The medicalisation of sexuality is the existence and growth of medical authority over sexual experiences and sensations. The medicalisation of sexuality is contributed to by the pharmaceutical industry, along with psychiatry, psychology (particularly evolutionary psychology), and biomedical sciences more generally.
Medicalisation is defined as a process of conceptualizing, defining, and treating nonmedical issues as medical problems. Human sexual activity is affected by many factors, including social norms, sexual identity and gender identity, and relationship structures. Sexuality is the way people experience and express themselves sexually. Much research in psychology and psychiatry has been devoted to understanding factors contributing to human sexuality, often playing a gatekeeping or legislative role in stigmatising certain behavior or promoting disease mongering. The medicalisation of sexuality has also been used to advance the pharmaceutical industry through treatments for erectile dysfunction and female sexual dysfunction. Another key influence of the medicalisation of sexuality is social control, mass surveillance and regulation related to risk profiling for medicalised sexual disorders.
While the additional funding from the pharmaceutical industry has been viewed as beneficial to medical research and practice in sexology and human physiology, there exists significant criticism of the medicalisation of sexuality, often on the grounds that it neglects sociocultural factors in favour of a profit motive. The medicalisation of sexuality has also historically been used to justify medical treatments, stigmatisation and incarceration of gay and lesbian people (generally known at the time as homosexual), intersex people and transgender people.
Medicalisation
Medicalisation describes the processes through which initially nonmedical problems such as social problems or natural processes become defined and understood in medical terms of illness, disorder, and disease, which is coupled with treatments. Medicalisation involves a combination of specialised language, explanations and treatments which are promoted at the expense of social language and explanations.
It is believed that the concept of medicalisation began with late 18th-century Age of Enlightenment philosophy, one of the first developments of pathologisation in Western society, including but not limited to sexuality. The three hallmarks of medicalisation are mind-body dualism, individualism and naturalism. Medicalisation has been attributed with humanising areas of social deviance, such as alcohol intoxication, insanity and rebelliousness previously only subject to cruelty or censorship. Medicalisation also has the potential to lend credibility to less socially acceptable illnesses; medical sanctioning of trauma, autism and chronic fatigue for example has been argued to in some cases improve quality of life. Regarding harmful effects, medicalisation can be used as a form of social control, and the diagnosis of various disorders such as female infertility or schizophrenia typically result in social stigma.
Individualism
Individualism in medicalisation states that as diseases are in individuals, individual solutions are required for treatment. In one description from 1994, "the body-centered, body-limited medical model has been and remains today the defining paradigm for our professional and philosophical conceptions of health". Individualism is practised extensively in biomedicine and psychiatry, and this has been articulated as an obstacle to activism for sexual rights.
Naturalism
Naturalism, closely related to evolutionary psychology, posits that human health, and sexuality more specifically, is a "transhistorical product of mammalian evolution" and that this lends significant uniformities across the sexualities of different species. Some initial research of sexuality in the 1920s studied animals intentionally to avoid ridicule by discussing human sexuality in public discourse, but most research related to naturalism applied to human sexuality occurred in the 1980s.
Derivative terms The term biomedicalisation was proposed in 2010 to describe a significant change in medicalisation in the United States focussed on using technology to identify and surveil health risks in individuals and populations. The term neomedicalization was also proposed independently in 2010 to describe corporate efforts to commercialise health risks for disease as a market for new drugs and technologies that purport to help manage these risks. The original authors of the theory argue that this strategy by pharmaceutical companies is reflective of neoliberalism as a political ideology, emphasising individualism and surveillance, especially self-surveillance through the use of marketed products.
The term sexuopharmaceuticals has been used to describe the category of medicalised pharmaceutical products for sexual disorders such as Viagra. The term sexuomedicine has also been used as an alternative term to refer to the medicalisation of sexuality as a field in itself.
History
18th and 19th centuries The tradition of representing illness as a punishment for sin has existed in Western culture since at least the Age of Enlightenment in the 18th century. The late 18th century marked the first attempts at artificial insemination of women using syringes, along with newly developed cultural views which undermined the value of female sexual pleasure as it was believed unnecessary in procreation.
In the 19th century this concept of illness as punishment for sin was medicalised into associating so-called perverted sexual traits and behaviors, such as masturbation, with increased morbidity. This was described by a symptom called spermatorrhoea invented by William Acton in 1857, at the time used as a medical justification of celibacy. Spermatorrhoea was later sub-classified into other symptom clusters based partially on how it affected semen. Treatment for spermatorrhoea at the time included catheterisation, cauterisation, circumcision, and sticking needles through the perineum into the prostate. In the 19th and early 20th centuries, the cultural stigma towards researching sexuality drove its unpopularity among doctors and in publications. The first recognition the symptoms described in spermatorrhoea as a disorder in itself is believed to be in 1883, termed ejaculatio praecox.
