Men's impotence has become the new 'hysteria'. Thus enabling pharmaceutical companies to emulate post Victorian psychiatrists who saw hysterical women as a group to 'make a living out of'. In a similar way, these companies can today 'make a living out of' male vulnerability cashing in on this new form of subjective experience that has been created. The social plays a part in forming the personal as do many other contributory forces; biological, economic, psychological, environmental and cultural. This new multi-factorial dimension has been shaped by the heightening of existing anxieties, that identify as well as exacerbate, the problem. 'He' has now become a product and therefore alleged to have become 'feminised' so drugs are used to help him to conform to a pre-determined and idealised form of masculinity: strong, rock hard, always ready and vulnerability free (Samuels 2001, Zilbergeld, 1980)

If our end goal is 'performance perfection' we are bound to fail. As most sex therapists will know, 'fear of failure' often itself leads to failure. However an inability to let go of our hopes and desires leads men to seek artificial solutions from the pharmaceutical industry, breeding a dangerous and risk-laden drug dependency culture. Such short-term thinking fails to address the political and economic aspects of such swift solutions, which are bound to fail sooner or later. The drug companies seem to find it hard to deal with the inevitability of such failure, so continue to pump huge resources into maintaining the production of ever more successful products.

It is also possible that drug companies would benefit from, and seek the inevitability, of some sort of failure. Mass marketing is frequently predicated upon a level of ultimate consumer dissatisfaction leading more people to continually purchase more products seeking, but never quite attaining, stability and contentment. (After all one of the essential qualities of fashion is its transience). .

Female 'dysfunction'

At the time of the launch of Viagra (1998) it was found that a high percentage of ED sufferers also had partners with a corresponding 'dysfunction'. Questions were raised at that time regarding the use of any drug affecting sexual activity between two people without the inclusion or knowledge of one partner. Nonetheless, Viagra rapidly became widely available, not only at GP surgeries but also via the Internet and on the street, providing Pfizer with sales amounting to $1.5 billion by 2001 alone. Monitoring appropriate use of this drug became impracticable and led to the virtual impossibility of a therapist meeting with both partners engaging in sexual activity. This more traditional approach was quickly forgotten.

The 'usefulness' of this drug has further extended the realm of medical judgements into political, economic, moral and social domains (Jary, 1991). The encouragement of 'financially sponsored' drug dependence links medicine to the interests of big corporations and negates the woman's part in the mutually social act of sex, (Illich, 1975). Multinational drug companies are likely to be much more interested in their own profits, than providing an "amelioration of misery" (Ussher 1991 p.248). Therefore, those earning money from the colossal trade in chemical interventions may declare it a 'forbidden research terrain' (Fuller, 1988; cited in Lee, 1993; Lee, 1993; Ussher 1991). One can only imagine the outcome of a cure for the common cold. It would probably empty two thirds of the chemists' shelves.

New or old findings?

Despite the current shock and surprise about alleged female sexual dysfunction, these 'new' findings are not so new. These attitudes and beliefs have continued for centuries; women have traditionally been held responsible for male impotence and there have been many solutions put forward to resolve male sexual concerns.

Gynopia

Now that these pharmaceutical interventions are being hailed a success, the review of the historical attitudes to human sexuality brings a socio-cultural dimension to the debate. A parallel process is identified where the post Victorian psychiatrists and scientists, who were male, is analogous to the all male team engaged in the research for these new drugs being licensed for impotence. Pfizer, the company that manufacture the drug Viagra, employed an all-male team for its clinical research before licensing of the drug. This research practice could be seen by some to be misogynistic or at best gynopiac whilst continuing to "legitimise male supremacy in public life and sustain women in a subordinate position" (Wollenstonecraft, 1792; Eichler, 1998 p.5). Research findings based solely on the experience of men negate the cultural and socio economic influences of gender relations (May, 1997). The disease-focused biological deterministic view adhered to by many in the medical field, and passed down to lay practitioners and sufferers alike, whereby Sildenafil offers a global cure to a specific problem is a singular and limited way of viewing the issue.

Other perspectives

There are other significant issues that fit into the established hierarchical paradigms for managing those physiological problems which do not always have a measurable or identifiable physiological cause yet, which may affect either gender differently. If men and women have different agendas and evolutionary goals one should question whether the same remedy, be it 'talk' or 'tablets,' work equally well for both.

Lets also not forget that therapists, like doctors (and lawyers), do not come 'value free'. The high expenditure required for their training narrows the social base from which likely trainees emerge, being centred upon the higher social classes as a result. That this may well have an effect upon the likely sets of cultural and social attitudes that therapists bring to bear upon their work (even if unconsciously) seems most likely. However, using pure psychology to diagnose and treat our patients can place us above the political fray within which pharmaceutical companies are firmly rooted (Samuels 2001).

A female perspective

Existing work is probably biased against women's interests. It reveals without question that the gender in the field is overwhelmingly male; women researching in the field of ED are underrepresented. It is obvious that both historically and in the present day men have had a relative monopoly over economic and political power, as well as the projection of ideas and images (Samuels, 2001). It is not difficult to see how there is an imbalance against women amongst those working in the field of ED. Science remains, on the whole, a male domain. Literature on human sexuality and sexual dysfunction needs review; a basis for future feminist points of view needs establishing. It is argued that sexual success is a distinctly different phenomenon for men and women, and we need to question the use of the 'talking cure' as well as that of the medical model and to debate the dichotomy between 'medical' approaches on the one hand and 'counselling' on the other, with regard to solutions for ED. Not necessarily to arrive at a definitive solution but instead to open up a much-needed debate with regard to the conditions under which drugs are prescribed for ED.

