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Sexualities
DOI: 10.1177/1363460707078320
2007; 10; 299Sexualities
Thea Cacchioni
Debates on Female Sexual Dysfunction
Heterosexuality and 'the Labour of Love': A Contribution to Recent
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Abstract It is increasingly taken for granted that `successful
heterosexuality' is contingent upon having a `normaľ and
`healthy' sex life. The recent popularity of the diagnostic label
`Female Sexual Dysfunction' (FSD) is evidence that this social
climate has fostered the (re)medicalization of women's sexual
problems. In response to feminist concern over the growing use
of the FSD label, this article considers data gathered as part of a
qualitative, empirical study, examining women's perceptions of
sexual difficulties and their treatment. It is argued that women
with perceived sexual problems, regardless of whether or not
they have been diagnosed with FSD, tend to engage in
relationship based `sex work': the rationalization, improvement,
and mastery of sex in their personal lives. Their decisions to take
part in or resist sex work are closely connected to the discursive
and material production of heterosexuality, gender inequalities
and power differences amongst women.
Keywords heteronormativity, heterosexuality, medicalization,
sexual practices, sex work
Thea Cacchioni
University of Warwick
Heterosexuality and `the Labour
of Love': A Contribution to
Recent Debates on Female
Sexual Dysfunction
As discussed in detail in a myriad of studies mapping women's domestic,
beauty, body, and emotional labour, meeting exacting standards of
successful heterosexuality is `hard work', especially for women. Why
should sexual relationships and sexual practises require anything less? In
light of recent debates surrounding FSD, this article examines the work
that women with perceived sexual difficulties undertake with an aim to
improve their sex lives, including their accounts of why they discipline and
monitor their sexual responses.
Article
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Vol 10(3): 299­320 DOI: 10.1177/1363460707078320
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In the long history of feminist and other debates on the social construction
of heterosexuality, much attention has been given to unpacking
models of male and female sexual behaviour as developed by sexologists
and other `experts' (Foucault 1979; Coveney et al., 1984; Irvine, 1990;
Tiefer, 1995; Hawkes, 1996). The fruits of this analysis can be seen in the
recent success of feminists in problematizing FSD as a medical, diagnostic
category. FSD is an emerging, although highly contested, label used to
categorize women's problems with sexual desire, arousal, orgasm and/or
pain (for classification details, see Basson et al., 2001). Proponents of the
FSD label position revived medical attention to this diagnostic category as
a sign of women's increased presence in the field of sexual medicine
(Berman and Berman, 2001). However, feminist critics argue that the
recent popularity of FSD research and diagnosis is a sign of renewed efforts
to medicalize women's sexual problems with profit-driven intentions (for
example, Kaschack and Tiefer, 2001; Loe, 2004; Tiefer, 2004).
The feminist critique of FSD stands at the nexus of two important issues
in feminist social criticism: the feminist critique of the standard `scripť for
heterosex (i.e. foreplay, leading to intercourse, leading to orgasm), and
the feminist critique of the power of medical `experts' to define sexual
norms. As a related point, critics highlight the growing role of `Big
Pharma', or the pharmaceutical industry, as a major player influencing
how `health', including `sexual health', is understood and approached.
Indeed, the critique of FSD emerged in large part from a parallel critique
of the medicalization of men's sexual problems, under the label `Erectile
Dysfunction' (ED) (Tiefer, 1995; Marshall, 2002; Potts et al., 2003,
2004; Loe, 2004). As Loe argues, the profitability of Viagra (Sildenafil
Citrate), launched in 1999 as a `miracle drug' for the treatment of ED,
inspired the pharmaceutical industry to fund medical research into the
development of `Pink Viagra' for women. Hence, using vascular,
hormonal, and neurological frameworks, drug company-sponsored scientific
researchers and medics have tried to establish women's sexual
problems as primarily physiological issues, treatable by a `magic bullet
cure'. Tiefer (2001) points out that insisting that sexual dysfunctions are
medical, not psychosocial issues is a lucrative tactical coup which will affect
future drug administration clinical trials.1
A key question in feminist debates on the social construction of heterosexuality
is the relationship between heterosexual sexual practises and the
wider institution of heterosexuality. Beginning with Adrienne Rich's
attack on `compulsory heterosexuality' (1980), there has been a tendency
to identify (hetero)sexual pleasures and practises with the oppressiveness
of heterosexuality as an institution. This conflation is challenged by critics
(Richardson, 1996; Smart, 1996; Jackson, 1999) who attempt to disentangle
heterosexual practises from heterosexuality as an institution
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and an ideology. In order to challenge heterosexuality as a `monolithic
entity' (Jackson, 1999: 81), some authors draw on poststructuralist
notions of power that validate people's ability to actively re-shape or reinscribe
their activities with new meanings and agency, especially at the
micro-level (Hollway, 1984b; Smart, 1996; Potts, 2002). However,
others argue that we should be wary of jumping too readily at this optimistic
possibility, as women's strategies for dealing with sexual difficulties
may remain deeply embedded in the power relations of heterosexuality.
Jackson, for instance, argues that `our capacity to undo gender and
heterosexuality is constrained by the structural inequalities which sustain
them' (1999: 181).
Despite the evolution of a now sustained critique of FSD, there is a
distinct lack of comprehensive empirical research that addresses women's
experience of dealing with perceived sexual difficulties in day-to-day life.
Although critics of FSD draw on important research mapping women's
experiences of sexual interactions, such studies are based mainly on data
pertaining to youth (for example, Tolman, 1994, 1995; Holland et al.,
1998). Certainly, empirical research by Duncombe and Marsden suggests
that considering women's strategic management of sexual difficulties is
fertile ground for exploring the connections between the micro-politics
of sexual relationships and the `institutionalized gender inequalities of
power' (1996: 221) in which they are embedded. However, their research
was limited to heterosexual married couples who did not explicitly
identify themselves as having sexual problems, and writing in 1996, they
were unable to address renewed pressures as seen in the `post-Viagra',
socio-medical climate.
