The medicalization of women's sexual pain

The medicalization of women's sexual problems under the overall rubric of female sexual dysfunction (FSD) has been thoroughly critiqued by feminist scholars, health practitioners, and sex therapists. However, there has been much less commentary on the medicalization of women's sexual pain-currently, a subset of an official FSD diagnosis. This article critically examines interdisciplinary understandings and ways of addressing sexual pain. It analyzes these frameworks in relation to feminist theories on medicalization, heteronormativity, and the reciprocal relationship between these two processes. We argue that many women who experience sexual pain have been eager for medicalization as a path to minimizing pain during sexual activity and reinstating normative heterosexual practices and identities. These goals have been lobbied for by patient advocacy groups and noted by professionals in the field. Although there are some clear benefits to this case for medicalization, there are also theoretical, personal, and political costs. Guided by a growing body of feminist theoretical and qualitative, empirical research on this topic, as well as the first author's personal experience of sexual pain, this article highlights some alternatives to medicalization and makes suggestions for change.     

Medicalizations and demedicalizations of sexuality therapies

This article complicates recent discussions about the expanding zones and influences of medicalization and biomedicalization on sexuality and sex therapy by contextualizing them with competing nonmedicalizing trends. These latter developments include an escalating nonexpert commercial sexuality sector on the Internet, as well as a long history of anarchic and democratizing social politics, such as "the counterculture" and "free love movements." What these nonmedicalizing trends have in common is the view of sexual problems and solutions as far broader than sexual dysfunctions and sex therapies, a belief in the social determinants of individuals' sexual experiences, and a deep concern regarding the socially harmful consequences of medicalization. With the quantity of sexuality information and advice available to the public through the Internet only likely to expand, a long era of clashing claims about relations between sexuality and health and about the role of expertise in sexual life can be foreseen.     

The Sex Check: The Development of an HIV-Prevention Service to Address the Needs of Latino MSM

The Sex Check is a brief, telephone-delivered, HIV-prevention intervention tailored for individuals who are at high risk of HIV infection or transmission but who are neither reducing their risk on their own nor seeking support for this purpose. Because the intervention is delivered on a one-to-one basis, permits anonymity, is marketed to "men who have sex with men," and is brief, it may be particularly responsive to cultural, structural, and attitudinal barriers to serving Latino MSM. Because many Latino MSM continue to engage in high risk sexual behaviors, developing and testing prevention interventions with this population is a public health priority.     

A Sociological Alternative to the Psychiatric Conceptualization of Mental Suffering

Uncovering both the structural causes and experiences of suffering is a central sociological endeavor. Sociologists study many different kinds of suffering; after all, strife is experienced both physically and emotionally, because of internal factors such as illness, due to external factors such as trauma, and as a result of economic, political or natural environments. In this paper, I address one form of suffering: mental suffering. In particular, I describe the medicalization of mental suffering in biological psychiatry, which focuses on the genetic factors of illness and equates mental suffering with mental illness. The psychiatric concept of mental illness highlights the continuing, crucial role for sociology in both understanding the experience and identifying the structural roots of suffering. Since the dominant conceptualization of mental suffering is as a medical concept, it is vital for sociology to offer alternative explanations and contribute to a multidimensional analysis. The roots of mental suffering are much more than biological; social comparison, social inequality, and other social stressors are equally important etiological considerations. Therefore, a true understanding of mental suffering requires multiple perspectives, and sociological constructs guard against a total medicalization of mental suffering.     

Selling slumber: American neoliberalism and the medicalization of sleeplessness

Sleeplessness is an ancient and cross‐cultural phenomenon that is socially structured and restructured against a backdrop of ideology and inequality. In an effort to make sense of sleeplessness, some scholars have invoked the medicalization framework, which highlights consumerism, managed care, biotechnology, and physicians as key “engines” that foster the transformation of this formerly “normal” condition to one that people view as a medical problem. However, this burgeoning literature has not answered the call of medical sociologists to situate the medicalization process in a political economic context. In this article, we employ the case study of sleeplessness and the creation of the “Sleep Industrial Complex” to expand the medicalization framework and illustrate how American neoliberalism creates an ideal environment for the primary engines of medicalization. We identify three critical features of American neoliberalism—enhancement culture, commodification of health, and a “productivity imperative”—that act in concert with the driving engines to foster an environment wherein medicalization not only survives but also thrives.     

