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The Science of O

Viagra raised the flag on a new sexual revolution, and women, with the help of doctors and drug companies, are finally getting in on the fun. Will they find better loving through chemistry?

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Dr. Jed Kaminetsky, a prominent urologist and clinical assistant professor at New York University Medical Center, used to keep a large model of a penis on his desk. But last year, Kaminetsky, in a symbolic nod to the growing number of women seeking his services, banished the plastic Johnson to an examination-room shelf. "That penis is gone," Kaminetsky acknowledges, glancing out his office window to where the Empire State Building rises stiffly and proudly toward the heavens.

Kaminetsky is an important figure in a new sexual revolution. By his own account, he's prescribed Viagra to roughly 3,000 men in the three years since Pfizer began marketing the drug. But no sooner had he begun dispensing the male wonder drug than he realized he was only treating half the problem. "Women felt left out, and in relationships that had adapted to having no sex, now men had this new toy, an erect penis, and the women in a lot of cases wanted no part of it," says Kaminetsky.

So Kaminetsky began searching for a way to bring equal opportunity back to the bedroom. (Viagra itself, though effective in some women, had too many side effects, and wasn't approved for women by the FDA.)

After some experimentation, Kaminetsky whipped up a concoction that came to be known as Dr. K's Dream Cream -- a "sexual enhancer" that functions much like Viagra, by increasing blood flow to the vaginal area. Happily, the cream, unlike Viagra pills, appears to have no side effects. Kaminetsky has no hard data on the cream's effectiveness; what he does have are the testimonials of hundreds of women who swear by the stuff. Since he began selling a version of it in April 1999, Kaminetsky has sold several hundred pounds of Dream Cream from his office and, more recently, via his Website, loveenhancement.com. "For so long there's been nothing to help make sex more pleasurable for women," says Janet, one of Kaminetsky's satisfied patients.

"In men, it's simple -- it's a plumbing problem. But until we get a handle on this, it's like shooting in the dark."

"Most women don't assume they're going to have an orgasm when they have sex." Janet uses Dream Cream to up her "orgasm-to-sex ratio." "My husband wants to have sex so much more often than I do -- I want to increase my chance of coming and make it more pleasurable."

As recently as two or three years ago, a woman talking to her doctor about orgasms was a highly unusual occurrence. The medical community showed virtually no interest in women's sexual problems. "The chairman of my department where I trained told me, 'I don't think anybody will hire you with that as your focus,' " says Dr. Jennifer Berman, a urologist, researcher, and co-founder of a groundbreaking women's-sexuality clinic at Boston University Medical Center. "It was and still is an attitude among the medical field in general."

But Viagra, by removing the stigma from male sexual inadequacy, seems to have spurred a new openness about sexual problems among women as well. Nationwide, women are knocking on their doctors' doors seeking satisfaction, and doctors are beginning to welcome them with open arms -- sometimes even a vibrator.

The phenomenon has particular resonance in New York, where the assumption is that everyone is having great sex -- and heaps and heaps of it. We're not living Ally McBeal here, after all; we're living Sex and the City. Or supposed to be. "There is a lot of guilt about being unable to have an orgasm, certainly, and about having sexual dysfunctions," says Manhattan psychiatrist Barbara Bartlik, who treats men, women, and couples with sexual problems. There's also less time for sex. "For many of our couples who come in for treatment, it's a major event if they're well rested at the same time and long enough for them to have sex. That's a very big problem."

Female sexual response is -- surprise -- a highly complex affair, affected in equal measures by factors physiological and psychological: Problems could have vascular, hormonal, or neurological causes, or they could be symptomatic of a bad relationship, a house full of demanding kids, or a voice in a woman's head that says good girls don't care about orgasms. Remarkably little has been known about the role of hormones in a woman's libido, or even the location and function of nerves in the pelvic area.

At the turn of the century, when Victorian attitudes virtually banned women from any claim to sexual enjoyment, patients suffering from "female hysteria" -- what might now be referred to unscientifically as "needing some action" -- sought treatment from physicians who "manipulated" them to orgasm, by hand at first, later with vibrators.

But not until very recently have doctors and scientists again taken an interest in a woman's orgasm. "There's been a void in terms of where women take these kinds of concerns," says psychologist Sue Chenoweth, who screens patients at a new women's-sexuality clinic in Hartford.

Some of this new interest is, of course, stimulated by money. Pharmaceutical companies, turbo-charged by Pfizer's $1.3 billion in sales of Viagra last year alone, are racing against one another to develop new pills, creams, suppositories, and therapeutic devices. There is also a slew of new over-the-counter aphrodisiacs, with names like Niagara and Rendezvous.

As science struggles to catch up with the market, a dizzying variety of sexual complaints have been newly categorized under the umbrella term female sexual dysfunction (FSD). FSD is actually a broad description that encompasses four distinct classes of sexual problems, which often have both physical and psychological causes. There's female sexual-arousal disorder, a lack of sensitivity or inability to be aroused. Then there's lack of libido, the absence of desire. There's also the condition called female orgasmic disorder. And there's pain during sex, which can occur along a broad spectrum.

Not surprisingly, FSD is highly controversial. For one thing, it allows doctors (read: the Patriarchy) to decide what's normal for women. And the huge potential for moneymaking makes some doubt the motives of these new Drs. Feelgood. "It seems a little odd now that suddenly there's a deficit of female sexuality," says the feminist writer Barbara Ehrenreich, who co-wrote the 1978 book For Her Own Good: 150 Years of the Experts' Advice to Women. "This is not to say that there may not be some women who could use this. But to declare a new widespread disorder and start marketing the drugs to treat it, that's a kind of commercial hype or fraud."

But many who are on the vanguard of this new movement speak a language not of profit but of empowerment. "We have two generations of women now who are struggling with this," says Dr. Laura Berman, a psychologist and a co-founder of the Boston clinic with her sister Jennifer Berman. "One is the baby-boomer generation that are saying, 'Wait a minute, I worked so hard for these rights, I'm not going to let go of them now.' Then we have younger women who are very empowered, very strong, very professionally successful women who still struggle with how to negotiate for their rights in the bedroom: 'How can I give him instructions on how to be in bed? It would totally emasculate him.' "


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