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Natural hormone balance for women
- Joyce D Friesen (22 January 2005)
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Disease marketing and doping
- Anthony Papagiannis (23 January 2005)
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Mineral deficiencies lower testosterone levels in diseases and contribute to sexual dysfunction.
- Ellen C G Grant (23 January 2005)
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It is not only Big Pharma that says that female sexual dysfunction exists
- Ketan K Dhatariya (24 January 2005)
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Marketing a disease: even more exploitation of women.
- Alexander SD Spiers (24 January 2005)
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Re: It is not only Big Pharma that says that female sexual dysfunction exists
- Petra M Boynton (25 January 2005)
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Re: Re: It is not only Big Pharma that says that female sexual dysfunction exists
- Ketan K Dhatariya (26 January 2005)
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COITAL ALIGNMENT - The Bleeping Cure for FSD?
- Edward W. Eichel, LHD, MA (27 January 2005)
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Joyce D Friesen, President, Sunlit Pathways Communications 785 Kingfisher Crescent Ottawa ON K1E 2L5
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I encourage all women to reject the myths and artifically created problems around our natural cycles of life in order to sell drugs. Our life cycles are not a disease. I have never used HRT. In reference to your article, I am not saying that female sexual dysfunction does not exist, but to create an advertising campaign to create huge problem for which a new drug will supposedly solve the problem to me is unethical when there are natural solutions to support women through our life cycle. In my opinion, the difficulties surrounding perimenopause, menopause, and post menopause are caused by our lifestyle--stress, toxins, processed and fake foods, pseudoestrogens which block our hormone receptor sites and drugs. I encourage women to look carefully at what you are putting into and on your body, and demand alternative natural solutions to your problems.They do exist. You just need to want to find them. Competing interests: None declared |
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Anthony Papagiannis, Respiratory physician St Luke's Hospital, Thessaloniki, Greece
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I cannot help thinking that if you need a multilayered global marketing campaign, several public relations companies and major advertising firms, and a budget of $100m, according to the data presented by Moynihan [1], to create awareness of an ‘illness’ affecting a major segment of the world population, then all those sufferers must be either comatose or completely daft not to realize their dire predicament. Alternatively, the implications of the disease in question are grossly overemphasized. Surely the promotion of female sexual dysfunction as a disease that must be treated (at a huge profit) cannot be dissociated from the image making business, be it cinema, fashion modeling, or plain commercial advertising. The Western world is deluged daily by pictures, still and moving, of men and women who look, dress, act and behave in a certain way, and can perform physical or sexual feats over and above the average mortal, who suffers from diurnal and seasonal variations in his or her prowess or simply from human frailty and unhappiness. This brainwashing has the effect that anybody whose performance is below par is compelled to feel unwell and in need of a ‘booster’. Anabolic steroids represent such boosters for athletes, and are rightly banned from legitimate use. Should we not view sex steroids in a similar light? 1. Moynihan R. The marketing of a disease: female sexual dysfunction. BMJ 2005;330:192-194. Competing interests: None declared |
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Ellen C G Grant, physicain and medical gynaecologist 20 Coombe Ridings, Kingston-upon-Thames, KT2 7JU,UK
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The rejection of Proctor and Gamble's experimental testosterone patch by advisers to the US Food and Drug Administration in December 2004 was a welcome relief in my 45 year battle against the misuse of hormones, either for contraception or disease “treatments”.1,2 Ray Moynihan points out that testosterone use is being actively promoted in spite to the proven unacceptable increased risks with HRT. The masculinising effects of contraceptive Pill androgenic progestogens, which included migraine, hirsuitism, weight gain, acne, hypertension and even violent aggression, were easily observable in the 1960s. An irony is that the main cause of sexual dysfunction in young women is low dose oestrogen progesterone-dominant oral contraceptives which dry up secretions, increase monoamine oxidase activities and cause loss of libido and depression.3 Apart from obvious financial gain, some of the impetus to prescribe testosterone or progesterone as HRT, in health and several diseases, is due to misinterpretations of research results. Significantly lower levels of testosterone and progesterone were recently found in the follicular phase of normal ovulatory cycles in women with multiple sclerosis.3 Women with post-Pill amenorrhoea and anovulatory cycles usually have severe mineral deficiencies and ovulation can be