BIG IDEAS + LESSON FOR THE SCIENCES OF SEX

Foucault, Feminism, and the Sexual Sciences

As we saw in the previous module, the first volume of Michel Foucault’s The History of Sexuality provides an influential critique of the “sciences of sex.” In this work, Foucault suggests that there is little that is scientific about the disciplines of psychoanalysis, psychiatry, and sexology that emerged in the 19th and 20th centuries. In each case, Foucault argues that the authority of science is exploited to facilitate the regulation of sexuality in a biopolitical era in which the sex life of the population has become a crucial political stake. Sex, according to Foucault, is managed by doctors not so much to cure health problems as to enforce social norms, and sexual science does not provide the truth of sex or make people healthy, but naturalizes the monogamous, heterosexual, nuclear family.

Leonore Tiefer

Feminism has also posed powerful critiques of the sexual sciences. Feminist sexologist Leonore Tiefer summarizes some of these critiques when she writes:

“Margaret Jackson argued that the role of sexology all along has been to normalize and universalize ‘the coital imperative’ and ‘the primacy of penetration’ in order to undermine women’s resistance to compulsory heterosexuality. Similarly, Mariana Valverde argued that sexologists’ role as marriage reformers in the twentieth century led them to insist that women, like men, have sexual needs and desires and that, conveniently, women’s sexual needs and desires were just like men’s, albeit a bit slower. Janice Irvine, in her extended analysis of the history of sexology in the United States, likewise has argued that sexologists’ primary concern has been for their own professional status and legitimacy and that this emphasis has required strategies and alliances that have time and again co-opted any interests they may have had in women’s self-determination.”

Leonore Tiefer, Sex is Not a Natural Act
Janice Irvine

Janice Irvine observes that sexology has been “a profession committed to rehabilitating [heterosexual] marriages through better sex.” Intervening in the “crisis in marriage” that threatens “the family” has been the fundamental justification for sexological research since Alfred Kinsey’s foundational work in the 1940s and 1950s and appears to be a crucial component of securing research funding and institutional support for this field of study.

Sexology has been promoted since its inception as a means of saving heterosexual marriages

As Irvine notes, feminist epistemology has rejected the purported neutrality of science, especially of the sciences that claim knowledge about sex and gender. Feminist and queer political theorists and activists have, moreover, “underscored the hollowness of solutions based on techniques” that are favored by sexologists; teaching men skills to resist premature ejaculation or to better stimulate their wives’ clitorises are not adequate resolutions to widespread and profound dissatisfactions with sex, gender, and marriage in a heterosexist and patriarchal society. As Irvine writes,

“Feminism and lesbian/gay liberation…challenged power inequalities between men and women and questioned the very concepts of maleness and femaleness, masculinity and femininity.…They presented alternatives to tradition and to expert power and authority. Therein lay their threat to American sexology.

Janice Irvine, Disorders of Desire: Sexuality and Gender in Modern American
Sexology

Given this antagonistic relationship, combining feminism and sexology was initially controversial. The work of feminist sexologist Shere Hite in the 1970s and 1980s was critiqued by sexologists and feminists alike: sexologists complained that the 1976 Hite Report was political and thus undermined the scientific prestige of sexology, while feminists criticized Hite for aspiring to a masculine scientific authority. Describing the relationship between feminism and sexology, Irvine notes that “the incompatibility of their concerns — science and market, on the one hand, versus progressive political change, on the other— led… to a contentious and emotionally charged history.”

Shere Hite
The Hite Report

One of the most contentious contemporary issues for feminist with respect to sexology has been so-called “Female Sexual Dysfunction” (FSD). While psychologists had pathologized female sexuality under the labels of “frigidity” and “hysteria” since the nineteenth century, sexual dysfunctions were relatively marginal in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 1952. In the DSM-1, frigidity (like impotence) was a subcategory of “Psychophysiological autonomic and visceral disorders,” which were themselves part of a larger group of “Disorders of psychogenic origin or without clearly defined physical cause or structural change in the brain.”

