Celebrating a Special Freedom on July 4
Today, Independence Day, let's take a moment to celebrate one of our culture's most basic freedoms: the freedom of unrelated men and women to mix in public spaces, virtually without limits.
Since most Americans are brought up with this as a fact of life, it's hard to remember that this is a very modern, very limited social experiment. Less than two centuries ago, unstructured male-female adult interactions were still very, very rare almost anywhere on Earth. America and Western Europe had some choreographed male-female interaction in the upper classes, and city life required a small amount for some workers and homemakers during the week. Things really started to change in America leading up to World War I. Asia only began to change dramatically about 40 years ago.
Historically, gender segregation has applied--and still applies, in many places--to all important activities, such as commerce, recreation, transportation, and eating.
Traditional societies separate men and women for eating. At a wedding feast I attended in the mountains of Azerbaijan last year (wow, do I love saying that!), the men and women ate in separate rooms, talking and laughing on colorful old cushions. There was simply no reason to mix. It being an enlightened tribe, the men and women ate the same food--prepared jointly, served quite separately.
The idea of mixed-gender relaxation is unknown in many parts of the world. In most of India, unrelated men and women don't go to the beach or park together without a chaperone. In places like Iran, women have to wear veils or headscarves if they're allowed to play soccer or basketball, and men do not attend these matches.
The old joke about 19th-century Lutherans (or pick your favorite denomination) prohibiting sex standing up because some voyeur might think the couple was dancing describes how mixed-gender dancing itself has often been viewed with suspicion. Orthodox Jews never do it, not even with their own wives. Neither do conservative or fundamentalist Muslims, or traditional Africans or Chinese.
In contrast, here in America unmarried, unrelated men and women find themselves close to each other in shops, churches, buses, and elevators. Patients undress for physicians, regardless of their respective genders; in tribal Pakistan or rural China, a woman would rather die than have a male doctor see her bare legs. Literally.
Aside from the intellectual stimulation and aesthetic variety offered by cross-gender life, it also helps dilute the idea of gender otherness--that if you're male, women are alien, and if you're female, men are alien. It's bad enough to think of "otherness" in terms of, say, race, ethnicity, or sexual orientation. But if you don't marry someone outside your race, ethnicity, or appropriate sexual orientation, this "otherness" is damaging primarily on a social level. When you marry an alien via gender, the "otherness" is part of daily life, and most certainly undermines intimacy and empathy.
Unfortunately, even Americans accept the concept of "the opposite sex," which is a terrible misnomer (I think "the other sex" works just fine). Too many people relate to each other as "men" or "women" rather than as George or Maria. When George doesn't ask for directions when lost it isn't because he's a man, it's because he's a proud jerk. When Maria gossips too much it isn't because she's a woman, it's because she has low-self esteem, or feels unable to express hostility.
If men and women thought of their sexual partners as persons more than as male or female, there'd be less questions about what men or women want in bed, and more questions about what Jose or Jing want. And that would lead to better sex for everyone.
So today, let's celebrate our freedom of association with the other sex. If you're in a mixed-gender sexual relationship, ask your partner a question about what s/he likes or wants in bed. Encourage your children to think of girls and boys as people, more similar than different. And give thanks that, with a few exceptions (such as breast-feeding, topless dancing, sterilization, and alimony), our government doesn't dictate people's behavior (such as their dress) based on their gender.
I'm wrapping up a two-week teaching and vacation trip to Ukraine. The former Soviet republic is west of Russia, east of Poland, south of Belarus, and north of the Black Sea (oil anyone?). It's been a rough neighborhood for some 20 centuries.
For years people have raved about the beautiful Ukrainian women. Sure, whatever.
Well, now I get it. They are beautiful--and not only do they know it, they show it off every minute of every day.
But it's confusing, which is why I'm telling you about it.
This is a country of poverty and powerlessness. There isn't enough money to go around. The food is terrible, the streets are ugly, the cars are dirty, small, and broken. So is the government. The Russian mafia and their friends in Kiev bought everything of value after the Soviet Union collapsed in 1991. Now they run the country exactly like Moscow did, without the subtle charm of communism.
So why is the average young Ukrainian woman dressed like a Park Avenue hooker?
I am not making this up, and I am not just being lecherous (well, not entirely). It's stripper heels, micro-miniskirts, push-up bras, and look-at-me cleavage for everyone under 30. As your observer-on-the-scene I'm not complaining, but in a country where doctors make $500 per month and live in 5-story walk-up apartments, it is striking.
So I've been asking about it: asking professors, cab drivers, translators, cops, waitresses (serving lunch wearing high heels, you understand). And the women themselves. While grocery shopping or waiting at a red light or in a museum ticket queue, I've been asking: why the fancy clothes, makeup and hair--on a dusty Tuesday afternoon? And even a blazing hot Saturday morning?
