The New View Manifesto
New View of Women's Sexual Problems
The Working Group on A New View of Women's Sexual Problems. [ 1 ]
Introduction: Beyond the medical model of sexuality
recent years, publicity about new treatments for men's erection problems
has focused attention on women's sexuality and provoked a competitive
commercial hunt for "the female Viagra." But women's sexual problems
differ from men's in basic ways which are not being examined or addressed.
We believe that a fundamental barrier to understanding women's sexuality
is the medical classification scheme in current use, developed by the
American Psychiatric Association (APA) for its Diagnostic and Statistical
Manual of Disorders (DSM) in 1980, and revised in 1987 and 1994.
It divides (both men's and) women's sexual problems into four categories
of sexual "dysfunction": sexual desire disorders,
sexual arousal disorders, orgasmic disorders, and sexual pain disorders.
These "dysfunctions" are disturbances in an assumed
universal physiological sexual response pattern ("normal function") originally
described by Masters and Johnson in the 1960s. This universal pattern begins,
in theory, with sexual drive, and proceeds sequentially through the stages
of desire, arousal, and orgasm.
In recent decades, the shortcomings of the framework, as it applies to women,
have been amply documented. The three most serious distortions produced
by a framework that reduces sexual problems to disorders of physiological function,
comparable to breathing or digestive disorders, are:
1) A false notion of sexual equivalency between men and women. Because the
early researchers emphasized similarities in men's and women's physiological
responses during sexual activities, they concluded that sexual disorders must
also be similar. Few investigators asked women to describe their experiences
from their own points of view. When such studies were done, it became apparent
that women and men differ in many crucial ways. Women's accounts do not fit
neatly into the Masters and Johnson model; for example, women generally do
not separate "desire" from "arousal," women care less about physical than subjective
arousal, and women's sexual complaints frequently focus on "difficulties" that
are absent from the DSM.
Furthermore, an emphasis on genital and physiological similarities between
men and women ignores the implications of inequalities related to gender, social
class, ethnicity, sexual orientation, etc. Social, political, and economic
conditions, including widespread sexual violence, limit women's access to sexual
health, pleasure, and satisfaction in many parts of the world. Women's social
environments thus can prevent the expression of biological capacities, a reality
entirely ignored by the strictly physiological framing of sexual dysfunctions.
2) The erasure of the relational context of sexuality. The American Psychiatric
Association's DSM approach bypasses relational aspects of women's sexuality,
which often lie at the root of sexual satisfactions and problems--e.g., desires
for intimacy, wishes to please a partner, or, in some cases, wishes to avoid
offending, losing, or angering a partner. The DSM takes an exclusively individual
approach to sex, and assumes that if the sexual parts work, there is no problem;
and if the parts don't work, there is a problem. But many women do not define
their sexual difficulties this way. The DSM's reduction of "normal sexual function" to
physiology implies, incorrectly, that one can measure and treat genital and
physical difficulties without regard to the relationship in which sex occurs.
3) The levelling of differences among women. All women are not the same, and
their sexual needs, satisfactions, and problems do not fit neatly into categories
of desire, arousal, orgasm, or pain. Women differ in their values, approaches
to sexuality, social and cultural backgrounds, and current situations, and
these differences cannot be smoothed over into an identical notion of "dysfunction"--or
an identical, one-size-fits-all treatment.
Because there are no magic bullets for the socio-cultural, political, psychological,
social or relational bases of women's sexual problems, pharmaceutical companies
are supporting research and public relations programs focused on fixing the
body, especially the genitals. The infusion of industry funding into sex research
and the incessant media publicity about "breakthrough" treatments have put
physical problems in the spotlight and isolated them from broader contexts.
Factors that are far more often sources of women's sexual complaints--relational
and cultural conflicts, for example, or sexual ignorance or fear--are downplayed
and dismissed. Lumped into the catchall category of "psychogenic causes," such
factors go unstudied and unaddressed. Women with these problems are being excluded
from clinical trials on new drugs, and yet, if current marketing patterns with
men are indicative, such drugs will be aggressively advertised for all women's
A corrective approach is desperately needed. We propose a new and more useful
classification of women's sexual problems, one that gives appropriate priority
to individual distress and inhibition arising within a broader framework of
cultural and relational factors. We challenge the cultural assumptions embedded
in the DSM and the reductionist research and marketing program of the pharmaceutical
industry. We call for research and services driven not by commercial interests,
but by women's own needs and sexual realities.
Health and Sexual Rights: International Views
move away from the DSM's genital and mechanical blueprint of women's
sexual problems, we turned for guidance to international documents.
In 1974, the World Health Organization held a unique conference on the
training needs for sexual health workers. The report noted: "A growing
body of knowledge indicates that problems in human sexuality are more
pervasive and more important to the well-being and health of individuals
in many cultures than has previously been recognized." The report emphasized
the importance of taking a positive approach to human sexuality and
the enhancement of relationships. It offered a broad definition of "sexual
health" as "the integration of the somatic, emotional, intellectual,
and social aspects of sexual being."
