The New View Approach to Women's Sexual Problems
Hicks, Karen, Contemporary Sexuality
THIS ARTICLE DESCRIBES THE ORIGINS of the New View (NV) approach to women's sexual problems, the factors in sexual medicine research that precipitated this approach and a guide to clinicians in the use of its classification scheme for women who present with sexual difficulties. The current debate on hormonal medical treatments for women's sexual problems and the sexual research data used to support that is also summarized.
A New View of Women's Sexual Problems (Kaschak & Tiefer, 2001) was written to help researchers, educators, and clinicians respond to the growing medicalization of sexuality following the introduction of sildenafil (Viagra) for men in 1998. The Working Group for a New View of Women's Sexual Problems arose as a response to the attention then focused on finding an equivalent medical treatment for women. Irwin Goldstein, a Boston urologist prominent in sildenafil research, had earlier predicted that treatment of female sexual dysfunction would create an "explosion" for the field of female urology (Bankhead, 1997). The research included studying sildenafil itself as a treatment for female sexual dysfunction (Berman, Berman, Toler, & Haughie, 2003; Basson & Brotto, 2003). Notably, Pfizer later announced that several large-scale, placebo-controlled studies, involving about 3000 women with female sexual arousal disorder showed inconclusive results regarding the efficacy of sildenafil. It was decided that the company would not file for regulatory approval to use the drug for female sexual arousal disorder (Moynihan, 2003).
Twelve clinicians and social scientists issued a document criticizing the APA's Diagnostic and Statistical Manual of Disorder (DSM) medical classification scheme for women's sexual problems and proposed an alternative classification scheme (Kaschak & Tiefer, 2001), described below. NV working group members criticized the medical model on several grounds: First, the notion of a universal, normative sexual response reduces sexual problems to disorders of physiological function, omitting the vast differences among women. Additionally, the focus on "normal" sexual function erases relationship contexts that often lie at the root of sexual dissatisfaction. The NV group also criticizes a false notion of sexual equivalency between men and women, based on the Masters and Johnson era in sexual research (Tiefer, 1991).
The NV Classification Scheme
A major goal of NV proponents is to offer a multidimensional model of sexual function that will assess women's experience as accurately as possible and lead clinicians toward more successful treatment outcomes, whether in psychosexual therapy or a medical context. Briefly, NV proponents position women's sexuality within a broader, multidimensional framework of sociocultural, economic, and relational factors, as they play a large role both in the development of sexuality and sexual problems. The NV therapeutic approach begins with a woman's own description of her sexual problem and attempts to place that description in her lived context. Thus, clinicians learn to consider a woman's sexual problems and conflicts and ambiguities in her feelings about her sexuality in the context of her particular experience in the society and social arena in which she lives.
The NV approach does not ignore the physiology of sexual experience, nor does it ignore or deny medical factors. However, it holds that a comprehensive and appropriate understanding and diagnosis of sexual problems must include an investigation and integration of psychosocial factors to any treatment protocol. Sexual medicine approaches acknowledge that these factors exist, yet they privilege biological or hormonal etiology and prescribe medical treatments for problems that may have a psychosocial etiology. (See a short summary of this issue in the section below titled Current Developments in Medical Treatments.)
The NV nomenclature rejects the definition of normal sexual response in terms of arousal, desire, and orgasm, and also rejects the identification of sexual problems as deviations from that norm. …