In this article, I address this gap by presenting the findings of an empirical
study undertaken with the aim of exploring women's perceptions of
their sexual problems and their treatment. As a way of analyzing the
empirical data, I develop the concept `sex work', a somewhat unusual
usage of the term mooted by Duncombe and Marsden (1996), who use
it as a way of conceptualizing women's engagement with the rationalization,
improvement and mastery of sexual pleasure in personal sexual
relationships. Like the notion of `emotional work' (Hochschild, 1983) ­
on which their concept is modelled ­ `sex work', in this context, refers to
the unacknowledged effort and the continuing monitoring which women
are expected to devote to managing theirs and their partners' sexual
desires and activities. Duncombe and Marsden found that `most emotion
(and by analogy sex) work will be undertaken by women' (p. 222).
Jackson and Scott (1997), who have also discussed the theme of sex work
in personal relationships, link this phenomenon to the unending stream
of sexual advice contained in women's magazines and `self-help' manuals,
which urge women to `work on' their sex lives.
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It is therefore with irony that this article's title refers to `the labour of
love', as one of its goals is to look more closely at women's accounts of
why they undertake sex work, highlighting the relevance of ideological
and material contextual factors. After describing the study from which the
data is drawn, I consider prevalent constructs guiding informanťs sex
work. The connections between the need to undertake sex work, and
wider gender relations, will be seen by identifying similarities and differences
between the situations of those who conform to, and those who
question, doing `the labour of love'.
Methodology
In my attempt to investigate women's perceptions of sexual difficulties
and their treatment, I undertook exploratory research in my home city
of Vancouver, Canada, between June 2003 and June 2004. In order to
find voluntary participants, I posted advertisements for informants at
Vancouver's only `sexual medicine' centre: the city's sole `covereď
resource which deals specifically with women's and men's sexual
problems.2 I also posted notices at a number of doctors' surgeries, sex
shops, bulletin boards and other community spaces, including a free local
newspaper. The advertisement called for participants who had problems
with sex that may or may not include difficulties with desire, arousal,
orgasm, or pain.
In-depth, semi-structured taped interviews were conducted with a total
of 31 women who identified themselves as experiencing a range of sexual
problems. To calculate how many participants had which sexual problems
would imply a degree of certitude and clarity that does not fit the ambiguity
of the data. For instance, women with sexual desire problems often
identified as having problems with orgasm and vice versa. It is worth
noting, however, that approximately one third of the sample identified as
having some form of sexual pain. Only those who believed their sexual
problems to stem from physiological issues, most of whom had consulted
medical advice, used the official language of FSD classification to describe
their sexual problems. This group consisted of six women who identified
as having sexual pain problems, three women who defined themselves as
having low sexual desire, and one woman who viewed herself as having
orgasmic dysfunction.
Participants consulted a number of different `experť resources when
attempting to deal with their sexual problems. Eleven participants had
received advice from Vancouver's sexual medicine centre and 12 had
sought, or were currently seeking, `other expert advice', including advice
from GPs, psychiatrists, psychologists and other counsellors. Eight women
had not directly consulted `experť advice or received treatment, although
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four of these actively sought out information from books, magazines,
television talk shows and the Internet.3
Respondents ranged in age from 21 to 62, from eight different nationalities
and a variety of ethnic backgrounds, including white European,
Chinese Canadian, Japanese Canadian, First Nations, Maori, IndoCanadian
and Latin.4 The sample was primarily heterosexual ­ an aspect
of the data which will be discussed throughout this article. Twenty-seven
women self-identified as heterosexual, one as lesbian, and three as
bisexual. Almost two-thirds of the sample described themselves as being
in long-term relationships at the time of being interviewed. One-third of
the sample had children under their care and one-quarter of the sample
identified as being single mothers.
Semi-structured taped interviews lasted from 45 minutes to two hours
and took place at the participanťs convenience at theirs or the researcher's
home. Background information questionnaires which helped plot various
connections between experiences and perceptions of sexual problems and
various facets of identity were filled out before the interview. Informants
were asked about their perceptions of their experiences of sexual problems
and the various strategies they adopted for dealing with these issues. All
interviews and fieldwork observations were transcribed and pseudonyms
adopted. For each predominant theme, a separate copy of all data was
made. Each transcript was manually colour-coded in terms of major
themes and concepts.
Wolfe explains that, as subjects positioned in power relational
dynamics, `we all carry experiences and values which shape our vision and
interpretation' (1993: 4). My understanding of women's experiences of
sexual difficulties, as described by my informants, may differ from the
informants' own (which may also change from time-to-time and in
relation to the audience they address). Holland, et al., argue that part
of the solution is to explicitly acknowledge that `there is no technique of
analysis or methodological logic that can neutralize the social nature of
interpretation'. Thus, the following interpretation of the collected data
is offered in the spirit that `there is a political difference between claiming
to know how women experience sexuality' and `opening up the possibilities
of multiple interpretations of the complex diversity of women's
lives' (1998: 25).
`Normaľ heterosexuality or the `heteronormative'
sexual encounter
The `sex work' that I interpret my informants as having undertaken must
be understood within the context of the well-established ideological
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constructions of heterosexual sexual interactions that they explicitly
articulate. Perhaps because the vast majority of the participants in this
study identified as heterosexual, the research findings are largely underpinned
by, and in turn may produce, the prevalence of heteronormativity:
the normalization of heterosexuality which `renders any alternative
sexualities "other" and marginaľ (Jackson, 1999: 163). In the heteronormative
framework, sexual practices such as kissing, touching, and oral
sex are relegated or demoted to `foreplay', not `real sex'. They are `other'
to the ideal of coitus ending in orgasm.
