Diagnosing Desire
BI O P O LITI CS A N D FEM I N I N IT Y
I NTO TH E T W E NT Y- FI R ST C E NTU RY
A LY S O N K . S P U R G A S
Diagnosing Desire
Biopolitics and Femininity into
the Twenty-First Century
Alyson K. Spurgas
T H E O H I O S TAT E U N I V E R S I T Y P R E S S
COLUMBUS
Copyright © 2020 by The Ohio State University. All rights reserved.
Copyright © 2020 by The Ohio State University.
All rights reserved.
Library of Congress Cataloging-in-Publication Data
Names: Spurgas, Alyson K., 1981- author.
Title: Diagnosing desire : biopolitics and femininity into the twenty-first century / Alyson
K. Spurgas.
Other titles: Abnormativities: queer/gender/embodiment.
Description: Columbus : The Ohio State University Press, [2020] | Series: Abnormativities:
queer/gender/embodiment | Includes bibliographical references and index. | Summary:
“Examines how low female desire is produced, embedded, and lived within neoliberal
capitalism. Rethinks ‘femininity’ by investigating sex research that measures the
disconnect between subjective and genital female arousal, contemporary psychiatric
diagnoses for low female desire, and new models for understanding women’s sexual
response”—Provided by publisher.
Identifiers: LCCN 2020022197 | ISBN 9780814214510 (cloth) | ISBN 0814214517 (cloth) |
ISBN 9780814280751 (ebook) | ISBN 0814280757 (ebook)
Subjects: LCSH: Sexual desire disorders. | Women—Sexual behavior. | Femininity. | Sex
therapy.
Classification: LCC HQ29 .S68 2020 | DDC 306.7082—dc23
LC record available at https://lccn.loc.gov/2020022197
Cover design by Regina Starace
Text design by Juliet Williams
Type set in Adobe Minion Pro
The paper used in this publication meets the minimum requirements of the American
National Standard for Information Sciences—Permanence of Paper for Printed Library
Materials. ANSI Z39.48-1992.
Copyright © 2020 by The Ohio State University. All rights reserved.
CONTENTS
Acknowledgments
vii
INTRODUCTION Diagnosing Gender through Desire: How You Know
You’re in Bed with a Woman
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CONCLUSION
1
Sexual Difference and Femininity in Sex Therapy
and Sex Research: Examples from the Nineteenth,
Twentieth, and Twenty-First Centuries
29
Interest, Arousal, and Motivation in Contemporary
Sexology: The Feminization of Responsive Desire
63
Women-with-Low-Desire: Navigating and
Negotiating Sexual Difference Socialization
107
Embodied Invisible Labor, Sexual Carework:
The Cultural Logic and Affective Valorization of
Responsive Female Desire
148
Reclaiming Receptivity: Parasexual Pleasure in the
Face of Compulsory and Feminized Trauma
184
The Freedom to Fall Apart: Feminine Fracturing and
the Affective Production of Gendered Populations
221
Copyright © 2020 by The Ohio State University. All rights reserved.
vi
•
CONTENTS
Appendix
235
References
239
Index
263
Copyright © 2020 by The Ohio State University. All rights reserved.
INTRODUCTION
Diagnosing Gender through Desire
How You Know You’re in Bed with a Woman
In 2009, popular writer Daniel Bergner published two articles on the complexities of female sexuality and desire in the New York Times Magazine. The
first, published in January 2009, was titled “What Do Women Want?” and
the second, published later that year, in November, “Women Who Want to
Want.” It was in these two popular pieces, over a decade ago now, that the
seeds of this book were sown. Twenty-first-century women were apparently
stricken with low desire, and their sexuality, their femininity, was a frontier
to be explored. Bergner’s articles described the new pioneers—the explorers
were young, smart, ambitious, and energetic; they called themselves feminists.
These new scientists were there to help women figure out what the problem
was, why they weren’t in the mood. It was upon reading these articles that I
realized that what I now refer to as the “new” science of female sexuality was
blossoming, and that it was going to be—already was—very big.
In the second of his two articles, Bergner points to both the ambiguous
nature of female sexuality and to the ambiguously feminist nature of the driving force behind this new science: “More than by any other sexual problem—
the elusiveness of orgasm, say, or pain during sex—women feel plagued by low
desire.” Many low-desiring women, however, want to want. He describes how,
in her efforts to help these women, the Canadian sex researcher and clinician
he interviews in the article, Lori Brotto, deals “in the domain of the mind,
or in the mind’s relationship to the body, not in a problem with the body
1
Copyright © 2020 by The Ohio State University. All rights reserved.
2
•
INTRODUCTION
itself.” Bergner suggests that the ultimate therapeutic goal for clinicians like
Brotto, then, might be to help women repair this estranged mind/body connection by suturing (physical) sensation and (subjective) sexual self-image,
and cultivate their own desire, even in the face of what he calls “women’s
complex sexual beings.” Questions of women’s sexual complexity, responsiveness or receptivity, and how their minds and bodies line up (or, more often
in these accounts, do not) seemed to be at the heart of this new science and
its accompanying sexual response models and treatment protocols for low
female desire. But how had it come to be that at the beginning of the twentyfirst century, self-identified feminist sex researchers described women’s sexuality as reactive, receptive, and responsive? Did these researchers believe, as
these popular articles implied, that women’s sexuality operated according to
a completely different logic than men’s sexuality? Why were women’s sexual
problems, no longer the result of hysteria or frigidity, still so confounding to
scientists? And if, as these popular articles posited, women were so sexually
complex, in many cases lacking an urgent sense of lust yet also demonstrating
strong physiological arousal and a fluid responsiveness and receptivity—how
did they get to be that way? Furthermore, how was the problem of women’s
low desire to be solved?
A few aspects of Bergner’s articles, and others like it, jumped out at me.
One was that the new science of female sexuality described desire from what
we might call a behaviorist perspective. In this way of thinking about sex,
human beings are almost robot-like organisms with instincts and drives. The
desire for sex, in this framework, is sometimes understood as inextricable
from the drive to reproduce, as one might expect given behaviorism’s frequent
pairing with evolutionary psychology. Even more to the point, though, the
behaviorist perspective reduces desire to a cost-benefit analysis of what the
organism is willing to seek out for sex—or more often, for women, what the
organism will be receptive to. The idea is that, like Pavlov’s dog, we learn (or
are trained) to find certain stimuli desirable, weighing internal and external
criteria to make rational, incentive-motivated, and reward-seeking decisions
about whether or not to engage in sex. Particularly in the first decade of the
twenty-first century, this cost-benefit analysis was often portrayed as being
more complex for women than for men, in part because the related evolutionary psychology discourse views women as beholden to a maternal drive that
complicates their sexuality and orients it toward finding a good mate. I came
to identify behaviorism and evolutionary psychology as the twin foundations
of several contemporary sexual response models that I will describe in this
book. I also came to see that, in these models, desire, per se, wasn’t part of the
sexual equation. And this seemed to be especially true for women.
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
3
This absence of desire in the new science of female sexuality was jarring
for me. For Freud, Lacan, all of the many queer, feminist, and postcolonial
scholars that followed (and critiqued) them, desire was about aims, objects,
fantasies, fetishes, power, and trauma. Desire was sexy, it was hot, sometimes
it was ugly, shameful, and unspeakable, but it was never fully capturable or
controllable; there was a je ne sais quoi that was indeed constitutive of it.
It was sometimes differentiated along the lines of gender in these theories,
but rarely reduced to evolutionary adaptations or machinelike rationality. For
post-Freudian psychoanalytic thinkers like Laplanche (1976), there may be
a mechanics or hydraulics to desire, a libidinal economy, but there was still
a wiliness to it that couldn’t be trained away—or conjured up—by any proverbial Skinner Box (the behaviorist black box trope of cognitive psychology
and operant conditioning designed by founding father B. F. Skinner [1938]).
If anything, as Jagose (2013) has pointed out regarding behaviorism and sexuality, whatever it is that cognitive conditioning models have tried to do to
human sexuality, from the sensate focus techniques of Masters and Johnson
in the 1960s to the erotic conversion therapy (including “orgasmic reconditioning”) used on gay men in the same era, these models cannot account for
desire’s vicissitudes. There is always an excess, a part of desire that cannot be
fully redirected, even if behaviors themselves can be changed. This is in part
because, unlike most other human behaviors, fantasy is constitutive of sexuality in a way that suggests that desire—that fundamentally intersubjective and
unrequited wanting or longing—is never reducible to behavior or motivation
and can never be approximated or fully delimited.
