Why Is Big Pharma Trying to Tell You How to Have Sex?

In the beginning there was sex. And sex begat skill, and skill (or its absence) begat judgment, and judgment begat insecurity, and insecurity begat doctors' visits, which begat treatments, which have flourished into a multibillion-dollar industry, so that sex between men and women is today almost inconceivable without the shadow of disorder, dysfunction, the "little blue pill" or myriad other medical interventions designed to bring sex back to some longed-for beginning: a state of certified healthfulness, the illusion of normal.

Sex has been missing from the healthcare debate. A shame, because sexual health, and disputes over its meaning, reveals most nakedly the problem at the core of a medical system that requires profit, huge profit, hence sickness, or people who can come to believe they are sick or deformed or lacking and therefore in need of a pill, a procedure or device. Case in point: female sexual dysfunction (FSD), said to afflict great numbers of women--43 percent according to some, 70 percent according to others, an "epidemic" in the heterosexual bedroom according to Oprah. Ka-ching!

More on that in a moment, but first a bit about FSD's precursor, hysteria, and the rustic science of bringing women off.

In my room is a curious artifact of late-nineteenth-century medicine: a heavy wooden chair with a cast-iron lever extending up to each arm, within easy grasp of the sitter. Pull the levers, and powerful springs activate a mechanism below to rock or jolt the sitter (depending on the vigor of the thrust) in a manner intended to produce the healthful effects of horseback riding for ladies suffering from "pelvic congestion."

This particular jolting chair was discovered by an antiques-dealer friend, Gilbert Ruff, in Chester, Vermont, but its provenance as an invention reaches back to a fabled arena of psychosexual medicine, the Salpêtrière hospital in Paris, and to Jean-Martin Charcot, teacher of Freud and father of modern neurology. Charcot was an enthusiast for the idea that women with a grab bag of complaints, from irritability to sleeplessness to sexual fantasies and ungratified desire, were diseased. Hysteroneurasthenic disorder was the name for their sickness then. For some, he prescribed long train trips over rough track beds. If they took another doctor's advice and sat in the rail carriage "so as to be leaning forward," they might have got surprising relief. But such journeys were impractical, so Charcot and his colleagues devised a more homely vibration therapy.

Various iterations of the jolting chair entered commercial self-help markets. Mine was manufactured in New York, and contemporary advertisements promoted it to strengthen "the parts that are usually most neglected by the fair beings." Now, a woman might enjoy the humpy bounce of this chair, varying the intensity, parting her legs, leaning forward and breathing deep, even calibrating her motions to the rhythms of a French dance tune, or gavotte, written for the purpose, but the jolting chair never proved as efficient at achieving that "hysterical paroxysm" of relief that doctors had been inducing in their female patients since at least the first century AD simply with their fingers. Nor could it compete with pulsing water cures or that ultimate women's aid, the vibrator, also invented by a doctor and first used on hysterics at Salpêtrière.

 As Rachel Maines demonstrates in her delightfully illuminating history The Technology of Orgasm, making patients out of sexually unsatisfied women was good business. The afflicted would neither die nor be cured but required regular massage treatments, weekly, sometimes daily, for an hour or even three. By one 1863 estimate, such therapies accounted for three-quarters of physicians' business, but doctors seem to have got no pleasure out of diddling women. It was, Maines says, "the job nobody wanted." And bringing women off was work, abstracted from sex (i.e., the robust progression from male hard-on to vaginal penetration to male orgasm) and requiring time and skill. With the vibrator, doctors' productivity exploded, as sixty-minute visits shrank to ten, raising more revenue from more patients per day, until the device became so popular and multipurpose (Sears marketed a home vibrator with attachments for beating eggs, churning butter, operating a fan) that the medical profession had worked itself out of a job. Miraculously, the sick were healed as soon as the first vibrator popped up in porno in the 1920s.