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Sexualities
DOI: 10.1177/1363460702005002001
2002; 5; 131Sexualities
Barbara L. Marshall
`Viagra Age'
`Hard Science': Gendered Constructions of Sexual Dysfunction in the
http://sexualities.sagepub.com/cgi/content/abstract/5/2/131
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Abstract This article locates Viagra, as both a biotechnology and a
cultural event, in relation to shifting and specifically gendered
interpretations of sexual function and dysfunction. While the
clinical and market success of Viagra has prompted biomedicine
and its popularizers to speak of a `new age' in human sexual
relations, and accord it causal agency in effecting social change, I
suggest that we might profit by attending to the social claims that
underlie such hyperbole. The story behind Viagra is a complex
history of the manner in which sexual function has been
constructed and reconstructed in relation to a range of distinctly
modern phenomena, including the rationalization and medicalization
of sexuality, the increased importance of expert systems
and knowledges in managing everyday life, and the expansion of
consumer culture. Conclusions suggest some ways that we might
think about the `sexually dysfunctionaľ as yet another `strategic
unity' consolidating various operations of knowledge and power.
Keywords sexual dysfunction, sexual medicine, sexual science,
sexual technology
Barbara L. Marshall
Trent University, Canada
`Hard Science': Gendered
Constructions of Sexual Dysfunction
in the `Viagra Age'
Introduction: welcome to the `Viagra age'
Viagra's role as a social catalyst . . . and its influence transcends the drug itself.
In the future, its appearance may well be remembered as the cutting-edge force
that created a whole new public attitude about the sexual problems that are so
prevalent in modern society and about the entire subject of sex in general . . . .
We may one day come to designate everything that has happened prior to April
1998 as `before Viagra' and everything since `after Viagra'. (Melchiode and
Sloan, 1999: 228)
Two Essays Critiquing Bio-Medical
Interventionism
Sexualities Copyright  2002 SAGE Publications (London, Thousand Oaks, CA and New Delhi)
Vol 5(2): 131­158[1363-4607(200205)5:2; 131­158; 022943]
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When Viagra was introduced to the US market in 1998, both the
popular media and the medical therapeutic community heralded it as
revolutionary. Far more than a pharmaceutical product, the little blue
diamond-shaped pill has become a cultural signifier of virility, bioperfection,
potentially unlimited sexual performance and a new era in
sexuality. Consider for example some of the claims made in a few of the
mass-market paperbacks on Viagra:
Viagra is more than just a drug. Its widespread use and effectiveness will have
vast consequences for our entire society. (Whitehead and Malloy, 1999: 6)
Now you can have sex when, where, and how you want it, dependably and reliably,
even if you're 100 and your partner's 102. (Vaughn, 1998: 14)
Simply stated, a revolution has begun. . . . For the first time, it is possible to
restore optimal sexual function to nearly every man who desires it. (Lamm and
Couzens, 1998: 11)
For some, the little blue pill is being granted even more far-reaching
powers:
Feminism has emasculated the American male, and that emasculation has led to
physical problems. This pill will take the pressure off men. It will lead to new
relationships and undercut the feminist agenda. (Bob Guccione, publisher of
Penthouse, cited in Handy, 1998: 44)
It is not just the hyperbole of the pop-market that has declared the `age
of Viagra' ­ scientists too have readily adopted the demarcation of a new
era (Hatzichristou, 1998; Kim, 2000; Krane, 2001; Weiske, 1999). All of
these assertions reflect a nave technological determinism, mistakenly
granting Viagra some sort of causal agency in bringing about social
change. In contrast, I want to suggest that as a cultural `evenť, it provides
a useful point of departure for re-examining the relationships between
gender, the body, sexuality, science/technology and consumption. The
story behind Viagra is a complex history of the manner in which sexual
dysfunction has been constructed and reconstructed in relation to a range
of distinctly `modern' phenomena ­ including the rationalization and
medicalization of sexuality (Jackson and Scott, 1997; Tiefer, 1995, 1996),
the increased importance of expert systems and knowledges in managing
everyday life (Giddens, 1991; Rose, 1996) and the expansion of consumer
culture (Slater, 1997). Drugs are social products and
`. . . much capital, both economic and cultural, is vested to move the
products on to the market and to construct robust beliefs that these
products are needed for the good life' (Palmlund, 1997: 159). That this
has been done so successfully in the case of Viagra provides a unique
context for analysis.
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Viagra is one of the most commercially successful prescription drugs on
record. Within months of its approval, millions of prescriptions had been
written, a number of mass-market paperbacks hit the stands, stories were
frequent in mainstream media outlets, it was the subject of countless
comedy monologues, cartoons and jokes, and hundreds of internet sites
emerged which offered online prescriptions and home delivery. What is
Viagra? Sildenafil citrate is a pharmacological compound that suppresses
an enzyme that allows blood to flow out of the penis. Taking effect
approximately 45­60 minutes after ingestion, it acts to increase and maintain
blood flow to the penis. The stuff of modern legend, the story is
widely told of how this effect was discovered accidentally while Pfizer was
conducting clinical trials for its use in angina treatment. It wasn't particularly
effective in increasing blood flow to coronary arteries, but its effect
on the penis came to light when test subjects apparently didn't want to
return their experimental pills. While there was a degree of serendipity in
Viagra's birth, in actuality pharmaceutical companies and urological scientists
have long been interested in developing oral therapies (Bivalacqua et
al., 2000; Guirguis, 1998; Kirby et al., 1999). Viagra did not just appear
out of the blue, nor is it the only clinical treatment for `erectile dysfunction'.
Biotechnical remedies for rehabilitating erections have been
common practice for many years.1 What sets Viagra apart, however, is its
relationship to the development of a molecular science of sexuality, its
location by the medical and therapeutic communities within the `naturaľ
sexual response cycle, and its cultural take-up as the `magic bulleť that will
usher in a whole new era of both sexual medicine and sexual relations.
My focus in this article is to locate Viagra, as both a technological intervention
and a cultural event, in relation to shifting and specifically gendered
interpretations of sexual function and dysfunction. My discussion
here is based on an analysis of both scientific articles in medical and clinical
journals and mass-market books that seek to `translate' the scientific findings
to an audience of consumers.2 While no formal coding of the texts
was undertaken, some consistent themes emerged in the analysis regarding
assumptions about the etiology and epidemiology of sexual dysfunction,
conceptions of scientific progress in the field and perceived social
consequences of sexual dysfunction and its treatment. After briefly locating
Viagra in relation to the development of sexual science and, in particular,
the medicalization of sexuality,3 I will outline what has emerged as the
current biomedical consensus on male and female sexual dysfunctions ­
including their bodily dimensions, social consequences and future
prospects ­ and suggest that we might profit from paying attention to the
underlying social claims. While the clinical and market success of Viagra
has prompted biomedicine and its popularizers to speak of a `new age' in
human sexual relations, according it a causal role in social change (and in
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particular, in affecting gender relations), the more interesting story is to
be found in how gendered, sexual bodies and responsible individuals are
being constructed in and through those discourses.