Other researchers of sexuality in the 19th and early 20th centuries included Havelock Ellis, Edward Carpenter, Marie Stopes and Alfred Kinsey, of which only Ellis had medical qualifications. In the 1920s and 30s, significant research was done into unsuccessfully finding physical causes of sexual dysfunction.
20th century
The origin of the modern version of ejaculatio praecox, called premature ejaculation, is thought to have begun with Alfred Adler before major developments of psychoanalytic theory. Similar to spermatorrhoea, Adler strongly advocated celibacy for women as he thought this would improve sexual satisfaction for women during penetrative sex, a theory later found to be fictitious.
Through the mid-20th century, Sigmund Freud published widely accepted and virtually unchallenged theories that penetrative sex was the only right way to achieve female orgasm, and that a man's erection was essential to female orgasm. This so-called coital imperative has later been argued as a medically recognised disorder that did not actually serve the satisfaction of women but rather contributed to the pressure on and pathologisation of men in obtaining a so-called optimal time to ejaculation.
The first major publication articulating a broad medicalisation of sexuality was the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-1). Published in 1952, it reframed behaviors previously viewed as immoral, such as masturbation, low sexual desire and homosexuality, as treatable; faults of character or morality were instead described as illnesses. Some treatments described in the DSM-1 included commitment to asylums, hormonal treatments, circumcision and castration. A cornerstone in the development of psychiatry, the DSM was highly influential and motivated significant eugenic research in a search for naturalistic, biological causes of sexually deviant behaviors, such as the so-called gay gene. By the 1950s, homosexuality was indisputably classified as a mental disorder in psychiatry. In the early 20th century, medical folklore held that 90-95% of cases of erectile dysfunction were psychological in origin, but around the 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, much like the 1920s and 30s. Physical causes as explanations continue to dominate literature when compared with psychological explanations . Treatments in the 80s for erectile dysfunction included penile implants and intracavernosal injections.
Male impotence, similar in meaning to the modern term of erectile dysfunction, was initially advanced by the discovery of papaverine in the 1980s by urologist Ronald Virag. Although referring to the same symptoms, impotence was considered to have psychogenic causes, whereas erectile dysfunction was considered to have organic causes. The use of medicalised diagnosis criteria also allows clinicians to inflate prevalence by using survey results and/or measuring the frequency of low severity cases; in one controversial case, a 1999 report claimed that 43% of all women have a sexual disorder. The use of the biopsychosocial model and 'weak sciences' like social science to explain human behavior lost significant popularity in 1960s and 1970s against 'hard sciences' like biomedicine, which can be attributed to a combination of deregulation and market factors pressuring economic growth in the political climate of the United States at the time.
Viagra
Academic consensus is that the main pharmaceutical product contributing to medicalisation of sexuality was sildenafil sold by Pfizer under the trade name Viagra approved in 1998, the first phosphodiesterase-5 inhibitor (see phosphodiesterase inhibitor) which became an instant bestseller for treating erectile dysfunction and largely replaced selective serotonin reuptake inhibitor (SSRI) treatments for sexual disorders. It was reportedly the fastest selling drug in history, outselling the most common pharmaceutical at the time, the SSRI fluexetine sold under the trade name Prozac. The economic success of Viagra motivated research for similar products. Public funding for sex research was decreasing during the 1990s and 2000s when corporate funding shifted the focus from nonmedical sexology and sex therapy research, to clinical trials and emphasising the concept of sexual dysfunction under a simplified epidemiological model. Viagra and other products for sexual dysfunction, termed sexuopharmaceuticals, proliferated new types of specialised marketing for such products based on neoliberal rhetoric framing viewers as "responsible informed, aspirational sexual subjects". Viagra and similar prescription pharmaceuticals were promoted by images in media to the extent of becoming a cultural icon, at the time a relatively new phenomenon known to be permitted only in the United States and New Zealand and which is believed to have significantly contributed to norms regarding male sexuality. One author notes that although the effect of Viagra is only limited to penile blood vessels, advertisements routinely use imagery of couples hugging, smiling and dancing, with the author claiming that pharmaceutical companies were deceptive in the use of such advertisements.