Medicalisation of sexuality
[4] Much research in psychology and psychiatry has been devoted to understanding factors contributing to human sexuality, often playing a gatekeeping or legislative role in stigmatising certain behavior or promoting disease mongering.
[2] While the additional funding from the pharmaceutical industry has been viewed as beneficial to medical research and practice in sexology and human physiology, there exists significant criticism of the medicalisation of sexuality, often on the grounds that it neglects sociocultural factors in favour of a profit motive.
[6] It is believed that the concept of medicalisation began with late 18th-century Age of Enlightenment philosophy, one of the first developments of pathologisation in Western society, including but not limited to sexuality.
[9] Medicalisation has been attributed with humanising areas of social deviance, such as alcohol intoxication, insanity and rebelliousness previously only subject to cruelty or censorship.
[7] Medicalisation also has the potential to lend credibility to less socially acceptable illnesses; medical sanctioning of trauma, autism and chronic fatigue for example has been argued to in some cases improve quality of life.
[7] The term biomedicalisation was proposed in 2010 to describe a significant change in medicalisation in the United States focussed on using technology to identify and surveil health risks in individuals and populations.
[5][6] The original authors of the theory argue that this strategy by pharmaceutical companies is reflective of neoliberalism as a political ideology, emphasising individualism and surveillance, especially self-surveillance through the use of marketed products.
[2][7] The late 18th century marked the first attempts at artificial insemination of women using syringes, along with newly developed cultural views which undermined the value of female sexual pleasure as it was believed unnecessary in procreation.
[13] In the 19th century this concept of illness as punishment for sin was medicalised into associating so-called perverted sexual traits and behaviors, such as masturbation, with increased morbidity.
[7] The "unnatural acts" initially treated as sins in the religious context were transformed into crimes or offences in the judicial context, and then, more recently, into diseases to be treated in the medical register, before leaving the field of pathology and being constructed as a form of social identity and participation in a "community" The origin of the modern version of ejaculatio praecox, called premature ejaculation, is thought to have begun with Alfred Adler before major developments of psychoanalytic theory.
Published in 1952, it reframed behaviors previously viewed as immoral, such as masturbation, low sexual desire and homosexuality, as treatable; faults of character or morality were instead described as illnesses.
[2][15][16] A cornerstone in the development of psychiatry, the DSM was highly influential and motivated significant eugenic research in a search for naturalistic, biological causes of sexually deviant behaviors, such as the so-called gay gene.
[7] Male impotence, similar in meaning to the modern term of erectile dysfunction, was initially advanced by the discovery of papaverine in the 1980s by urologist Ronald Virag.
The impact of this medication has been enormous, not just in the narrow area of treating erectile dysfunction (ED) for which it was approved, but also in the way we think of sex and sexuality, and even in the realm of relationships between men and women.
[1][20] It was reportedly the fastest selling drug in history, outselling the most common pharmaceutical at the time, the SSRI fluexetine sold under the trade name Prozac.
[11] Viagra and similar prescription pharmaceuticals were promoted by images in media to the extent of becoming a cultural icon, at the time a relatively new phenomenon known to be permitted only in the United States and New Zealand and which is believed to have significantly contributed to norms regarding male sexuality.
These assessments in the United States and Britain carried significant weight as they could be used to indefinitely incarcerate individuals after their criminal term expired, if the expert believed reoffending was likely.
[24] As 19th century Western culture shifted from religious to secular authority, homosexuality began to receive increased scrutiny from the law, medicine, and later psychiatry, sexology and human rights activism.
[26] The term homosexuality was first used in a medical context in 1869 by Hungarian doctor Karl Maria Kertbeny, who argued against the harsh laws and punishments against sodomy in the Prussian legal code.
In the 1940s, Freud's followers including Edmund Bergler, Irving Bieber, and Charles W. Socarides took another approach, re-establishing homosexuality as a psychiatric disorder with negative caricatures such as "megalomanical, with free floating malice, unreliability and superciliousness".
Socarides' research was released under his newly-elected position as chair of the Task Force on Homosexuality appointed by the New York County branch of the American Psychiatric Association (APA).
[28] Expressions of non-heterosexuality are now broadly considered to be normal variations of human sexuality, although continued discrimination results in worse mental health of this population.
Later investigation by Jem Tosh has shown that GIDC was based on research which worked under the assumption that treating gender nonconformity in feminine AMAB children would prevent them from becoming homosexuals as adults.
[28] This line of reasoning, that gender nonconformity and homosexuality develop primarily in childhood, was proposed as a justification to allow parental intervention to force such treatments onto children.
[28] The groups responsible for revising gender identity disorders in the 10th edition of the International Classification of Diseases (ICD-10) and the DSM-4 into the DSM-5 have been noted to share the experts Jack Drescher and Peggy Cohen-Kettenis.
[43] This bias in research has been argued to reinforce a narrow, medicalised model of sexuality on transgender people focussed on individual sex acts unrepresentative of the population being studied.
One of the most popular criticisms is that biological reductionism and other tenets of medicalisation, individualism and naturalism, generally fails to take into account sociocultural factors contributing to human sexuality.
[citation needed] One author writes, "linking drugs with risk factors and lowering thresholds for 'at-risk' conditions pave the way for pharmaceutical expansion from disease to discomfort".
While this is beneficial in that it improves detection of serious medical conditions, this kind of "penile health gauge" is argued to have a perverse incentive in which increasingly intrusive, and possibly even mandatory surveillance of patients is expected.
[53]: 18–19 Another case study argued that even in large LGBT organisations in the United States with significant resources to conduct HIV/AIDS support such as Bienestar, medical models of sexuality and disease prevalence were routinely used to justify gender discrimination in employment (see gender inequality in the United States), and significantly disproportionate support for programs for gay men at the expense of programs for women.