Sexual science and sexual `dysfunction'
Without recounting a detailed history of sexual science, two significant
shifts should be noted: first, the rise of science as the authenticating voice
on what constitutes the `normaľ and `abnormaľ, and second, a reframing
of the `abnormaľ to emphasize dysfunction rather than moral danger.4 It
is this drive to identify and rectify sexual dysfunction that is `. . . manifested
in anxieties about sexual performance, in the efficient deployment
of the equation of desire with outcome' (Hawkes, 1996: 71).
What is the `function' that `sexual dysfunction' threatens? Quite
simply, it is penile­vaginal intercourse in the marital (or at least stable
heterosexual) unit. The `function' is `successfuľ intercourse, which is
`functionaľ for the couple, which is `functionaľ for society. It is not that
this understanding of sexual `function' is overtly repressive of other forms
of sexual expression or behaviour, but that it operates through an increasing
valorization of, and eroticization of, marital intercourse. This has a
long history. Much of classical sociology assumed a positive role for
sexuality only within marital relations, and was insistent on the function
of marriage in regulating passions (Marshall, 2001b; Sydie, 1994). The
eroticization of marriage in the 20th century has always been seen as being
in the service of the greater social good. During the inter-war period, for
example, a number of influential `marriage manuals' directed at a mass
audience stressed the necessity of orgasm ­ his and hers ­ in the conjugal
bed, and advised the anxious on erotic technique. Yet, `. . . while the
means employed by the writers of the marriage manuals appeared radical,
their goal ­ the defence of the existing family structure ­ was fairly conservative'
(McLaren, 1999: 54). The increasingly scientific turn of sexology
did not effect any divestment of this normative framing. Kinsey, for
example, while putting on the white coat of the value-free taxonomist,
repeatedly emphasizes the role of successful `marital coitus' in `maintenance
of the home' and `effectiveness of the home', and locates his work as
contributing to the education of `effective marital partners' (Kinsey et al.,
1953). Masters and Johnson suggest, in the introduction to Human
Sexual Response that `. . . the greatest single cause for family-unit destruction
and divorce in this country is a fundamental sexual inadequacy in the
marital uniť (Masters and Johnson, 1966: vi).5
Sexology, though, has always had problems of legitimacy, and one of
the strategies used historically to establish itself as an authoritative science
has been to assert a physiological basis for sexual problems within a
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medical paradigm of diagnosis and treatment (Bullough, 1994; Irvine,
1990; Tiefer, 1996).6 Thus, sexuality has become medicalized, rendering
it amenable to intervention and management according to a biomedical
model. This biomedical model accepts scientific rationality as a basic
premise, and seeks universal truths about the body as a biochemical
machine (Gordon, 1988). Medical discourses and practices ­ what
Foucault (1975) has called the `clinical gaze' ­ construct the body and its
truths, rather than just `discovering' them. Universalized bodily norms are
constructed against which individuals can be measured and compared, and
which provide a context whereby we not only understand our bodies, but
experience them ­ as sick or healthy, functional or dysfunctional. Within
sexual science, models of `human sexual response' have provided such a
universalized normative framework.
Masters and Johnson's physiology of the `human sexual response cycle'
(HSRC), continues to be the standard of `function' against which sexual
`dysfunction' is measured. Central to the HSRC is the assertion of the
basic physiological similarity of males and females, and the standardization
of a series of stages or phases of physiological change that define `normaľ
sexuality. The original HSRC identified `arousaľ, `plateau', `orgasm' and
`resolution' as involving identifiable and quantifiable physical events,
involving blood flow, tissue expansion and contraction, changes in heart
rate and blood pressure, secretion of fluids and so on. Later revised, largely
due to the influence of Helen Kaplan's work (Kaplan, 1977, 1995) to
include `desire' as a preliminary stage (although no physical changes are
associated with this stage), the HSRC continues to be received as `truth',
forming the framework for the diagnosis of sexual dysfunction in the Diagnostic
and Statistical Manual of the American Psychiatric Association
(DSM-IV). `Disturbances' to this `naturaľ sexual response cycle can occur
at any of these stages, and parallel male and female dysfunctions are
identified for each stage (other than desire disorders, which are apparently
gender-neutral). While the similarity of physiological response in males
and females is emphasized through the mapping of the `sameness' of the
stages for each, `dysfunctions' in each stage are specific to each sex. But in
each case, the nomenclature of sexual dysfunction identifies particular disorders
in terms of deviation from the `expecteď physiological response for
that stage, in terms such as, for the arousal stage, `failure to attain or maintain
the lubrication-swelling response' or `the inability to achieve or sustain
an adequate erection' (Halvorsen, 1997: 45). Penile­vaginal intercourse
is the assumed goal of arousal, as both lubrication in women and the erection
in men are deemed adequate if they are sufficient to allow them to
proceed to successful intercourse. A satisfactory orgasm, which is neither
`premature' nor `delayeď, is the assumed goal of intercourse for both partners.
Thus, the HSRC requires physiological success at each stage to move
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on to the next stage in enacting this `normaľ cycle, and `dysfunctions' are
defined and treated as abnormal events that disrupt this `natural flow'.
While a detailed critique of the HSRC and the DSM-IV's use of it in the
nosology of sexual dysfunction is beyond the scope of this article,7 a couple
of points are worth emphasizing here. First, it has a remarkable tenacity
in terms of its acceptance as a scientific, rather than social construction.
This is particularly evident in the construction of `orgasmic dysfunctions'
in women, where it has been noted that what is, in fact, the `norm' for
women (inability to achieve orgasm through intercourse) is cast as a `dysfunction'
(Boyle, 1994: 74). As Boyle notes, even as sexual science has
recognized women's need for clitoral stimulation to reach orgasm, it tends
to be expressed as a need for `additionaľ or `extra' stimulation, implying
something different from some normative level of stimulation (intercourse)
which it is additional or extra to. Second, it is inherently tautological
in its construction, where what is deemed to be an `adequate'
response or `sufficienť excitement is defined by criteria of the model itself.