Why medicalization? Introduction to the special issue on the medicalization of sex

This special issue grows out of the need to bring into focus the historical and sociocultural contextualization of sex to the sexological community. The specific focus is on analyzing how medicalization is affecting many areas of sexual life and discourse, but the larger goal is to help situate sexuality studies in its broadest perspective. Articles will be of general interest to those interested in interdisciplinary scholarship; the specific articles address HIV politics, sex therapy, women's sexual health, sex and aging, the popularization of weak science, and the media's view that sexual exuberance is a central marker of recovery from cancer. Medicalization is a current trend that illuminates the importance of a broader view of sexology.     

Personal reflection and experience of a Fulbright Scholar: teaching a mental health course in Vietnam’s changing culture

This paper documents the experience of developing and teaching a course on mental health for undergraduate social worker students during a semester in Vietnam. Social work is a profession at the early stages of development in Vietnam, requiring much curriculum development. There are over 40 universities with undergraduate social work education programs, but few of the faculty have had training or experience in practicing social work. The paper will summarize the main reasons for developing such a course given the current state of mental health need and services in a changing culture, as well as the current state of professional social work education and the newly established profession of social work. The author describes the contexts underlying the course—the status of social work and social work education in Vietnam, the context of mental health and mental illness in Vietnam, and curriculum adaptation to the cultural context. From this experience, the lessons learned about the role of cross-cultural critical thinking, cultural knowledge, and other strategies will be discussed about teaching a subject like mental health internationally.     

From desire to disease: human papillomavirus (HPV) and the medicalization of nascent female sexuality

This article critically examines the proliferation of information on the human papillomavirus (HPV) vaccination as integral to contemporary processes of medicalization that take the young female body and her nascent sexuality as its primary object and target. We suggest that the recent introduction of voluntary HPV vaccination for girls, in North America and elsewhere, constitutes a form of neomedicalization (Batt & Lippman, 2010 ) that links risks for future disease (cervical cancer) with the transmission of a common, sexually transmitted infection (HPV). Informed by findings from a critical discourse analysis of Canadian English newspapers, magazines, and public information about HPV vaccination, our interest is on how the emergence of sexual relationships becomes constructed as a time fraught with risks to future health, and that must be managed through biotechnological intervention (vaccination). We suggest that this configuration of medicalization, rather than demarcate a new category of abnormality that can be treated with pharmaceutical or medical intervention, positions the emergence of sexuality itself as the basis of risk and pathologization. The article concludes by considering the implications of this form of medicalization for constructions of female sexuality and sexual health education.     

Reading Scandal: Civic Gothic as Genre

This article proposes that recent media accounts of the "priest pedophile" employ a conventional Gothic mode as frame. The binary split into sentimentalized victims and demonized adults stabilizes a narrative that verges toward incoherency for reasons of genre form, readerly investment, and factual inaccessibility. In addition, because of a bias built-in, as it were, to all genre narrative, the Gothic frame silently consolidates political or cultural conclusions that are sometimes far removed from the sexual drama supposedly under investigation. Such genre "flattening" undergirds most media forms in commodity exchange culture; it is not specific to scandal or unique to this cycle of priests and children. Nonetheless, the rubric of scandal-and the priest-child trope in particular-displays the effects of genre-manipulation in a concentrated form. Thus, in "reading scandal," more important than the predictable division of heroes and villains, monsters and innocents, are the mechanics of representation by which a public ceremony of outrage and shame positions itself as a neutral agent of civic work while erasing the implications of this positioning.     

The State of Sex Research in MFT and Family Studies Literature: A Seventeen‐Year Content Analysis

The ability to conceptualize and treat sexual problems has been widely accepted as a crucial skill to master the MFT training. However, clients’ sexual relationships are often ignored by clinicians because of a lack of experience or training, or personal discomfort. In this content analysis, we review sex and sex therapy research within MFT and family studies journals since the turn of the century. Of the 13,919 articles published within the 15 journals, 137 focused on sexuality or sex therapy. The articles were divided into five themes: sexual and relational health, sexual diversity, treatment and contributors of sexual dysfunction, sex therapy practices, and sexual education and development. Implications for clinical practices, sex therapy integration, and future research are discussed.     