Sexual scientists now talk of “Female Sexual Dysfunction” rather than frigidity

Each new edition of the DSM has given sexual dysfunctions a more prominent place, however, and has tended to proliferate their number, although the DSM-5 in fact merged five types of female sexual dysfunction into three. Over time, not only have more sexual dysfunctions been named, but they have moved from being symptoms of disorders to being disorders themselves. In the DSM-5, released in 2013, sexual dysfunctions are a category of their own, and FSD is divided into the following disorders: Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, and Genito-Pelvic Pain/Penetration Disorder.

A poster by the Cardiovascular and Hematological Agents in Medicinal Chemistry claiming that 40% of women are sexually dysfunctional

Of these, Female Sexual Interest/Arousal Disorder, formerly known as Inhibited Sexual Desire or Hypoactive Sexual Desire Disorder, was by the late 1980s “the most common presenting problem, constituting half of all diagnoses,” and is diagnosed more frequently in women than the parallel disorder in men. According to the National Health and Social Life Survey, published in 1999, 32 percent of women and 15 percent of men have Hypoactive Sexual Desire Disorder. In turn, Female Orgasmic Disorder “includes any difficulty or delay in reaching orgasm that causes the woman personal distress,” even, judging from case studies, if the “difficulty” is that she cannot orgasm from vaginal penetration. A woman may be treated for this disorder if she is does not orgasm from a “sufficient” amount of stimulation, although what constitutes “sufficient” is highly subjective. A woman may likewise be treated for FSD if she experiences pain during intercourse or clenches her vaginal muscles in a manner that makes penetration difficult. “Personal distress” is the marker for whether a woman is sexually disordered in each of the categories of FSD: a woman can be treated for FSD if she experiences “a lack of sexual desire that causes [her] distress,” or if “the problem causes clinically significant distress or impairment.”

Some so-called sexual disorders may in fact point to relationship breakdowns or dysfunction

Importantly, the DSM-5 specifies that sexual dysfunction refers to symptoms that are “not better explained” by “severe relationship distress (e.g., partner violence), or other significant stressors,” but repeatedly lists as a “specifier” of FSD “relationship factors (e.g., poor communication, discrepancies in desire for sexual activity).” The implication seems to be that if a woman has difficulty with penetration, orgasm, or arousal because of partner violence, she is not disordered, but she may be disordered if her difficulties result from “discrepancies in desire” between herself and her partner that endure for at least six months. Tellingly, one of the symptoms of Female Sexual Interest/Arousal Disorder is that the woman is “typically unreceptive to a partner’s attempts to initiate.” Thus a woman may be pathologized by psychiatry if she regularly declines sex with her partner over an extended period.

In the medical literature we can find many cases of women who are in fact accepting of their lack of sexual desire, and whose male partners have pushed them to get medical treatment, whereupon they are diagnosed with and treated for FSD.

In many of the case studies recounted in the literature, the distress on the woman’s part is a response to a relationship in turmoil. As Irvine writes:

“An angry and dissatisfied partner is often the impetus for someone to seek professional treatment for [Inhibited Sexual Desire Disorder].”

Janice Irvine, Disorders of Desire

A woman may in fact not feel troubled by her decreased postpartum or postmenopausal libido, for instance, but consults a doctor about it because of a frustrated husband. Women are diagnosed and treated as sexually disordered because they have sex-related marital tensions, even if they are personally well adjusted to their sexual response. Much of the problem with FSD seems to arise from lack of education, rather than from something aberrant about the women; for instance, although this goes directly against a caution expressed in the DSM-5, many of the couples discussed in the clinical literature appear ignorant of the fact that most women do not orgasm from intercourse, and yet this does not prevent doctors from treating the women as disordered, prescribing them testosterone, and even subjecting them to surgeries. Although sexologists since William H. Masters and Virginia E. Johnson (who began work on sexual dysfunctions in 1957) note that a large part of their job is pedagogical, women today are still being treated for mental health problems in cases where sexual education seems more in order.