As Leonore Tiefer puts it: `Effective sexual stimulation is that stimulation
which facilitates a response that conforms to the HSRC' (1995: 85). My
emphasis in the remainder of this article will be on how this acceptance of
a natural `cycle' of sexual response grounds the intensive focus on specific
physiological disruptions and their treatment, and the continuing difficulty
that sexual science has negotiating the simultaneous `sameness' and
`difference' of men and women ­ distinctions that the scientists themselves
construct.8
Male sexual dysfunction
Throughout the 1980s and 1990s, a decisive shift was made from `impotence'
to `erectile dysfunction' (ED). In 1982, the International Society
for Impotence Research was founded, to facilitate research on `. . . the basic
science of erection, defects in the erectile mechanism, and the clinical
aspects of diagnosis and treatment of erectile dysfunction'.9 In 1983, Dr
Giles Brindley astounded an audience of his colleagues at a conference by
injecting his penis with phenoxybenzamine, and displaying, for all to see,
an erection obtained by purely chemical means.10 While this led to the
development of new therapies such as intracavernosal injection and
transurethral therapies, the more revolutionary import was to visibly sever
the mechanism of penile erection from any sort of psychological or
emotional arousal, or even tactile stimulation, and to reconceptualize it as
a primarily physiological event. The shift from `impotence' to `erectile dysfunction'
was stabilized by the National Institute of Health's `consensus
development conference' on impotence (NIH, 1993). Thanks to `harď
scientific advances, experts now confidently claim that ED is a physiological,
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not an emotional or psychological problem.11 As one of the leading
researchers in the field summarizes it:
Few fields in medicine can match the rapid progress that has been made in our
understanding of male erectile function. These changes have been profound,
and fundamental. Baseless speculation about the essential vascular mechanisms
of erection and the belief in a predominantly emotional etiology have given way
to the identification of the molecular events resulting in an erection and to effective
pharmacological treatment of their alterations. The current state of the art
is a pre-eminent example of what is achievable by systematic and conscientious
application of basic research and clinical observation. (Morales, 1998: xv)
While the DSM recognizes four broad categories of sexual `dysfunction'
(desire, arousal, orgasmic, sexual pain), it is ED, under the category of
arousal, which has been the focus of research and treatment with regards
to men. The full and firm erection is generally viewed as the lynchpin on
which the whole business of sex depends. Despite evidence from both
community studies and clinical samples12 that desire disorders may, in fact,
be more prevalent, the assumption seems to be that if you can get the penis
`functioning' properly, desire will follow and/or simply be enacted. Similarly,
even though premature ejaculation (an `orgasmic disorder') has
higher prevalence rates than `erectile dysfunction' in many studies, we do
not hear of an `epidemic' of premature ejaculation.13 But erectile dysfunction
is `epidemic', a `serious health problem' with disastrous consequences
for relationships and society more generally. This assertion is
made repeatedly, in both the scientific and popular literature.
The study most frequently cited in support of the `epidemic' of erectile
dysfunction is the Massachusetts Male Aging Study (Feldman et al.,
1994; McKinlay and Feldman, 1994). This study is considered pivotal
because it is considered to have established `levels of impotence', rather
than treating impotence as an all or nothing condition. In a selfadministered
sexual activity questionnaire, which included nine questions
related to sexual activity and satisfaction, 1,290 men (all between the ages
of 40 and 70) reported on the frequency of their erections, and whether
or not they had experienced difficulty getting or keeping an erection
during the previous six months. The `levels of impotence' assessment was
made on the basis of a later `calibration study', where approximately 300
men presenting at a urology clinic were asked the same questions, and in
addition, were asked to rate themselves as `not impotenť, `minimally
impotenť, `moderately impotenť, or `completely impotenť. The resulting
rates reported were that 17 percent considered themselves `minimally
impotenť, 25.2 percent considered themselves `moderately impotenť,
and 9.6 percent considered themselves `completely impotenť. The
researchers also established that erectile function was both age-related,
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and related to specific diseases such as diabetes, heart disease and
hypertension.14
What doesn't get reported in the ubiquitous citations to this study that
seek to establish the epidemic conditions requiring immediate medical
intervention, is the following finding of the researchers:
Despite the marked declines in actual events and behavior and in subjective
aspects of sexuality, men in their sixties reported levels of satisfaction with their
sex life and partners at about the same level as younger men in their forties.
(McKinlay and Feldman, 1994: 272)
The researchers attribute this to differing normative expectations associated
with specific age groups. Thus, what the ED `industry' is really tackling
is not so much a medical epidemic, as it is a re-orientation of the
normative expectations.
As has been long established, a `healthy' male can expect some changes
in erectile function as he ages. Specifically age-related changes include the
need for more direct penile stimulation to achieve an erection, an erection
which is somewhat less `firm and fulľ than in his youth, less ejaculatory
`force', orgasms which feel less genitally centred and more diffuse, and a
longer `refractory perioď (the length of time between one ejaculation and
the next erection) (Levy, 1994; Masters and Johnson, 1966). These are
precisely the normative experiences of the `healthy' male that are now
pathologized under the rubric of `erectile dysfunction'.15 What the underlying
science of the physiology of erection has stressed is that deviations
from the expected penile response to arousal are not a result of `age' per se,
but identifiable biological processes that are associated with aging and
other diseases related to bodily aging (heart disease, diabetes, hypertension,
arterial hardening). Identifying with precision the vascular pathways
of flow and retention of blood in the penis as the site for medical
intervention is, in these terms, a remarkable achievement. Male sexual dysfunction
becomes a simple mechanical problem. Dr Irwin Goldstein, one
of the leading ED scientists, has reduced the problem to one of achieving
`sufficient axial rigidity' to overcome the `typical resistance posed by the
average vagina' (2 pounds), and to `create' an erection which does not
`collapse' or `deform' when engaging that resistance:
I am an engineer . . . and I can apply the principles of hydraulics to these problems.
I can utilize medical strategies to assess, diagnose and manipulate things
that are not so straightforward in psychiatry. (cited in Hitt, 2000: 36)
Viagra, then, is a mechanical solution to a mechanical problem; it
`. . . facilitates robust vascular functioning so the flow of intimacy, pleasure
and eroticism is not subverteď (McCarthy, 1998: 307). In other words,
fix the technical problem and the rest is `doing what comes naturally'.
