11 Feb, 11 | by BMJ
Like most things related to sex, “This House believes that Female Sexual Arousal Disorder is a fabrication,” proved a popular motion for the 41st Maudsley Debate at the Institute of Psychiatry in London on 2 February. The auditorium was packed to bursting. Combining libido, a distinct whiff of disease mongering and the sticky paws of big pharma, this was a heady mixture of controversy for a team of expert panelists to contend.
Hands raised prior to proceedings hinted that Ben Goldacre and Petra Boynton would have an easy time arguing for the motion. Their casting of the pharmaceutical industry as the bad guys in a narrative consisting of biomedicine’s inappropriate monopolisation of a patch of normal humanity was an easy crowd pleaser.
Petra Boynton, academic and agony aunt, was quick to point out the disingenuous claims of pharma’s pretence of championing a feminist cause. Her long list of ways in which women might have problems with arousal showed to what extent a reductionist biological research agenda was not just missing the point but
pathologising female sexuality. Where, we might ask, are the studies on the impact of moderate red wine consumption?
Ben Goldacre exposed the carefully choreographed process of manufacturing a condition and marketing it, alongside some colourful pills, to doctors and their patients. As he remarked, the twin dangers of bad science and pharma’s marketing muscle should surely feature more prominently in medical school curricula.
Arguing against the motion were Sandy Goldbeck-Wood and John Dean, specialists in psychosexual medicine. They were quick to agree with their opponents on the nefarious role of pharma in medicalising female sexuality, but were adamant in insisting on the distressing reality of sexual dysfunction for many women. Their principal argument was that of the utility of such a diagnosis, however imperfect the paradigm in which it is framed, to explore and alleviate the myriad causes which could give rise to it.
The danger of dismissing such diagnostic labels, Dr Goldbeck-Wood warned, is that these same problems crop up under different guises to different services, entailing greater distress for women and higher costs of care. The failure to find a pink Viagra might bear witness to the greater sophistication of the female sexual response, but should not, they argued, negate the validity of such a diagnosis. It should rather reinforce the importance of the biopsychosocial model and foster greater therapeutic humility for a condition that medicine is unlikely to ever have all the answers for.
From molecules to cultural anthropology, the motion’s broad terms of reference allowed for a rich variety of approaches to the subject. This in itself was perhaps what won the day for the motion’ love, it seems, is more than a drug. The comfortable majority voting for the motion before the speakers took to the podium, had grown by the end.
Like other Maudsley Debates the evening was a showcase for the diverse disciplines that psychiatry in particular, and medicine more generally, should converse with, for their own health and those they care for. For any medical students looking for a refreshing tonic for the weary protocol of clinical medicine or the tedium of textbooks, they come highly recommended.
Podcasts of previous debates are available here
Jonny Martell is a medical student in London.