Virginia Johnson and William Masters

According to a frequently cited report from the National Health and Social Life Survey, published in the Journal of the American Medical Association, FSD was found to be widespread, affecting “43 percent of American women, young and old … — a significantly higher percentage than that of men, who suffer [from Male Sexual Dysfunction] at a rate of 31 percent.” Numbers are even higher in older women: “more than half the women over age 40 in the United States have sexual complaints.” As in these examples, the literature on FSD moves fluidly between writing about sexual “complaints,” “sexual dysfunctions,” and “disorders,” implying that any dissatisfaction on a woman’s part may indicate a psychiatric problem with the woman and not with her lover or the societal fantasies of female sexuality to which she is trying to live up.

Resisting the medicalization of women’s sexuality: Leonore Tiefer

Leonore Tiefer

Leonore Tiefer is a professor of psychiatry at the New York University School of Medicine and has a private sex-therapy practice in Manhattan, and she is the main spokesperson in the feminist movement resisting the medicalization of women’s sexuality. She is featured in two documentary films about FSD: PharmaSutra and Orgasm Inc., the latter of which is the assigned resource for this module.

Orgasm Inc. is a feature-length documentary film by Liz Canner on the marketing of FSD.

With Ellyn Kaschak, she is the coeditor of A New View of Women’s Sexual Problems.

A New View of Women’s Sexual Problems

In a collection of her own writings, Sex Is Not a Natural Act and Other Essays, Tiefer draws on Foucault to argue that sex is “socially constructed” – a social and political phenomenon and thus not best studied by science.

Sex is Not a Natural Act & Other Essays

Having come to see sexuality in humans as a social and political rather than a biological phenomenon, Tiefer repudiates her doctoral experiments on rodents, recalling:

“Writings from the women’s movement convinced me that the primary influences on women’s sexuality are cultural norms internalized by women, reinforced by institutions and enacted in significant relationships. Hamsters had taught me nothing about social norms.”

Leonore Tiefer, Sex is Not a Natural Act

Hamsters and other nonhuman animals are tortured by academics in vain: as Tiefer argues, since these animals are not subjected to the same processes of socio-sexual normalization that we are, they can teach us nothing about our own sexuality. Tiefer also rejects the medical approach to sex that assumes statistical surveys and laboratory observations of sex acts will tell us the truth about mammalian sexuality. In fact, these studies — at least those done with human subjects — only tell us about the effects of sexual socialization, not timeless truths about how sex is and ought to be.

A hamster being used for medical experimentation

Tiefer argues that, beyond misinterpreting social sexual conditioning as biological facts, the sexual sciences are actively constructing and shaping female and male sexuality in new ways, replacing an old set of social constructions with a new one. Tiefer notes that Masters and Johnson’s human sexual response cycle, proposed in their 1966 book Human Sexual Response, is “social construction in action” as is “the Viagra phenomenon.”

Viagra pills

Although in her words “sex role socialization introduces fundamental gender differences and inequalities into adult sexual experience,” Tiefer thinks that sexual scientists assume that women and men are sexually the same; more importantly, Tiefer thinks that they actively construct women and men to be sexually the same. She observes that Masters and Johnson selected women for their studies who were atypical in their culturally “masculine” sexuality: the women were unusually interested in improving coital technique, as demonstrated by the fact that they were eager to be involved in Masters and Johnson’s studies at all; they were sexually uninhibited enough to have sex in a laboratory (Masters and Johnson had initially hired prostitutes for their studies, thinking no “normal” women would want to participate); and they had histories of orgasms from both masturbation and intercourse. The scientists then generalized from results using these atypical subjects to form their theories about female sexuality generally, thus producing a distinctly masculinized female sexuality as the norm that all women must live up to or be deemed “inadequate.”

The DSM-5

According to Tiefer’s trenchant criticism, the DSM and contemporary sexual scientists carry on this tradition of assimilating women into a masculinized construction of female sexuality by pathologizing women who do not conform to masculine norms (most notably: orgasming easily from intercourse). Tiefer criticizes the DSM for presupposing that disorders of female sexuality will fall into the same categories of disorder as male sexuality and will be genital focused and coitus focused. She argues that this version of sexology, “with its alleged gender equity, disguises and trivializes social reality, that is, gender inequality, and thus makes it all the harder for women to become sexually equal in fact.”

We will now listen to a CBC Radio podcast on “The Ideas of Leonore Tiefer,” in which Tiefer discusses these and other subjects. It is divided into three short parts.

