what's being referred to as the "medicalization of sexual behavior" -- "is that social and interpersonal dynamics may be ignored," writes Graham Hart, a public health researcher at the University of Glasgow.

His paper, appearing in the latest issue of the British Medical Journal, says that for the last 20 years, we've been involved in nothing less than "mass surveillance" of sexual performance. We're measuring ourselves -- and being measured -- against what we perceive as norms and standards for sexual performance.

The downside: "Many people feel inadequate when faced with evidence about extremes of sexual performance," Hart says. "This can turn sex into a problem --'Is this normal, doctor?'"

"Articles peppered with physiological and technical terms confirm and elaborate on the right way to perform 'to please him or her,'" he writes. "Viagra (sildenafil citrate) -- the first oral drug to treat impotence, or erectile dysfunction -- ranks as one of the greatest success stories in pharmaceutical history."

Women are part of this picture, too: Studies are evaluating Viagra's potential in helping women with arousal problems. And gynecological surgery is being harnessed to enhance sexual pleasure and improve aesthetics. The "designer vagina" involves laser "pruning" of genital warts or an "extra stitch" to tighten vaginal muscles.

All this focus on performance has led to a prevalence of sexual dysfunction, Hart writes. "Our obsession with sexual gratification has undoubtedly increased people's expectations, and it may have increased people's feelings of inadequacy," he writes.

"Although many men with erectile dysfunction daily thank Pfizer for their efforts, others who once thought their low libido was "normal" and acceptable now feel dissatisfied with their sexual lives."

"People choose one another for their uniqueness," Hart writes. "The last century saw a considerable increase in acceptance of diversity of sexual expression -- it would be a shame if this century saw diversity replaced by uniform expectations of performance and desire."

There's not really this across-the-board focus on sexual performance that Hart reports, says Nadine Kaslow, PhD, professor of psychiatry and behavioral sciences at Emory University and chief psychologist at the Grady Health System, both in Atlanta.

"People simply know there are options to make sex better," she tells WebMD. "Some people want those options, some people are confused or ambivalent about them, and some really don't care."

It's true, Kaslow says, "there's nothing wrong about choosing those options if it's done in the context of a relationship. If Viagra makes you enjoy your partner better, makes the interaction better, more power to you."

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