When considering the function of normative sexuality, a number of
theorists reference a poststructuralist approach, privileging the relationship
between discourse, knowledge, and disciplinary power and the way
in which these factors shape sexual identities and practices (Hollway,
1984a, 1984b; Gavey, 1993; Smart, 1996; Potts 2002). For example,
Gavey refers to the `tyranny of inferred normality' in heteronormative
discourses, constructing female heterosexuality as naturally passive and
male heterosexuality as naturally active. She stresses that these discourses
now typify numerous discursive fields, not just women's and men's own
accounts of their sexuality and sexual relationships, but also:
representations of sexuality and heterosexual relations in popular women's magazines,
film, television, romance and other fiction, pornography and sex manuals;
sexology and practice of sex therapy; practices of contraception; sexual humour;
church prescriptions on sexuality; legislation on sexuality and sexual violence;
sociobiological explanations for sexual violence, and so on. (Gavey, 1993: 97)
The majority of participants cited various combinations of these discursive
fields as profoundly influencing on their own outlook on sexual practises.
For instance, Simone, a 30-year-old former sex worker, commented:
Iťs everywhere in all our forms of entertainment and everything we're sold.
[. . .] Certain images, certain ways to have sex, and certain ways to enjoy all of
that. And so many people don't fit into that.
Sarah, a 25-year-old student, was adamant that `every single individuaľ is
affected by the dominance of `certain definitions of sexuality [. . .] in the
media', proclaiming that `girls are more attuned to iť. Anna, a 24-year-old
writer, viewed her early exposure to pornography as having directly
`imprinted on me' or her `sexual imagining' that `I am there to give
pleasure or pleasure myself, but that I'm not going to be the recipienť.
Such comments are testament to the complex roles various discursive fields
play in women's understandings and experiences of sexuality. However,
they also indicate that women reflect on these mediums critically.
Informants claimed that from their late teens or early twenties, they
began to feel immense pressure to have sexual experiences mirroring
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dominant heteronormative standards. Many participants reflected on their
subjection to these regulatory ideals at a young age. Consider the following
comments by two participants, both white university-educated women
in their twenties:
I wanted to be in a relationship where the other person did not care whether
or not they were having sex with me. So, for a long time, I just dated virgins,
thinking naively, "They're not going to want to have sex!" But university guys
are a little bit different so, I . . . yeah, I just kept trying to find someone that
it wouldn't matter about stuff like that. (Courtney)
Um, my first boyfriend was when I was 16, and we started . . . Like we were the
first people to kiss each other. We started from the beginning. And it felt like as
soon as he got one taste of the genital . . . He was just a fiend for it. Thaťs all
he cared about. He didn't care about kissing me or anything. He didn't care
about touching my breasts. He only cared about that one area . . . (Maria)
Although the majority of participants described learning about compulsory
intercourse as teenagers, a few middle-aged women from traditional
backgrounds claimed not to feel pressure to engage in coital penetration
until marriage, (for example, Celia, 56, Chinese Canadian; Grace, 53,
Chinese Canadian; and Olivia, 37, Mexican). After describing the sense
of pride she felt about her early decisions regarding pre-marital abstinence,
Olivia explained, `But then we were married and it was like, "Well if you're
married, you have sex". Whereas it was previously considered to be acceptable
to engage in what is known as foreplay, marriage required getting out
of that pattern.'
Ironically, as the group of participants who were the least likely to enjoy
penetrative sex, informants with sexual pain problems were the most likely
to argue that engaging in coital sex was important to their identities as
women. For instance, Danielle, a 44-year-old married teacher who identified
as having chronic vuvlar pain, claimed that for years her inability to
have coital sex had made her feel like `an androiď, not `a real woman'.
According to her, she felt she could not `perform what I see as the sexual
acts that women do'. Similarly, Sophie, a 32-year-old single administrator
with a history of sexual pain, described feeling `foolish' and like she is
`disappointing men' because she is not able to `do a pretty basic thing that
a woman should be able to do'. These findings mirror those of Kaler
(2006), who interviewed 20 women face-to-face and 70 women online,
about their experiences of chronic vulvar pain. Kaler concluded that
women who are unable `to perform this one hallowed heterosexual
activity [. . .] invoke images of gender failures, of women who were not
really women' (p. 51).
Feminist scholars argue that sexual pleasure has become `an entitlemenť
but also `an obligation for women' (Braun et al., 2003: 16). (See
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also Holloway, 1984a; Gilfoyle et al., 1992; Hawkes, 1996.) Indeed,
orgasm also seemed to be of great importance to perceptions of
positive sexual encounters. Many participants described orgasm deficiency
using `building' and `climbing' metaphors. For instance, Samantha, a
24-year-old actor, lamented that she `didn't have that feeling of climbing
up and getting to that poinť. Orgasm was viewed paradoxically as the
natural outcome of sex ­ the only option for successful sex ­ but also as
an outcome which requires skill and concentration, as evidenced in
comments such as `If I really concentrate, I can nail iť (Anna).
Furthering their normative views of sex, participants also subscribed to
`the male sex drive discourse' (Hollway, 1984a). This popular and `experť
validated discourse positions `men's sexuality as directly produced by a
biological drive', creating `insatiable' sexual needs which women are
expected to fulfill (p. 231). For example, Mika, a 27-year-old Japanese
Canadian woman with chronic vulvar pain, justified her ex-boyfrienďs
decision to dump her by citing his `biological urge to thrusť. Kate, a 43year-old
white, stay-at-home mother, referred to sex as being `like food for
men', concluding that for men, but not for women, sex `is a physical neeď.