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One recent development has been a shift in the boundaries of the
`disease' to more inclusive definitions of erectile dysfunction. While the
initial justification for the `disease modeľ of ED was clearly framed in
terms of a discernable physiological basis, and the relationship of ED to
potentially serious health problems (including the medical evidence that
ED could be seen as an early indicator of diabetes, hypertension, arterial
sclerosis, and so on), the efficacy of Viagra in producing erections regardless
of the etiology,16 not to mention the huge profitability of expanding
the market, has considerably broadened the clinical framing of ED as well
as the way the user is being `configureď (Woolgar, 1991).17 Thus, we have
the oft-repeated assertion that the existence of a highly successful and welltolerated
treatment reveals the `true incidence of EĎ (Broderick, 1998:
205), which has hitherto been clearly `underdiagnoseď (Seiden, 1998: 3).
The `user' is now configured not just as the man who is, due to a physiological
problem, unable to get or keep an erection much of the time, but
includes all those whose erections could be `improveď. Both the popular
literature and recent advertising stress that you might have ED and not
even know it!18 One doctor sums it up well:
Should a man take the pill to improve erections if he doesn't think he has ED?
The issue can be side-stepped by saying that if a man takes the pill and his erections
improve, then he had ED after all. (Lamm and Couzens, 1998: 82)
There is also an emergent shift in the scientific literature to viewing
ED as a progressive condition (hence the language of `early warning
signs of EĎ, and `phases of EĎ) and to looking at prevention in
addition to treatment. This shift has incorporated, on the one hand, an
increased responsibilization and individualization of risk, but on the
other hand, an increased reliance on scientific expertise and consumption.
The threat of sexual dysfunction as a consequence of an unhealthy
lifestyle has been rapidly incorporated into health promotion discourses.
Men are thus exhorted to eat a healthy diet, get lots of rest, stop
smoking, drink in moderation and engage in a regular exercise programme
in order to minimize the likelihood of `problems that impede
blood flow to his penis' (Whitehead and Malloy, 1999: 169). Also predicted
is the potential use of Viagra or Viagra-like drugs as a prophylactic
measure, similar to the manner in which aspirin is used to ward off
heart disease: `Some experts are predicting that, in the near future, the
drug will be taken two or three times a week, even when the man is not
engaging in sex, to ensure erectile health' (Lamm and Couzens, 1998:
137). However, the `reaľ advances are expected to occur in molecular
biology, where `. . . the future of the genetic therapy of human erectile
dysfunction seems bright indeeď (Christ, 1998: 193) As one scientist
confidently predicts, `It is clear that early in the new millennium,
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ED will not only be effectively treated but also potentially preventeď
(Padma-Nathan, 1998: 216).
The `new' female sexual dysfunction
Virtually all of the literature on the scientific discoveries about male sexual
dysfunction suggests that one of the positive outcomes might be attention
to the long-neglected issue of female sexual dysfunction. Female sexual
dysfunction, not surprisingly given the emphasis on the erect penis in the
construction of male sexual dysfunction, is dominated by a concern with
the viability of the vagina for receiving the erect penis. The recent outpouring
of scientific work on `female sexual dysfunction' has been spurred
on by the `pharmaceutical revolution' in treating male sexual dysfunction.
As summarized in a recent scientific article:
Based on our understanding of the physiology of the male erectile response,
recent advances in medical technology, and the recent interest in Women's
Health Issues, the study of female sexual dysfunction is gradually evolving.
(Berman et al., 1999a: 385)
The `evolution' referred to here is one that takes the new science of the erection
as its blueprint. While for a long period of time work on female sexual
dysfunction has lacked the emphasis on performance outcome measures that
characterized the study of men, this has begun to change. A new subspecialty
is developing in urology which focuses on `female sexual arousal
disorders', with a great deal of research now directed at measuring vasocongestion
(blood flow) in the genitals, lubrication of the vagina, and so on.
The physiology of the penis and the erection is constructed as normative, and
that to which the physiology of the clitoris and the receptive vagina is
compared. No one, however, is sure as to what the problem is that vasoactive
drugs such as Viagra would be treating in women. One book suggests that
`clitoral tumescence' is the parallel phenomenon of male erection. (Jarow
et al., 1998: 133). Another suggests that `vaginal lubrication . . . is the female
equivalent of an erection' (Melchiode and Sloan, 1999: 213). As another
book puts it, `we're the same, yet we're very different!' (Seiden, 1998: 69).
That is, while physiological similarity continues to be a central tenet (and
has been since Masters and Johnson), women are, well, `differenť. Consider
the conclusions of the team of scientists who are widely considered to be on
the leading edge of the physiology of female sexual dysfunction:
Although there are significant anatomic and embryologic parallels between men
and women, the multifaceted nature of female sexual dysfunction is clearly distinct
from that of the male . . . . The context in which a woman experiences her
sexuality is equally if not more important than the physiologic outcome she
experiences . . . . (Berman et al., 1999a: 390)
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Women, it seems, remain the `dark continenť for sexual medicine. (One
can almost hear the refrain of, `why can't a woman be more like a man'
ringing through the labs). They are distinctly unlike men, for whom sexuality
can be reduced to a fairly simple question of the mechanics of the
erection, and apparently stripped from its `contexť. Gender is never absent
for women in the way it can be rendered invisible for men. For example,
the issue of the context of intimacy, and things such as `body image' and
concern with appearance, are frequently cited as `confounding' variables
in sorting out the physiology of female sexual response. Thus, in the treatment
protocol for female sexual dysfunction advocated by Berman and
Berman and their associates (Berman et. al., 1999a, 1999b; see also
Berman et. al., 2000), who are among the frontrunners in the use of
vasoactive drugs with women,19 all patients are evaluated by a sex therapist
who `evaluates the context in which the patient experiences her sexuality,
her self-esteem and body image, and her ability to communicate her sexual
needs to her partner' (Berman et al., 1999a: 389). Nowhere in the literature
on male sexual dysfunction is it suggested that such concerns should
be given prominence in the diagnosis and treatment of ED.20 The centrality
of the firm, full and reliable erection to the male self-concept is
assumed and naturalized, never problematized as a question of `insecurity',
`poor self-esteem' or `body image'. In fact, rather than incorporating
evaluation by a sex therapist, ED diagnosis has shifted to a primarily `selfreporť
basis (is it as hard as you'd like?) and it is predicted that the widespread
efficacy of Viagra will eliminate the need for medical diagnosis
altogether.
