This is a summary of some of the topics discussed in the “Ace Pathologization” session at the 2017 SF Asexuality Unconference.
In this session, we talked about how asexuality is pathologized in some medical or psychological circles. In the DSM-5 (the latest version of the handbook for diagnosing mental disorders), there are a pair of similar disorders: Male Hypoactive Sexual Desire Disorder and Female Sexual Interest / Arousal Disorder. The diagnostic criteria for these “disorders” are things like “Absent interest in sexual activity”, “No initiation of sexual activity, and typically unreceptive to partner’s attempts to initiate”, and “Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity.” Or, as an asexual might call it, “Just another Tuesday.” Now, the DSM-5 has made a few improvements over the DSM-IV. It removed “Interpersonal distress” as one of the criteria, which means that you can’t be diagnosed if you’re fine with it, but it bothers your partner. More importantly, the DSM-5 introduced explicit exclusions for asexuality, stating plainly that if someone self-identifies as asexual, they should not be diagnosed with either “disorder”.
Now, hey, that’s great, asexuality is recognized and all, but there are several problems here. First, is use of phrase “self-identifies”. In order to qualify for the asexuality exclusion, you have to say something like “I am asexual, so I don’t have MHSDD”. But if you’ve never heard of asexuality, well then, you can’t say you’re asexual, so congratulations, you’ve got MHSDD! (And now that you have MHSDD or FSIAD, here’s some potentially dangerous pills for you. Here’s some ineffective therapy tips that will only make you feel more broken.)
Second, the asexuality exclusions in the DSM-5 are buried in the notes about these “disorders”, where it’s easy to overlook them, and only in the full version. The desk reference for the DSM-5 omits these notes and any mention of asexuality entirely.
Going back to the remark on “potentially dangerous pills”, we talked about Addyi/Flibanserin. Addyi is terrible on several fronts. First, it doesn’t really work. Clinical trials showed barely any difference over a placebo, and what little difference there is comes with side effects like “sudden loss of consciousness” and a restriction on drinking alcohol (and grapefruit juice!) while taking it. Second, the approval process was questionable. It had failed FDA approval several times before (because it didn’t work and was dangerous). It was originally meant to be an anti-depressant, but it didn’t work as one, so they decided to change what it’s meant to treat and try again. Part of the clinical trials for a pill designed for women were only tested on men. Because the pill was a medical failure that couldn’t be approved on the basis of safety and effectiveness, the company who owned the rights decided to push a “gender equality” angle instead, saying that it’s unfair that men have Viagra and Cialis and Levitra and women have nothing. (Disregarding the fact that they are entirely different types of pills. Addyi isn’t a mechanical drug designed to aid physical arousal, it’s literally meant to be a mind-changer, something that’ll make you mentally more interested in having sex. Men don’t have a pill that does that, either.) And third, the corporate shenanigans going on with the companies involved with this pill are a staggeringly clear example of what people are complaining about when they talk about greedy pharmaceutical companies. I don’t spend my days decrying Big Pharma as the devil, but hoo-boy do these people have some slimy things going on.
There is an ever-present fear that the makers of Addyi will eventually start to make a marketing push for the pill (they haven’t yet because congressional investigations, federal subpoenas, and the SEC poking its nose in your business tends to make you nervous about introducing a pill that can cause a “sudden loss of consciousness”). When they do, it will undoubtedly lead to thousands of asexual women (especially ones who don’t know they’re asexual, but certainly not limited to them) being pressured into taking this dangerous pill that doesn’t work. Well-meaning people will throw “They have a pill for that now” at anyone who says they’re asexual, and doctors will push this medication on their patients, because the ballpoint pen they just got says it’s wonderful. The existing marketing materials for Addyi push it as a treatment for Female HSDD, which isn’t even recognized by the DSM-5 anymore. They make no mention of asexuality, because asexuals aren’t going to be profitable.
A lot of things have been written about Addyi/flibanserin, so I’ll leave a few of them here and move on.
The Ace Flibanserin Task Force
For Asexual Community, Flibanserin Is A Bitter Pill To Swallow
Flibanserin: The Female Viagra is a Failed Me-Too Antidepressant
I’m a Feminist. Here’s Why I Don’t Support The “Female Viagra”
The prevalence of asexuality was discussed. We went over the 1% statistic, the wider 1-6% estimate, and talked about some of the problems with accurately determining the true number of asexual people. This post provides a decent overview of the numbers and what’s wrong with them, and potentially what can be done about it.
We talked about good and bad experiences with therapists, but as those conversations were of a personal nature, I will not repeat them here. Suffice it to say, there are some therapists who are good and some who should have their licenses revoked.
We talked about finding an effective therapist. One of the tips was to look for a solid LGBTQIA+ friendly therapist. Ask around for references. If you don’t have any friends you can ask, your local LGBTQ Center/QRC might be able to help point you in the right direction. However, that’s not a sure-fire solution. Some people mentioned that they have encountered queer therapists who are not ace-friendly. Another tip was to provide your caregiver with research or informational materials on asexuality, if they are skeptical. RFAS has some good resources, some of which are designed for healthcare practitioners.
At the same time, it was clear that it shouldn’t be the patient’s responsibility to make sure their doctor knows how to work with an asexual patient. We talked about more proactive outreach, where asexual people talk to doctors and therapists and others about asexuality and working with asexuals. Maybe that’s going to a conference and running a session on asexuality, or maybe that’s talking to a local clinic about doing a lunchtime brownbag session for their doctors. Is anyone out there working on something like this?
FYI my brand new blog post, posted minutes before this web page went online actually, has a large section about the drafted FDA new guidelines on ” Low Sexual Interest, Desire, and/or Arousal in Women: Developing Drugs for Treatment” and a couple asexual perspectives left in the comments section in December, which is actually not an overlap with what seems to have been discussed at the Unconference, but rather more an “addition” to it, in case you’re curious.
You’ll have to maybe Control+F “the FDA” to see the beginning of the relevant section of my blog post:
Yeah, those are some great additions. I wish that had come up during that session.
I really wish the ace community would actually talk about pathologization as the topic of discussion. This article just talks about asexuality on its own along with the plain facts of what’s written in the book. At the conference I tried to steer the conversation to address the fact that *nothing* in the DSM is an actual medical issue, but no one seems to care about allyship or solidarity. Well, don’t complain that cis gay men got homosexuality removed and then stopped caring about everybody, because that’s exactly what you’re doing now.