CBC Radio Podcast: The Ideas of Leonore Tiefer, Part 1 of 3 (15:15)
CBC Radio Podcast: The Ideas of Leonore Tiefer, Part 2 of 3 (18:43)
CBC Radio Podcast: The Ideas of Leonore Tiefer, Part 3 of 3 (20:08)

Four Similarities Between Tiefer and Foucault

One: questioning the normal

Beyond taking a social constructivist perspective on sexuality, Tiefer’s feminist sexology resonates with Foucault’s writings on sex in at least four ways. First, like Foucault, Tiefer historicizes and critiques the modern preoccupation with normalcy – and with sexual normalcy in particular. While Foucault provides a genealogy of the shift from thinking of most sex acts as sinful to seeing them as abnormal and cause for psychiatric concern, Tiefer sees the medical discourses on abnormality as taking up where religious discourses on sin left off. In their book, For Women Only, sexual scientists Laura and Jennifer Berman tell us that “Am I normal?” is one of the most frequently asked questions that they are posed. Tiefer states that the most common question that she is asked in her practice is: “Is my partner normal?” She observes that in sex therapy, normalcy “typically is something couples fight over and accuse each other about. ‘You’re not normal,’ ‘No, you’re not normal.’”

A couple fighting in therapy

Tiefer writes that

“the public seemed to acquire an insatiable appetite for information to answer the question, ‘Am I normal?’”

Leonore Tiefer, Sex is Not a Natural Act
Sex therapists act as normalcy referees, according to Tiefer

As a sex therapist, Tiefer finds that she is regularly expected to be a “normality referee.” Scientists, it seems, are our recognized authorities on normalcy, and normal is what people want their sex lives to be. In her work, however, Tiefer distinguishes between six uses of the term “normal” and criticizes the conflation of these uses. For instance, while “normal” is sometimes used to refer to the statistically common, so-called Female Sexual Dysfunction is deemed “abnormal” even while it is claimed that nearly half the female population suffers from it. Sometimes, as we can see in this example, abnormal does not refer to something unnatural or unusual, but simply to something that the dominant society (or the patriarchy) has decided is not ideal. For these reasons, Tiefer problematizes the presumed connection between abnormality and pathology and argues that the concern with abnormality is not ultimately about health, but about social conformity.

Two: remembering pleasure

The second Foucauldian moment in Tiefer’s work is her observation that in sexological writings, pleasure has been forgotten. The medical discourses on sexual dysfunction focus on performance and genital mechanics, including orgasm, but are silent about pleasure. Orgasm is not the same as pleasure, however: orgasm isn’t necessarily pleasurable, and there are all kinds of sexual pleasure other than orgasm. For men, sexual function in the medical literature is about getting a “normal” erection and sustaining it for a “normal” amount of time before ejaculating. For women, it is about feeling a “normal” amount of desire and responding “normally” to sexual stimulation (arousal and orgasm). Doctors speak of Hypoactive Sexual Desire Disorder and Sexual Arousal Disorder, but say nothing of pleasure dysfunctions. “Personal distress” and pain are viewed as signs of a disorder, but their opposite, pleasure, is nowhere to be seen.

What about pleasure?

In an interview, Foucault similarly argued that we have focused so much on desire that no one knows what pleasure is anymore. We know from his writing that Foucault included himself in this statement. Tiefer suggests that we shift our focus of attention from desire and performance to pleasure, and Foucault makes a parallel argument, suggesting that bodies and pleasures, rather than sex/desire, might be the “rallying point” for resisting sexual normalization. Tiefer, unlike Foucault, is usefully attentive to gender when she discusses pleasure. She observes,

“An early 90s U.S. probability sample survey conducted in Chicago asks one question about sexual problems experienced in the past 12 months, and about twice as many women (27 to 17 percent, younger to older) as men (10 to 6 percent) reported that sex was not pleasurable. However, unlike the results about arousal and orgasm, these provocative findings on pleasure were not further analyzed.”