restored with patience and verified nutritional supplementation, in my experience. This suggests that nutritional deficiencies may impede testosterone production first before ovulation and luteal progesterone production become impeded later. Okun and colleagues have also found lower serum testosterone levels in patients with Alzheimer and Parkinson diseases.4 A knee-jerk reaction is to prescribe testosterone in the same way as HRT has been given to “treat” menopausal physiological falls in oestrogen and progesterone production. This approach fails to consider the real reasons for impairments in hormone production which are essential nutrient deficiencies. Underlying severe deficiencies of zinc, magnesium and often of copper are being found in recent studies of patients suffering from numerous conditions including multiple sclerosis, Alzheimer and Parkinson diseases.5,6 These common deficiencies also tend to intensify with ageing but can be easily and safely corrected if supplementation is monitored by mineral analyses. The reality is that adding extra exogenous sex hormones to patients who already have severe essential nutritional deficiencies will further compromise failing systems and exacerbate the underlying mineral deficiencies and imbalances. The WHI and MWS studies of the effects of HRT were prematurely terminated because of unacceptable increases in vascular diseases and cancers which are the inevitable consequence of fundamental impairments of cellular function. Why is the international medical community taking so long to come to terms with these basic facts of life? Apart from the obvious financial implications, hormone analyses are more readily available than are white blood cell zinc, red blood cell magnesium and red blood cell superoxidase dismutase activity analyses. This situation should be remedied as quickly as is possible. 1 Moynihan R. The marketing of a disease: female sexual dysfunction. BMJ 2005;330: 192-194 (22 January), doi:10.1136/bmj.330.7484.192 2 Grant ECG. Testosterone HRT is dangerous. http://bmj.com/cgi/eletters/329/7477/1255#88135, 6 Dec 2004 3 Tomassini V, Onesti E, Mainero C, Giugni E, Paolillo A, Salvetti M, Nicoletti F, Pozzilli C. Sex hormones modulate brain damage in multiple sclerosis: MRI evidence. J Neurol Neurosurg Psychiatry 2005; 76:272-5. 4 Okun MS, DeLong MR, Hanfelt J, Gearing M, Levey A. Plasma testosterone levels in Alzheimer and Parkinson diseases. Neurology. 2004 Feb 10; 62 :411-3. 5 Grant ECG. Damp climates, oestrogens, nutritional deficiencies and multiple sclerosis. http://bmj.com/cgi/eletters/330/7483/120#88738, 12 Dec 2004. 6. Grant ECG. Parkinson's disease and HRT. http://bmj.com/cgi/eletters/329/7458/180#67686, 18 Jul 2004 Competing interests: None declared |
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Ketan K Dhatariya, Consultant Endocrinologist Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital, Norwich, NR4 6PR, UK
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Sir, In the article by Moynihan on whether female sexual dysfunction is a product of a pharmaceutical executives’ fevered imagination or not, he makes the statement that there have been no published peer reviewed articles on testosterone replacement in women. This incorrect, Jan Shifren, who is quoted later in the article, herself had a Proctor and Gamble sponsored trial published in the New England Journal of Medicine (1). Several independent authors have reported the prevalence of some form of sexual dysfunction in women between 18 and 75 years of age in the region of 40 to 45% (2-5). It is difficult to imagine that these authors have all been ‘bought’ by Big Pharma. These studies show, amongst other things, that those who suffer most, are those who have lower androgen levels than those in whom sexual function is reported as ‘normal’ There is, however, broad agreement that there has previously been inherent difficulty in establishing the ‘normal’ range for free and bioavailable testosterone in women, because it is only recently that the ultrasensitive assays have become available. Many of the assays used previously have not been able to detect any circulating testosterone in women. Thus, much of the initial data used to create the ‘normal range’ may not have taken this into account, and so it is highly likely that many of the women used to establish ‘normal’ values had some form of sexual dysfunction, with a large proportion having low testosterone levels. This, however, would underestimate the true prevalence of this condition. 1. Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N.Eng.J.Med. 2000;343:682-8. 2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States prevalence and predictors. JAMA 1999;281:537-44. 3. Nazareth I, Boynton P, King M. Problems with sexual function in people attending London general practitioners: cross sectional study. BMJ 2003;327:423-8. 4. Guay AT,.Jacobson J. Decreased free testosterone and dehydroepiandrosterone-sulfate (DHEA-S) levels in women with decreased libido. J.Sex Marital Ther. 2002;28:129-42. 5. Mercer CH, Fenton KA, Johnson AM, Wellings K, Macdowall W, McManus S et al. Sexual function problems and help seeking behaviour in Britain: national probability sample survey. BMJ 2003;327:426-7. Competing interests: My NIH/Mayo Foundation funded research assessed the effects of the adrenal androgen precursor dehydroepiandrosterone on sexual function in hypoadrenal women and healthy elderly women. |
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Alexander SD Spiers, Retired Professor of Medicine Cookham, BERKS SL6 9TR
