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Sexual interest disorder

The Sunday Times

Love sickness

The Sunday Times Magazine, September 28 2003.

By Brian Deer

Nine years before she would announce the discovery of a new disease, Dr Rosemary Basson, consultant in the Centre for Sexual Medicine at Vancouver General Hospital, Canada, got a phone call from a medical research company working for the New York-based drug giant Pfizer. Would her clinic be interested in joining a trial of Viagra, the now-famous penis-stiffening blue pill?

Today, sitting at a grey steel desk in her 9-by-12ft white-painted office, she smiles, recalling the ignorance of the caller: he didn't know "generalised" from "situational" dysfunction. But she accepted his offer, which brought a tidy wad of dough that would strengthen her department's work. The British-born Basson was at the time nudging towards her fifties, and struggling to advance understanding of vaginismus, an anxiety complaint in which a woman seems to tighten in reflex opposition to penetration.

She was no great researcher. Her love was clinical medicine: hands-on caring for patients. Taking referrals from throughout the province of British Columbia, she saw only the most intractable sexual problems that had defeated family doctors or smaller hospitals. Of her caseload, 60% were women, mostly complaining of the pain condition dyspareunia, with men presenting with erection problems or difficulties with ejaculation.

With a demeanour that reminds me of an English sitcom actress, Basson had published nothing in medical journals before the Viagra call came through. And although she holds a professorship in the University of British Columbia's psychiatry and gynaecology departments, records show that in the year before Viagra's launch in 1998, three projects she hoped to undertake went unfunded due to lack of wider interest.

But the landscape changed in the blue pill era as profits from the penis poured in. Although by no means Pfizer's most popular line (grossing only a quarter of Lipitor, the world's No 1 prescription drug), Viagra brought the company windfall revenues: currently $2 billion a year. And with the launch of "me too" competitors - such as Cialis from Eli Lilly, and Levitra from Bayer and GlaxoSmithKline - the Cinderella speciality of sexual medicine was suddenly dressed for the ball.

These days, Basson snags sponsorship deals like a sports star spotted by Nike. Pfizer commissioned her to look at the effects of Viagra in women with sexual arousal difficulties. Then came finance from Lilly to psychologically profile patients. More Pfizer work followed on women's orgasm problems, then "questionnaire validation" for Procter & Gamble. Currently, she is testing a new oestrogen receptor blocker for her longtime companions at Pfizer.

Nourished by funding, she blossomed with ideas that have now lifted her to guru status. Mostly promoting what she calls a "new model" of female sexuality, her journal publications jumped from a single paper indexed by the Medline database for 1999, to three for 2000, six for 2001 and seven for 2002. She wins finance to lead panels and to attend international conferences concerned with "female sexual dysfunction". And she's currently co-authoring a global textbook that will be translated into half a dozen languages.

Having scaled this platform, what she says from it is startling, "It's as big as [the feminist sexologist] Shere Hite," she claims. Arguing that healthy women in established relationships may experience "interest" but rarely "desire" before sex with their partners, she goes on to claim that many of those who don't may be suffering from a mental illness. Out goes passion as motivation for lovemaking, and in comes a diagnosis for a medical condition that she compares to a broken leg or appendicitis.

With industry-funded colleagues, she has suggested, astonishingly, that one third of all women may suffer from this condition - this "sexual interest disorder", as she calls it. "If they truly have no interest in sex, yes, you could say they have a disorder," she tells me on the phone, setting me scrabbling for a flight to Vancouver. "It's a disorder because it's out of line with the expected situation, and the range that seems to be normal."

Can this be right? Now is the time to find out. Rosemary Basson is the new Queen of Desire. Even as we spoke, her ideas were being prepared for a sexual dysfunction brochure to be pounded out for doctors around the world. Footnotes to her textbook will cascade through the literature, giving the impression of a new-found consensus. And in a softly-softly move, official disease definitions are being targeted for wholesale revision.