No matter who I asked, the answers were similar, always in one of three categories:
it's the national style
hoping to marry out
Many people said, with some pride, that this is how Ukrainian women dress. "They (or we) are beautiful, and they (or we) like to show off," said many. So they're flaunting their sexuality? Not exactly, it seems. Surprisingly, many people insist that it's beauty on display, not sex. It's an interesting distinction. And what do people think when they see woman after woman dramatically revealing their breasts, thighs, and butt on an average afternoon? "Not such a big deal," said one cabbie. "All our women are gorgeous." "People like to see it," said one long-legged 20-year-old beauty. "It makes everyone happy."
But this is a dreadful country for anyone with imagination, and so young women (along with young men) are eager to emigrate. There are marriage bureaus in every city, and their clients are the "Ukrainian women who want to meet YOU"--if you're a westerner who can get them a visa out of hell. How do these women feel about marrying someone they barely know, and certainly don't love, just to get a plane ticket out of borscht city? "It's a good deal for everyone," said a short woman in a black cocktail dress several sizes too small. "These men get a beautiful young wife, the girl gets to America or Canada, it's better for everybody."
Until, of course, the women learn that these men aren't loaded with either money or emotional skills--and the men learn that these women expect gift after gift, that they never intended to fall in love, and they very much believe in divorce.
I found the third category the most intriguing: local competition.
I was told over and over that Ukrainian women dressed to kill because there are too many women chasing too few men. Why? The answers reveal plenty about Ukrainian society.
First, many men drink so much that they're uninteresting companions, poor sexual partners, lousy marriage prospects, or violent. Second, many men clearly have poor job and financial futures--they're under-educated, under-motivated, and living through a poor economy. Third, many men are unprepared for women who are now feeling more entitled and more independent.
The result: the few guys who are good catches can be very, very picky. For better or worse, young Ukrainian women are competing for these guys by advertising their, um, beauty. Or sexuality--take your pick.
Taken together, the three theories--national style, desire to emigrate, and local competition--say a lot about this country and this world. Whether a society is communist, capitalist, corrupt, or confused, female sexuality is still a desirable currency. And it's too simplistic to say that women who take advantage of their account are just Natashas with low self-esteem.
The big news in the world of sex is that Flibanserin, the drug that's supposed to increase desire in some pre-menopausal women, has been rejected by the federal Food & Drug Administration (FDA).
A group of activists is taking credit for pointing out the drug's side effects, limited efficacy, and big-ticket marketing campaign. They also criticize the medicalization of female sexuality, accusing drug maker Boehringer-Ingelheim (B-I) of creating a disease where none exists.
Despite clear evidence that the lobbying had no serious impact on the FDA process, these activists are now celebrating, having made the world safe for, um, low desire.
But what's really been accomplished?
* The further public confusion of desire and arousal. People everywhere are referring to "pink Viagra," which is a fundamental error.
Viagra addresses arousal, not desire. Flibanserin addresses desire (albeit imperfectly), not arousal.
* Reinforcing the myth that women's sexuality, especially desire, is more complicated than men's.
No, no, no. Eroticism in adults is complicated, and it insults both genders to suggest that only women have emotions around sexuality. Professionals don't understand why men don't desire women they love any more than we understand why women don't desire men they love.
Most men are not heartless machines eager to screw anything with a heartbeat, any more than most women are frigid creatures who only acquiesce to sex out of duty.
* Denigrating the idea that some women (and their relationships) really do suffer from low sexual desire even when the emotional and relational conditions are supportive.
It's accurate, of course, to say that there isn't a single level of desire that's "normal." But women who experience dramatic drops in their desire know there's something wrong. And isn't it obvious that one definition of "healthy adult" is the experience of sexual desire when the conditions are right?
* Knocking down the straw man that "women's sexuality is so simple it can be fixed with a pill."
C'mon, no one--certainly not the drug company--has suggested this. Flibanserin is proposed for women whose reduced desire can't be explained by a dozen other factors, including well-known desire killers such as ambivalence about the relationship, sexual trauma, and husbands who don't bathe.
* * *
While continually repeating that women's desire is complex (yes, we all received that memo, thanks), the solution proposed by anti-flibanserin activists is both limited and very tired.
1. More conversation among professionals, and between professionals,
policy-makers, and the public;
2. A "comprehensive approach" to (female) sexual distress.
Well, more public conversation about sex is good, especially if it's about the right things (as opposed to, say, deliberate lies about abortion making you sterile or premarital sex making you depressed). But you don't have to be against flibanserin to favor "more conversation." Every competent sexologist has been encouraging, and participating in, such conversations for years.