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Ray Moynihan's article on the marketing of a disease, namely female sexual dysfunction, is a trenchant comment on some unlovely aspects of the pharmaceutical industry. The scientific basis for the existence of the disease is controversial, as is the desirability of "treating" the "disease" with a testosterone patch. This view was endorsed by the advisers to the Food and Drug Administration when they recommended that the patch should not be approved for marketing. Mr. Moynihan feels that women are at risk of being exploited, because they are being encouraged to take a medicine that may be unnecessary and worse, may be harmful. There is nothing new about this. For centuries, women have been exploited for commercial gain, and with great success. Billions of pounds are spent by women each year on cosmetics, perfumes and fashionable clothes. They purchase uncomfortable shoes that imperil the health of their feet. Vast amounts are spent on hair and skin products, encouraged by dubious claims of restoring youthful properties. Dental entrepreneurs offer effective but very expensive measures to beautify the teeth. In the search for perpetual youth, collagen is injected into lips and botulinus toxin into facial muscles. Tattooing and body piercing are expensive, insanitary and deforming assaults on the human frame. The beauty industry promotes the desirability - or the necessity - of possessing a perfect figure: hence innumerable questionable diets and ever more ingenious plastic surgery are promoted and huge profits are made. If diets, cosmetics, hair shampoos and nonmedical dermatological products were subjected to strict regulation, and scientifically acceptable proof of efficacy was demanded, many such products would disappear from the market and the exploitation of women would be drastically reduced. Competing interests: None declared |
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Petra M Boynton, Non clinical lecturer in international health care research University College London
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Ketan may wish to re-read some of the papers cited in his letter. Many researchers assessing sexual functioning are concerned about the way in which female sexual dysfunction is being constructed. Measuring dysfunction doesn't mean that researchers don't have concerns about how female sexual dysfunction is being overmedicalised, at the expense of social and cultural factors affecting men and women. Estimates that women's sexual dysfunction levels are in the region of 40% have also been criticised, given women may report what a questionnaire study defines as a 'dysfunction', but they don't report being unhappy with their relationships. In our paper (Nazareth, Boynton and King) which Ketan sites, we said: "Much less is known about sexual difficulties in women, and criticism has recently been expressed about the involvement of the pharmaceutical industry in "building the science of female sexual dysfunction."20 Although the results of a British population study of women accord with our findings,21 a woman centred definition of sexual problems has recently been preferred to concepts of sickness and health.19 20 The word dysfunction implies a state of "disease" that needs rectification. Our data indicate, however, that sexual dysfunction cannot be considered as one generic problem. Dyspareunia, vaginismus, reduced arousal, and aversion to sexual contact were uncommon problems and were associated with other psychological and physical difficulties. Women with these ICD-10 diagnoses were also much more likely to have consulted their general practitioners about sexual matters than women who received a single diagnosis of lack or loss of sexual desire. This suggests that many people do not regard lack or loss of sexual desire as a serious difficulty". Overmedicalising women's sexual functioning, ignoring other factors, and specifically quoting high levels of female sexual dysfunction out of context, is not helping women, or their partners. Competing interests: I have completed research on sexual functioning. |
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Ketan K Dhatariya, Consultant Endocrinologist Norfolk and Norwich University Hospital, Norwich, NR4 6PR
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I thank Petra Boynton for her comments. I agree that there are difficulties in defining sexual dysfunction, and there is a great danger in medicalising a condition for which many women seek no help, and which they perceive as being 'normal for them'. However, there is a cohort of individuals who do feel the need to seek medical help, such as resulting from another medical problem that leads to sexual difficulties. In this population, when testosterone levels are found to be low, then a trial of testosterone may be warranted. It is certainly not everyone who has a low testosterone, nor for everyone who complains of sexual dysfunction. Thus, as with every drug prescribed, it should be the discretion of the prescribing physician to decided if the change in sexual function that the patient describes, along with the condition that may have caused the change in androgen levels and thus the change in sexual function. Competing interests: None declared |
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Edward W. Eichel, LHD, MA, Psychotherapist, sex researcher Marriage Science, Inc. 463 West Street (A-1106), New York, New York 10014, U.S.A.