Beyond the lack of attention to desire, another thing stood out to me
about these popular articles and other discussions of the new science of
female sexuality, including the research studies that I began to voraciously
read. Many of these studies were deeply invested in making comparisons
between the objective arousal of the body, as measured by a subject’s physiological sexual response (determined by attaching machines to her genitals),
and her subjective experience of arousal—the desire she experiences in her
mind, abstracted into quantitative and behaviorist terms. These two measurements were increasingly taken in laboratories, and the gap between them was
made to say a lot of things about gender (long story short: women have a
much bigger gap). This seemingly new trend, what I have come to call the
work of the gap, was all over the place in the scientific research and its popular interpretations. I learned that experiments that used arousal-measuring
instruments were called volumetric studies, and that the use of these machines
was called plethysmography (the machine for people with penises was sometimes called a penile strain gauge). In his first 2009 New York Times Magazine
Copyright © 2020 by The Ohio State University. All rights reserved.
4
•
INTRODUCTION
piece, for instance, Bergner describes the work of the Canadian experimental sex researcher Meredith Chivers. Chivers uses plethysmography to measure her subjects’ physical arousal, then compares the results to the numbers
these subjects record on an “arousometer,” a tool for registering how turned on
they feel. In many of these volumetric studies, cisgender men and cisgender
women1 are compared in terms of this gap.
The studies work something like this: A person sits down in a LaZBoy
recliner, alone in a lab, and inserts a probe into their vagina (in more recent
studies, measuring devices may also be attached to the labia or clitoris) or
attaches one to their penis. They watch different films or other stimuli, maybe
listen to an audio recording. Some films are considered neutral (like a documentary on lei-making in Hawai’i—true story), while some feature sexual
content. The sexual stimuli include a variety of scenes and situations—men
having sex with women, women having sex with women, men having sex
with men, a naked man alone walking on a beach, a woman working out.
Sometimes there are rape scenes. Sometimes there are animals having sex,
like bonobos, overdubbed with loud ape sex noises. Across these studies, the
common finding has been that cis men—both gay and straight—tend to have
physiological and subjective experiences of arousal that line up with each
other. They are “concordant.” Cis women, on the other hand, particularly
those attracted to cis men, tend to be physically aroused by everything, or at
least any “relevant sexual stimuli,” even when they report low levels of subjective desire via the arousometer. They are “discordant.” In other words, women
who are attracted to men have the biggest gap.
This was the cutting-edge research of the twenty-first century. I had spent
many years in graduate school reading Freud, Foucault, Fanon, Butler, and
many other bad guys, girls, and genderqueers of critical race and queer theory,
cultural studies, psychoanalysis, and poststructuralist feminism, but I was way
more shocked by the new science of female sexuality than I was reading about
hysteria, wish fulfillment, and the repressive hypothesis. In the January 2009
article, Chivers tells Bergner that she hopes one day to develop a “scientifically
supported model to explain female sexual response.” Bergner writes:
1. In some cases, such as in a study conducted by Lawrence, Latty, Chivers, & Bailey
(2005), the subjects are also transgender women, who are referred to as “male-to-female transsexuals” and are said to “display male-typical [sic] category-specific sexual arousal” (p. 135).
The potentially violent cisnormativity and heternormativity inherent in the methodology of
studies like this—particularly those conducted in the first decade of the twenty-first century—is
a theme I will interrogate throughout this book. See chapter 2 especially for more on the construction of “category-specificity” in terms of genital sexual response.
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
5
When she peers into the giant forest, Chivers told me, she considers the
possibility that along with what she called a “rudderless” system of reflexive
physiological arousal, women’s system of desire, the cognitive domain of lust,
is more receptive than aggressive. “One of the things I think about,” she said,
“is the dyad formed by men and women. Certainly women are very sexual
and have the capacity to be even more sexual than men, but one possibility
is that instead of it being a go-out-there-and-get-it kind of sexuality, it’s more
of a reactive process. If you have this dyad, and one part is pumped full of
testosterone, is more interested in risk taking, is probably more aggressive,
you’ve got a very strong motivational force. It wouldn’t make sense to have
another similar force. You need something complementary. And I’ve often
thought that there is something really powerful for women’s sexuality about
being desired. That receptivity element.”
I read these words and saw the history of sexology flash before my eyes. I
was immediately struck by how this idea of female reactivity, responsiveness,
receptivity, that had been supposedly abandoned with all the other misogyny
of the premodern sciences (including psychoanalysis, abandoned much to my
dismay) had somehow been maintained in the twenty-first century. How were
words like these being uttered by a feminist scientist in 2009? Why was this
being discussed in the New York Times Magazine? What would the impact
be? Then I read the comments. Of course, many people lauded the Times for
publishing such an article. Others said this research diminished the variation
across women’s sexualities. And plenty said that the “gap” of female discordance identified in this research indicates that women are lying about what
turns them on, or that they don’t know the truth of their own desire. For
instance, commenter “George” from Irvine says: “Undamaged, quality women
want real men. They want the strength, protection, leadership, stability and
commitment of a man who isn’t afraid to express his masculinity. A man who
understands that women are driven by their emotions, not necessarily by logic
and reason, as the article well points out. When men understand this, they
can have their way with women.” Similarly, “David” from Boston tells us: “So,
the conclusion among leading (female) sexologists is: Women are selfish narcissists who don’t know what they really want, except that, underneath it all,
what they really want is to be ravished against a wall in a dark alley by a
stranger. Well! Any man could have already told you that!”
Beyond the retrograde nature of the scientists’ words and the way they
were being taken up by everyday misogynists, another thing that caught my
attention in these articles was the focus on new ways for women to enhance
their desire, including through sex therapy techniques that utilize cognitive
Copyright © 2020 by The Ohio State University. All rights reserved.
6
•
INTRODUCTION
behavioral methods and mindfulness. Although at the end of the first decade
of the twenty-first century, plenty of antimedicalization feminists were focused
on critiquing pharmaceutical interventions like Addyi for women, in the wake
of the supreme success of Viagra for men (see the work of the New View Campaign2 for the quintessential example of this anti–Big Pharma movement), I
was more interested in what other sexual enhancement techniques were being
developed and deployed. This was in keeping with my interest in the work
of French theorist Michel Foucault and his notion of biopolitics (1978, 2000,
2003)—or the ways that our lives are governed, in late neoliberal capitalism,
through technologies that don’t so much discipline us as make us live in certain ways. Bergner underscores some of these new techniques and associated
research in his second 2009 Times article. For instance, according to Bergner,
while Brotto’s “patients’ genitals commonly pulse with blood in response to
erotic images or their partners’ sexual touch, their minds are so detached—
distracted by work or children or worries about the way they look unclothed,
or fixated on fears that their libidos are dead—as to be oblivious to their bodies’ excitement, their bodies’ messages.” Mindfulness, by combining an attention to bodily sensations with the “power of positive thinking,” allows women
to cultivate a subjective sense of sexual arousal or “trains patients to immerse
themselves in physical sensation”—that is, it trains them to work to bridge the
mind/body gap. Through Bergner’s interviews with Brotto and another Canadian sex researcher, Rosemary Basson, readers also learn about women’s tendency toward “responsive” or “receptive” desire, and the formulation of a new
“trigger-based” sexual response model. For women, Basson reports, “the start
of plenty—and maybe the great majority—of sexual encounters is defined not
by heat but by slight warmth or flat neutrality.” This was the new “arousal-first”
sexual response model for women, based on reactivity, receptivity, and bridging the gap: I will refer to it from now on as the circular sexual response cycle,
as it is described in the literature. “Basson’s lesson for women, which has been
distilled by sex therapists into three words, ‘desire follows arousal,’ is a real
rearrangement of expectation and a reweighting of sexual theory,” Bergner
wrote. But was it really so new? The idea that women lack free-flowing desire
and require sexual activation (by men) seemed pretty old to me. Indeed, it
appeared in some of the earliest sexological texts, including in those by Wilhelm Stekel, Havelock Ellis, and Richard von Krafft-Ebing.
