Feeling Un-Sexy in America

The market is huge and tantalizing: in the midst of a culture drenched in sex, one in three American women say they have about as much interest in sex as Monday Night Football.

That's why the recent rejection by the Food and Drug Administration of flibanserin, the latest drug intended to boost female libido, was such a disappointment to the pharmaceutical industry intent on hitting the jackpot with a female Viagra.

Trials of the drug showed it did too little to warrant approval, and that finding, in turn, sparked the latest debate on why it's so much harder to find a sex drug for women than men. After the usual chatter about sexual desire being so much more dependent on women's emotions then men's came the theories that essentially blame women's drive for equality.

For example, after chalking up some of the apathy to a resurgence of 19th century "bourgeois propriety, " Camille Paglia, writing in a New York Times op-ed, blamed Super Moms who've turned men into "cogs in a domestic machine commanded by women." She also slapped at workplaces where women are finally enjoying some modicum of equality with men as leading to a suppression of physicality and then to boredom with each other.

The sad part of this commentary is that is is so ill informed by facts. Take a look at the recent medical literature on women's sexuality, as I have recently in researching a book on the subject, and you find the authors still quoting 1960s work by Masters & Johnson. Our culture glorifies sex but when it comes to doing actual research on the subject we're stuck in old-fashioned prudery.

The best evidence, however, points to far-different culprits than those plucked out of the air by Paglia: the 600,000 hysterectomies a year performed on women plus women's use of birth control pills and medications like Prozac.

By the time a woman in America reaches the age of 60, the chances are one in three that she will have had a hysterectomy. Afterward, it is common for women to report loss of sexual desire, less sexual activity, decreased genital sensation and difficulty achieving orgasm. This is a reality that the surgeons don't want women to know, and that hysterectomized women most often keep to themselves out of shame and fear.

Why does hysterectomy adversely affect sexuality? Part of the answer is that about 300,000 of the women who undergo hysterectomies also lose their ovaries at the same time. Perhaps half the others also suffer a loss of ovarian function as a result of damage from the surgery done to remove their uterus. That means about 450,000 women will lose ovarian function this year, and every year.

When ovaries are removed or cease functioning, that is castration. Castration is an ugly word, but when you cut out someone's reproductive/sex organs, it is the proper medical word. Shrinking from it just allows doctors to continue to recommend the removal of healthy organs as no big deal, and in fact a benefit to women, a way of reducing their chances of ovarian cancer. Not calling it castration helps conceal the fact that without her ovaries, a woman loses not only estrogen--the main concern of men because it enables vaginal lubrication--but also most of her testosterone, often called the "hormone of desire."

For men, the equivalent would be recommending routine removal of healthy testicles to prevent testicular or prostate cancer. Of course, I've never heard of a man willingly giving up healthy testicles unless he's deliberately changing gender. I once knew a man who consented to surgical castration because he had prostate cancer. Afterward, he told me how indifferent he had become to things like sexy movie scenes that before had turned him on.

Women I've interviewed who have been castrated say there is no artificial cocktail of replacement hormones that comes close to making them feel like their old selves. And believe me, they've tried to find one. Before the surgery, they had ample desire. Afterward, zip. This change had nothing to do with their emotional state, only the very drastic loss of the hormones produced by their sex organs.

When it comes to the birth control pill, the manufacturers have long been coy about the effect on women's sex lives, listing as a side effect "sexual changes." Translation: less desire. Loss of desire is also a side effect of anti-depressants including Prozac.

Now, I'm not saying that over-worked women don't have less interest in sex than women who get enough sleep, or that deeply entrenched negative attitudes toward women's sexuality don't still exist. Of course they do. And women suffering from serious depression may have a need for medication that outweighs any worry about the impact on their sex lives.

But it's certainly anti-woman to suggest, as Paglia did, that the culprit is women's desire for equality in the workplace. Or that our excellent organization skills, which make it possible for us to bring in a critical paycheck while raising children and keeping a home, should be criticized as de-masculinizing our partners.

Women are being castrated by the hundreds of thousands every year. That's a fact, and that's where the focus and the outrage should be because there are organ-sparing alternatives as much as 90 percent of the time.