Another increasingly popular discourse bolstering heteronormativity
is the belief that sex is a part of health and wellness, reflecting the
`healthicization' of sex. The term `healthicization' (Conrad, 1992) refers
to the role of health promotion, as opposed to medical intervention, in
regulating constructions of health and illness, and is particularly relevant
in western, predominantly middle-class locales, where sex is increasingly
`talked of in the idiom of health promotion and lifestyle choices' (Jackson
and Scott, 1997: pp. 557 ­ ;58). Vancouver proved to be an appropriate
place to test not only the `medicalization' of women's sexual problems,
but to explore the overall `healthicization' of sex as promoted by a
number of non-medical, `self-help' and `alternative' sources of advice on
healthy lifestyles.
The data confirms the existence of a social climate in which sex is
increasingly viewed as being integral to our psychological development,
personal growth, emotional satisfaction and physical health. Elizabeth, a
57-year-old former counsellor with one grown child, referred mainly to
physical health, saying, `you know, a healthy sexuality is a GOOD thing
to have into your 70s and as long as you can'. Julie, 27, and Lucy, 29,
cited the importance of `stress relief' benefits. Faye, 42, and Monica, 47,
focused on the relationship between sexual problems and `energetic
blocks', using a New Age framework.
The wishes of the informants to experience sexual, emotional and
physical pleasure is not to be under-estimated, although untangling
`authentic' bodily urges and pleasures from social expectations is not easy.
Apart from just `wanting to be normaľ (Danielle, Louise, Sophie, Mika
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and Olivia), as related to the discursive construction of heteronormativity,
experiencing emotional and corporeal `pleasure' was, albeit less
frequently, cited as a motivator for participanťs distress over sexual difficulties.
However, discourses of normativity are often embedded within
discourses of pleasure. Consider one of the rare comments on sexual
pleasure by Louise, a 35-year-old married office manager. She acknowledged
that sex is `supposed to be a pleasurable experience. It is supposed
to be fun [. . .] it is supposed to be exciting and romantic' and a `physical
and releasing and all of those kinds of things'. Although Louise articulated
the emotional and corporeal sensation of `a physical release', sexual
pleasure is mainly mentioned in this comment in relation to how `sex is
supposed to be'. This finding is admittedly likely to be more prominent
in a sample of women who self-identify as having difficulties with sexual
pleasure. However, Duncombe and Marsden (1996) also struggled to find
`authentic' discourses of sexual pleasure in their research on heterosexual
couples who were not selected based on having problems with sex. They
reflect, `perhaps in the pursuit of "authenticity" we are asking impossible
questions' (p. 236).
Strategies for dealing with sexual problems:
`The Labour of Love'
In keeping with the findings of other sociological research (Duncombe
and Marsden, 1996; Jackson and Scott, 1997), in order to achieve what
they viewed as `normaľ heterosexuality, most informants undertook what
I interpret as `sex work'. I was able to identify three distinct types of sex
work involving physical and psychological work on participants' own
bodies and minds, in addition to the minds and bodies of their sexual
partners. Participants who identified as having various sexual difficulties
tried different types of sex work at certain stages in their lives for a range
of reasons which will be explored. The three types of `sex work' I have
identified are Discipline Work, Performance Work and Avoidance Work.
Discipline Work refers to sex work aimed at changing one's mental and
physical sexual response to standard heterosexual sexual practices. By
contrast, Performance Work entails `faking iť, using a range of techniques.
Avoidance Work involves evading the issue altogether, employing a
number of strategies.
Of all the types of sex work, the interview accounts suggested that
Discipline Work is the option most likely to be advocated by sex `experts.'
Jackson and Scott (1997) have pointed to the inconsistency in messages
from sex `experts' that frequently convey the message that sex should be
`spontaneous' despite requiring `working harder and practicing in order
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to achieve the best possible outcome' (p. 562). As evidence of this trend,
Charlene was told by her sex therapist that she `musť do `whatever it
takes' ­ `read books', `look at pictures', `use toys', `masturbate' ­ even
though, as she explained, she was `too tireď from her double-shift of paid
work and family care.
Indeed, participant accounts suggest that Discipline Work was advocated
when informants consulted orthodox or alternative advice from sex
`experts' in a face-to-face setting, or through `self-help' materials. Discipline
Work is characterized by a quest to implement a certain skill and/or
degree of concentration to manipulate the body or the mind. Therefore,
participants who consulted GPs, gynaecologists, psychologists, psychiatrists,
sexual medicine specialists, pelvic physiotherapists, marriage
counsellors, sex therapists, naturopaths and New Age healers, were
advised to discipline the way they responded to sexual prompts. Participants
who tried pills, creams, gels, herbal remedies, vaginal dilators,
dildos and vibrators to improve their sex lives, took part in Discipline
Work. Those who accessed information explaining how to change their
mental and physical sexual response in books, magazines, the Internet,
and through friends and partners, were similarly implicated in this type
of work. Thus, in service of Discipline Work, participants allowed their
bodies to be examined, monitored, assessed, and touched in the most
intimate of ways. Participants' overall attitude, whether or not they saw
themselves as being sexually dysfunctional, was that they could hone skills
such as discipline, concentration and focus, which would alter their
response to the heteronormative sex.
Turning to Performance Work, Duncombe and Marsden (1996) found
that women in long-term relationships took part in what these authors
refer to as `playing the couple game', denoting a cycle common to longterm
`fading' heterosexual relationships wherein women `deep acť away
feelings of doubt, presenting the image of `the happy couple', before
`leaking' criticisms about their relationship to outsiders (p. 221).
