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SEXUALITY IN THE CROSSHAIRS OF CULTURE
1 THE PLEASURE GAP
Tomorrow sex will be good again.
—Michel Foucault, The History of Sexuality, vol. 1, 1978
IN THE LOBBY of Building 31 at the Food and Drug Administration’s White Oak Campus, a display case houses a small but terrifying exhibit of recalled or otherwise perilous medical inventions. As I passed by, the iconic shape of the Dalkon Shield snagged my attention. An oblong disk ringed with spikes, in appearance it has been compared to a stingray or a crab, but it has also been described as an instrument of torture, which, it turns out, is precisely what it was. Marketed in the early 1970s as a “superior” intrauterine device—the Cadillac of IUDs for a new birth-control-savvy generation, the shield resulted in the deaths of more than twenty women and rendered at least thirteen thousand women sterile or infertile. By the mid-1980s, some two hundred thousand women claimed to have been injured by its use.1
This totem to regulatory caution lingered in mind as I made my way into the FDA’s Great Room for the day’s proceedings. Although in the past the agency had weighed in on women’s access to quality contraception, that particular week in the fall of 2014 it was considering another matter: women’s access to quality sex. Several hundred experts, activists, pharmaceutical reps, and lobbyists had gathered to make—and contest—the case that female sexual dysfunction represented an unmet medical need.
Shortly after I entered, a woman who called herself Vicky took the stage and delivered an emotional testimony. Thirty-nine, a mother of four, she said she used to enjoy her sex life with her husband. “Our friends would even make comments about how we couldn’t keep our hands off each other.” But out of the blue, her desire vanished. It became nonexistent. She turned to specialists, but in vain, and tests revealed no ready answers. Her symptoms worsened; she found herself avoiding even “simple hugs and kisses.” Matters came to a head during a child-free escape to Mexico. “In the past when we had taken vacations together we barely left the room,” she said. “My mom always joked, ‘don’t get pregnant’ when we left. But unfortunately my symptoms stayed the same. In a beautiful place with the man I love, my body was like a shell with nothing inside.”2
As the conference continued, a steady parade of women came on stage to explain how their libidos had been whittled down to a fraction of their former size.3 For some it was a gradual diminishment. For others it was “like a switch that went off.” One woman lamented, “I don’t even think about sex.” Others spoke of how intimacy had become more a form of duty than a source of delight. “I am able to grit through it,” said one. Another: “I might not even want to have sex but if he wants sex and I give it to him then, yes, I was a good wife today.” One woman, who had spent over $35,000 on thirty specialists for treatments that included pudendal nerve injections, painkillers, and muscle relaxants, said her diminished interest affected far more than her sex life. In addition to the pain, it caused depression and low self-confidence and undermined her relationships with friends and family. One after another, the women described the anguish provoked by their dimmed desire: anxiety at the mere thought of sex, heartache over their inability to enjoy what they once heartily did, shame and embarrassment about something so essential having gone awry, disconnection from their bodies, and injury to their relationships.