Leonore Tiefer, Sex is Not a Natural Act
Studies show many women do not find their sex lives pleasurable

Thus a second point we might take from Tiefer and Foucault is that we should worry less about performance and desire and more about pleasure. In particular, we should be concerned with why many women are not finding sex pleasurable.

Three: resisting the medicalization of sex

Third, Tiefer, like Foucault, suggests that we might replace the medical approach to sexuality with an aesthetic approach. Rather than sex being something that we consult a psychiatric manual about, Tiefer suggests that sex could be thought of as an artistic endeavor. She writes,

“Open a textbook on human sexuality, and nine times out of ten it will begin with a chapter on anatomy and physiology.…Open a textbook of music, in contrast, and you will not find chapters on the bones, nerves, blood vessels, and muscles of the fingers (for playing the piano), the hands (to play cymbals or cello), or even the mouth or throat (for flute or singing). And what about the physiology of hearing or of the sense of rhythm? Why don’t music texts start with biology? Isn’t biology as fundamental to music as it is to sexuality?”

Leonore Tiefer, Sex is Not a Natural Act
Music textbooks do not start with anatomy

The reason sexuality textbooks begin with biology, while textbooks on music do not, is that we think of sex as a “natural” act, whereas we think of music as artistic or as a creative human endeavor. However, Tiefer argues, human sexuality is a thoroughly cultural phenomenon and, like music, is a way in which we can express ourselves creatively.

The Kama Sutra is an example of an ars erotica approach to sex: sex is approached as an art rather than as an object of scientific study.

Foucault also contrasts the sexual science approach to sexuality with an aesthetic model, first in the ars erotica (erotic art) comparison of the first volume of The History of Sexuality and later in his discussions of the aesthetics of the self in volumes Two and Three of The History of Sexuality. These examples are meant to show that we could approach our lives, including our sex lives, as works of art, rather than as objects of knowledge for the biological and psychological sciences. Approaching sex aesthetically would be a way out of the normalizing discourses of the psychological sciences, since art does not aspire to normalcy. For Foucault, an artist would only make art in order to transform herself or to become other than what she is:

“The transformation of one’s self…is, I think, something rather close to the aesthetic experience. Why should a painter work if he is not transformed by his own painting?”

Michel Foucault, “An Ethics of Pleasure”
Self-transformation

If we approached our sex lives aesthetically, it would not be to prove our normalcy. Normalcy is not the aspiration of art, after all. Imagine going to an art gallery opening and trying to compliment the artist by saying, “Your work is so… normal!”

Would an artist be flattered if told that their paintings are “normal”?

Rather that aspiring to normalcy, a sexual aesthetic could be about transforming ourselves, using sexual practices and pleasures to become other than what we are. An aesthetic approach to sex might undo the disciplining (including the gendering) of our sex lives and enable us to experience new bodies and new pleasures, or to become new bodies of pleasure.

Four: insisting that sexuality is optional

Finally, the fourth way in which Foucault’s and Tiefer’s work overlaps is that while they both propose an aesthetic rather than a medical approach to sex, neither prescribes it. The overwhelming message of the first volume of The History of Sexuality is that our current fascination with sex is problematic and contingent. In volume Two of The History of Sexuality, The Use of Pleasure, Foucault repeatedly notes that the ancient Greeks did not share our keen interest in sex and thought that food was a much more interesting pleasure. Similarly, Tiefer stresses that

“sexuality is an option in life, although one wouldn’t think so to listen to many ‘experts’ talk. If someone wants to have a long and lively sexual life —and believe me, I don’t care whether anyone does or does not want to and I am making no recommendations —but a person who does want to needs to learn about sexuality and take time to practice.”

Leonore Tiefer, Sex is Not a Natural Act
Tiefer argues that sexual skill, like musical skill, may involve talent but also takes practice.

Like musical ability, Tiefer argues that sex may be a talent that some people have and others lack. If one does not have a talent for sex, it is no more terrible than if one does not have a talent for music. There are other fulfilling pursuits in life, and sexuality should be no more privileged a pursuit than any other. Indeed, one of Tiefer’s reasons for rejecting the health model for sexuality is that she does not think we need to be sexual to be healthy. The contingency of thinking that sex is and should be significant to everyone’s lives is an important message for feminism to convey.