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The discovery of the coital alignment technique (CAT), termed "the new intercourse" in the media [1], may reflect an evolutionary step - a change in sexual relating that fosters simultaneous orgasm. The CAT and related breakthroughs in sex research are providing an understanding of the nature of the sex act that is relevant to ethical issues posed in the BMJ article "The marketing of a disease: female sexual dysfunction" [2]. Most importantly, the three classic problems of sexual "dysfunction" have been redefined as interdependent parts of ONE behavioral syndrome - the problems are NOT "diseases"; secondly, men and women play a mutual role in each other's sex problems. The "cure" is a fundamental change in sexual technique that is challenging emotionally because it transcends archetypal gender tendencies; there is greater empathy. PREMATURE EJACULATION (PE) - the man climaxes too quickly Relevant to the timing of sexual response, every man knows that the quicker he moves his hand in masturbation the quicker he reaches orgasm. That scenario logically parallels his experience with intercourse. During typical intercourse in the "missionary" position, a man is dependent on friction from the speed of his "in and out" thrusting to keep his erection. With heightened sensation at the approach of orgasm, he automatically starts moving faster and harder -- that archetypal tendency greatly accelerates his climax. Hence, "premature ejaculation" is a direct result of the man's hyperactivity during coitus -- there is no mysterious disease at work. The male problem baffled the late Alfred C. Kinsey as evident in his 1948 report on Male Sexual Behavior [3]: "It would be difficult to find another situation in which an individual who was quick and intense in his responses was labeled anything but superior, and that in most instances is exactly what the rapidly ejaculating male probably is, however inconvenient and unfortunate his qualities may be from the standpoint of his wife in the relationship" (p. 580). FEMALE COITAL ANORGASMIA - failure of woman to climax from coitus. In his 1953 Female report (1953) [4], Kinsey did a turnabout. He stated, "There is a widespread opinion that the female is slower than the male in her sexual responses, but the masturbatory data do not support that opinion. Kinsey concluded, "It is true that the average female responds more slowly than the average male in coitus, but this seems to be due to the ineffectiveness of the usual coital techniques" (p. 164). In typical intercourse, the faster and harder thrusting of the man at the approach of orgasm CUTS OFF the orgasmic buildup of the woman -- It would be physically painful for her to move as the man's movements becomes more aggressive. The woman tends to adjust to the man as best she can, often slowing or stopping any movement of her own. Hence, partners have a mutual role in a scenario that makes it a PHYSICAL impossibility for the woman to reach orgasm in coitus. (It'simple, one minus one doesn't equal two.) The woman's failure to climax is rarely, if ever, caused by a physical "disease" or a mental disorder (like so-called "frigidity"). HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) - lack of sexual desire and arousal It is logical that a long-term pattern of intercourse that does not lead to complete and mutual sexual satisfaction for a man and woman would eventually result in a loss of sexual desire. Recent media attention to the problem of "sexless marriages" may reflect the fact that failed intercourse can condition the woman (and also the man) creating apathy about sexual relating. That conditioning process can also cause "impotence" in the man, and "arousal" problems for the woman. THE COITAL ALIGNMENT TECHNIQUE The original CAT study [5] reported significantly high frequency of female orgasm, as well as regularity of simultaneous orgasm. Controlled replication studies reported effective treatment of Hypoactive Sexual Desire [6]. The CAT research supports the premise of a natural anatomic design for coital orgasm that is dependent on a specific interplay of the male and female genitalia -- IN MOTION. That kind of model was called for by pioneer sexologist R.L. Dickinson, the author of Human Sex Anatomy (1949) [7]. The CAT technique involves a basic position and a coordinated form of sexual movement: (A) The basic position was referred to by Dickinson as the "riding high" position in which the man is up forward along the woman with his pelvis high up on hers; the base of his penis is bowed over the woman's public bone pressing against her upper vulva stimulating her clitoris (and urethral meatus). (B) Secondly, a specifically coordinated pattern of sexual movement must be maintained continuously. The woman leads the upward stroke with the man providing a slight counter-pressure. The man leads the downward stroke with the woman providing a slight counter-pressure. In the CAT training, couples were instructed to think of orgasm as the build-up of a "bio-electric" charge (as theorized by Freud [8] and his disciple Wilhelm Reich [9]); they were told to let the orgasm charge overtake them without disrupting the pace and pattern of their movement. Pioneer sex therapists Masters & Johnson [10] experimented with the "male pelvic-override" position; predictably, it failed because the subjects did not coordinate their sexual movement sensitively (p 60). The man's heavy thrusting at orgasm caused the woman pain. That kind of pain from the man's, uncoordinated thrusting has been termed "dyspareunia," yet another mysterious "disease". THE PROSTATE (MALE AND FEMALE) - a primary erogenous zone A video [11] was previewed at the 15th Congress of the World Association for Sexology (Paris, 2001) that documented the CAT model in real-time and synthesized researches relavent to the CAT model: The sensory arm of the female prostate has been identified by the histologic research of Milan Zaviacic [12, 13] as being at the urethral meatus, correcting the "G-spot" researchers' assumption that it was located behind the woman's pubic bone where it could not be stimulated directly by the male penis during intercourse. Zaviacic's finding affirmed that CAT provides simultaneous stimulation of both primary female erogenous zones - (a) the clitoris and (b) the female prostate, polar zones for a complete "blended" orgasm. Richard J. Ablin, whose discovery of the PSA is the basis for the standard prostate cancer test, has revealed that male spermatozoa deposited in orifices other than the vagina can be carcinogenic (as in anal intercourse) [14]. Studies by clinical psychologist Stuart Brody [15] have substantiated the premise that intercourse is unique and effects many aspects of physical and mental health; Brody has stressed that masturbation exercises do not help couples to succeed with intercourse. In conclusion, there is a form to the sex act that has a unique chemistry; as Freud concluded -- it is "imperative" that the sex act be a regular and complete experience. WHOSE AFRAID OF THE BIG BAD CAT? The CAT model provides a fundamental matrix for the analysis of classic sex problems and other subtle, but widespread, sex-related health problems. Unfortunately, the lack of sexual fulfillment and confusion about sex allows for much exploitation. There is no pill that will correct the sexual positioning of partners or teach them to coordinate their sexual movement. The CAT is quietly becoming a standard of the sex therapist's regimen, internationally. But, those therapists adopting the CAT may be fearful that they will be black-listed if they adopt and openly acknowledge a natural cure for sex problems that largely obliterates the need for drugs. (It is important to be mindful that FSD symptoms have often been the side effects of pharmaceutical products.) Historically, drugs have helped save the world from lethal pandemic diseases. It would be tragic if Big Pharma becomes the CAUSE of the most universal health problems in our time. References 1. Nobile P. The new intercourse. Cosmopolitan 1991;211(no 3). 2. Moynihan R. The marketing of a disease: female sexual dysfunction. BMJ 2005; 330 (7484):192-194. 3. Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the human male. Philadelphia: WB Saunders, 1948. 4. Kinsey AC, Pomeroy WB, Martin CE, Gebhard PH. Sexual behavior in the human female. Philadelphia: WB Saunders, 1953. 5. Eichel EW, Eichel JD, Kule S. The technique of coital alignment and its relation to female orgasmic response and simultaneous orgasm. J Sex Marital Therapy 1988; 14:129-141. 6. Pierce AP. The coital alignment technique (CAT): An overview of studies. J Sex Marital Therapy 2000; 26:257-268. 7. Dickinson RL. Human sex anatomy (2nd Ed). Baltimore: Williams & Wilkins, 1949. 8. Freud S. The justification for detaching from neurasthenia a particular syndrome: The anxiety neurosis. Collected papers. London: Hogarth Press 1894/1950; 1:97-98. 9. Reich W. (Trans. Wolf TP). The function of the orgasm. New York: Farrar, Strauss & Giroux, 1942. 10. Masters WH, Johnson VE. Human sexual response. Boston: Little Brown, 1966. 11. Eichel EW. Orgasm the natural way: The coital alignment technique, 2001: Vers 1.0. 12. Zaviacic M. The human female prostate (English text). Slovak Academic Press, 1999. 13. Zaviacic M, Zajickova M, Blazekoya J, Donarova L, Stvrtina S, Mikulecky M, Zaviacic T, Holoman K, Breza J. Weight, size, macroanatomy, and histology of the normal prostate in the adult human female: A minireview. J Histotechnology 2000; 23(1):61-69. 14. Ablin RJ, Stein-Werblowsky R. Sexual behavior and increased anal cancer. Immunology and Cell Biology 1997; 75:181-183. 15. Brody S. Concordance between women's physiological and subjective sexual arousal is associated with consistency of orgasm during intercourse but not other sexual behavior. J Sex & Marital Therapy 2003; 29:15-23. Competing interests: Producer of educational video: Orgasm the Natural Way - The Coital Alignment Technique (2002) vers. 1.1 |
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