Duncombe and Marsden (1996), and Jackson and Scott (2001) have
noted that performance extends to sexual practises themselves. Women
often `perform' or `fake' orgasm using their bodies and voices.
The data supports the notion that women in short-term and long-term
relationships do Performance Work, both within the sexual encounter
itself and in relation to their wider social group. Jolene, a 51-year-old First
Nations woman living below the poverty line, commented on women's
roles as performers of an ideal femininity. She stated:
I've never enjoyed it [sex]. Iťs like something I'm supposed to do. Why?
Because I'm a woman. And women are expected to. Thaťs how you keep a guy
happy. I'm such a good actress.
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This comment, coming from a woman who identified as having problems
with sexual desire, arousal, orgasm and pain, exemplified Butler's (1993)
theory that gender is performance. As further evidence of Performance
Work during sex, Maria, a 22-year-old single student, was often preoccupied
by the need to `tuck in her stomach'. Yet, this performance of
normative heterosexuality extended to her conversations with friends as
well. She reflected:
I caught myself doing it so many times. Just pretending like when high school
girls talk about sex. Like iťs so great and everything. I could tell that a lot of
them, they don't feel it was really good. It was just that they felt good about
having sex and being able to say that they had good sex but they didn't really.
Contrary to predictions by Duncombe and Marsden (1996), Maria's
account suggests that this type of outward performance or `deep acting'
is not exclusive to long-term relationships but is seen as a standard feature
of teenage heterosexuality.
Participant accounts suggest that engaging in Performance Work can
be a painful task. Susan, a 62-year-old Japanese Canadian woman who
suffers from sexual pain, recalled the consequences of performing sexual
enjoyment. She claimed, `There were times when [. . .] I'd just go ahead
and do it anyhow. And it would hurt a lot afterwards'. Linda, a 26-yearold
woman diagnosed with a sexual pain disorder recalled `playing it off'
or `sticking it ouť, pretending not to be in pain in order to have `penetration'.
She claimed that she would `hide it from him [her partner]'
because she, `didn't want him to know he was hurting' her. She therefore
`turned the lights ouť and `cleaned up' before her partner could see the
resulting `blooď from the `open wounď that would form as a result of
these encounters. Linda's comments are exemplary of how the decision
to endure `excruciating' sex is possibly a decision made by women, independent
of pressure from their partners. Not only informants who identified
as having medically defined sexual pain problems claimed to be
familiar with enduring pain in order to take part in intercourse. For
example, Faye, a 42-year-old waitress of Maori descent, described a lack
of sexual desire and arousal as her main sexual problems. She claimed that
she frequently had painful sex with former partners when she was not
aroused ­ one time shortly after giving birth. She admitted, `I ignored the
pain'; an experience she remembered as being `amazingly painfuľ.
Finally, many participants developed sexual avoidance strategies,
arguably a form of work in and of itself. There were numerous techniques
employed in Avoidance Work, including `falling asleep before he diď
(Nicola), and `pretending to have my period for longer than I diď (Kate).
Before getting divorced, Celia encouraged her husband to travel more
often and made sure she was `busy doing laundry, cooking, cleaning' upon
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his return. There was a general consensus that Avoidance Work was not a
sustainable long-term strategy. Of the women quoted above as engaging
in Avoidance Work, Nicola and Louise claimed their partners divorced
them in part because of their strategies for avoiding sex. Elizabeth eventually
opted for Discipline Work and Kate, a firm believer in `faking it,'
juggled Avoidance Work with Performance Work as a means of sustaining
her marriage.
Sexual lifestyle changes: an alternative strategy?
Some women deemed it `not worth iť to do any sex work, or gave up on
it when they found it was `not working'. Twelve women in the Vancouver
study made what I term `sexual lifestyle changes' at certain times in their
lives. Rather than working towards mastering, strategically mimicking, or
carefully avoiding sexual practises, sexual lifestyle changes can be understood
in opposition to sex work, as they involve challenging normative definitions
of sex and even the overall importance of sexual activity. Sexual
lifestyle changes might involve queering sexual activities; in other words,
privileging sexual activities typically deemed as foreplay, and/or valuing
non-goal oriented masturbation as an acceptable sexual activity on par with
intercourse with another person. They also might entail questioning the
overall importance placed on sexual relationships, institutions and practises.
Both queering sexual practises and prioritizing the non-sexual can be
undertaken when single, or in the context of finding a partner who is similarly
open-minded and understanding about one's desire to transgress
sexual norms.
Queering normative sexuality
In part because none of the participants in this study consulted `experť
advice which explicitly incorporates a feminist or queer perspective, only
two participants decided to `queer' normative sexuality following the
advice of a sex `experť. These examples are important to consider as they
elucidate the potential of sex `experts' to challenge, rather than reinforce,
sexual norms. Samantha, a 24-year-old white actor, claimed to have never
had an orgasm, despite the efforts of her `eager to please' long-term
partner. She consulted a sexual medicine specialist who told her, `Iťs
something that will happen. Just don't let it become a big focal point in
your life'. According to Samantha, this advice led her and her partner to
`try some different things' in the realm of `foreplay' which `felt really
gooď. As a result, she claimed that she was `not really distressed abouť
her orgasm troubles, further stating, `I'm fulfilled in so many other ways
that iťs not ­ Iťs not taking over'. Similarly, Danielle, the 44-year-old
teacher who once viewed herself as an `androiď for her inability to have
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intercourse, referred to the sexual medicine specialist she consulted as
`different from all the other doctors I saw'. According to her, this physician
was the first `experť to ask her, `What sort of sexual activities can
you do that are mutually satisfying and [. . .] not intercourse?' Danielle
elaborates on the influence of this physician on her heteronormative views
stating, `All of a sudden, it just came together at the same time where I
said, "You know what? I've got to stop thinking about this. I have to. I
just have to. I have to change my mindset".'
