We need more sex science

Sometimes two seemingly unrelated pieces of upcoming news reveal themselves to be part of one and the same iceberg. The film Kinsey, based on the life of the notorious sex researcher Alfred Kinsey, will open in South Africa early next year. In the United States it was damned by the religious right and a furious row has erupted about Kinsey and his motives.
This month saw a fast-track review by the Food and Drugs Administration of a testosterone patch that aims to improve the sex lives of menopausal women. The iceberg? The science of sex — or rather, the lack of science of sex.

Scientists working in the field of sex elicit one of three reactions: that you must be some sort of voyeuristic pervert, that you are only doing it to court controversy, and last: “They pay you to do this? Cool!’’ The perceived wisdom is that you cannot be a scientist of quality if your subject is sex — which, of course, is wrong.

The United Kingdom’s National Survey of Sexual Attitudes, a collaboration between social scientists, epidemiologists and statisticians, began in 1989. It involved detailed questioning of 20 000 Britons and illustrated the difficulties of linking a scientific survey with sex.

Margaret Thatcher tried to ban it and only the support of the Wellcome Trust allowed it to continue. The results of this research also revealed another uncomfortable problem in this field — quantitative data obtained from large epidemiological studies was at odds with the qualitative research practised by Shere Hite and her ilk.

This brings us to the first of two fundamental problems about sex, research and science. First, people lie about their sex lives, embellishing and fantasising, making much data instantly suspect. This should be an advantage to science, for surely its quantitative approach is less prone to such bias. Hmm. Now tell me why anyone would offer themselves up as a subject for sex research?

But even where there has been no problem about willing subjects, science has not covered itself in glory as far as sex is concerned. For instance, not even Gray’s Anatomy describes the full nerve and vascular connections of the clitoris. And for decades the clitoris has been described in medical textbooks as “a poor homologue of the male”.

Only in 1998 did dissections by an Australian urology surgeon, Helen O’Connell, show that the clitoris extends deep into the body with a total size twice as large as most anatomy texts show. The actual ratio of mass of men-to-women erectile tissue is 5:4, similar to the usual weight ratio of men to women.

Nor can the physiologists hold their heads up much higher; the scientific literature on the basics of arousal and intercourse, particularly in women, is pathetically small. It begins in 1957, when American gynaecologist William Masters hired psychologist Virginia Johnson and they began a project that was to involve direct laboratory observation of 700 men and women while having sex or masturbating, information presented in their book Human Sexual Response.

Masters and Johnson’s work continued through the Seventies and Eighties. Since then, there have been a small number of magnetic resonance imaging studies, but more remains to be known.

It has to be said that for something of such fundamental importance to the human race, there is extraordinarily little hard science available, which is where we return to testosterone patches.

Procter and Gamble are seeking to promote awareness of their testosterone patch for something termed hypoactive sexual desire disorder (HSDD). There are no doubt women, particularly those who have had a surgical menopause, who would benefit from testosterone, along with the more familiar female hormones. And there are surely women with specific sexual problems who should and ought to be helped in this way. However, HSDD is a controversial, newly minted, condition. The claimed “74% increase in sexual activity’’ actually turns out to increase sexual activity by less than one episode a month and no peer-reviewed data on the patch has been published.

Anyone can see the direction in which this horse is bolting. Once approved, more women, the majority of whom may simply be suffering from BWB (Bored With Bloke) syndrome, will be persuaded that they are suffering from this new disease and require testosterone patches, which can have serious side effects.

Meanwhile, Procter and Gamble will laugh all the way to the bank, secure in the knowledge that since so little quality research on sex is available, they are hardly likely to be challenged. Support a sex researcher — you know it makes sense. — Â

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