The final thing that stood out to me as I read these articles over a decade
ago was the way they discussed diagnoses for sexual dysfunctions, including low desire. In the second of his 2009 articles in the Times, Bergner raises
questions surrounding the next incarnation of the Diagnostic and Statistical
2. Website: http://www.newviewcampaign.org/
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
7
Manual of Mental Disorders, or DSM, the psychiatric bible since the 1950s that
infamously once included an entry for homosexuality. The volume was scheduled to be updated and rereleased in 2013. What would the new low desire
diagnosis look like, Bergner asked, given all of this new research into female
sexuality? The existing unisex diagnosis of hypoactive sexual desire disorder,
or HSDD—defined in the DSM-IV as “persistently or recurrently deficient
(or absent) sexual fantasies and desire for sexual activity”—struck him as
“simplistic,” or at least as insufficiently complex to apply to women. Bergner
wouldn’t know it for certain yet, but similar concerns would eventually lead to
the development of a new female-specific diagnosis for low-desiring women—
female sexual interest/arousal disorder, or FSIAD. And so it was, that in an
attempt to depathologize women’s responsive desire, the DSM-5 (2013) sexual
and gender identity disorders work group included a new criterion for women
only (three out of six criteria are required for an FSIAD diagnosis): “does
not initiate/is not receptive to a partner’s initiations.” The scientific research
and clinical treatments described in Bergner’s articles and in other popular
accounts, and later the revised low female desire diagnosis itself, in concert
indicate that women should not be diagnosed with a disorder just because
they lack fantasies or a strong initiating sexual urge (they aren’t men, after
all?). These discourses instead suggest that if more women knew about their
own responsive desire, then maybe they wouldn’t feel like their desire was low.
And here, I began to see, is where all the pieces fit together.
Throughout the rest of this book, I will refer to the broad paradigm
connecting these strands as the feminized responsive desire framework. This
paradigm, which became ubiquitous at the turn of the twenty-first century
and which has left its imprint through today, consists of all the themes I just
outlined: the absence of desire from behaviorist models of sexuality; plethysmographic research suggesting a commonplace discordance between
objective and subjective experiences of female arousal; a theory of circular
sexual response for women in which desire is said to be triggered by receptive
arousal, and new DSM diagnostic criteria for low desire in women codifying that theory; and finally, new modes of treatment for women’s discordant
desire/arousal system, including mindfulness practices intended to work on
the gap by bringing the undesiring mind into line with the aroused body.
Something didn’t sit well with me about this entire framework, and this book
is an attempt to explain, analyze, and theorize what that reaction was and
where it came from.3 It is only in a moment in which liberal feminism has
3. Since the publication of the DSM-5 in 2013, several of the experts involved in this
original line of research have stated that responsive desire may be common in men, too, and
more research has since been conducted on men in this vein. I am aware of the quickly shifting
Copyright © 2020 by The Ohio State University. All rights reserved.
8
•
INTRODUCTION
been mainstreamed, right alongside evolutionary psychology, that this model
of female sexual response could make it into the media spotlight and be read
as feminist. And it was only at the turn of the twenty-first century, with no
critical or activist response, that this type of reductionist, hetero-/cisnormative, and anti-intersectional thinking about female sexuality could become
common parlance across the Global North, and particularly in the North
American context.
While the new science of female sexuality and the feminized responsive
desire framework are certainly meant to be feminist, and in fact came into
being as a response to what was understood to be a restrictive male-oriented
model of desire (Tiefer, 1991, 1995, 1996), I question the feminism of this new
paradigm on a variety of bases. My concerns include the way that “women”
are (re)produced as a population here; how this population is read as white,
wealthy or middle-class, straight, and cisgender; how widespread gendered,
raced, and classed trauma too often goes unaccounted for in this framing;
and how this feminized population is positioned to be managed through new
techniques framed as “safe” simply because they don’t involve psychopharmaceutical drugs or hormones. I argue that this framework must be interrogated
as it plays into tropes about white cisgender heterofemininity, and particularly
because it will invariably affect a lot of other people who don’t fall into this category. I write from a crip-queer-femme perspective, and want to attend to the
ways in which these discourses pathologize queer femmes and nonbinary and
gender-nonconforming folks, including femmes of color and trans women. A
further gap that I will explore in this book is why trauma—including banal,
everyday, and insidious forms of trauma including but also beyond childhood
sexual abuse—has been largely unaccounted for when considering the differences between men’s and women’s desire. My analysis suggests that this
is a direct result of a shift away from psychoanalytic/psychodynamic thinking in mainstream psychology. But what is also important to consider is how
women—cis and trans, across racial backgrounds, of different embodiments
and other disparate statuses—understand their own desire, or lack thereof. My
terrain of sexual science and recognize that much has changed even in the last five years, but in
this book, I want to emphasize how these reductive ideas about women’s desire have been taken
up broadly in the mainstream since the turn of the twenty-first century through today. One
problem is how quickly media latch on to scientific explanations for gender differences in sexuality; however, over the course of the last two decades, the scientists themselves have also made
broad, sweeping claims in both media interviews and in their expert publications, even when
their findings are actually just hypotheses in an ever-shifting world of scientific knowledge (see
DeJesus et al., 2019 for empirical evidence [!] on problems with scientific overgeneralizing).
Thus, I argue that even as they move their research agendas forward in the spirit of feminist
inquiry and ethics, these experts must first reckon with their own recent pasts.
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
9
main quest was to seek information from these folks themselves about how
well this feminized responsive desire framework applies to them. And I found
out that for a lot of them, it doesn’t work so well. Certainly, some of these folks
do feel receptive and responsive, but those experiences are often related to
trauma, and with how the people we call women are socialized; they are not
neutral or natural. So, let me be clear: My project here is not to make the case
that men’s and women’s sexualities, or that masculine and feminine desires,
are exactly the same. Instead, I argue, along with the new scientists of female
sexuality, the pioneers and explorers of this frontier, that many women are
absolutely different from many men. But in this book, I consider and honor
how they’ve come to be that way, rather than simply describing them as such.
To this end, I want to explain how I use the term femininity in this book,
and why I chose to use she/her pronouns in most cases throughout the text. I
did this for a couple of reasons, and my decision-making here was an incredibly fraught and difficult process. First, for reasons that I will explore throughout this book, it was primarily cis women who responded to participate, and
all participants used she/her pronouns at the time of the interviews; however, these interviews represent only a snapshot in time in terms of participants’ gendered subjectivities. I strongly suspect that in the case of at least
a few folks, their pronouns have changed, but conducting follow-up interviews about participants’ gender identities to confirm this is the province
of a future study. Indeed, how trans women, nonbinary, two-spirit, agender,
genderqueer, and gender-nonconforming individuals uniquely experience
these heteropatriarchal medical and scientific norms regarding femininity should be explored further and in greater depth. How some trans men
have potentially experienced coercive medicalized norms for responsive femininity pre-transition is imperative to study, as well, particularly insofar as
these men have a unique perspective to offer on the gendering of desire and
sexual expectations. Second, and relatedly, I talk about women and femininity throughout this book because those are the terms used—and taken for
granted—in much of the medical and scientific literature that I engage with
and critique, and it is this research that I argue produces these very categories
(categories that individuals, in the case of this study assigned-female-at-birth,
or AFAB, individuals, are then forced to navigate—and in some cases reject
but are often still haunted by). I hope that readers will understand the delicacy of choosing language to use for a project such as this one, dwell with me
in this conceptually difficult space, and read my use of the terms women and
feminine throughout the text as somewhat tongue-in-cheek—yet also uttered
with a certain sobriety and solemnity. The truth is that I know these categories
could never be so monolithic, and that they are coproduced with race, class,
Copyright © 2020 by The Ohio State University. All rights reserved.
10
•
INTRODUCTION
nationality, and so many other categories of difference. This is precisely why I
wage the critique that I wage in this book—the “femininity” that clinical and
experimental researchers too frequently imagine belongs to a white, cisgender, middle-class or wealthy, normatively able-bodied woman in the Global
North. But this femininity is then deployed as timeless and universal—even
evolutionarily ordained.
