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'Female sexual dysfunction' is a relatively recent addition to our repertoire of favourite scientific buzz terms. It's been barely six months since the syndrome was officially labelled and unleashed upon the world, along with the rehashed results of a three-and-a-half-year-old study by the American Medical Association, which suggested that as many as 43 per cent of American women suffered from this condition. But already, we've entertained a variety of rapidly evolving theses on it, and its causes: we've watched a TV documentary or two; we've been promised a variety of cures - the most newsworthy of which was the development of Pfizer's 'pink' Viagra, a drug that operates along the same lines as traditional Viagra by increasing the blood flow to the sexual organs, and which managed to land itself a plug on Sex and the City.
But the latest research into the issue suggests that no pill will ever solve this problem. Trials have revealed that Viagra, pink or otherwise, can't do for women what it does for men, because it affects only the body, not the mind.
'The male sexual process is different,' says Alan Riley, professor of sexual medicine at the University of Central Lancashire. 'Men have physical arousal. Women have physical arousal, too, but they need mental arousal on top of it. Viagra only provides the physical, so for women it's only partially helpful.'
As well as the mental-physical divide, there's another difference between male and female sexual response, and it's this that could offer the answer to some women's prayers. The mental arousal, it seems, must be extremely well linked to the physical one. 'I call this the Cognitive Physiological Feedback Loop [CPFL],' says Dr Eileen Palace, director of the Centre for Sexual Health in New Orleans, and the scientist pioneering the new research movement. 'Male CPFL is more efficient. A man's cognitive component is provided by the feedback he receives from his erection. He sees it, or feels it, and this sends a very clear message to the brain to have sex. Women, on the other hand, have nothing physical that's such an obvious signal. They have tingling, throbbing and lubrication, but it's very subtle, and you can't see it. To fully enjoy sex a woman needs something that links what's happening down below to the brain.' In other words a man's erection and his brain are extremely well connected, whereas a woman's genitals don't always send such effective messages, and because the brain is such a key part of her sexual response, it's crucial that they do.
In an attempt to address this, Palace has done a series of tests which reveal how female CPFL works. In a clinical trial, she created physical arousal in women with sexual dysfunctions by getting them to work out (interestingly Viagra provokes the same response in women that exercise does). She provoked mental arousal by showing patients a soft-porn film and created the vital CPFL by hooking each patient up to a machine designed to measure sexual response, and proving to them that they were extremely aroused, even if they weren't registering that fact independently.
'At the end of the experiment, these dysfunctional women were as aroused and full of desire as the most sexually functional woman,' says Palace. 'This illustrates that reminding the brain that the body is ready for sex and concentrating on it is key to the maximum sexual experience for a woman. That is female CPFL.'
So what inhibits CPFL in some women? According to experts, it's all down to what's going on in the brain - the mental part of the female sexual process, their cognitive attitude. It's this that switches CPFL on or off.
'The cognitive element and how it links to the physical, the CPFL, is crucial.' says Riley. 'The lack of a functional cognitive link-up during arousal dampens physical desire.'
Social views of sex are, says psychosexual therapist Julia Cole, possibly the main reason for an unhelpful cognitive process. 'Women in most cultures are taught that enjoying erotic feelings is bad, sluttish and so on. Therefore when the sensations are felt, a lot of women don't attend to them.' Research shows that if sexual urges are ignored for a significant period of time, the brain switches off from them. This is a negative cognitive process in action - a woman thinking she can't let go for social reasons, shuts herself off from her arousal. So there's no CPFL.
Palace suggests that women address sexual dysfunction by consciously taming their cognitive process, so that it delivers the sexual goods they all want by accepting that being sexual is good, and by masturbating, to learn what works for them. Most importantly, they should practise some sort of focusing technique, so the brain finds it easier to concentrate on the sex they are experiencing, and nothing else. This could involve visualisation, meditation, progressive muscle relaxation or yoga's 'red tantra'.
'Red tantra teaches women that they will only achieve maximum sexual potential by harnessing the immense power of their minds,' says yoga expert Gurudharam Khalsa. They are taught to do this through visualisation techniques. 'The suggestion that Viagra could work for women seems crazy to me,' says Khalsa. 'Women's sexual process is a mental-physical one - very, very different to a man's.'
'I think we need to find out and communicate what normative sexual function is in women,' says Dr Beverly Whipple, director of the International Society for the Study of Women's Sexual Health. 'Instead of putting their sexuality in the monolithic linear model that describes male sexuality, we need to document the many, varied physical and mental ways women achieve sexual pleasure.' Modified Viagra, it's clear, is a male solution to a problem that isn't male in nature. It will help women with physical arousal problems, but for many women who are unsatisfied sexually, it offers false hope. It may not be pink, and it may not be a one-tablet cure-all, but cognitive conditioning looks like the more female-friendly solution to sexual dysfunction.
Hazel Curry
The Observer
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