The suggestion of a "comprehensive approach" as if it's some wonderful and effective new technology is troubling. Western psychologists have known for a century that sexuality is a complex and subtle combination of biological, psychological, and social components. And so all competent therapists use a "comprehensive approach" to sexual issues. And we encourage other therapists to use it as well.
But here's the unfortunate truth of American psychotherapy, marriage counseling, and clinical sexology: this "comprehensive approach" isn't nearly as effective as we or our patients would like. In fact, inhibited desire in both men and women is the sexual issue with which therapists have the least success.
Now I come here not to praise Flibanserin--I know its limitations better than most people. But let's be honest about what's left after its rejection--the same old "comprehensive approach" that doesn't work very well.
Besides, there's something unseemly about activists--self-described feminists, sexual health advocates, whatever--working so hard to prevent a drug from coming to market because its creators might manipulate and confuse possible consumers.
I didn't hear much about this when Viagra was cooking (actually, I wrote one of the few cautionary articles about this back in 1998). I still don't hear much about how Viagra exploits people's over-emphasis on erection as a prerequisite to enjoyable sex. Is that sexism?
And I don't like the idea that we have to protect women from being told by a drug company that their sexuality is problematic. Women--people--are told every day that their sexuality is problematic, by beer commercials, Cosmo magazine, Dr. Phil, and priests.
Millions of women (and their partners) know their lack of sexual desire causes suffering. Whether taking a drug is the best treatment for any woman isn't the point. Dismissing B-I's drug and its marketing as "disease mongering" is terribly disrespectful to the many women who struggle with low desire.
The vociferous righteousness about this drug is terribly reminiscent of the hysteria over other sex-related drugs such as Plan B, RU486, and gardasil. Historically, conservatives have always attacked any technology designed or used to support sexual expression. But getting this resistance from progressives who care about women is new.
So with Flibanserin's defeat, I don't want to hear about the "patriarchal drug companies" who are "willing to develop a drug to help men, but cruelly withhold one from women."
And complaints that the drug would create unrealistic expectations in consumers--doesn't sex therapy do that, too? Most people don't realize we do so poorly enhancing our customers' sexual desire. A typical outcome is that people acquire better communication skills--not more reliable desire.
Fortunately for sex therapists (and the public), no one's trying to prevent the public from getting access to us. Or demanding data on the effectiveness of our treatments. If people saw our numbers, I don't think the public would ever trust us again.
And we cost more than a pill--sometimes with side effects that are just as complicated.
If you want to deprive women and men of their right to an abortion, at least be honest about it.
In Iowa, Planned Parenthood offers an innovative service to facilitate private pharmaceutical abortion. Since most Iowans live far from the state's very few abortion providers, Planned Parenthood is offering telemedicine service. The patient goes to a nurse or other non-provider in her home town, who connects with the physician-provider in a Planned Parenthood office, perhaps 100 or more miles away. The doc asks the usual medical questions, the patient answers, and if she qualifies, the doc OKs the nurse to dispense RU-486. Both the nurse (in person) and the doc (via teleconference) are available for followup.
Predictably, the procedure has its opponents. After all, some Americans are obsessively against abortion, no matter when, where, or how it's done.
But these opponents--who believe that government should be shrunk smaller and smaller until it can fit under the bedroom door--are claiming they are terribly, terribly concerned about the doctor-patient relationship. They're concerned that teleconferencing creates "one-size-fits-all" medical care.
These people should be ashamed of their hypocrisy.
Since 1973, people who are against other people's right to choose abortion have made the procedure increasingly difficult to find or use. Some 90% of all U.S. counties now lack a qualified abortion provider.
Thirty-four states require that a woman undergo pre-abortion "counseling"--which isn't even required to be accurate (and so women are told about bogus 'connections' between abortion and breast cancer or depression). Twenty-four states require a waiting period after that, often more than 24 hours--meaning that most women would have to make two separate trips to a clinic or physician, often 5 or 6 hours away. The latest insult is the requirement, in several states, that women get (and often pay for!) a fetal ultrasound before being granted the privilege of a legal abortion.
Having made abortion hard to find, hard to get, and even more emotionally wrenching than necessary, anti-choice zealots have the nerve to criticize a program that makes abortion easier, safer, more private, and slightly less grotesque and frightening.
In an era when many HMOs require visit after time-consuming visit just for a patient to see a specialist (who may just prescribe medication anyway), telemedicine is a great way for many people to get high-quality medical care.
It's a great solution to the problems of access, confidentiality, and fear that the Religious Right has created for women who want a medical procedure with which they disagree. At the very least, people who want to disempower 2,000,000 or more American women per year could be honest about what they're doing--and why.