In this vein, I am not describing femininity as an identity in this book;
instead, I describe it as a process—one that is embodied and experiential
but not essential, one that in its hegemonic or dominant formulation may
be experienced as coercive, and one that is most specifically connected, in
my analysis, to the traumatizing effects of receptivity as a clinical protocol,
as a technoscientific framework, and as a lived—but extremely mercurial
and unstable—materialization of sexual difference. Here, women-with-lowdesire, sexuality, and contemporary sexology are co-constituted; there is no
natural category of “woman” here to be recuperated. Femininity is then a
material-discursive socialization process, enacted in part through medicine
and science, and it is the project of this book to connect that process to its
promulgation via contemporary sexological discourse and that discourse’s
popular framings. My formulations here of femininity-as-process have much
in common with other contemporary sociotechnical investigations of gender, including with the pharmacopornographic or techno-chemical dimensions of gender in the work of Preciado (2013), the biopolitics of gender in
the post–John Money era as analyzed by Repo (2016), and the production of
gender via scientific and medical categories, particularly as they pertain to
discourses around hormones and to treatment of intersex, as described by
Jordan-Young (2011) and Jordan-Young and Karkazis (2019). Other important recent interlocutors include Labuski (2014, 2015, 2017), who considers
how vulvodynia and its treatment inform experiences of race, gender, and (a)
sexuality, and Ward (2015), who examines straight white men’s sexual behaviors outside of the deterministic logics of biology and identity but instead as
part of a culturally delimited process that is bound up with misogyny and
white supremacy.
Ideas about women’s responsive sexuality and fluidity are found in myriad
popular cultural domains today. And it is the pervasiveness and popularity
of “expert” discourses on receptive femininity that are precisely why many of
the AFAB folks I interviewed—most of whom identify as women but some of
whom also reinvent or reject femininity—still have to navigate and grapple
with these ideas about women (and what it means to be one) throughout their
lives. So, although all the participants in this study describe interacting with
femininizing discourses, technologies, and protocols, they absolutely occupy
a diversity of spaces in relation to femininity and feminine or femme iden-
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
11
tity. This is in no small part due to the fact that they come from a diversity of
racial, ethnic, cultural, religious, and other backgrounds in addition to being
of diverse sexualities; a fact that emphasizes the need to implement an intersectional feminist framework and to consider the racialized Eurocentric and
white supremacist origins of sexual difference, which I address below.
Race, Femininity, and the Whiteness of Sexual Difference
Very little work has looked at the phenomenon of low desire through an intersectional (Collins, 1990; Crenshaw, 1991) lens, so desire issues have either been
framed as universal for women or the impression has been given that concerns
about desire are specifically problems encountered by white women (my data
suggest otherwise). Following the recent work of Snorton (2017) and Schuller (2018), I seek to highlight the racialized terrain of sexual difference production—for this project, within contemporary discussions of female sexual
dysfunction and women’s low and/or responsive desire. Schuller (2018), for
instance, argues that discourses of sexual difference are not only related to
racial difference narratives, but that sex difference is a function of racial difference—that is, without the evolutionary logic embedded within racist scientific discourses of the nineteenth century and before (including, for Schuller,
impressibility and sentimentalism—white people are more “receptive in a
good [evolved] way,” according to these logics), there would be no civilizing
project in which male and female as distinct types emerged.
The idea encapsulated in early racist scientific narratives is that as the
“races” became more evolved and civilized—moving up the “great chain of
being”—masculine and feminine types became more distinct. The white European male was produced as anatomically, behaviorally, and psychically distinct from the white European female; in some sense, the passive, receptive
nature of the white European female became the constitutive ground for white
European male rationality and objectivity, while white femininity became
produced as something in need of protection (in most cases from the figure
of the Black male rapist). Of course, the other constitutive ground here has
always been Black femininity—conceived initially as not very differentiated
from Black masculinity (i.e., “Black gender” or “flesh” for Spillers, 1987), and
then as hypersexual, exotic, and tempting to white men (Collins, 2004; Hammonds, 1994, 1999).
Black feminist scholars have opened up critical investigations of the ways
in which notions of sexual difference have always rested upon regimes of
racial difference—to the point where neither can be examined alone. Spillers (1987) argued that the treatment of Black bodies under slavery produced
Copyright © 2020 by The Ohio State University. All rights reserved.
12
•
INTRODUCTION
them as ungendered flesh—that bodies that were enslaved and produced as
Black were not gender differentiated or subject to the same regimes of sexual
difference as white bodies, and further that sexual differentiation was part
and parcel of narratives of racial evolution and civilization. Hartman (1997)
extended this argument and examined the ways that Black womanhood (or
the figurative lack thereof) was codified under regimes of slavery in the US
and thus illuminated “the contingency of woman as a category” (p. 101). In
Scenes of Subjection, Hartman (1997) examines sexual injury as it relates to
conceptualizations of femininity, addressing how Black women were legally
figured as “unrapeable” and thus as not really “women” at all, stating:
By interrogating gender within the purview of “offenses to existence” and
examining female subject-formation at the site of sexual violence, I am not
positing that forced sex constitutes the meaning of gender but that the erasure or disavowal of sexual violence engendered black femaleness as a condition of unredressed injury, which only intensified the bonds of captivity and
the deadening objection of chattel status. (p. 101)
Hartman’s discussion of the relationship between sexual injury and femininity has special import for the current project—particularly in that my project investigates the widespread popular deployment of expert discourses of
purportedly “unmarked” feminine receptivity and responsiveness, discourses
that have their origin in colonialist science, but that are now disseminated
broadly and sometimes taken up by—or forced upon—women of diverse
backgrounds.
Scholars who critically interrogate philosophies and histories of science have also added much to this conversation about racialized femininity.
McWhorter (2004, 2009) makes a case for the co-constitution of biopolitical regimes of racial and sexual difference, and Somerville (1994, 2000) has
described the ways in which the designation of the “homosexual” has always
been a racially freighted category. Somerville (1994) illuminates how the
pathologization of the purported anatomical idiosyncrasies of lesbian bodies (large labia and other genital anomalies) were bound up with racialized
descriptions of the supposedly abnormal bodies of Black women (the socalled hottentot apron, or enlarged labia, also analyzed by Fausto-Sterling,
1994). Markowitz (2001) extended the conversation by looking specifically at
how ideas about female pelvic size were used in conceptualizing racist frameworks of sexual difference. In both early comparative anatomy and sexology,
including in the work of Havelock Ellis, white women were figured as having larger pelvises than Black women—a trait that was said to have evolved
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
13
because white women needed to have more pelvic space in order to give birth
to white babies (who were figured as having larger skulls according to the
logics of craniology and phrenology!). At the same time, Black women, who
in these early discourses were regularly framed as having larger and more
voluptuous lower bodies than white women, were said to look this way due
to “steatopygia”—a physical anomaly that included large buttocks, which gave
the (compensatory and deceptive) appearance of a larger pelvis without actually having that “evolved” trait (Markowitz, 2001).
Snorton (2017) has recently revisited these themes, as he analyzes how the
formation of white femininity quite literally relied on medical experimentation conducted on Black women by early gynecologists such as J. Marion
Sims. Snorton argues that the regular occurrence of vesicovaginal fistula
(VVF) in Black women slaves was a product of the circumstances of living
on the “medical plantation” of chattel slavery, but was simultaneously blamed
on the lack of expertise of Black midwives and/or posited as a product of the
biologically inferior and categorically “unfeminine” bodily constitution of the
Black woman. Snorton (2017) sums up this paradox, and the imbrication of
racial difference and sexual difference, stating: “The founding of the field of
American gynecology thus raises a number of questions, including how race
constructs biology, and whether sex is possible without flesh” (p. 20). Importantly, these differences in discursive production and material treatment of
real live (Black) bodies is not just a thing of the past—Black women today
experience disproportionately poor treatment in terms of gynecological care
and sexual and reproductive outcomes, including in maternal and infant mortality rates (Casper & Moore, 2009; D. C. Owens, 2017; Washington, 2006).
All of these scholars illuminate the whiteness of sexual difference discourses as these are produced under colonialist medicine and via scientific
racism. Whiteness is similarly the foundation of the feminized responsive
desire framework I analyze in this book. If sexual difference is, in fact, a function of race (and I argue, along with the scholars cited above, that it is), then
there can be no feminine receptivity without race—or, more specifically, without the privileging of whiteness. White feminine receptivity has always been
produced against Black feminine hypersexuality as its counterpart. Further,
white women have traditionally been framed as more sexually receptive, but
women of color have traditionally been expected to actually be more receptive
to sex. In this study, I do not extensively examine the Black hypersexuality
against which white receptivity is framed, but rather illustrate the dominant
white discourses and the insidiousness of their reach, as I critique a particular
moment in contemporary popular psychology that is very much white (i.e.,
the publication of the DSM-5 and its related discursive formations). While
Copyright © 2020 by The Ohio State University. All rights reserved.
14
•
INTRODUCTION
these discourses about women’s sexuality are racialized as white or are left
“unmarked,” my findings importantly suggest that women across racial identities experience low desire and are forced to navigate this white framework
of receptive femininity.