Yet queering normative sexual practices was more often the result of not
seeking any `experť advice on sexual problems. Of the sample who sought
no direct `experť advice for their sexual difficulties, six of the eight chose
to rethink the heteronormative repertoire, rather than work on their
sexual problems. For instance, Zoe, aged thirty-four, never consulted a
sexual advice practitioner for her sexual problems, and instead decided to
break up with her male sexual partner and `explore my sexuality in terms
of my bisexuality'. While her sex life did not improve directly through
same sex sexual practices, her `involvement with the Queer community'
and her friendships with gay people `who were much more open about
sex' led her to change her previously narrow views regarding what sex was.
She was also inspired to experiment with masturbation, an activity she
formerly thought that `only men do'. She described this experience as
being a `turning poinť, stating, `It did feel really good to be able to take
care of my sexual needs'.
When considering what constitutes `queering' sexual activities, the data
suggests that involvement in same sex relationships did not in and of itself
represent a challenge to all aspects of normative sexuality. With only one
lesbian and three bisexual participants, the sample cannot represent the
experiences of lesbian and bisexual women generally, but it does illuminate
some possible evidence for existing debates in feminist theory.
Leanne, 29, the only self-identified lesbian, viewed female sexual relationships
as involving less pressure, stating, `There wasn't that same issue
about intercourse'. She also argued that men tend to be sexually more
goal-oriented than women, concluding, `Iťs kind of a relief to be with a
woman partner', and, `Women don't have as much at stake'. However,
she was one of the most distressed and goal-oriented participants in the
study. She claimed that her quest for orgasm, fuelled largely by her
`embarrassmenť over `being dysfunctionaľ, had caused her to use
vibrators so vigorously that she had damaged the nerve endings of her
clitoris. Further, when discussing the influence of the `media' and `stereotypes'
on her perception of how sexual she should be, Simone, a
30-year-old woman who identified as having sexual desire problems
explained, `I can still feel really screwed up with a woman. I can still bring
in all [. . .] that sort of confusion that I feel as a result of the media and
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some stereotypes'. Similarly, Zoe thought it was `bizarre' that `gender
roles' influencing sexual enjoyment `get played out in gay relationships
where there's the butch and the femme'. These findings support those
feminist critics who have argued that heteronormativity may have not
entirely `relinquished its hegemonic holď on the experiences of gays and
lesbians (Richardson, 1996: 3). (See also Jackson, 1999.)
Challenging normative heterosexuality by prioritizing the non-sexual
While no participants in this study readily identified themselves as embracing
an `asexuaľ identity as expressed by the burgeoning `asexual
movemenť,5 some participants challenged normative heterosexuality by
prioritizing non-sexual aspects of life and non-sexual relationships. Like
queering sexuality, prioritizing the non-sexual aspects of life was not
unique to one age group, though in this case, the way that participants
approached this strategy differed according to age.
Women in their twenties and thirties were more likely to take on
prioritizing non-sexual relationships and activities as a temporary strategy.
The most effective way of dealing with sexual difficulties for Jas, age 27,
was `taking a vacation from men'. During her early twenties, Jas felt that
she `was not able to conduct any sort of healthy relationship with a guy'
and did not understand why people `thought sex was enjoyable'. Despite
consulting friends and her GP and receiving counselling therapy for her
sexual problems, Jas felt she was unable to break a pattern of having
unwanted, non-pleasurable sex. Finally, she made the decision to `take a
vacation from men'. She referred to this decision as `my turning poinť,
where she began `suddenly seeing myself from a different perspective. Like
I stepped outside of myself and said, "What are you doing?"' As a young
woman, Jas never approached her sojourn from sexual relationships as a
long-term strategy. However, she now views this `vacation' period, that
she described as `healing within myself', as instrumental to her current
ability to engage in pleasurable sex.
Middle-aged women tended to adopt this sexual lifestyle change as a
long-term strategy. According to Celia, a 56-year-old Chinese Canadian
nurse, she had never enjoyed sexual activity. However, rather than seeking
`experť advice, she sought a divorce. She described single, non-sexual life
as analogous to `finding myself', which `was important to me'. Aside from
dreading sex with her husband due to lack of interest, arousal and orgasm,
Celia explained that in her marriage she was `sort of losing myself'. She
described her divorce as being `very liberating'. She claimed that she was
now searching for a companion who would be similarly willing to
prioritize non-sexual aspects of relationships; someone `who will make me
flush when he did something non-sexual that really endeared me to him'.
Similarly, Hannah, a 53-year-old German single-mother, who recently
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returned to university to do postgraduate work, divorced her ex-partner
with whom she did not enjoy sex. She described this decision and her
subsequent relocation from a small town to Vancouver as, `selfempowerment
for me'. She elaborated, `I feel my own strength'. Hannah
was now interested in finding a companion who she could `go to a
concerť or `go for a ride' with, `but not romance'.
Nicola, a 34-year-old school teacher, was able make this type of sexual
lifestyle change by finding a companion who was similarly willing to
prioritize the non-sexual aspects of life in a long-term relationship.