One of the puzzles for medical researchers is the difficulty of `measuring'
arousal in women. Female sexual responses are `. . . difficult to quantify
objectively. The changes that occur are not only difficult to measure
but are also often not readily visible or recognized by the patienť (Berman
et. al., 1999a: 388). Another researcher (Heiman, 1995) notes that
`. . . the clitoris presents more measurement problems because of its size,
sensitivity and movement during arousaľ (p. 160) and that `. . . technical
problems have also plagued the development of a good direct measure of
lubrication' (p. 167). Even more perplexing to scientists is the fact that
women do not always perceive what the measuring devices tell them is
arousal as arousal:
While genital measures have attracted researcher attention as the more accurate
or `true' markers of sexual experience, the majority of psychophysiological
studies have found revealing and perplexing differences between genital and
subjective measures of arousal. (Heiman, 1995:161)
As Berman et al. (1999b: S35) put it: `. . . women are often not cognizant
of their level of arousal (i.e. the amount of lubrication or genital swelling)'.
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Thus, `arousaľ becomes a technically mediated experience, to be determined
by objectively measured physiological responses, not by one's
subjective experience. For both men and women, `arousaľ becomes
coterminous with measurable vasculogenic activity. The corollary of
`erectile dysfunction' in men is `vaginal engorgement and clitoral erectile
insufficiency syndromes' (Goldstein and Berman, 1998) in women. Once
`female sexual arousal disorder' is defined is this way, it is rendered amenable
to biotechnical treatment. It is no surprise to learn, then, that pharmaceutical
companies are a major source of research funding ­ in research
directed at defining problems as well as research directed at their solutions.
Of the 19 scientists convened for the `International Consensus Development
Conference on Female Sexual Dysfunction' (Basson et. al, 2000), all
but one acknowledged their association with a pharmaceutical company.21
While Leonore Tiefer predicted several years ago that the medicalization
of women's sexuality could likely follow the pattern of the medicalization
of men's sexuality `. . . should some new physiological discovery about the
genitalia emerge that could be developed into an industry and a clinical
practice' (Tiefer, 1995: 200), it does not seem as if such a new physiological
`discovery' is required as a prerequisite. It appears more and more
like research on female sexual dysfunction is directed at `discovering' the
problem for which lucrative remedies already exist. As with the expansion
of the disease-model of erectile dysfunction to reflect the success of the
available therapy, there is no simple linear move from an objectively
defined disease state to `discovery' of a cure ­ rather the `cure' often
appears to define the `disorder'.
While the initial clinical trials of vasoactive drugs (such as sildenafil) with
women have been disappointing in their results, the Food and Drug
Administration in the USA has recently approved the first mechanical
therapy for `Female Sexual Dysfunction' ­ the EROS-CTD, a small,
battery-powered suction pump designed to stimulate blood flow to the
clitoris. Taking as unproblematic the assumption that it is inadequate
blood flow to the genitalia that is the primary cause of `female sexual dysfunction',
and that `more than 43 percent of American women' suffer
from this disorder, the press release from the manufacture shouts: `40
Million U.S. Women Capable of Regaining a Healthy Sex Life with EROSCTĎ
(Urometrics, 2000). The `CTĎ stands for `clitoral therapy device'.
While one can imagine that providing `gentle suction directly to the
clitoris' may indeed be a very good thing from the perspective of women's
sexual pleasure, conceptualizing this as `clitoral therapy' could only occur
within the paradigm of Female Sexual Arousal Disorder as a vasculogenic
deficiency.22
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Looking forward?
The hegemony of medicalized understandings of sexuality and sexual
`function' in both men and women seems to have been secured, as
both scientific and popular accounts proclaim a `new era' of sexuality.
Epidemiologists are building models to predict incidence and prevalence
rates (Aytac et. al, 1999). Health economists are now turning their attention
to cost­benefit analyses, as governments and private insurers are called
upon to pay for an increasing array of treatments for sexual dysfunctions
(Keith, 2000).23 Yet a number of emergent issues suggest that there are
questions that are far from resolved.
The increasingly fuzzy boundaries between correcting a `dysfunction'
and providing enhancement raises questions about the extent to which the
medical/scientific community can maintain authority over diagnosis and
treatment. There has already been a significant shift in the medical locus
of diagnosis/treatment from specialists (urology) to primary care
physicians (the family doctor). Diagnosis of erectile dysfunction, for
example, has become an almost entirely self-assessed condition, based on
a short-form of the International Index of Erectile Dysfunction.24 A recent
article in The Lancet suggests that `the question has been raised whether
any diagnostic investigation is required at all in an age of cost containment
and the availability of a safe and effective oral medication' (Morgentaler,
1999: 1716). Another article predicts that medical intervention will only
be required for `oral-agent resistant EĎ (Broderick, 1998: 205). Two
recent studies have documented the ease with which Viagra is obtainable
through internet pharmacies, circumventing direct contact with a
physician altogether (Armstrong and Schwartz, 1999; Kahan et al., 2000).
Also widely circulated are anecdotes of men and women using Viagra
`recreationally' (Trebay, 1999), lots of Viagra humour ­ jokes, cartoons,
stand-up comedy ­ and even a new genre of porn (which I've dubbed
`viagerotica'25). We might draw some parallels here with the history of the
vibrator, as documented by historian Rachel Maines (1999). She suggests
that the vibrator was originally introduced as a `labour saving' device for
physicians treating `hysteria' and was under the authority and control of
the `experts'. However, both technological developments (i.e. the
development of devices which were small and able to be mass-produced,
in contrast to the original large, rather unwieldy contraptions) and the
cultural `takeup' of the vibrator (e.g. its introduction as a prop into erotica
and its marketing directly to consumers) resulted in a shift of the locus of
control of the technology. Medical science was unable to sustain its
authority as the legitimate `prescribers' and `users' of vibrator `therapy'.
Similarly, previous technologies for erectile dysfunction required direct
professional involvement ­ either through surgery (implants) or provision
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of specialized equipment and instruction in its use (e.g. injection therapy)
­ which the introduction of effective oral pharmaceutical agents has largely
eliminated. What may happen as such technologies become un-moored
from their original locus in physiological `dysfunction' and move away
from clinical control remains a set of open questions. Certainly the consequences
are never foreclosable in advance, and they may, in fact, reconfigure
bodies, sexualities and relationships in ways that are unpredictable.
Yet because technologies like Viagra are premised upon certain assumptions
about the bodily and cultural parameters of sexuality, they may
suggest particular ways of constructing and disciplining sexual subjects
even in non-medical contexts. That is, rather than representing an emancipatory
de-medicalization of sexuality, the loosening of medical control
over such sexual technologies might be seen as part of the process of their
`black-boxing',26 through which the very assumptions about sexual bodies
that made them possible are both consolidated and obscured. For
example, as Potts (2000: 99) suggests, `very few men might ever actually
experiment with the sensations of the non-erect penis due to the prioritization
of the erection in notions of healthy and satisfying male sex'.