In spite of a plethora of excellent intersectional research from critical
scholars, contemporary scientific narratives of sexuality and gender continue
to reify binary conceptions of sexual difference, specifically since the modern
Darwinian synthesis in which male and female were firmly cast as distinct
and complementary types, with all of their binary trappings, and since the
X chromosome was formally posited as the “female” chromosome (Richardson, 2012). Beginning with this neo-Darwinian shift and through to today,
(discursively unraced) women are broadly understood as being more sexually
receptive, responsive, and reactive than (discursively unraced) men—and this
is in part due to how ubiquitous experiences associated with white feminine
sexuality have become. Part of what I will engage with in this book is how the
idea that women as a whole are sexually “receptive” became popularized and
how it has come to affect diverse individuals. How did sex difference as binary
become such a truism in popular culture in the Global North, and how is
this idea perpetuated through expert knowledge? What are the contemporary
technologies that produce binary sex difference? And why is it that so many
women today do, in fact, end up experiencing their desire as low or lacking?
Diagnosably Low Female Sexual Desire: A Brief Clinical
History
Although the contemporary iteration of feminized responsive desire is my
focus in this book, the main sexual complaint that women tend to present
with clinically is “low desire.”4 Indeed, sexology, sex therapy, and sexual medicine shifted to a responsive model of female desire in part because of the prevalence of this complaint. Beginning in roughly the 1970s, antimedicalization
feminists began to argue that a male model of spontaneous desire had been
applied to women, and that women were therefore pathologized (or pathologized themselves) when in fact their desire was simply different from men’s:
4. Although there is little to no epidemiological data on racial or class demographics of
the women who seek medical help for low desire, due to the very structure of what it means
to “present clinically,” particularly in the US, where health insurance is a commodity, we can
assume that most of these presenting women are white, cisgender, and middle-class or wealthy.
However, due to the way that expert discourses travel in the popular sphere, many other women
may self-diagnose as low in desire and self-treat. That is precisely what this book is about.
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
15
potentially weaker, more receptive or responsive, often following arousal
and needing to be triggered. However, as “low desire” has been registered as
women’s key complaint and as the notion of women’s responsive desire only
entered mainstream medical discourse in its newest guise around the turn of
the twenty-first century, I will elucidate a brief history of low female desire
here.
Many sexual disorders are accounted for in the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental Disorders, but none
included the language of desire until 1980. That year, two new disorders—
inhibited sexual desire (ISD) and sexual aversion—were introduced into the
DSM-III, both emphasizing desire disorders as dyadic; in other words, they
were said to afflict the (implicitly heterosexual) couple rather than just one
partner, and were brought to bear in the context of sex therapy treatment. In
the DSM-III-R, published in 1987, ISD was divided into two categories: hypoactive sexual desire disorder (HSDD) and sexual aversion disorder (SAD),
and when the DSM-IV was introduced in 1994, these diagnoses remained the
same. Up until the publication of the DSM-5 in 2013, both men and women
could be diagnosed with hypoactive desire, although women have consistently been diagnosed much more frequently than men. In the DSM-IV-TR
(text revision), HSDD was defined as “persistently or recurrently deficient
(or absent) sexual fantasies and desire for sexual activity.” The 1999 National
Health and Social Life Survey (NHSLS) reported that around 32 percent of
women between the ages of eighteen and thirty-nine were afflicted with low
desire (as compared to about 14 percent of men in the same age range). A
nationally representative study conducted in 2008 suggested that 26.7 percent
of premenopausal women and 52.4 percent of naturally menopausal women
fit the criteria for diagnosis with HSDD (West et al., 2008), and another study
suggested that up to 40 percent of women lack interest in sex (K. R. Mitchell
et al., 2013).
Even within the terms of these studies, these numbers should be qualified.
The number of low-desiring women reported by the NHSLS study has been
critiqued as inflated, including by the main researcher on the study. Meanwhile, these percentages are often dramatically reduced when potential diagnosees must also be “troubled” or “distressed” by their lack of sexual desire
in order to receive a diagnosis, a criterion that is built into the new DSM-5
diagnosis (i.e., women who are not distressed by their low desire should not
receive the diagnosis, as some may identify as asexual instead). According to
most contemporary estimates, the number of women who lack sexual motivation and who are concomitantly troubled by this experience hovers at around
12 percent (Shifren, Monz, Russo, Segreti, & Johannes, 2008). Regardless of
Copyright © 2020 by The Ohio State University. All rights reserved.
16
•
INTRODUCTION
the details of these studies, the prevalence of low female desire remains a cultural trope, and statistics continue to be cited as proof of the pervasiveness of
the phenomenon. Although recent estimates do not indicate an increase in
the actual number of women afflicted with diagnosably low desire over the
last few decades, widespread attention to women’s desire problems in clinical
literature, a proliferation of recent reports in the popular media (for examples,
see Bergner, 2009a, 2009b, 2013a; Elton, 2010; Gottlieb, 2014; Schreiber, 2012),
and an increase in reports of women who lack interest in sex as demonstrated
in both clinical settings and on national surveys gives the impression that low
desire in women is on the rise, at least in the Global North. Further, as pointed
out by Charest and Kleinplatz (2018), there has been a shift from an emphasis
on sexual problems as dyadic to the increased pathologization of individuals with sexual complaints—and in the case of low desire, this is most often
individual women.
Hence, in most clinical and popular discourses today, it is widely accepted
that men and women have very different sexual problems (Basson et al., 2001;
Basson, Brotto, Laan, Redmond, & Utian, 2005; Brotto, 2010a; Leiblum &
Rosen, 1988; Tiefer, 1991, 1995). Low sexual desire appears not only to occur
more regularly in women, it is expected to be a more common experience for
women. Here, it is important to recognize that many women do in fact experience themselves as low or lacking in desire, and this experience now cuts
across race and class lines, among other categories of difference. The questions I seek to answer in this book do not challenge the reality or validity of
this highly gendered sexual experience of low desire, but instead, its etiology
and assumptions: Why are women more likely to be afflicted with this problem? Do we assume this gendered experience is natural, biological, hardwired?
What does that assumption look like, or how does it manifest, and with what
consequences, in our contemporary climate? Unlike much feminist analysis in
the medical sociology and social psychology traditions, which tends to argue
that sexuality is socially constructed, and that heteronormative gender expectations influence us to pathologize women’s low desire when it is actually just
“normal variation”—or, more recently, that women’s desire may not be disordered but simply “responsive” and “receptive”—I want to consider how these
ideas about receptivity, responsiveness, and even “normal variation” themselves become gendered, and how this framing influences men’s and women’s
lived experiences of desire and their sexual expression more broadly. I want
to think about how gender differences in desire are carved out in the world,
in all their specificities, and with what effects, including for women who come
to identify as either deficient or disordered, or as normal—but receptive and
responsive. Is there a way to understand low desire as disorder, yet simulta-
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
17
neously to question and complicate its supposed neurobiological or essential
origins? Is there a way to look beyond both social constructionism and biological determinism when it comes to sexual difference? Relatedly, is there a
way to think beyond disability, debility, and disorder as objective, medical,
and measurable, yet to simultaneously foreground their material and embodied existence? And is it possible to endeavor a deep critique of the racialized
and gendered nature of scientific and medical discourses while at the same
time acknowledging that some women are disturbed by their lack of desire
and want treatment for it?
Theoretical and Methodological Framework
Before beginning my analysis, I posed a number of research questions: How
do contemporary and historical scientific, medical, and therapeutic discourses
define sexual desire? How do these discourses (and the experts themselves)
frame sexual difference? Do they identify gender differences in desire, arousal,
and sexual behavior? If so, how do they interpret and explain these differences? Are masculine and feminine desire framed differently across sexual
medicine, sex therapy, and clinical psychology paradigms over the last two
centuries? Is anything consistent across these paradigms? And finally, how do
women themselves understand the machinations of their own desire, or lack
thereof?