In 1999, the World Association of Sexology, meeting in Hong Kong, adopted a
Declaration of Sexual Rights." In order to assure that human beings and
societies develop healthy sexuality," the Declaration stated, "the following
sexual rights must be recognized, promoted, respected, and defended":
- The right to sexual freedom, excluding all forms of sexual coercion, exploitation
- The right to sexual autonomy and safety of the sexual body;
- The right to sexual pleasure, which is a source of physical, psychological,
intellectual and spiritual well-being;
- The right to sexual information...generated through unencumbered yet scientifically
- The right to comprehensive sexuality education;
- The right to sexual health care, which should be available for prevention
and treatment of all sexual concerns, problems, and disorders.
Sexual Problems: A New Classification
problems, which The Working Group on A New View of Women's Sexual Problems
defines as discontent or dissatisfaction with any emotional, physical,
or relational aspect of sexual experience, may arise in one or more
of the following interrelated aspects of women's sexual lives.
SEXUAL PROBLEMS DUE TO SOCIO-CULTURAL, POLITICAL, OR ECONOMIC FACTORS
A. Ignorance and anxiety due to inadequate sex education, lack of access to
health services, or other social constraints:
1. Lack of vocabulary to describe subjective or physical experience.
2. Lack of information about human sexual biology and life-stage changes.
3. Lack of information about how gender roles influence men's and women's sexual
expectations, beliefs, and behaviors.
4. Inadequate access to information and services for contraception and abortion,
STD prevention and treatment, sexual trauma, and domestic violence.
B. Sexual avoidance or distress due to perceived inability to meet cultural
norms regarding correct or ideal sexuality, including:
1. Anxiety or shame about one's body, sexual attractiveness, or sexual responses.
2. Confusion or shame about one's sexual orientation or identity, or about
sexual fantasies and desires.
C. Inhibitions due to conflict between the sexual norms of one's subculture
or culture of origin and those of the dominant culture.
D. Lack of interest, fatigue, or lack of time due to family and work obligations.
II. SEXUAL PROBLEMS RELATING TO PARTNER AND RELATIONSHIP
A. Inhibition, avoidance, or distress arising from betrayal, dislike, or fear
of partner, partner's abuse or couple's unequal power, or arising from partner's
negative patterns of communication.
B. Discrepancies in desire for sexual activity or in preferences for various
C. Ignorance or inhibition about communicating preferences or initiating, pacing,
or shaping sexual activities.
D. Loss of sexual interest and reciprocity as a result of conflicts over commonplace
issues such as money, schedules, or relatives, or resulting from traumatic
experiences, e.g., infertility or the death of a child.
E. Inhibitions in arousal or spontaneity due to partner's health status or
III. SEXUAL PROBLEMS DUE TO PSYCHOLOGICAL FACTORS
A. Sexual aversion, mistrust, or inhibition of sexual pleasure due to:
1. Past experiences of physical, sexual, or emotional abuse.
2. General personality problems with attachment, rejection, co-operation, or
3. Depression or anxiety.
B. Sexual inhibition due to fear of sexual acts or of their possible consequences,
e.g., pain during intercourse, pregnancy, sexually transmitted disease, loss
of partner, loss of reputation.
SEXUAL PROBLEMS DUE TO MEDICAL FACTORS
Pain or lack of physical response during sexual activity despite a supportive
and safe interpersonal situation, adequate sexual knowledge, and positive sexual
attitudes. Such problems can arise from:
A. Numerous local or systemic medical conditions affecting neurological, neurovascular,
circulatory, endocrine or other systems of the body;
B. Pregnancy, sexually transmitted diseases, or other sex-related conditions.
C. Side effects of many drugs, medications, or medical treatments.
D. Iatrogenic conditions.
Conclusion, Footnotes, Translations
document is designed for researchers desiring to investigate women's
sexual problems, for educators teaching about women and sexuality, for
medical and nonmedical clinicians planning to help women with their
sexual lives, and for a public that needs a framework for understanding
a rapidly changing and centrally important area of life.
For further information about the Campaign for "A New View of Women's
Sexual Problems," to obtain additional copies of this document, or to
make a financial contribution, please contact:
Dr. Leonore Tiefer, 163 Third Ave., PMB #183, New York,
Members of the Working Group *
- Linda Alperstein, M.S.W., Assoc. Clin. Prof., Psychiatry,
University of California at San Francisco; Psychotherapy
Practice, San Francisco, CA Carol Ellison, Ph.D., Author;
Psychotherapy Practice, Oakland, CA
- Jennifer R. Fishman, B.A., Doctoral Candidate, Department of Social
and Behavioral Science, UCSF, CA
- Marny Hall, Ph.D., Author; Psychotherapy Practice, San
- Lisa Handwerker, Ph.D., M.P.H., Institute for the Study
of Social Change, University of California at Berkeley,
- Heather Hartley, Ph.D., Ass't Professor, Sociology,
Portland State University, OR
- Ellyn Kaschak, Ph.D., Professor, Psychology, San Jose
State University, CA
- Peggy J. Kleinplatz, Ph.D., School of Psychology, Univ.
