Donata Villari
Saffo - Ereso - 630 avanti Cristo - Leucade 570 avanti Cristo
Eros shakes my mind
like a mountain wind falling on oak trees
Paul Julius Moebius -1835-1907
Über den phisiologische Schwachsinn des Weibes 1900
Nature holds the maiden in the obscure vision of her instincts. Her repugnance for men, the repulsion that inspires her sensuality, appears to the consciousness of the virgin as absolute, enduring feelings ... The better a girl is, the more firmly she is convinced that she has no desire... and that her longings should be turned towards the ideal.
“The Mental Inferiority of Woman," 1900, preface to the third edition
. .. yes and how he kissed me under the Moorish wall and I thought well as well him as another and then I asked him with my eyes to ask again yes and then he asked me would I yes to say yes my mountain flower and first I put my arms around him yes and drew him down to me so he could feel my breasts all perfume yes and his heart was going like mad and yes I said yes I will Yes.
from Molly Bloom’s monologue in James Joyce, Ulysses - Paris, 1922
Since the 1970s the term “sexual medicine” has become common usage [1]. Interestingly and appropriately enough, the introduction of the 2012 ESSM Syllabus of Sexual Medicine [2] stresses that the use of the term “sexual”, understood, however, simply as an adjective referred to sexual or gender identity, was borrowed from studies of botanical taxonomy at the beginning of the nineteenth century [3]. And even after being transferred to the context of a discipline that analyzes human sexuality, the term was at first employed exclusively in the study of reproduction.
The term “sexology” appeared for the first time in Elizabeth Osgood Goodrich Willard’s 1867 work, Sexology as the Philosophy of Life: Implying Social Organization and Government [4]. And the mathematician Karl Pearson, one of the founding fathers of modern statistics and a convinced believer in eugenics, in the 1888 inaugural lecture of the Men and Women’s Club, which he had founded, entitled “The Woman’s Question,” stressed the need for a “real science of sexology” [5].
The Italian Paolo Mantegazza (1831-1910), physiologist and pathologist, a visionary writer who was among the first to spread Darwin’s theories in Italy, published La fisiologia dell’amore (The Physiology of Love) (1873), L’lgiene dell’amore (The Hygiene of Love) (1877), La fisiologia del piacere (The Physiology of Pleasure) (1880), and La fisiologia della donna (The Physiology of Woman) (1893). He dedicated himself to important studies in neurophysiology and pharmacology based on animal models, treating topics absolutely in the vanguard for his time, among which were female sexuality, male and female infertility, masturbation, erectile dysfunction, and vaginismus [6].
But it was the dermatologist Iwan Bloch in his 1907 work, Das Sexualleben unserer Zeit in seinen Beziehungen zur modernen Kultur [7], who was the first to stress the importance of a multidisciplinary approach for those who intend to do in-depth studies of the “life of love,” by integrating knowledge from diverse fields such as biology, anthropology, philosophy, psychology, sociology, ethnology, and medicine, a concept that is completely shared nowadays.
At the start of the 1900s, this “new science” seemed to be something chaotic and vague. It was in this field that Freud came onto the scene as precursor and interpreter of his times. Still, his theory of female sexuality was strongly conditioned by the ethical principles and the customs of the society of his day, despite the transgressive and groundbreaking questions his theories introduced (we need only think here of childhood sexuality).
Freud has no organic theoretical work specifically dedicated to the female psyche in the sexual sphere; what exist are mainly clinical cases or fragmentary theories. By his own admission, the origin and development of female sexuality remained an inextricable enigma, which led him, despite his charisma, to collaborate with contemporary women analysts [8].
While the myth of Oedipus remains a cornerstone in the psychosexual history of the male individual, it is attributed to the woman in its “reciprocal” form (reverse Oedipus), though with various interpretative complications and a marked asymmetry that led Freud himself to state that at the very best in the female sex “Oedipus” can never be completely overcome. Freud held that the penile substitute, the clitoris, was initially invested with strong focalization and very intense sensations but that afterward, in the so-called genital phase, these sensations were transferred to the vagina, and this represented the achievement of psychosexual maturity. In this way the clitoris was disinvested, losing its importance for orgasm, to the point that continued clitoral orgasm was interpreted as evidence of a neurosis, synonymous with fixations and regression to the pregenital phase.
Recent psychophysiological studies disclaim Freud’s theory of female sexuality. Indeed, current analytical interpretation has reappraised and reformulated his hypotheses, with the consequence that the opposition between clitoral and vaginal orgasm is no longer accepted.
As we have already noted, an important contribution to the study of female psychosexual development has been given by the work of the first women analysts, the Danish Lampl-de Groot ( 1895-1987) and the American Ruth Mack Brunswick (1897-1946), though in a perspective that has since been accused of “female misogyny.” They went more deeply into the questions of the passive-active sex role, the conflictual mother-daughter relationship, and female castration in the process of working through the negative Oedipus [9]. Helene Deutsch (1884-1982) adopted the Freudian theory of the natural masochism of women [10], while Karen Horney (1885-1952), whose convictions were influenced by sociology and anthropology, countered with an explicative model of female development strongly influenced by social and cultural elements [11].
In 1974 Luce Irigaray identified the foundation of female sexual identity in the mother-daughter relationship [12]. This first love is banned in the patriarchal order, which relegates it to an aphasic function of identification. Irigaray went on to demand women’s right to diversity, to self-love and the love of other women, without effacing themselves in the competition to win the sexual favors of men [13].
