How Did Erectile Dysfunction Become “Natural”? A Review of the Critical Social Scientific Literature on Medical Treatment for Male Sexual Dysfunction

Abstract

This article reviews the multidisciplinary social science literature assessing the social consequences of medical treatment for male sexual dysfunction. This literature applies medicalization theory and social constructionist approaches to gender to assert that Euro-American cultural ideals of masculinity and sexuality, as well as ageism and ableism, determine which sexual changes and experiences get defined as “dysfunction” and shape the marketing and use of medical treatments for those changes. These medical responses assuage the suffering of men who become unable to meet cultural ideals for sexuality but in the process make reductive norms for male sexuality seem biologically natural. In addition, the critical social science research suggests that an economic logic underlies the process of redefining diversity and change in men’s sexual function as medical pathology. However, comparative qualitative data on men’s and their sexual partners’ experiences of sexuality and aging across world regions suggest that people do not universally accept the narrow ideals of male sexuality embedded in medical discourse regarding men’s sexual dysfunction. The diversity in people’s sexual desires across the life course and their responses to sexual function change highlight the cultural nature of medical definitions of sexual dysfunction.

Acknowledgments

I am grateful to Sari van Anders for her support as I conceptualized this piece, to the reviewers for their helpful feedback, and to Ajay Nangia and Leonore Tiefer for their insights on earlier versions of this work.

Notes

¹ There are also rich literatures on other aspects of men’s sexual and reproductive health that draw on similar theoretical approaches and make similar critiques as those discussed here in reference to the sexual function literature (for a discussion of these similarities, see Inhorn & Wentzell, 2011). For example, the critical social science literature on male fertility control and infertility treatment critiques the exclusion of men from research on and policy regarding reproduction and reproductive technologies (Almeling & Waggoner, 2013; Culley, Hudson, & Lohan, 2013; Daniels, 2006; Dudgeon & Inhorn, 2003, 2004; Greene & Biddlecom, 2000; Lohan, 2015; Marsiglio, Lohan, & Culley, 2013; Wentzell & Inhorn, 2014). It offers a rich body of qualitative research redressing this issue by identifying men’s context-specific experiences of assisted reproduction technologies and the specifics of local cultural understandings of the relationships between masculinity and reproduction, as well as how these are influenced by factors like law, economics, and religion (e.g., Açıksöz, 2015; Adrian, 2010; Almeling, 2011; Barnes, 2014; Bledsoe, Lerner, & Guyer, 2000; Carmeli & Birenbaum-Carmeli, 1994; Gannon, Glover, & Abel, 2004; Gürtin, 2015; Herrera, 2013; Hinton & Miller, 2013; Inhorn, 1996, 2003, 2012; Inhorn, Tjornhoj-Thomsen, Goldberg, & Mosegaard, 2009; Locock & Alexander, 2006; Mohr, 2014; Moore, 2008; Reed, 2005; Throsby & Gill, 2004; Webb & Daniluk, 1999; Wu, 2011). This literature also calls for attention to how culturally specific ideas of masculinity shape men’s uses of contraception (Adongo et al., 2014; Amor et al., 2008; Cragun & Sumerau, 2015; Gutmann, 2007; Pomales, 2013; Shropshire, 2014; Terry, 2014; Terry & Braun, 2011a, 2011b, 2011c), as well as scientific efforts to develop male contraceptives (Oudshoorn, 2003).

² A robust body of critical research has identified the ways that women’s unhappiness with their sex lives, or fears that their sexual function is “abnormal,” are rooted in poor sex education (which fails to challenge the idea that orgasm from penetration is the “normal” and even a common way to climax), interpersonal problems related to gender inequality, and deliberate disease mongering which casts the resulting issues as “female sexual dysfunction” to be treated medically rather than socially (Bancroft, 2002; Bedor, 2016; Cacchioni, 2007; Drew, 2003; Farrell & Cacchioni, 2012; Fishman, 2004; Fishman & Mamo, 2002; Hartley, 2003, 2006; Hartley & Tiefer, 2003; Jutel, 2010; Labuski, 2013, 2015; Lavie-Ajayi, 2005; Moynihan, 2003, 2010; Nicolson & Burr, 2003; Potts, 2008; Tiefer, 2003). This work is interlinked with activist campaigns that lobby against government approval of drugs which treat these social problems (Kaschak & Tiefer, 2001; Moynihan, 2014; Tiefer, 2002a, 2002b, 2006)—a process documented in the film Orgasm, Inc. (Canner, 2008; Canner, Benello, Ettinger, Helfand, & Weiss, 2009), and medical analysis arguing that U.S. Food and Drug Administration approval campaigns are based on marketing rather than demonstrations of efficacy (Jaspers et al., 2016; Woloshin & Schwartz, 2016). A similar critical literature is also emerging on “cosmetogynecology,” in which women undergo cosmetic surgery to remove parts of the vulva considered unaesthetic and thus meet increasingly narrow genital beauty norms (Braun, 2005, 2009, 2010; Liao, Taghinejadi, & Creighton, 2012; Tiefer, 2008a).

³ Discussions of “sexual health” in general reflect this same history of medicalization as men’s sexual function change. The concept of “sexual health” similarly isolates sexuality from interpersonal, economic, and political context, while casting culturally specific ideas of how sexuality and gender should be as biological universals (Giami, 2002; Segal, 2012).

⁴ Anthropologist Margaret Lock proposed the idea of “local biologies” to understand this concept, in her study of quantitative differences in menopause symptoms reported by North American and Japanese women, which she relates to a combination of different cultural expectations regarding symptomology and different body practices, such as diet (Lock, 1993; Lock & Kaufert, 2001).