Describing herself as having `low sexual desire', she was married to her
`high school sweethearť for 10 years: a man she described as `different
sexually'. Initially, Nicola attempted Performance and Avoidance Work
to deal with the imbalance between his `high sex drive' and her `low sex
drive', stating, `I had sex when I didn't want to. And then that hatred
grew'. Her marriage ended with him leaving her, `and then [. . .] my
life really changed. I mean it changed for the better'. After a few years
of single life, she met her current long-term partner. According to
Nicola, her current partner `doesn't need to be sexual with me or to be
sexual to get satisfaction'. Thus, her new sexual partner defies the notion
that all men have a `high sex drive'. Reflecting on her current partnership
she explained, `I'm really not a very sexual person but [now] I don't
feel guilt for it. I don't feel like I'm not doing my duty [. . .] Iťs
completely differenť.
The gender division of the labour of love: the
importance of material factors
Some critics (Duncombe and Marsden, 1996; Holland et al., 1998;
Jackson, 1999) argue that material factors are a crucial aspect of the
context of women's sex work. For example, Jackson maintains that
women's awareness of their relative position of inequality with men is
pivotal to their understandings of the choices they perceive themselves as
having in sexual relationships. She warns that `discourses do not float free
from material structures or material inequalities characterizing the
societies in which they are produceď (p. 181). Duncombe and Marsden
similarly emphasize this point, stating, `sex work takes place in the context
of an interpersonal balance of power [. . .] Undoubtedly, the balance of
power in such exchanges tends to be tilted toward men' (p. 222).
Heterosexual participants who were financially dependent on their
partners were less likely to make sexual lifestyle changes. From their
perspective, the material `costs' outweighed the `benefits' that might be
gained through having greater freedom to express themselves sexually. For
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Kate, a 43-year-old mother with no post-secondary or career training, and
no paid job, her rationale for doing sex work was as follows:
For all of us. Iťs worth it for Bob. Yeah, I think iťs working where my
daughter has two parents, where my husband is not wound up and I'm just
doing something that I don't find very pleasant and would like to find a lot
more pleasant [. . .] I'm well aware that I love my husband and I want to stay
with my husband. Our life is great. Iťs almost like [. . .] you don't want to do
many things but you do them. So, I have sex probably twice a week.
Indeed, sexual lifestyle changes roused fears surrounding financial
insecurity, especially for participants with children and/or women who did
not have paid careers of their own. Informants in all different situations
went ahead and made sexual lifestyle changes, but for employed, childless
women, such as Jas, Maria, Danielle, Samantha and Nicola, these transitions
were easier. As women whose lives were first and foremost dedicated
to their roles as mothers, Jolene, Celia and Hannah bore the
financial brunt of divorce; the gateway to their sexual lifestyle changes.
Their ability to make drastic changes to the organization of their sex lives
was therefore complicated by material factors. For instance, Jolene was
aware that her decision to forsake sexual relationships and live as a single
mother placed her in a vulnerable position. She explained, `Right now, I
exist day to day by just being able to put a roof over my head, feed myself.'
Celia reflected on her decision to divorce, stating, `There was no exchange
of support even though he made a heck of a lot more money than me.'
She concluded, `Actually, that turned out to be financially quite harď.
Hannah decided to file for divorce after years of emotional and physical
abuse. Though she has raised her ex-partner's children, one of whom was
disabled and required full-time care, she did `not receive any child support
anymore ­ nothing'. At the time of the study, she was disputing this legal
issue in court.
The data further suggests that conformity to heteronormative ideals
can also be linked to experiences of male physical violence, threat of
violence, or mental abuse. While many participants were involved in
supportive, caring relationships with men, many had past experiences of
non-reciprocal, male-dominated relationships, and 10 of the 31 participants
mentioned experiences of physical or sexual violence. Indeed, some
participants learned to conform to normative heterosexual ideals via
coercion, in the form of sexual and physical abuse by men. Both Maria,
a 22-year-old student, and Jas, a 27-year-old yoga instructor, described
how experiences of abuse put them in tune with men's sexual needs and
their duty to work towards satisfying `the male sex drive'. When
discussing her reaction to being sexually abused by her grandfather,
Maria, who sought no `experť advice for her orgasm problems, claimed:
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And I find it really hard not to respond to it [sexual tension] whether I really
want to or not. I always respond to sexual tension [. . .] So, iťs kind of like
being obligated. And so yeah, that just goes on from all that. (Maria)
Jas, a 27-year-old Indo Canadian woman who was raped by her uncle
from the age of five to 15, felt she had problems with sexual desire,
arousal, orgasm and pain. She described her relationships with men,
stating, `I can automatically understand how the other person feels. I'm
very much into what they're feeling. Iťs the result of much conditioning.'
Other participants felt that forsaking their sexual duties could result
in violence. For instance, Jolene and Jas were both beaten on several
occasions for resisting sexual abuse. Lauren, a 21-year-old student, said
that in her struggle to hold on to her `virginity', she narrowly escaped
violence. She elaborated, `I almost got myself raped last year because of
a situation where saying "no" angered someone'. Not taking part in sex
seemed to expose some participants to mental abuse by male partners.
As a prime example of what Gavey (1993) refers to as `heterosexual
coercion', Charlene's partner expressed anger and revoked romantic gifts
when she withheld intercourse.
It might be thought that, by focusing on relations of power and
inequality, this account gives too little space to women's agency in
choosing to engage in `the labour of love'. For instance, Duncombe and
Marsden (1996) remind us that, `sex work may be either fulfilling or
distasteful, depending upon the relational context in which it is
performeď (p. 235). Some participants described Discipline Work in
terms of `getting to know myself sexually', or `learning about my sexuality'.
In other words, it is possible that they constructed and reaffirmed
their sexual identities through sex work, as well as enjoying the process of
exploring their sexuality. Nevertheless, the interviews reveal that when sex
work is discussed in-depth, there is a prevalence of biographical or contextual
issues, such as financial dependence on men or prior experiences
of male violence, and these overshadow the positive portrayals.
