Apples and Oranges: "Sexual Medicine" and the Effort to Deny That Counting and Classifying Are Political Acts.

Criticisms and controversies about scientific method are rarely just about science. As or more often, they are sociological exercises in boundary patrol, helping determine which work is in and which is out. The recent back-and-forth on the question of whether psychological treatments for sexual desire complaints are sufficiently "rigorous" is part of the effort to define the field of sexual medicine. Limiting good sexual science to quantitative clinical trial style is a rhetorical maneuver which must be challenged.

Bremelanotide and flibanserin for low sexual desire in women: the fallacy of regulatory precedent.

The US Food and Drug Administration (FDA) has approved two drugs for 'hypoactive sexual desire disorder' in women, flibanserin (Addyi) in 2015 and bremelanotide (Vyleesi) in 2019. In this paper we examine the outcome measures and clinical trial data upon which regulatory approval was based. In clinical trials, flibanserin led to an average of only one additional enjoyable sexual experience every two months, bremelanotide to none. Trials for both drugs feature shifts in primary outcomes and a contested indication. A politicised industry-sponsored advocacy campaign and conflicted patient and expert testimony likely influenced flibanserin's approval at its third attempt. Bremelanotide, with even weaker efficacy, capitalised on the regulatory precedent set by the approval of flibanserin. Reconsideration of regulatory decisions to approve these drugs is in order, as well as a broader examination of how future regulatory decisions can better address conflicts of interest and clinically meaningful benefit.

Activism on the medicalization of sex and female genital cosmetic surgery by the New View Campaign in the United States.

The New View Campaign is a grassroots initiative begun in 1999 to challenge the over-medicalization of sex in the wake of publicity following the release of Viagra. This paper describes the history of the campaign and its activities, which started with analysing the construction of female sexual dysfunction, and moved on to develop a critical understanding of sexuality as a market for the pharmaceutical industry to exploit. The campaign has also had much to say about a positive model for sexuality, sex education, treatment of sex problems, and sex research. From 2006, we began to look at the new female cosmetic genital surgery industry. In 2008, we wrote letters to many government and medical professional groups expressing our concerns about female cosmetic genital surgery and asking for support. We also organised a demonstration outside the office of a New York surgeon who was doing this surgery and developed a webpage as a resource for students, scholars, journalists and activists. In 2009, we held an event in an art gallery that celebrated artists who support and encourage female sexual diversity. Supporters and colleagues of the campaign have published books and articles, and created visual and training materials, including a project called Vulvagraphics.

Missed Opportunities in the Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction Held at the FDA, October 2014.

There were numerous missed opportunities at the October 2014 U.S. Food and Drug Administration (FDA) meeting on female sexual dysfunction (FSD). They included opportunities to hear from a diverse range of patients and to engage in evidence-based discussions of unmet medical needs, diagnostic instruments, trial end points, and inclusion criteria for clinical trials. Contributions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) nomenclature, based on extensive research, were dismissed in favor of language favoring a seemingly clear but scientifically unsupportable distinction between women's sexual desire and arousal. Numerous participants, including patients recruited by their physicians, acknowledged travel expenses paid for by interested pharmaceutical companies. Conflicts of interest were manifold. The meeting did not advance the FDA's understanding of women's sexual distress and represents a setback for our field.

Medicalizations and demedicalizations of sexuality therapies.

This article complicates recent discussions about the expanding zones and influences of medicalization and biomedicalization on sexuality and sex therapy by contextualizing them with competing nonmedicalizing trends. These latter developments include an escalating nonexpert commercial sexuality sector on the Internet, as well as a long history of anarchic and democratizing social politics, such as "the counterculture" and "free love movements." What these nonmedicalizing trends have in common is the view of sexual problems and solutions as far broader than sexual dysfunctions and sex therapies, a belief in the social determinants of individuals' sexual experiences, and a deep concern regarding the socially harmful consequences of medicalization. With the quantity of sexuality information and advice available to the public through the Internet only likely to expand, a long era of clashing claims about relations between sexuality and health and about the role of expertise in sexual life can be foreseen.

Why medicalization? Introduction to the special issue on the medicalization of sex.

This special issue grows out of the need to bring into focus the historical and sociocultural contextualization of sex to the sexological community. The specific focus is on analyzing how medicalization is affecting many areas of sexual life and discourse, but the larger goal is to help situate sexuality studies in its broadest perspective. Articles will be of general interest to those interested in interdisciplinary scholarship; the specific articles address HIV politics, sex therapy, women's sexual health, sex and aging, the popularization of weak science, and the media's view that sexual exuberance is a central marker of recovery from cancer. Medicalization is a current trend that illuminates the importance of a broader view of sexology.

The emerging global discourse of sexual rights.

Since 1945, United Nations (UN) conferences and documents have promoted human rights as essential to individual liberty and international peace. It took until 1994, however, for the term "sexual rights" to first appear in a UN document. Recently, other groups have also been promoting the idea of sexual rights. The professional and scientific World Association of Sexology offered a Declaration of Sexual Rights in 1999. In 2000, The World Health Organization co-authored "Promotion of Sexual Health," including a central role for sexual rights. This emerging sexual rights discourse can be linked to the women's rights and gay and lesbian rights movements of the 1970s, and to the AIDS pandemic of the 1980s.

Beyond dysfunction: a new view of women's sexual problems.

A new theoretical framework and classification system for women's sexual problems, written by feminist clinicians and social scientists, was released in October 2000. Part one critiques the current American Psychiatric Association nomenclature for women's sexual programs. Part two highlights international sexual rights documents. Part three begins with a women-centered definition of sexual problems: "discontent of dissatisfaction with any emotional, physical, or relational aspect of sexual experience" (pp. 228-229). It also provides four categories of causes: (a) sociocultural, political, or economic factors; (b) partner and relationship factors; (c) psychological factors; and (d) medical factors. The document is designed for professionals and the public.