Because I wanted to focus on the low desire diagnoses in the new DSM-5
and related feminized responsive desire framework, I interviewed women
identifying as low or lacking in sexual desire, including those who have either
sought medical or alternative therapeutic treatments or who have considered
seeking treatment. However, I chose to include within my study interviews
with women who had not undergone medical treatment or received a diagnosis, for a few reasons. It is actually quite difficult to acquire a low-desire
diagnosis from a psychiatric practitioner due to obstacles within the US health
care system, internalized shame about female sexuality, and a variety of other
factors (additionally, this population is also very difficult to reach due to
medical gatekeeping). But I was also actively interested in speaking not only
with women who have received official diagnoses and medical treatment for
low desire but also with potential consumers of medicine—or of alternative
therapies such as mindfulness, yoga, tantra, and feminine energy “healing”
workshops—intended to remedy low desire. In other words, I was interested
in how not only the low desire diagnosis itself but also the broader feminized
responsive desire framework I outlined at the beginning of this introduction
Copyright © 2020 by The Ohio State University. All rights reserved.
18
•
INTRODUCTION
affects a broad population of women. This study deals with medicalization
and healthism (to be defined below), but it is not a medical ethnography. I
am more interested in how the logic of feminine receptivity impacts women
broadly than in the experience of patients who have been diagnosed with a
specific disease state or disorder. Or, rather, I am interested in the increasing blurriness of these categories—the diagnosed and the undiagnosed—particularly as self-medicalization becomes more and more prevalent due to the
impact of the internet and social media.
The sociological study and critique of medicalization—what Conrad (1992)
referred to as “a process by which non-medical problems become defined and
treated as medical problems, usually in terms of illnesses and disorders” (p.
209)—has been an important subfield within sociology since the 1960s, borne
out of the symbolic interactionist and sociology of knowledge traditions.
Early theorists of medicalization included Szasz (1960), who wrote about the
historical invention of mental illness; Zola (1972), who argued that medicine
has become an institution of social control; and Conrad (1975), who argued
that hyperkinesis or attention deficit disorder (ADD) in children, among
other disorders, were iatrogenically produced.5 These sociologists examined
how disorders are socially constructed via powerful medical discourses, and
how they then affect individuals and the “biosocial” communities who take
them up, contest them, or navigate them in a variety of other ways (Rabinow,
1996). More recent scholars in this area have focused on biomedicalization
(Clarke, Shim, Mamo, Fosket, & Fishman, 2003) and healthism or healthicization (Crawford, 1980). These terms reflect a shift in which the dominant
status of medical professions has diminished under neoliberal capitalism, and
increasingly, individuals are targeted by corporations; they may self-diagnose
and self-treat (via online protocols); and alternative, functional, holistic, and
“Eastern” medicine and extramedical protocols have become more popular,
both within so-called Western medical arenas and also outside of the clinic.
The medicalization of sexuality—and specifically the project of making
sexual difference a focal point of psychiatric interest and intervention—has a
long history in the Global North, particularly in the Anglo-American context.
Many feminist scholars have suggested that medicine and science, including
psychology and psychiatry, should be deemed irresponsible not only for their
5. Goffman, with his work on institutionalization (1961) and stigmatization (1978), and
Foucault, with his genealogical analyses of madness (1965), the productive power of expert
discourse (1972), the development of the clinic and the clinical gaze (1973), and disciplinary
regimentation within surveilling institutions (1977), are also associated with the sociological
critique of medicalization. For this project, I am more interested in Foucault’s later work on
governmentality, regimes of sexuality, and the biopolitical production and management of populations, as I elaborate below.
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
19
social control techniques in general, but for their social control of women as
deviant others in particular (Birke & Hubbard, 1995; Boyle, 1993; Harding,
1986; Hubbard, 1990; Irvine, 2002, 2005). Feminists of the 1960s and 1970s
analyzed the legacy of psychoanalysis in this regard, and much of the pathologization of women’s minds and bodies has been attributed to Freud’s drive
model of sex, and the concept of penis envy. These scholars further argued
that the “feminine neuroses”—female masochism, hysteria, frigidity, and even
eating disorders today—were socially constructed as ways to pathologize femininity or, alternatively, that they were the tangible and devastating material
results of the suffocating societal control of women. For other scholars, these
illness experiences may also be read as radical forms of feminist refusal or
resistance to patriarchal modes of being (Bordo, 1993; Ehrenreich & English,
1978).
Today, disability studies scholars such as Garland-Thomson (2002) and
Kafer (2013), and feminist psychiatric disability and madness studies scholars
such as Donaldson (2002), Johnson (2010, 2013, 2015), and Mollow (2014) in a
crip theoretical frame (McRuer, 2006) offer a way of understanding gendered
and racialized illnesses as being simultaneously real and legitimate (rather
than just “socially constructed”), yet still emergent as social products and not
simply forms of refusal. Some feminist and sexuality studies scholars have also
taken up critiques of sexism and misogyny in sexual dysfunction discourses
and in the areas of women’s sexual, reproductive, and mental health more
broadly (Angel, 2010, 2012; Cacchioni, 2015; Labuski, 2015; Moore & Clarke,
1995; Tiefer, 1995). Additionally, asexuality studies scholars have highlighted
regimes of compulsory sexuality (Barounis, 2014, 2015, 2019; Flore, 2014, 2016,
2018; Gupta, 2011, 2015, 2017; Kim, 2014; Milks & Cerankowski, 2014; Przybylo, 2013, 2014), and feminist science studies scholars have unpacked categories of diagnosis, including in regard to intersex embodiment, exposing
the heteronormative rhetoric that operates under the guise of scientific objectivity (Fausto-Sterling, 1992, 1994, 2000; Jordan-Young, 2011; Jordan-Young
& Karkazis, 2019; Karkazis, 2008). As mentioned above, many scholars in
this vein have importantly highlighted the whiteness of these regimes and of
racialized sexual difference more broadly (Hartman, 1997; Markowitz, 2001;
McWhorter, 2004, 2009; Schuller, 2018; Snorton, 2017; Somerville, 1994, 2000;
Spillers, 1987). I offer an analysis of low desire in women that is in conversation with all of this scholarship.
Recent sociological critiques of the medicalization of sexuality, including
prolific critiques of the social construction of female sexual dysfunction and
low desire, have primarily taken an antimedicalization, antipharmaceuticalization or anti–“Big Pharma,” anti-“disease-mongering” stance (Jutel, 2010;
Copyright © 2020 by The Ohio State University. All rights reserved.
20
•
INTRODUCTION
Moynihan, 2005; Tiefer, 1995, 1996, 2006). By contrast, I focus on the ways
in which sexual difference is carved out through clinical discourses, how
gendered ways of being are thus prescribed within these domains, and ultimately, how discursive regimes for active masculinity and receptive femininity
become circuitously attached to bodies and lived out socially. In the present study, I address these crucial—and too often neglected—components of
the current context within which “female sexual dysfunction” (FSD) and low
female desire are constructed, debated, and, by some critics, denounced as
wholly fictitious. I do not think non-asexual women’s low desire is fictitious or
purely “socially constructed,” but nor do I think it is simply “normal variation,”
in the most generous reading, or essential to female sexual constitution, in the
most reductive reading (it is worth noting that both “normal variation” and
“female essence” here operate within the logic of a reductive biological frame).
Instead, I want to turn the gaze back upon the very feminist-identified clinicians and scientists who study and work on women’s desire, and show how
they are complicit with the production of receptive femininity as something
to be regulated, controlled, and optimized. Women-with-low-desire here is
produced as a category, as a population to be managed, and the members of
this population are in many cases produced and managed by self-identified
feminist researchers and clinicians themselves.
In this vein, my research questions further lend themselves to a theoretical exploration proceeding from a biopolitical framework. Beginning with
the work of Foucault in the late 1970s, there has been much attention to the
dynamics of identity and population production, embodiment, and other
forms of corporeal politics in late neoliberal capitalism (Clough, 2007, 2018;
Cooper, 2008; Cooper & Waldby, 2014; Mbembe, 2003, 2019; Murphy, 2012,
2017; Puar, 2007, 2011, 2017; N. Rose, 2001, 2007; Weheliye, 2014). Scholars
following and critiquing Foucault began to explore these questions within a
biopolitical and affective framework beginning in the late 1980s. The primary
common claim is that neoliberal discourses under late global capitalism—
which are attuned to and productive of race, gender, sexuality, nationality,
(dis)ability, and other categories of citizenship and governance—manipulate,
surveil, and affectively control bodies and populations, increasingly through
consensual rather than disciplinary means. Some of these control mechanisms
operate through the domains of medicine, science, and psychiatry—and their
popular instantiations that are now accessible through new media, digital formats, and self-help techniques—and they regulate and manage the health, illness, capacity, debility, life, and death of various populations and the body
politic at large. This management is increasingly performed in the name of
“self-improvement” and individual “health” to the benefit of certain groups
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
21
at the expense of certain others (all of whom are raced, gendered, sexualized,
and nationalized). All of these investments are part of a larger neoliberal project of submitting social life—including family configurations, sexual relations,
and other embodied aspects of this sociality—to market logic. My project, as
it examines the lived experience of racialized and gendered medical and scientific discourses—including those that extend beyond the clinic—and their
effects on women’s bodies and psyches, and insofar as it focuses on the management, regulation, and production of certain iterations of feminine desire,
is firmly situated within this biopolitical framework.