Negotiating Personal Experience over the Lifetime: Narrative Elasticity as an Analytic Tool

Sociology and neighboring disciplines have produced different analytic tools to examine the dialogical relationship between individuals and society (“narrative work,” “identity work,” “moral career,” “moral breakdown”). However, the question of how individuals negotiate the interpretation of personal experience over their lifetimes in a changing cultural context remains unexplored. This article introduces narrative elasticity as a feature of narrative work and as a time‐sensitive analytic tool for conducting inquiries into processes of temporal retraction and expansion of what storytellers conceive as the normal order of significance. The application of this tool to the analysis of mature and elderly Chileans' life stories shows how cultural change occurs at the individual level, considers factors that motivate and inhibit processes of reinterpretation of personal experience, and identifies different levels at which it operates.     

Locus of illness control: a cross-cultural study

A comparative study of rural Haitian and southern Appalachian health beliefs revealed significant differences both within and between groups regarding perceived control over illness. Data consisted of scores (N = 293) on the Locus of Illness Control Scale, a 15-item forced-choice instrument designed to include two subscales, one focused on illness prevention, the other on cure. Both cultural groups scored more externally on the cure dimension than they did on prevention. Group differences, however, were reversed for the subscales. While Appalachians apparently expect greater success in preventing illness, interestingly, Haitians show greater perceived ability to cure illness. The findings have implications for traditional views of "fatalistic" cultures, for the refinement of concepts related to health locus of control, and for the practical utility of standardized instruments among populations that vary in health problems and therapeutic resources.     

DISLOCATING MORAL ORDER AND SOCIAL IDENTITY IN CINEMATIC SPACE:

A certain type of film, the "genre stretcher," is of special interest to the sociology of deviance because it captures deviantizing discourse as if in a moment of crisis. A crisis in moral representation is at issue and with it the capacity for rendering symbolically coherent social action and cultural differentiation through narrative. This article investigates two instances of a genre stretcher— Tightrope (1983) and Cruising (1980)—and places analytic emphasis on interpreting their distinctive persona, the "inverted detective." This figure encases features of an emergent moral imagination in its condensation of certain conundrums, especially the problem of reinscribing deviance in a poststigma surround. The films thereby animate and trace out the implications of a discourse that was initiated by the 1960s and 1970s "revolt against stigma" they function as allegories of the relations between normality and deviance amid symbolic instability.     

Parental Grief and Serious Mental Illness: A Narrative

Serious mental illness is associated with substantial personal and interpersonal distress and life disruption for the sufferer and for his/her family. A common response to having and caring for a family member with a serious mental illness is feeling loss and grief. This paper presents a representative narrative that attempts to capture the essence of the experience as conveyed by 22 parents of adult children with a serious mental illness. The implication of the narrative is examined.     

The construction of fear: Americans' preferences for social distance from children and adolescents with mental health problems

Debates about children's mental health problems have raised questions about the reliability and validity of diagnosis and treatment. However, little research has focused on social reactions to children with mental health problems. This gap in research raises questions about competing theories of stigma, as well as specific factors shaping prejudice and discrimination toward those children. Here, we organize a general model of stigma that synthesizes previous research. We apply a reduced version of this model to data from a nationally representative sample responding to vignettes depicting several stigmatizing scenarios, including attention-deficit/hyperactivity disorder (ADHD), depression, asthma, or "normal troubles." Results from the National Stigma Study-Children suggest a gradient of rejection from highest to lowest, as follows: ADHD, depression, "normal troubles," and physical illness. Stigmatizing reactions are highest toward adolescents. Importantly, respondents who label the vignette child's situation as a mental illness compared to those who label the problem as a physical illness or a "normal" situation report greater preferences for social distance, a pattern that appears to result from perceptions that the child is dangerous.     

"I HATE MY VOICE":

This article presents a narrative, autoethnographic, theoretical account of the public and private negotiation of "minor bodily stigmas," which are mild physical "imperfections" that make us fear we stand out and might be rejected. To examine the situated complexity of stigmatized identity, I tell a story that shows concrete interactional details of an episode in which minor bodily stigmas evolved into a significant topic of conversation between strangers. My personal narrative explores the felt experience of minor bodily stigmas from the perspective of the experiencing and interacting holder. Thus, my work problematizes Erving Goffman's sociological approach to stigmas, which examines inclusively all forms of stigmas from a distanced observational stance of beholder that privileges the outsider perspective of how others see us. Using minor bodily stigmas as a heuristic category, I emphasize how they are experienced as a double bind in interaction (to notice or not to notice) and a double bind in personal feelings (of moral character as well as physical appearance). I seek to connect theoretical and categorical understandings of minor bodily stigmas to their concrete felt experience in day-to-day life in order to examine possibilities for resisting and reframing stigmas in everyday life.     

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

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.