The sex doctors will see you now

Sexual medicine as a subspecialty
In addition to treating patients at Alvarado, Goldstein hopes to beef up the training hours medical students get in sexual medicine and to draw upon academic experts there. Ultimately, Goldstein wants the American Medical Association to recognize sexual medicine as a certifiable subspecialty such as family medicine or sports medicine.

That’s already happened in Europe, where the European Academy of Sexual Medicine recently began issuing recognized accreditation, a development Goldstein calls “a huge breakthrough for our field.”

Goldstein’s view that different medical specialties should work together has been boosted recently by the evidence that erectile dysfunction in men is often a sign of blooming cardiovascular disease.

Patients coming to Goldstein’s clinic would first see a psychologist or sex therapist who will take a complete psychosocial, medical and sexual history. Then the patient will be examined by the appropriate professionals and any indicated tests conducted. Goldstein hopes to include sexual partners whenever possible because, he argues, “sex is about partners. It is about couples.” Finally any treatments, whether surgery, drugs, physical therapy or psychological counseling, will commence and patients educated about necessary lifestyle changes.

Real problem or disease mongering?
New York University psychologist Leonore Tiefer, among others, has been a longtime critic of such interventions. She believes, as the title of her 2005 article states, that “dyspareunia [pain with intercourse] is the only valid sexual dysfunction and certainly the only important one.” Tiefer has argued that orgasms and desire aren’t very important and that “the creation and promotion of female sexual dysfunction (FSD) is a textbook case of disease mongering by the pharmaceutical industry and by other agents of medicalization.”

We have been deluded into wanting more and better sexual experiences, she says. “People fed a myth that sex is ‘natural’ — that is, a matter of automatic and unlearned biological function — at the same time as they expect high levels of performance and enduring pleasure, are likely to look for simple solutions. This sets the stage for disease mongering, a process that encourages the conversion of socially created anxiety into medical diagnoses suitable for pharmacological treatment.”

Sloan Kettering’s Mulhall vehemently disagrees.

Sexual medicine clinics like the ones Goldstein envisions “are absolutely necessary,” he says. “If a 75-year-old man can’t have an erection and wants one, or a sexually active 75-year-old woman wants to be sexually active but has no vaginal lubrication, why are we not treating them?”

Mulhall’s comment reminds me of a conference I attended at which Tiefer spoke. She discussed the medicalization of menopause and decried the efforts to “cure” it, saying that an absence of desire could be a very good thing, natural and not to be regretted.

After her talk, a middle-aged woman tentatively raised her hand, drew it back down and then raised it again with great determination. When the moderator called on her, the woman stood up and said, “But I liked sex!”

MSNBC.com columnist and Glamour magazine contributing editor Brian Alexander’s book, “America Unzipped: In Search of Sex and Satisfaction,” will be published Jan. 15 by Crown/Harmony Books.

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