of Ottawa, Ontario, Canada
- Meika Loe, M.A., Doctoral Candidate, Women's Studies
Emphasis, Sociology,University of California at Santa
- Laura Mamo, B. A., Doctoral Candidate, Department of
Soc. and Behav. Sci., UCSF, CA
- Carol Tavris, Ph.D., Social Psychologist; Independent
Scholar, Los Angeles, CA
- Leonore Tiefer, Ph.D., Assoc. Clin. Professor, Psychiatry,
New York University School of Medicine and Albert
Einstein College of Medicine, NY
* Affiliations as of 2000, when the manifesto was written.
American Psychiatric Association (1980, 1987, 1994). Diagnostic and
Statistical Manual of Mental Disorders, 3rd, 3rd-revised, and 4th editions.
Washington, DC: APA.
Masters, W. H. & Johnson,V. E. (1966) Human Sexual Response. Boston:
Little, Brown, and Co.; Masters, W.H. & Johnson, V. E. (1970) Human
Sexual Inadeqacy. Boston: Little, Brown, and Co.
e.g., Tiefer, L. (1991) Historical, scientific, clinical and feminist
criticisms of "the Human Sexual Response Cycle" model. Annual Review
of Sex Research, 2, 1-23; Basson, R. (2000) The female sexual response
revisited. J. Society Obstetrics and Gynaecology of Canada, 22, 383-387.
Frank, E., Anderson, C., & Rubinstein, D. (1978) Frequency of Sexual
dysfunction in "Normal" couples. New England Journal of Medicine, 299,
111-115; Hite, S. (1976) The Hite Report: A nationwide study on female
sexuality. NY: Macmillan; Ellison, C. (2000) Women's Sexualities: Generations
of women share intimate secrets of sexual self-acceptance. Oakland,
CA: New Harbinger.
WHO Technical Report, series Nr. 572, 1975. Full text
available on the Magnus Hirschfeld Archive for Sexology
Full text available on the website listed in footnote
6 and also on the World Association of Sexology website http://www.tc.umn.edu/~colem001/was/wdeclara.htm.
It is published in E.M.L.Ng, J.J. Borras-Valls, M. Perez-Conchillo
and E.Coleman (Eds.) (2000) Sexuality in the New Millenium.
Bologna, Editrice Compositori.
Entire "New View" Manifesto Has Been Published in the Following:
L. (2001) A new view of women's sexual problems: Why new? Why now?.
Journal of Sex Research, 38, 89-96.
L., Tavris, C. & Hall, M. (2002) Beyond dysfunction: A new view
women's sexual problems. Journal of Sex & Marital Therapy, 28, 225-232.
L. (2002) Beyond the medical model of women's sexual problems: A
campaign to resist the promotion of 'female sexual dysfunction.' Sexual and
Relationship Therapy, 17,127-135.
E. & Tiefer, L. (Eds.)(2002) A New View of Women's Sexual
Problems. (Binghamton, NY: Haworth Press). [manifesto on
D., Striepe, M. I. and O'Sullivan, L. (2003) Women's Sexuality:
Breaking down barriers. In The Complete Guide to Mental Health for Women,
edited by Lauren Slater, Amy Banks, and Jessica Henderson Daniel. (Beacon
L. (Winter, 2003) Taking Back Women's Sexuality. In the Family, V.8,
#3, P. 15, 16, 27.
L. (2004) New attempts to medicalize women's sexual problems. In
Bias in Psychiatric Diagnosis, edited by Paula Caplan and Lisa Cosgrove
(eds) (Jason Aronson)
Working Group (2003).
Manifesto: A New View of Women's Sexual Problems. Psychological Foundations:
The Journal, volume V, pages 63-67. [this is an Indian journal]
The Myth of Female Sexual Dysfunction
Top researchers say physiological approach won't improve sex for women.
Straight Goods (Canadian online independent news magazine June 28, 2005)
Entire "New View" Manifesto Has Been Translated and Published in the
Une Nouvelle vision des problemes sexuels feminins.
Sexologie Actuelle, 2001, 9 (3) 4-6.
(also forthfoming in 2003 in the bilingual European Journal of Medical
The Working Group on A New View of Women's Sexual Problems
(2003). A New
View of Women's Sexual Problems. Tijdschrift voor Seksuologie, 27(2), 89-91.
(This is an entire section of the June, 2003, issue of the journal, with an
introduction by Ine VanWesenbeeck and 3 commentaries.)
The Working Group on a New View of Women's Sexual Problems
neue Sicht der Sexuellen Probleme von Frauen. Zeitschrift fur
Sexualforschung, 16, 160-166.
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