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Sexual interest disorder

The Sunday Times

Love sickness

As her slides sped by, many of her mostly male audience talked among themselves, fired off text messages or fiddled with drug company gifts. After an afternoon session on phosphodiesterase (PDE-5) inhibitors, which sent a hundred fingers tickling free Viagra computer mice, Basson's lecture on the finer points of female motivation failed to trigger a mexican wave in the Palais des Congrés. There was still no pill for an ugly spouse that, if prescribed, wouldn't send you to jail.

But her model was a centrepiece for the Paris event's sponsors: there's gold in that feedback loop. With men's treatable concerns mostly confined to (a) penis hardness, or (b) penis hardness, drug companies are sure how to keep consumers happy. The benchmark of success is conspicuous. But if women are more subtle and their concerns less clear, then industry needs to know PDQ.

Enter the disease she unveiled from the lectern: the previously unheard-of sexual interest disorder. "There are absent or diminished feelings of sexual interest or desire, absent sexual thoughts or fantasies and a lack of responsive desire," was how her committee's report described the problem. "Motivations (here defined as reasons/incentives) for attempting to become sexually aroused are scarce or absent."

More dry words, but do they mean or change anything? You can bet your underwear they do. Describing disorders is like sizing goal mouths: allowing the guys with the tape measures and spirit levels a say in what reaches the net. "Diseases are not just out there in nature," says Dr Richard Smith, editor of the British Medical Journal (BMJ), who questions the very existence of many industry-backed dysfunctions. "They are creations in many ways, and where you draw the boundaries, and what you define as a disease, is a very tricky business indeed."

The boundaries Basson challenges are some of medicine's most authoritative, thrashed out over decades of debate. Currently, the consensus-setting Manual of Mental Disorders, issued by the American Psychiatric Association - which in turn feeds into the World Health Organization's (WHO's) International Classification of Diseases - recognises a condition called "hypoactive sexual desire disorder", described as "a deficiency or absence of sexual fantasies and desire for sexual activity".

This might sound similar to what she's suggesting, but, as so often, the devil is in the detail. The concept of "interest" is plainly bigger than "desire", so already we get dysfunction inflation. But even widening the net with a broader definition is only the start of the reconstruction she seeks. At present, the psychiatric association has an essential requirement to diagnose a disorder: "marked distress or interpersonal difficulty". And the WHO includes a crucial prerequisite that for a person to have a problem they must be "unable to participate in a sexual relationship as he or she would wish".

But these criteria will be dumped if the plans unveiled in Paris gain a foothold in official classifications. In place of the requirement that a patient must complain of a problem, Basson wants to substitute "descriptors", including a "scale of distress" which, according to her committee, includes "none".

"So," I debate her on the phone from London before catching my flight to Canada. "You are saying that women can have this sexual interest disorder even if they don't feel they have a problem themselves?"

"Yes," she says. "It's a bit like saying a man can't ejaculate. Now, he's not trying to be a father. He doesn't care. He enjoys everything he does - the arousal and intercourse - if he wants to. He just doesn't ejaculate, and he doesn't mind. Does he have a disorder or not?"

Ouch. "I'd say he probably did."

"Why?" she hits back. "If it doesn't bother him?"

"For the same reason you could have a broken leg and not be concerned," I joke.

"I agree with you on both of them," she says. "You've still got a disorder. I think the man's got a disorder. And it's reasonable to say the woman's got a disorder, even though it doesn't bug her. Because it's a kind of assumption that most women have an interest in sex."

Hey presto, the numbers with a disorder hit the ceiling like a guy with no problem at all. Although research published in June from the world-famous Kinsey Institute in Indiana suggests that only 7.2% of women complain of this problem, according to a stream of papers recently pumped into the medical literature, the number of women who say they "lack interest in sex" is between one third and 40%.

Here's a vision of a market to restore vigorous appetite to the most dysfunctional pharmaceutical boss.

*****

Sexual interest disorder
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