Conclusions: reflections on the `sexually
dysfunctionaľ
Viagra has already shed more light on the once forbidden area of sexual function
than any medical discovery since the dawn of time . . . (it) has thrown open
the door to frank discussion and enlightened study of human sexuality in a way
that no scientific development has ever done before. (Melchiode and Sloan,
1999: 230­1)
If the advent of Viagra has brought about a new `discursive explosion'
on sexuality, it has been one which Foucault might have characterized as
consolidating yet another `strategic unity' which forms `specific mechanisms
of knowledge and power centering on sex' (Foucault, 1978: 103):
the `sexually dysfunctionaľ. In conclusion, there are several key aspects of
this `strategic unity' that I want to emphasize, very briefly, in order to make
some connections with some existing and emergent themes in the sociological
literature.
First, there is a remarkable story to be told about the science of sexual
dysfunction. The story told by the scientists themselves is one of progressive
discovery, assisted by new technologies of visualization, which has
allowed them to get at the truth about `molecular events resulting in an
erection' (Morales, 1998: xv). Yet the hegemony of scientific and specifically
physiological definitions of `dysfunction' renders invisible the matrix
of assumptions about gender and sexuality on which they rest. In doing
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so, the `human sexual response cycle', with penile­vaginal intercourse as
its centrepiece, is re-naturalized by intervening to correct `disturbances' in
its `naturaľ flow. Following Roelcke, we might term this the `biologizing
of social facts' (Roelcke, 1997).27
Second, the redefinition of typically observed changes in sexual response
associated with `healthy' aging as `dysfunctions' poses some interesting
questions about the more general `disciplining' of old age (Katz, 1996),
and the shift from `health' to `fitness' in the discipline of the body (Marshall
and Katz, 2001). As indicated in an earlier section of the article, a reorientation
of the normative expectations of the aging population was
integral both to the definition of the medical `problem' at hand, and the
marketing of a solution.
Third, the technologically determinist framing of the scientific literature
on sexual dysfunction, and specifically on Viagra, deflects attention from
both the social/political context of the design and development of technologies
and `interpretive flexibility' in the use of technology.28 (Bijker et
al., 1987; Bijker and Law, 1992; Casper and Berg, 1995; Grint and Gill,
1995; MacKenzie and Wajcman, 1999; Pinch and Bijker, 1987). Importantly,
technologies are not only `testeď in the laboratory, but also in the
media and in public discourse more generally (Oudshoorn, 1999).
Fourth, the filtration of scientific `discoveries' through popular media
coverage and more mundane forms of sociality such as humour and erotica,
opens a number of interesting lines of inquiry about the `weighť that sexuality
and adequate sexual performance carries in terms of the formation of
the `modern self'. As Jackson and Scott note, being `bad at sex' isn't like
being bad at gardening or golf (Jackson and Scott, 1997). This very centrality
of sexuality to identity connects to two key themes in the literature
on self-formation in modernity: the role of expert systems and knowledges
in constructing the self, including the sexual self (Giddens,1991, 1992;
Rose, 1996), and the increasing emphasis on consumer `choice' in solving
problems of identity (Slater, 1997). There are certainly some clear indications
that the `sexually dysfunctionaľ is being configured as a `bad consumer'29
who is unwilling and/or unable to recognize that a solution exists.
The `gooď consumer is promised even better choices to come.30
Finally, this seems to be yet another site where cultural expectations of
`gender' (here, as heterosexual performance) seem more rigid and less
malleable than physiological `sex', while at the same time locating masculinity
and femininity more deeply within the body, more resolutely presocial,
and less open to reconfiguration. There are clear implications here
for thinking through the problematic distinction between sex and gender
as it implicates the body, and as it invokes a `heterosexual imaginary'
(Hausman, 1995; Ingraham, 1996; Marshall, 2000; Marshall, 2001a;
Witz, 2000).
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It is tempting to summarize by pointing a finger at the root cause of all
this. Certainly, it seems that not since Freud have we seen such a phallic
construction of `sexual dysfunction', nor one that is so saturated with functionalist
notions of the positive social benefits of `successfuľ conjugal
relations. I do not want to suggest, however, that it represents some sort
of masculine medical conspiracy, as is implicit in some feminist accounts
of sexual science (Jackson, 1987; Jeffries, 1990).31 It is equally tempting
to blame the sheer profit motive of biomedical industries, but neither is
that a satisfactory explanation. As Bauman suggests:
Market forces can be blamed, at the utmost for exploiting without scruples the
resources already at hand . . . . Charging them with the powers to conjure up
the resources themselves would be like accepting the alchemisťs authorship of
the gold found in the test-tube. (Bauman, 1998: 21­2)
I think that what has occurred is more the result of a sometimes uneasy
and constantly shifting coalition of actors ­ including scientists, doctors,
patients, industries, media and consumers ­ operating within a cultural
horizon of rationalization, medicalization, commodification and gendered
heteronormativity. My concern in subsequent stages of the research is to
more precisely trace the history and contemporary dimensions of the
`strategic unity' of the `sexually dysfunctionaľ as it implicates all of these
actors, and as it intersects with some important domains of sociological
concern.
Acknowledgments
Research for this article was supported by a grant from the Trent University
SSHRC Committee on Research. An earlier version was presented to the
Canadian Sociology and Anthropology Association meetings at the University of
Alberta in May, 2000. For encouragement and/or helpful feedback on earlier
drafts, I wish to thank Claude Denis, Jorgen Jensen, Stephen Katz, Claudia
Malacrida, Deborah Parnis (who also deserves credit for suggesting the title),
Don Slater, Anne Witz, and the various and sundry members of Gaiľs kitchen
table caucus. I would especially like to thank Sexualities' reviewers for their
constructive suggestions for revision.
Notes
1. A complete history of biotechnical remedies for inadequate or absent
erections is beyond the scope of this article. These run the gamut from early
forms of splints and supports, hormonal and glandular therapies, rejuvenation
tonics, herbal remedies and penile exercises, to more recently standardized
treatments including penile implants and prostheses, vacuum cylinders,
penile injections, urethral suppositories, and oral medications. Historically,
this is an arena of treatment in which struggles for legitimacy and authority
over diagnosis and prescription have figured prominently.
2. The initial selection of texts was undertaken in the spring of 2000, when
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searches for scientific articles were conducted on Medline, Pubmed and
Current Contents, using `erectile dysfunction' and `Viagra' as keywords.