This is not to suggest that one should approach this from a bland and 'genderless' viewpoint; conducting research from a female perspective can provide a fresh view of the matter. It can also bring about its own problems; the author is aware of 'occupational stigma' that may adversely affect the presentation of findings to those with a crude stereotypical view of research into minority group issues and other sensitive topics (Troiden, 1987). Results may become trivialised, criticised or even ridiculed. Researchers in this field can make use of the parallel process that may be likely to occur. Kirby and Corzine (1981; cited in Lee, 1993) identify this as a 'stigma contagion', whereby the researcher comes to share the stigma of those being researched. In psychoanalytic terms, this is the process whereby the subject's phenomenology maybe transferred to the researcher (Racker, 1968).

The timing of this debate is especially pertinent - research conducted from a female perspective can inject new thinking into the traditional male positivist domain of science as new discoveries and perspectives can have an effect upon society and its dominant paradigms. Yet the operations of Pfizer, Bayer and Eli Lilly tend to reinforce the notion of sex from purely fixed male perceptions of female sexuality despite the progress of feminism in challenging notions of male ownership over women.

A Brief History of attitudes to sexuality

It is now widely accepted that sex does not always take place within marriage. In earlier times extramarital sex was considered a sin and punishable, then pathologised, then psychiatrised (Foucault, 1979). During the Middle Ages a negative attitude to sexuality in general prevailed. Sex was purely for procreative purposes; nowadays the pleasures of sexual activity are at the forefront of attitudes and consequently the associated problems too. The division between procreational and recreational sex between partners, whether married or not, also has to be considered.

We must set out to dispel the myths of sexual dysfunction and place sex in a broader social, political and cultural context and reject the notion of penile erection as a purely mechanistic function and reposition it within the domain of the interpersonal.

Conclusions

New pathways of progress need to be established for men presenting with ED that considers all associated factors of the disorder and also involves the partner within the treatment plan. The same must be considered for women. The 'marital miseries' of any relationship where there may be 'desire differences' have not yet been explored.

The manufacturing of drugs is androcentric 'hard science', whereas feelings and interpersonal issues are gynaecentric 'soft science'. Hard science attracts funding; soft science is not backed by the huge amounts of money that pharmaceutical companies are prepared to provide for their research. At the first European Symposium of Female Sexual Dysfunction (FSD) in April 2003, Professor Alan Riley informed attendees that during his many confidential trials for drug therapy for FSD he discovered that only 10% of women with lower sexual desire than their partners wanted any intervention at all. Of those women (involved in the studies) who did want help, 57% held their intervention of choice as psychosexual therapy and/or counselling, Now that many schools in sex therapy either have closed, or are closing, (Whittington, St Georges, Maudsley and so on...) the needs of these women are not going to be met where a lucrative and legal drugs and money battle takes precedence. Alan Riley was questioned regarding this at the conference and he replied that 'education about sexuality needs review and that maybe universities are not the best place for this type of education'. Shocking!!!!

Changes to be made

A shift in thinking is required however, the author acknowledges that paradigm shifts are hard to initiate by writing articles or a book. Although such shifts have been achieved before, they are rare. There have been previous attempts at paradigm shifts throughout history the failure of which has succeeded in perpetuating masculine hegemony by the use of gender politics. Thomas Kuhn (1962) identifies the difficulties in achieving a paradigm shift unless certain factors are in place. He maintains that a paradigm defines the 'normal science' of an age; the main criteria being that the majority of practicing scientists in a field accepts it. The conference mentioned above was largely about doctors informing other professionals how we as psychosexual therapists operate. It had not previously been understood or acknowledged exactly what takes place in a psychosexual and relationship psychotherapists consulting room in terms of 'the helping process'. However, when these practices are articulated by a doctor they appear 'new, fresh, innovative' and henceforth become part of the status quo. By doing this, the doctor normalises sex therapy. Whereas when the same technique is (and has been for some time) performed by another it is regarded as out of the norm, odd, weird, untrustworthy, dubious, doubtful.

The power of 'Cult' thinking processes

Michael Shermer (1997) argues that 'the power is made visible in social and political aspects of science: research and professorial positions at major universities; influence within funding agencies; control of journals and conferences and prestigious books and so forth....' This is clearly identified by author Roy Moynihan in his article in the BMJ (2003). The system he exposes in the USA is almost identical to that in the UK. Pfizer fund the Impotence Association; Professor Alan Riley from the University of Leicester runs courses on female and male sexual dysfunction. The latter is the Chairman of the Impotence Association and editor of the journal of BASRT; he hosts annual conferences regarding sexual dysfunction and the use of medication for its resolution, and all of this is heavily funded by Pfizer (and probably other drug companies). This allows him the power to maintain the status quo of our time, that sexual dysfunction is a diagnosable medical condition and therefore resolvable by the use of drugs. Powerful and renegade scientists are needed to overthrow the existing paradigm (Shermer, 1998).

Intentions

The author suggests that it is not so much the women who require treatment as those who are pathologising female sexual dysfunction; who would benefit from being educated with regard to female sexuality. This is especially so where women within a relationship experience occasional or persistent reluctance to engage in sexual intercourse because of stress, tiredness, or pure 'marital miseries' and are now being told they have a disease. New work is needed to initially expose and then to debate just that. The personal must become the political. (This is an extract from work in progress)

References

Diana Goss MSc. PsSC is a Member of the Academy of Experts in Traumatic Stress, a BASRT Accredited Psychosexual & Relationship Psychotherapist, UKCP Reg. Psychotherapist, BACP Reg. Counsellor, and UKRC Reg. Practitioner in the U.K.