But is she using industry help to understand women? Or do those who pay the piper call the tunes? Is a well of unfulfilment at last being recognised, or is modern life being fashioned into a disease? At a time when "big pharma" is hunting sex-related products that could dwarf Viagra's sales, is Dr Basson's recent rise a sign of social maturity, or of foundations being laid for new drugs?

"Why has she been anointed? That's a good question," Dr Leonore Tiefer, a New York clinical psychologist and author of A New View of Women's Sexual Problems, told me before I flew to the beautiful Canadian west coast city squeezed between mountains, sea and the US border. "I've been to all the relevant sexological meetings since before you were born, and she wasn't at any of them."

*****

Well, she has been at some - at least in recent years. I saw her in Paris in July. Basson had flown in at industry expense as vice-chair of the Second International Consultation on Erectile and Sexual Dysfunctions - which, although almost entirely financed by at least seven drug companies, brought a thousand doctors and scientists from all over the world to the vast Palais des Congrés, west of the Arc de Triomphe.

Claiming to be "transforming data into knowledge and knowledge into action", the £1m conference's aims, like a similar meeting four years ago, were to hammer out definitions of sexual dysfunctions; to agree means of measuring them in both men and women; and to create benchmarks for trials of new products. The visual landscape was dominated by motor-show-sized stands for Pfizer, Lilly, Bayer and GlaxoSmithKline.

Into this event she strode, in a sleeveless cocktail dress, to unveil her new model and disorder. Presenting the findings of a powerful international committee she chairs, which has met over the past two years to rule on definitions of female problems, she stood at a lectern and rattled through blue slides as if reporting from some frontier of knowledge.

Her model, in a nutshell, rejects conventional wisdom about what makes women want sex. Whether from the austere teachings of 1960s sexologists, such as William Masters and Virginia Johnson, or from headline-grabbing feminists such as Shere Hite in the 1970s, Basson fears we've got the message that women's responses are like men's - or, if they're not, then they ought to catch up.

Au contraire, she argues. Women are different. But not in the way feminists suggest. While men may be prisoners to testosterone-driven urges, trying to mate with what moves and pull the ring on what doesn't, Basson thinks women mull precoital calculations enough to double their cellphone bills.

"When a woman senses a potential opportunity to be sexual with her partner," she explained in a recent article in the Journal of Sex and Marital Therapy, "although she may not 'need' to experience arousal and resolution for her own sexual wellbeing, she is motivated to deliberately do whatever is necessary to facilitate a sexual interaction as she expects potential benefits that, though not strictly sexual, are very important."

To me, this sounds sneaky, but she shows us a slide: a reinforcing feedback loop of sexual interest. Starting with "One or more reasons for sexual activity; not currently aware of sexual desire", Basson takes her audience clockwise around a diagram that she says maps the sexual encounter. "Willingness to be receptive," the cycle continues, then "subjective arousal", "more intense arousal and responsive desire", "emotional and physical satisfaction". And, at cigarette time, "positive influence on motivation".

In less than bonkbuster language, she elaborates on this process with an erection-killing description if ever there was one. "The increased emotional closeness, bonding, commitment, tolerance of each other's imperfections, and expectation of increased wellbeing of the partner all serve as highly valid motivational factors that activate the cycle."

There's a sidebar to all this about "information processing", but "need a hard shag" is nowhere on the screen and even "orgasm" has dropped off the map. As she elaborated in the International Journal of Obstetrics and Gynaecology last year: "In this cycle, departing from the traditional one... [physical] arousal is experienced before desire, and orgasm is not mandatory for a normal response."

As a gay man, I luxuriate in the ninth row of the conference hall feeling eerily untroubled by all this. But Basson is proposing a concept that, should her campaign succeed, could transform medical involvement in sex. "I have presented a model that more accurately depicts the responsive component of women's desire and the underlying motivational forces," she wrote in 2000. "The purpose is to prevent diagnosing dysfunction when the response is different from the traditional human sex-response cycle, and to define subgroups of dysfunction. The latter is necessary before progress in newer treatment modalities, including pharmacological, can be made."

*****

Sexual interest disorder
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