Conclusion:`a woman's work is never done'
This research data, which examines women's experiences of sexual
problems and their treatment in Vancouver, Canada, contributes to a
number of sociological discussions and debates. Firstly, as examined in a
growing number of sociological empirical studies depicting women's
emotional and sex work, as well as historical sociological studies highlighting
women's engagement with therapies and `self-help' recommended by
`experts', it is evident that women have a long-term legacy of engaging
with `the labour of love', or `working at their sex lives'. Therefore, the
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data adds strength to existing literature, arguing that `sex work' occurs in
the private as well as the public sphere. Alhough not the focus of this
article, men also engage in sex work. However, as a result of women's
greater likeliness to be exposed to `experť advice and to be financially
dependent on male partners, they are arguably more likely to do so.
Secondly, this research contributes to debates surrounding the social
construction of sexuality: more specifically, the role of discourses in
shaping sexual practises as compared to the role of material inequalities in
informing such activities. Though a discourse of sexual pleasure is not
entirely absent from participants' accounts, attempting to identify motives
linked to an `authentic' desire to experience emotional or corporeal
pleasure is problematic considering the dominance of a number of
discourses constructing `normaľ heterosexuality in narrowly-defined
terms. This study shows the interdependence of culture and economics.
Cultural discourses such as the healthicization of sex and the male sexual
drive discourse were evident in the majority of participants' accounts of
why they were distressed about sexual difficulties. Even bisexual and
lesbian participants brought goal-oriented views of sex to the sexual
encounter and were deeply distressed by not `performing' well. Women
who were more dependent on their partners financially ­ typically those
who had young children ­ did not see themselves as being able to challenge
normative expectations of sexual practises as easily as women of
various ages without children and/or with paid careers. Though evidence
of women's `sexual lifestyle changes' is not to be underestimated, their
link to material factors adds credence to Jackson's (1999) argument that
a `sexual revolution in the bedroom will not take place without a concurrent
revolution in the sexual division of labour and the end of male
violence'. Arguably, one of the major reasons why women are expected to
take part in sex work is that socio-economic and sexual equality with men
has not yet been fully realized.
Finally, the data provides a contribution to recent debates surrounding
the medicalization of women's sexual problems via the FSD label. The
current focus of the feminist critique has been mainly aimed at the significance
of the increasing role of `Big Pharma' in defining sexual problems
in terms which will justify the invention of a `magic bullet cure' for FSD
(for example see Tiefer, 2001; Loe, 2004). At the time of writing, the only
`cure' for FSD approved by the FDA is `The Eros Clitoral Therapy
Device', described by FSD critics Fishman and Mamo (2001) as a `safe
and effective' medical device, clearly marketed in order to `differentiate
itself from fetishized sex toys' (p. 188). Ultimately, the findings of this
study confirm the importance of existing critiques of FSD, while reminding
us of the pervasiveness of the regulation and commodification of
women's sexual problems even in the absence of the anticipated `female
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Viagra'. Working to achieve heterosexual norms with or without the direct
help of the `experts' is an established pattern for women which predates
the FSD label and pharmaceutical interventions into women's sexual
problems. Thus, while challenging the medicalization of women's sexual
problems under the FSD framework is key, greater changes in women's
material freedom at the macro-level, in addition to changes in sexual
patterns at the micro-level, will be necessary for any radical disruption of
the gender division of `the labour of love'.
Acknowledgements
I would like to thank Dr Carol Wolkowitz for her contribution to this article
and her ongoing support. I would also like to thank Dr Simon J. Williams and
the anonymous reviewers for their helpful comments.
Notes
1. In 2003, medical journalist Roy Moynihan reported favourably on the
feminist critique of FSD in his critical article `The Making of a Disease:
Female Sexual Dysfunction' published in The British Medical Journal (2003).
The publication of this article encouraged international online responses to
the BMJ website from physicians and the lay public, many of which opposed
the efforts of the pharmaceutical industry and medics seeking to define and
treat women's sexual problems using a medicalized framework.
2. Canadian universal health insurance `covers' all physician services that are
deemed `medically necessary' by provincial health authorities. In British
Columbia, `sexual medicine' falls into this category.
3. The prevalence of women in this sample who had actively sought out `experť
advice for their sexual difficulties may be related to several factors. The
predominance of a middle-class sample is key. Twenty-five of 41 participants
had some university education. Universal access to health insurance covering
the majority of physician services is also relevant. For instance, 22 of 31
informants sought GP advice for their sexual difficulties.
4. Women in the study from numerous ethnic backgrounds, including white
European, felt that their ethnic origin influenced their negative sexual
experiences. This finding suggests that gender may be a more influential
factor shaping sexual experiences than ethnicity.
5. Recently, a small movement has begun amongst young people in the West to
challenge the notion that one must fit into one of the following categories:
heterosexual; homosexual; bisexual; or transsexual. They position themselves
as separate from abstinence movements associated with religious reactions to
the AIDS pandemic and the growth of Christian fundamentalism, for
instance, the US-based `Silver Ring Thing'. They defend asexual relationships
as being of equal importance as sexual relationships, which they see as being
imbued with greater value in our culture (The Asexuality Visibility Network
www.asexuality.org).
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Biographical Note
Thea Cacchioni (BA, MA) was recently awarded a PhD in Sociology at the
University of Warwick. Her PhD thesis, from which this article has been
developed, is entitled `Female Sexual Dysfunction: The Medicalization of
Heterosex in the Post-Viagra Age'. Her research interests include gender,
sexuality and medicalization. Address: Department of Sociology, University of
Warwick, Coventry, CV4 7AL, UK. [email: Thea.Cacchioni@gmail.com)
Sexualities 10(3)
320
 2007 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
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