In order to investigate how individuals live out low or responsive female
desire discourses, I employed a mixed methodological qualitative approach. I
utilized three different sociological research methods, including critical discourse analysis of peer-reviewed scientific and sexual medicine journal articles, a limited amount of analytic observation6 at medical clinics and sexual
enhancement workshops, and in-depth interviews with thirty-seven individuals. Most of these interviews were with cisgender women who identified as
currently lacking in sexual desire or who have experienced problematic low
desire at some point in their lives. I also conducted a small number of interviews with a variety of practitioners who do “desire work,” including clinical
psychologists, sex therapists, yogic/tantric practitioners, sexual enhancement
workshop leaders, and antimedicalization activists. By analyzing emergent
themes through in-depth qualitative data-analysis techniques, I was able to
excavate the parallels and tensions between “expert” discourses on low female
desire and the experiences of low-desiring women themselves.
How do women think about low desire, receptivity, responsiveness, complexity, and sexual flexibility? How do they experience their sexualities and
genders? How do they characterize their current and past sex lives? What
turns them on or off? How could their sexual partners help them increase
their desire and give them more pleasure? Why do women themselves think
their desire is low, or has been throughout their lives at different times and
with different partners? In order to shed light on these questions, among
others, I conducted in-depth, one-on-one, semistructured, qualitative interviews with thirty low-desiring women. These interviews ranged from thirty
to 210 minutes in length, but most were between one and three hours long.
Most participants contacted me on the basis of experiencing low desire currently or because they had experienced troublingly low desire at some point in
6. I use the term analytic observation rather than participant observation, as I was not
actually a participant in any of these spaces. Rather, I conducted interviews in medical and
alternative therapeutic spaces and was able to observe certain dynamics in these “clinics” during the interviewing process.
Copyright © 2020 by The Ohio State University. All rights reserved.
22
•
INTRODUCTION
their lives; two had participated in medical treatment programs that utilized
behavioral, therapeutic, and pharmaceutical interventions to treat sexual pain
and concomitant low desire. They ranged in age from twenty-one to fiftysix years, but most were between the ages of twenty-five and thirty-seven,
and all except for one were premenopausal. These women were of diverse
racial and ethnic backgrounds, with about one-third of the sample identifying as women of color. They grew up with a multitude of cultural, community,
and religious backgrounds. Most were born in the US, and almost all had at
least a college education (or were currently attending college). They were of
diverse sexualities (most were straight or bisexual; some identified as queer)
and lifestyles (some were married or in long-term partnerships, some were
single, some were polyamorous or in open relationships, and only a few were
pregnant or had children), but all of the women I interviewed who identified
as low-desiring (or who had previously experienced distressingly low desire)
had been sexually involved with cisgender men at some point in their lives.
One participant identified as being on an asexual/pansexual spectrum, and
one identified as genderqueer/nonconforming. A participant also interviewed
me, using the same interview schedule I had used with all of the low-desiring
women I interviewed. See the appendix (Table 1 and Table 2) for full participant and expert demographic information. All of the names used for participants in this study are pseudonyms. The names in Table 1 (low-desiring
participants) were chosen by the participants themselves. I selected the names
in Table 2 (the experts; although some of the experts agreed to use their real
names, not all did, so in order to be consistent, I gave them all pseudonyms.
All of the experts are white).
Most of the participants responded to a flyer I posted in a variety of spaces
around Brooklyn, Queens, and Manhattan in New York City—including in
college health centers and other university settings, coffee shops and restaurants, grocery stores, yoga and dance studios, and other public places with bulletin boards for posting events and activities. The flyer was also disseminated
to initial participants to email to their friends and post on their Facebook and
other social media pages, so many of the later participants were recruited via
snowball sample (Berg & Lune, 2011; Miles, Huberman, & Saldaña, 2013). I
also posted the recruitment flyer on my personal blog, Facebook, and Twitter
pages and made it shareable so others could post it. This type of convenience
sampling is appropriate given the sensitive nature of the interview topics, and
is useful for making exploratory grounded theoretical observations that are
not generalizable to any larger population.7 My sample could be said to be
7. Most of the interviews were conducted at my apartment, at the participants’ apartments, or in a public space such as a café or park (in all cases, the participants chose where
they preferred to be interviewed—and a handful of interviews were conducted via Skype or
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
23
somewhat disparate, but I argue that this makes sense and is in keeping with
the scientific literature, as what it means to be a “low-desiring” woman is
confusing and ill-defined, and the medical discourse itself is confusing and
ill-defined. There is no consensus in experimental or clinical psychology or
sexual medicine or sex therapy on what “desire” even is, or what “low desire”
indicates, and the new female sexual interest/arousal disorder diagnosis attests
to this, as I will explain in chapter 2.
In the remaining six interviews, which were conducted with clinicians,
therapists, activists, and yogic/alternative health practitioners, emergent
themes included these experts’ thoughts on feminine receptivity, innate or
neurological differences between men and women, evolutionary sexual adaptations, and gender differences in mind/body disconnects or alignments (i.e.,
arousal/desire “concordance” versus “discordance”). I also examined how
practitioners dealt with the same themes that emerged from the low-desiring
women’s interviews. Different practitioners grappled with these themes differently, and they had diverse ideas about the most appropriate and effective
treatments for low female desire. I utilize these expert interviews sporadically
throughout the remainder of this book, primarily to frame the textual analysis
and low-desiring participants’ interview data.
Chapter Overview
In the first half of Diagnosing Desire, I examine historical and contemporary
formulations of both clinical and popular discourses about femininity, sexuality, and gendered sexual response; in the second half of the book, I turn more
closely to the interviews and the themes that emerged from them.
In chapter 1, I examine how femininity, women’s sexuality, and female
desire have been framed in sex therapy, sex research, and specifically as part
of conceptualizations of human sexual response, from the nineteenth century through to today. I pay special attention to how notions of feminine
responsiveness and receptivity have been maintained through different sexual
response models, from early psychoanalytic configurations to more behavioristic accounts to evolutionary psychology formulations of sexual difference. Although paradigms through which sexuality is interpreted have shifted
immensely (and much has been lost in the movement from trauma-based
psychoanalytic/psychodynamic theories to the more reductive evolutionary
FaceTime) between 2012 and 2014. I did not compensate any of the interviewees monetarily,
although I did offer to buy them coffee or tea if we were at a café, and if they came to my apartment to conduct the interview, I cooked dinner for them and/or provided food and beverages.
Copyright © 2020 by The Ohio State University. All rights reserved.
24
•
INTRODUCTION
psychology and behavioristic models), the idea that men and women operate
on different sexual planes of existence has remained constant.
In chapter 2, I pick up with contemporary behavioristic and evolutionary
models and focus on the trajectory of the new science of female sexuality as
it relates to these models, and specifically on the development of the circular
sexual response cycle as part of the feminized responsive desire framework. I
show how these models for thinking about women’s sexual response began to
take hold over the last twenty-five or so years, and came fully into the popular spotlight during the first decade of the twenty-first century, and I consider
how the notions of sexual “interest,” “arousal,” and “motivation” have come
to replace the language of (female) “desire” and have simultaneously come to
dominate in individualized sex therapy, sexual medicine, and contemporary
sexology. I further show how this feminized responsive desire framework—
along with experimental psychology research on women’s subjective/genital
discordance—culminated in the newly gendered FSIAD diagnosis in the 2013
edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM5). The feminization of responsive desire is not only an issue for those who
are diagnosed with FSIAD, however—because of the far reach of ideas about
feminine sexual receptivity via popular media, many women have internalized
these notions, and will self-diagnose and seek treatment, including through
mindfulness-based sex therapy, or MBST, one of the most popular methods of
treatment today. I analyze this entire framework as it relates to themes about
women’s sexuality that have emerged in evolutionary psychology, and consider
treatments—including mindfulness to enhance desire—through a biopolitical lens. Members of the population women-with-low-desire are produced
as such through sexual medicine and treatment protocols and come to regulate themselves accordingly. This self-surveillance rehearses antiquated narratives about (white) feminine receptivity and has dire negative consequences
for women’s sexual agency—which is paradoxical, in that the framework and
treatments are designed to “empower” women.
