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. 2002 Jul 6;325(7354):45.

Sexual behaviour and its medicalisation

Many (especially economic) forces promote medicalisation

Leonore Tiefer 1
PMCID: PMC1123558  PMID: 12098735

Editor—The subject of the medicalisation of sexual behaviour requires an even larger perspective than that offered by Hart and Wellings,1 one specifically identifying socioeconomic trends and agents. For example, the addition of sexual dysfunctions to the American psychiatric nomenclature in 1980 came at a time when psychiatry needed to become more biological and quantitative to participate in new American insurance reimbursement plans. The Masters and Johnson list of disorders, focusing on dissatisfaction with genital arousal and orgasm but omitting “soft” problems of pleasure or intimacy, fitted these quantitative and biological needs but popularised standards for sexual satisfaction that are overly genital and performance oriented.2

The involvement of urologists in male sexual problems in the 1980s came about because of specialists' needs for new topics and patients, the encouragement of newly interested industries, and shifts in relations between academics and these industries.3 It was widely promoted in the press, creating heightened expectations about medical sexual expertise.

When Hart and Wellings cite epidemiological statistics for sexual problems they inadvertently contribute to the problems of medicalisation by citing weak research and failing to discuss how definitions of a problem play a part in market-driven medicalisation. American studies of the prevalence of sexual problems use overinclusive definitions—not surprising given the extent of drug company involvement in the research.4

A discussion of medicalisation needs to examine the fit between models of sexuality and the medical model.5 Hart and Wellings conclude that the problems of medicalisation are really those of overmedicalisation, but I believe that that is superficial. Sexuality is a social construction, and medicalisation is the new social construction. Excessive medicalisation may be malpractice, but we must question the fundamental model of sexuality as a biological rather than a sociocultural and political entity.

Hart and Wellings's final sentence (“The last century saw a considerable increase in acceptance of diversity of sexual expression—it would be a shame if this century saw diversity replaced by uniform expectations of performance and desire”) is their strongest, but their analysis needs to be more comprehensive. I would direct readers to a new feminist campaign that has emerged to resist the for-profit medicalisation of women's sexual problems (www.fsd-alert.org).

References

  • 1.Hart G, Wellings K. Sexual behaviour and its medicalisation: in sickness and in health. BMJ. 2002;324:896–900. doi: 10.1136/bmj.324.7342.896. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Tiefer L. Historical, scientific, clinical, and feminist criticisms of “the human sexual response cycle” model. Annual Review of Sex Research. 1991;2:1–23. [Google Scholar]
  • 3.Tiefer L. In pursuit of the perfect penis: the medicalization of male sexuality. American Behavioral Scientist. 1986;29:579–599. [Google Scholar]
  • 4.Tiefer L. Sexology and the pharmaceutical industry: the threat of co-optation. J Sex Research. 2000;37:273–283. [Google Scholar]
  • 5.Tiefer L. The medicalization of sexuality: conceptual, normative, and professional issues. Annual Review of Sex Research. 1996;7:252–282. [Google Scholar]
BMJ. 2002 Jul 6;325(7354):45.

HIV-AIDS prevention efforts deserved greater mention

Alain Giami 1

Editor—In their account of the medicalisation of sexual behaviour Hart and Wellings do not pay sufficient attention to the HIV-AIDS prevention efforts that were undertaken during the mid-1980s.1-1 They can be considered to be the most important effort to medicalise sexuality in the 20th century. The enormous amount of social, scientific, medical, and public health responses generated are evidence of the complex and multiple dimensions of such a process.

In the absence of a vaccine and a magic bullet against HIV and the disease it engenders, public health authorities had to develop a comprehensive prevention strategy. This included, firstly, national surveys on sexual behaviour in most industrial and developing countries to collect information on the sexual practices of the populations, to an extent never before achieved; secondly, a dramatic change of sexuality-related values and meanings (heterosexual intercourse becoming a major risk behaviour; masturbation considered to be a low risk practice, etc); and, thirdly, a global strategy of behaviour modification to promote behaviour change (systematic use of condoms, reducing the number of partners, etc).

An overall evaluation of the response to AIDS today shows, on the one hand, an insufficient response by public health authorities, as evidenced by the increasing numbers of HIV carriers in developing countries and among vulnerable groups in industrialised countries. On the other hand, it represents the most important and comprehensive effort at controlling sexual activity and changing its meaning on the global level.

In conclusion, Hart and Wellings would have given a more balanced analysis of the process of medicalisation of sexuality if they had included the responses to HIV infection and AIDS in their article.

References

  • 1-1.Hart G, Wellings K. Sexual behaviour and its medicalisation: in sickness and in health. BMJ. 2002;324:896–900. doi: 10.1136/bmj.324.7342.896. . (13 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]

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