杏吧原创

IN 2001, Viagra earned Pfizer a cool $1.5 billion. Not surprisingly, the company would like to sell its little blue pill to women as well as men, and envious competitors are keen to develop their own Viagra-like products for women.

But there鈥檚 a problem. Women do not suffer the same physical problems with sex as men, and you cannot market a drug unless there is an accepted clinical need for it. So what鈥檚 a company to do? Answer: invent a condition called 鈥渇emale sexual dysfunction鈥� and persuade experts to claim a whopping 43 per cent of women suffer from it at some time.

That, at least, was the charge levelled at the drugs industry earlier this month. In a bold attack that made headlines across the world, the British Medical Journal argued that the prevalence of female sexual problems was being systematically exaggerated by researchers with financial links to the drug industry. Though by no means the first or only case of everyday biological life being medicalised, FSD was, said the journal, 鈥渢he freshest, clearest example that we have of the corporate-sponsored creation of a disease鈥�.

As someone who has researched female sexuality for more than two decades, I have just one quibble with this attack: it doesn鈥檛 go far enough. The pharmaceutical industry is guilty not just of cynical, money-grabbing exaggeration 鈥� it has misunderstood the basics of female sexuality. It is not women who need to change, or be made different through drugs, but the drug industry鈥檚 own outdated notion of how couples should have sex.

The arguments of those who claim female sexual dysfunction is real have a veneer of sophistication. Many, for instance, like to point to four distinct categories: lack of desire, lack of arousal, pain during intercourse and lack of orgasm. It鈥檚 the lack of arousal variety of 鈥渄ysfunction鈥� that Pfizer thinks Viagra can solve. But in reality none of these categories is independent of the others. Anticipating pain will kill off desire. An arousal pill may be a costly waste of time if the root cause of that lack of arousal is not addressed.

My own research, based on the testimonies of thousands of women, points to a lack of orgasm during coitus as a crucial and common underlying reason why many women become disenchanted and uninterested in sex. Most women don鈥檛 orgasm regularly during coitus. But does that mean they need pills to help them? Not a bit of it. Merely making women more receptive to sex will not lead to more orgasms. What might is recognising the truth about the mechanics of female orgasm.

To this end, the drug industry should pay more attention to masturbation. The overwhelming majority of women, according to my research, can have orgasms easily during masturbation. So why not also during coitus? The answer is that during masturbation women choose to stimulate the clitoral or pubic area. Only rarely, in 2 per cent of cases, does it involve vaginal penetration.

In other words, the stimulation women give themselves to reach orgasm is 鈥� unlike that used by men 鈥� radically different from the stimulation most women receive during coitus. So it is not at all surprising that the rate of orgasm during coitus is low.

It has been accepted for at least two centuries that women can masturbate 鈥渃litorally鈥� to orgasm. Yet even today the definition of what we call sex is focused on coitus as the time when both people should reach orgasm via the same type of stimulation. Even in supposedly sophisticated pornographic material, clitoral stimulation is used only as a warm-up and is never depicted all the way to orgasm. It is this limited definition of sex that is at fault, not women鈥檚 bodies: sex should be composed not only of coitus but also of clitoral stimulation, by hand or mouth.

So why isn鈥檛 it? Freud proclaimed that at puberty girls should transfer their need for clitoral stimulation to the vagina; later psychiatrists went on to label lack of orgasm during coitus a disease or a dysfunction. For these and other reasons a version of sex took hold that put male orgasm before female orgasm, reflecting the subservient position of women in society as a whole.

But if notions of sex in the past excluded clitoral stimulation out of a sort of prejudice against non-reproductive activity, it is time for people to move on. In these days of equality sex is supposed to be an act that brings two people together.

Drug companies that set out to 鈥渟olve the problem of female orgasmic dysfunction鈥� risk making matters worse if they neglect this and focus simply on female readiness to participate in sex. Putting money into supposed treatments that don鈥檛 work could mean financing unhappiness and divorce, leaving women鈥檚 feelings invisible or unexplained, and placing men on insecure ground. It risks fostering an atmosphere of fear and confusion in which love, including intense sexual intimacy and experimentation, needlessly becomes an area of conflict rather than pleasure.

Women know how to have orgasms but do not feel free to express this during sex with men. It鈥檚 not arousal pills we need, but a whole new kind of physical relations with each other.