Through the qualitative analysis of interview data, several primary themes
emerged as specifically affecting women who identify as low in sexual desire,
and they are the topics of the remaining chapters. In chapter 3, I examine concepts associated with the FSIAD diagnosis, such as “interest,” “arousal,” “motivation,” and “receptivity,” and consider how well they apply (or do not apply)
to the women I interviewed. I also examine how second-wave feminism, specifically cultural feminist strains within the “psychology of women,” and even
ideas about women that have emerged from antimedicalization activism, have
been imported into the feminized responsive desire framework. Today, this
model of women’s sexual response is offered as “feminist”—however, I argue
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
25
that it can only be interpreted as such if women’s empowerment is defined narrowly within a white liberal feminist framework. I argue that more in-depth,
intersectional feminist goals are undercut by the racialized, cisnormative, and
heterornomative contours of the feminized responsive desire framework itself.
The primary theme that emerges from my interview data here is the notion of
sexual difference socialization, or the experience of one’s sexuality (and femininity) through pervasive scientific, therapeutic, and popular discourses that
prescribe gender differences in sexual desire and behavior. Here, I consider
how the category women-with-low-desire is not only produced discursively
via sexual medicine but also how members of this population are socialized
into being, through gendered sexual expectations that are part and parcel of
contemporary sexology and its associated scripts.
In chapter 4, I consider embodied invisible labor in the form of sexualized social reproduction, or what I call sexual carework. This theme from
my interview data does not only concern the ways women are expected to
sexually service men under heteropatriachy (although it does concern that).
I also focus on how the medical and scientific discourses I analyze in the first
part of the book support notions of feminized sexual carework, which has
particular import for women-with-low-desire, and even more specifically for
women of color in this category. Further, I consider how, under regimes of
compulsory gendered (hetero)sexuality, sexual carework becomes a mandate
for self-care—for the good of the hetero/cis relationship, the bourgeois family,
the nation/state, and sometimes the woman’s “own health”; here, alternative
therapies, including mindfulness, become tools of self-care as self-regulation,
and femininity becomes a duty. Feminized sexual carework is thus a biopolitical mandate, and feminine carers are a population to be invested in and who
are expected to invest in themselves in order to self-appreciate (in the sense of
accruing value, or making oneself more valuable).
In chapter 5, I analyze the interviews and consider how and why some
low-desiring women are drawn to submission in bondage and discipline/
dominance and submission/sadism and machochism or BDSM practice, and
concomitantly interrogate the problem of the missing discourse of trauma
within the feminized responsive desire framework. In this vein, I consider
the fraught nature and importance of sexual intentionality—including the
necessity of actively negotiating sexual taboos and attempting to build sexual
trust (particularly for women who have sex with men)—in the face of many
low-desiring women’s frequent experiences with and histories of feminized
trauma as a result of gendered and sexual violence. Here, I further expose the
violence inherent in the feminized mandate to sexual receptivity, including
as it is deployed via the FSIAD diagnosis and mindfulness-based sex ther-
Copyright © 2020 by The Ohio State University. All rights reserved.
26
•
INTRODUCTION
apy and related discourses. I show, however, that receptivity can be and is
reclaimed by women, including through mindful and intentional submission,
for instance via BDSM. This intentional and queer reclamation of receptivity
via submission throws into stark relief the (ironically) more self-disciplinary
mandate of enhancing one’s own responsive desire via biopolitical techniques
such as mindfulness, and thus what I refer to as parasexual pleasure is able to
be experienced even in the face of compulsory and feminized trauma. Here, I
add to ongoing conversations about asexuality, demisexuality, and other nonnormative versions of erotic life.
I bring all of these themes together in the conclusion of Diagnosing Desire
and consider a different model of care and parasexual agency through the
lenses of crip theory, critical feminist disability studies, and feminist madness
studies. Here, I think through the implications of the biopolitical analysis of
femininity that has been laid out in the book; if the responsive feminine are
produced as a population, then there may be an experience of vitality to be
found in “falling apart” or “fracturing” together—rather than self-surveilling
and constantly seeking to individually enhance under white supremacist, ableist, cisheteropatriarchal capitalism. There is revolutionary potential in falling
apart in the face of trauma and low desire, with others, in radical community,
rather than using biopolitical techniques in order to simply “get by.”
•
I want to acknowledge a few final things before I go any further. First, while I
will argue throughout this book that contemporary discourses of femininity
are framed as universal or are racially “unmarked,” but that they ultimately
recapitulate ideas about white women’s sexuality (founded in early scientific
discourses of racialized sexual difference), the one-on-one interviews for this
this book did not focus on race in an in-depth way. I reflexively acknowledge
the limitations of this book in this vein; while I did speak with several women
of color for this project, we did not extensively discuss the many ways that
race, racism, and white supremacy undoubtedly impact their experiences of
their own sexuality and desire. To some extent, this was a limitation of my
interview schedule and the substance of the overarching research question
that brought these participants to speak with me in the first place (the connection between gender and low desire), but my own whiteness surely influenced
how I chose to analyze the interviews and what themes I ultimately centered
in the final analysis. There is a strong connection between my own work here
and research that suggests how (sexualized/gendered) trauma and (sexualized/gendered) carework are disproportionately experienced and enacted by
Copyright © 2020 by The Ohio State University. All rights reserved.
DIAGNOSING GENDER THROUGH DESIRE
•
27
poor women, women of color, and folks of other marginalized statuses, and
I highlight that research throughout the text with a nod to the limits of my
own project. I take seriously Nash’s (2019) critiques of the burden thrust upon
feminist scholars of color to do intersectional work and Puar’s (2017) critiques
of the ways in which (white) new materialist feminist scholars specifically
have too often ignored an intersectional frame. I hope that my research here
on the whiteness of the contemporary medical and scientific milieu of sexual
difference production and regulation can open the door for more in-depth
analyses of racialization and unmarked whiteness as it travels in this milieu
(and it is white scholars, including me, who should endeavor to perform these
analyses).
A few final points I’d like to acknowledge include the time scale of this
research, the pervasiveness of what may appear to be a narrow discourse, and
the complexity of the experts I analyze. The science that I have been studying
moves fast, and narratives and hypotheses offered in experimental and clinical psychology publications have changed quickly since I began this project.
Thus, this book focuses primarily on a very specific time period: the first ten
to fifteen years of the twenty-first century, when women’s (receptive) desire
increasingly came into the spotlight, and the discursive space of “feminism”
was increasingly occupied by mainstream sexual medicine practitioners,
researchers, and sex therapists. This book, then, is also a critique of white liberal feminism as it has been taken up in mainstream psychology.
In this vein, one of my goals is to inspire an interdisciplinary dialogue.
Many popular mainstream psychologists are still primarily working with the
categories of “males” and “females,” are only recently beginning to examine
the social construction of gender, and assume universal sex categories without
analyzing their founding within colonialism and white supremacy. By contrast, scholars in critical race and sexuality studies, disability studies, queer
and feminist theory, and queer of color and crip of color critique have moved
well beyond social constructionist arguments and forefront white supremacy as undergirding all of our medical and scientific categories. I hope this
book can promote useful and practicable discussions among these scientific
researchers and cultural theorists, so that our most cutting-edge science and
medicine can be informed by our most cutting-edge theories of gender, sexuality, race, and embodiment. These discussions will be imperative in improving both clinical/therapeutic treatments for marginalized populations, and the
scientific research upon which those treatments are based.
Finally, it must be noted that this project has been difficult in part because
of the complexity of the medical figures and experts who have become the primary characters in this story. While I critique the way their various research
Copyright © 2020 by The Ohio State University. All rights reserved.
28
•
INTRODUCTION
projects, treatment protocols, and activist endeavors have come together to
form the feminized responsive desire framework that I see as ultimately detrimental and retrograde, I also recognize that these women are progressive
and innovative scholars in their fields and have done much to shift the terrain
of mainstream psychology and sexology. They have moved sex therapy and
research forward in many invaluable ways, and my intervention here is meant
in the spirit of feminist dialogue and critical engagement with those projects.
We are all steeped in our own disciplines and have to navigate the constraints
therein, and I hope that my argument and analysis in this book will provoke
a necessary conversation.
Copyright © 2020 by The Ohio State University. All rights reserved.