Beginning with the most recent `state of the arť reviews (e.g. Hatzichristou,
1998; Padma-Nathan, 1998; Wierman, 1999), key researchers and most
frequently cited works were identified, resulting in approximately 40 articles
that formed the basis for the initial analysis. Reviews of the scientific
literature have been ongoing, with several hundred articles now in my files.
These tend to be highly repetitious with respect to their general framing and
assumptions (often using exactly the same phrasing), so only a minority are
directly cited here. The eight mass-market books analysed represent all titles
returned on a `Viagra' keyword search through chapters.ca, an online
bookseller, in March 2000. They include Drew (1998); Jarow et al. (1998);
Katzenstein (1998); Lamm and Couzens (1998); Melchiode and Sloan
(1999); Seiden (1998); Vaughn (1998) and Whitehead and Malloy (1999).
3. My project is greatly indebted to the work of Leonore Tiefer, who has
provided a path-breaking analysis of the medicalization of male sexuality
based on pre-Viagra treatments (Tiefer, 1995) and of the medicalization of
sexuality more generally (Tiefer, 1996).
4. The distinction between dysfunction and danger is never complete, nor is the
medical/scientific framing of dysfunction ever free of assumptions about
moral imperatives to be sexually functional and the potential dangers to the
individual and to the social order should their performance not be up to
scratch.
5. While the assumption that lots of good sex leads to good marriages is often
asserted, there is no clear empirical evidence to support it. One review of a
number of surveys on sexual activity and marital happiness suggests that it is
far from a linear relationship, that it is bound up with other measures of
compatibility, and that it is reciprocal. In any case, as the authors conclude,
the relationship `. . . is not nearly as strong as one might surmise on the
basis of the normative definition of American marriage' (Edwards and
Booth, 1994: 254)
6. See also Adele Clarke's excellent study of the development of the reproductive
sciences, in which she relates their struggles to disassociate themselves
from the less `scientific' and somewhat disreputable field of sexology
(Clarke, 1998).
7. On this, see Boyle (1994), Irvine (1990, 1995), Morrow (1994, 1996) and
Tiefer (1995, 1996).
8. See Marshall (2001a), where I review the genital anatomies that sexual
medicine constructs, and how these reflect socially derived assumptions
about how properly heterosexed bodies should `function'. For related work
on sexual anatomies, see also Moore and Clarke (1995), Petersen (1998)
and Wilton (1997).
9. This statement is taken from their website, at www.issir.org (last visited
23/09/01). At their meeting in 2000, the organization adopted a new
charter, and changed its name to the International Society for Sexual and
Impotence Research, broadening their orientation `towards the whole field
of human sexuality'. In practice, this seems to be related to a growing
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interest by urologists in female sexual dysfunction, as evidenced by articles
being published in their journal, the International Journal of Impotence
Research, which published a supplement devoted to this in 1998.
10. This incident is widely recounted as a watershed in the shift from psychological
to physiological etiologies of impotence. See for example Broderick
(1998) and Whitehead and Malloy (1999).
11. The shift from psychological pathology to physiological pathology in the last
few decades reverses an earlier shift from physiology to psychology that
occurred alongside the development of psychology and psychoanalysis
earlier in the 20th century. For elaboration of this shift, see Marshall and
Katz (2001).
12. See for example Laumann et al. (1999), Simons and Carey (2001) and
Spector and Carey (1990). However, Simons and Carey note a number of
methodological limitations of the studies reviewed.
13. There is some evidence that premature ejaculation ­ or `ejaculatory
dysfunction' as some recent research has called it (e.g. Morales, 2000) ­ may
be gaining more attention, although it has not achieved nearly the degree of
attention that erectile dysfunction has in the scientific literature. Certainly its
prevalence and the age profile of those `afflicteď would make it a large
and profitable market for intervention, and increased attention to this
`disorder' would fit well within the exisisting `performance' model of male
sexual function. I thank Leonore Tiefer for raising this point in personal
communication.
14. `Erectile function' was largely determined by two questions: `During the last
6 months have you ever had trouble getting an erection before intercourse?'
and `Have you ever had trouble keeping an erection once intercourse has
begun?' It is interesting to note that these two questions specifically locate
erections in relation to intercourse only, and had only `yes' or `no' answers.
Methodological details of the original and calibration studies are recounted
in Feldman et al. (1994). For a review of the use of sex surveys more
generally in sexual science, see Erickson (1999) and Stanley (1995).
15. Marshall and Katz (2001) provide a detailed and historical analysis of male
`sexual fitness' as a pivotal age/sex problematic.
16. Numerous clinical trials have demonstrated that Viagra is most effective in
cases of erectile dysfunction for which no organic origin has been identified
(classified as `psychogenic')(Shabsigh, 1999; Steers, 1999). That it so
effectively `works' in these cases acts to reinforce the conviction that it must
have been physiological after all.
17. One of the noticeable ways that this is occurring is the shift in marketing
strategies towards younger men, see Langreth (2000).
18. Nor, indeed might your partner: `Erectile dysfunction can range widely in
severity from men who are completely `impotenť in every negative and
absolute sense of the word to men whose problems are so slight that not
even their partners are aware they have iť (Katzenstein, 1998: 5).
19. Drs Jennifer (an urologist) and Laura (a therapist) Berman are not only
central figures in urological circles, but have become the public face of the
new interest in `female sexual dysfunction'. They have made television
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appearances on programmes such as Oprah since publishing a book for the
popular market (Berman and Berman, 2001), and have recently established
the Female Sexual Medicine Center in the Department of Urology at the
University of California Medical Centre in Los Angeles. They have also
started a website ­ Network for Excellence in Women's Sexual Health
(NEWSHE) at www.newshe.com (last visited 26/09/01) which disseminates
the latest medical word on female sexual dysfunctions.
20. Where self-esteem is an issue in the literature on male sexual dysfunction, it
tends to be taken as a dependent variable, rather than a contributing
variable, as in `. . . no malfunction of the human apparatus ­ not even cancer
or heart disease ­ can be more painful to the male ego or catastrophic to the
male psyche than sexual impotence' (Melchiode and Sloan, 1999: 17).
21. See the special issue of the Journal of Sex and Marital Therapy published in
2001 (v. 27) for extended discussion of the `consensus' conference. For a
critical analysis of the relationship between the pharmaceutical industry and
sex research more generally, see Tiefer (2000).
