The making of a disease: female sexual dysfunction

Editor—Moynihan wrote about female sexual dysfunction as a disease in the making.1 As co-chairs for an (unpaid) international committee, commissioned and supported by the American Foundation of Urological Disease, to improve definitions of women's sexual dysfunction, we regret the sensational biased view of industry funded research of biological components of women's sexual function. The common error of equating self reported sexual problems with medically diagnosable disorder is well recognised. However, to focus only on this and neglect the need for research into aetiology, pathogenesis, and treatment of women's sexual dysfunction from disease, medical, and surgical interventions, is unfortunate. To date, neither the major neurotransmitter involved in vaginal congestion nor the autonomic innervation of the vulval structures has been established. Industry funding facilitates research of interrupted sexual responses from chemotherapy, pelvic surgery, neurological disease, premature menopause, and drug treatment, as well as healthy sexual physiology. We question the concept of a “new definition of human illness.” Women's sexual dysfunction has been diagnosed throughout the centuries. The committee meeting in 1998 tried to modulate definitions in the American Psychiatric Association's Diagnostic and Statistical Manual of Disease, to be more reflective of women's sexuality and did not create “new disorders.” However, the formulation of accurate diagnosis is a continuing process—what is “normal” for women of different ethnic, religious, and cultural backgrounds, and of different ages and life stages is still unclear. Women's sexual function is highly contextual; many aetiological factors—physical, psychological, and interpersonal—must be not only evaluated but included in the diagnosis. Thus the definitions are becoming less rather than more medical. Without accurate definitions of dysfunction, any potential contributory role for pharmacotherapy in holistic management of dysfunction cannot be explored. Without support from the pharmaceutical industry, little new research into sexual physiology is likely or the means by which psychological factors alter the biological processes involved.

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