Female sexual dysfunction is an artificial concept driven by commercial interests: FOR: FSD is a multimillion dollar business.

Abstract

Female sexual dysfunction (FSD) can be classified as low sexual desire (diminished libido), sexual arousal disorder (difficulty to become aroused or maintain arousal during sexual activity), orgasmic disorder (persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and continuing stimulation), and sexual pain disorder (pain associated with sexual stimulation or vaginal contact). Prevalence data suggest that 10–42% of women experience orgasmic disorder, and that 15% of women report some pain during intercourse. If a woman has an orgasm through clitoral stimulation, but not during intercourse, it does not meet the criteria for a clinical diagnosis of female orgasmic disorder. If the orgasmic difficulties are the result of inadequate sexual stimulation, these cases should not be diagnosed as a disorder of female orgasm (American Psychiatric Association, American Psychiatric Publishing 2013). Questionnaires are used to establish the diagnosis and to assess the response to treatment of FSD. The female sexual function index (FSFI) questionnaire is the most widely used measure of FSD, and has been cited in more than 1500 articles; however, the validity of the FSFI has not been addressed in the literature (Forbes et al. J Sex Res 2014;51:485–91). Physiologically the FSFI does not provide an assessment of female sexual function as it contains mainly psychological terms (Rosen et al. J Sex Marital Ther 2000;26:191–208). The FSFI seems to assess the degree of lubrication and ease of penetration, whereas very little attention is paid to clitoral sensation. In fact, a decline in desire, and a decreased ability to achieve orgasm, is associated specifically with penile–vaginal intercourse. As a matter of fact, FSD as a concept is popular because it is based on something that doesn't exist, i.e. the vaginal orgasm. Female orgasm is caused by the female erectile organs and, physiologically, female sexual satisfaction is based on orgasm and resolution (Puppo Clin Anat 2013;26:134–52). Moynihan stated: ‘I described the making of female sexual dysfunction as the freshest, clearest example of the corporate sponsored creation of a disease…The 19 item female sexual function index, published in 2000, was supported by Bayer and Zonagen at a time they hoped to treat so-called arousal disorder. The sexual function questionnaire was funded by Pfizer, and half of the authors on the 2002 paper describing its development were Pfizer employees, including the lead author’ (Moynihan BMJ 2010;341:c5050). FSD has become the centre of a multimillion-dollar business, and seems to be essentially focused on sexual function resulting from penile–vaginal intercourse. The FSFI questionnaire must not be used to assess FSD. Is FSD an illness constructed by sexologists under the influence of drug companies? Questionnaires for the diagnosis and treatment of male and female sexual dysfunctions must mainly assess the presence or absence of orgasm (a function of the human body, which must be assessed in the subject) with masturbation, and the questions posed should not use the words ‘intercourse’ or ‘satisfaction’. None declared. Completed disclosure of interests form available to view online as supporting information.