22. That clitoral stimulation increases women's sexual pleasure is hardly a
cutting-edge scientific insight. Yet the clinical trials on which the FDA
approval of the EROS-CTD was based did not compare its effectiveness
with other forms of clitoral stimulation (such as cunnilingus, manual
stimulation or stimulation with a vibrator). Even more fascinating is the
comparison of this biomedical technology, framed as therapy, with other
devices framed as `sex toys'. The EROS-CTD is available on prescription at a
retail cost of approximately $360, which is expected to be covered by
insurance companies. Sextoys.com, an online erotic merchandiser, markets a
`vibrating clit pump', not as a device to correct a disorder, but as something
that can produce `intense pleasure', for $34.95. When is a sex toy not a sex
toy? When iťs a sophisticated piece of biomedical technology. I hope to
pursue the implications of this `market segmentation' in a future paper.
23. The acceptance of Viagra as a bona fide medical treatment by insurance
companies has raised the question of how many pills per month will be
covered ­ which implicitly involves deciding what an appropriate frequency
of sexual intercourse is. This frequency differs considerably across contexts,
with some private insurance companies allowing for 10 pills per month,
some government agencies allowing for 8 pills per month (for example, this
is what is covered for Canadian war veterans), and others for only 4 pills per
month (some state medicaid programs ­ see the editorial in Formulary,
2000).
24. Originally a multidimensional 15-question instrument which covered the
domains of erectile function, orgasmic function, sexual desire, intercourse
satisfaction and overall satisfaction (Rosen et al., 1997), recent studies
suggest that only the erectile function domain questions are necessary
(Cappelleri et al., 1999) and that of the six questions in this domain, the
primary `end points' are two questions, which determine the `ability to
achieve an erection sufficient for sexual intercourse and the maintenance of
an erection after penetration' (Padma-Nathan, 1998: 210). More recently,
Padma-Nathan (1999: 13) suggests that Viagra's efficacy may be assessed
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simply `in terms of the number of patients reporting erections hard enough
for sexual intercourse'. It is the performativity of the penis in the context of
penetrative sex that defines its function.
25. For a remarkable example of this, see Myles and MacFarlane (1999). While
the subtitle is `Women Who Take it Reveal Their Erotic Tales' and the cover
blurb promises `a candid peak into the new FEMALE sexuality', the content
delivers anything but! Of the 18 `stories' (all very sexually explicit) only nine
actually involve women ingesting Viagra. Of these, the main effect was to
make women insatiably penetratable, and was frequently used as an excuse
for them to transgress the boundaries of what they would normally do (e.g.
to have anal sex, to perform fellatio, to have intercourse with two men in
one evening, to engage in a bisexual threesome). Of those where the
`ingester' was male, women frequently appeared as mere props in the story ­
for example, as prostitutes in a Nevada brothel. In short, women are
configured here as `using' Viagra even if they are merely the paid recipient of
the Viagrified penis. What this demonstrates is the ease with which such a
`revolutionary' technology is absorbed into very conventional (and malecentred)
narratives of gendered sexuality.
26. The term `black-boxing' originated in the social construction of technology
(SCOT) literature (see, for example the collection edited by Bijker et al.,
1987), where it refers to the tendency for technologies to become stabilized
in such a way that they appear to be naturalized and/or immune to political
critique. See also Marshall (forthcoming)
27. There are clear connections, in this sense, to the literature on reproductive
technologies and historical research on rejuvenation technologies (Clarke,
1995; Clarke, 1998; Melo-Martin, 1998; Sengoopta, 1998; Squier, 1999;
Trimmer, 1967).
28. For an innovative reading of Viagra from the perspective of technology
studies and `technological embodimenť that considers some of these
questions, see Mamo and Fishman (2001).
29. Elaboration of this thread is beyond the scope of the present article.
However, two aspects that form consistent themes in the mass-market books
on Viagra are worth mentioning briefly. First, the male reader is positioned
as already having taken the `first step' to making good consumer choices by
buying that particular book, and nothing short of a life-altering change is
promised should they `take advantage' of the `choices' available to them.
Second, women are ambivalently constructed as `consumers' of Viagra in
different ways ­ (i) as enthusiastic, though indirect, consumers who
encourage their partners to make the right choices and welcome the renewal
of his erection; (ii) as potentially direct consumers of the drug (every book
contains a section or even a chapter on its potential in treating female sexual
dysfunction); and (iii) as defective consumers, who for a variety of reasons
(all pathological ­ narcissism, aggressiveness, ignorance) resist or reject the
viagrified penis.
30. Pfizer is reportedly working on a faster-acting version of Viagra in the form
of a nasal-spray or wafer (apparently, some consumers don't like the 45­60
minute wait, despite the fact that many sex therapists see this as one of the
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benefits of Viagra in its current form ­ it actually promotes anticipation and
foreplay!). A number of oral and topical pharmaceuticals are also in
development and clinical testing by other companies, all of which promise
even greater tolerability, faster action and easier use (Alger, 2000; Burnett,
2001; Goetzl, 2000; Marcial, 2000; Morales, 2001; Pryor and Redman,
2000; Stipp and Whitaker, 1998). It is truly a limitless horizon for the
receptive consumer.
31. Such a perspective tends to gloss the history of the construction of
masculine sexuality, which suggests that male bodies have long been acted
on by bio-medical sciences, often in extremely invasive ways (Parsons,
1977), that individual men have long experienced great anxiety over their
inability to conform to an idealized masculine sexuality (Hall, 1991), and
that there is very little about pleasure for men in all of this ­ only
performance. This is not to deny that sexology is male-centred, only that to
imply some sort of an intentional conspiracy in making it so is misguided.
For other discussions of masculine sexuality and its discontents, see
Buchbinder (1987), Haller (1989), McLaren (1997), Morgan (1993),
Mumford (1992) and Nye (1989).
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Armstrong, K. and Schwartz, J. C. (1999) `Direct Sale Of Sildenafil (Viagra) To
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Basson, R., Berman, J. et al. (2000) `Report of the International Consensus
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Berman, J., Adhhikari, S. P. and Goldstein, I. (2000) `Anatomy and Physiology
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Biographical Note
Barbara Marshall teaches sociology at Trent University. She is the author of
Engendering Modernity: Feminism, Social Theory and Social Change (Polity,
1994) and Configuring Gender: Explorations in Theory and Politics (Broadview,
2000), as well as various articles on feminism, social theory and gender. She is
continuing to explore the historical and contemporary intersections of gender,
sexuality, technology and consumer culture, and, in a joint project with Anne
Witz, is conducting an interrogation of the masculine ontology that underpins
sociological theories of modernity. Address: S103 Lady Eaton College, Trent
University, 1600 West Bank Drive, Peterborough, Ontario, Canada K9J 7B8.
[email: bmarshall@trentu.ca, website: www.trentu.ca/sociology/bmarshall]
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