Going back to the father of the psychoanalytic approach to sexuality, in the end Freud proposed two types of femininity that are possible to find in adult women: one is altruistic, maternal, masochistic, and receptive, while the other is narcissistic, seductive, autoerotic, and not ready to love authentically - two contrasting and practically incompatible prototypes.
This dichotomy of femininity, which in a certain sense creates a gap between the generative-maternal and the erotic roles, underlies all the subsequent great battles for emancipation in industrialized countries in the twentieth century. However, in the end it has proven difficult to achieve a widespread sentiment of “interior” liberty, free from the age-old internalized identity/role models (mother/wife). Doubtlessly there has been progress in women’s “rights” and in safeguarding their health and their maternity. But at the same time, the difficult climb to achieve equal opportunities in pay and positions in important social roles is still steep and uneven [14].
What is evident is that the disciplines that study sexual behavior, both male and female, have undergone a revolution in their scientific and cultural approaches in recent decades and that this is especially true as regards female sexual dysfunction (FSD). Nowadays one concept stands out clearly - female sexuality is complicated. It cannot be totally closed within a context of anatomical and physiological districts; rather, it has to be understood and contextualized in all its manifestations, which involve the biological, psychological, and sociocultural spheres. All of these have to be set in a scenario that does not underestimate economic, racial, and religious aspects, as well as differing access to resources and the presence in the world of conflicts and wars that unfortunately lead to systematic sexual violence. Indeed, even today over 135 million women worldwide have had to undergo the ritual procedure of infibulation.
The borderline between what was once considered “anomalous” and what is felt to be “normal” today is continually shifting. This is reflected in the change over the years of the system of classification of FSD that has partly revolutionized its nosography [15]. Since 1952, in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), many versions have been published, characterized by successive updating [16-21]. The “Consensus Development Conference on Female Sexual Dysfunction,” organized by the American Foundation for Urological Disease in 1998 and followed by the one of the same name in 2003 [22-24], while maintaining some continuity with the criteria of the DSM-IV-TR 2000 [21] and of the ICD-10 1992 [25], has introduced important novelties [22-24].
The receptive/motivational desire model introduced by Deborah Bateson in 2001, characterized by its circularity, repositions sexual response as the result of the modulation of interactions between the brain and the genital area through positive or negative feedback [23, 24]. The concept of “personal distress” is also introduced. By this is meant the emotional repercussions in terms of feelings of frustration felt by women due to and in relation to a sexual dysfunction. This concept represents an attempt to get beyond certain critical aspects of the previous classifications. The most important of these are the following:
• The description of male and female sexual dysfunctions as specular phenomena
• The representation of female arousal as a series of phases following a “linear model” that does not really fit it [26]
• The problematic distinction between the phases of desire and arousal
• The neglect of emotional and interpersonal aspects and of prior and current sexual experiences
• The exclusive reference to a heterosexual orientation in women living in a longterm couple relationship
Perhaps even today no effort at the classification of FSDs and the distress they cause fully encompasses such a highly complex issue. What is certain is that any future changes in definition will have to be supported by evidence-based research, though the basic domains that have already been identified (desire, arousal, orgasm, and pain) will undoubtedly continue to be cardinal fields of reference [27].
The role of sexual health as an essential prerequisite for a person’s well-being, happiness, and development is universally recognized today [28, 29]. But sexual health, far beyond simply meaning the absence of disease (which, however, in many parts of the world is still a goal), requires universal awareness and promotion.
We are light-years away from the times when for primitive man the moon was the visible representation of the woman, silent and mysterious symbol of the genuine receptive essence of the feminine, in antithetical contrast with the active, bright solar essence that represented man [30]. In our day, men and women have to discover and experience a repositioning of their roles, including their sexual roles, from a perspective of mutual respect and sharing. What is more, a reconsideration of possible gender orientations also involving the sexual sphere is necessary.
References
1. Riley A. The birth and development of sexual medicine: reflections of my personal journey. J Sex Med. 2007;4:815-21.
2. Porst H, Reisman Y, editors. The ESSM syllabus of sexual medicine 2012 written by the ESSM Educational Committee. Amsterdam: Medix Publischers. 2012.
3. Hirschfeld M. Über sexualwissenschaft. Zeeitschr Sexualwiss. 1908;1:1-19.
4. Sexology as the philosophy of life: implying social organization and government. Chicago: J. R. Walsh; 1867.
5. Walkowitz JR. Science, feminism and romance: The Men and Women’s Club 1885-1889.
6. Paolo Mantegazza La fisiologia dell’amore (1873 - Libreria Editrice G. Brigola - Milano) Igiene dell’amore (1877 - Libreria Editrice G. Brigola - Milano) La fisiologia del piacere (1880) La fisiologia della donna (1893 - Treves - Milano)
7. Bloch I. Das sexualleben unserer Zeit in seinen Beziehungen zur modernen Kultur. Berlin: Marcus Verlagsbuchhandlung; 1907.
8. Sigmund F. Drei Abhandlungen zur Sexualtheorie. Lipsia e Vienna: Franz Deuticke; 1905.
9. Ogilvie MB, Harvey JD. The biographical dictionary of women in science; 2000.
10. Psychoanalysis of the sexual functions of women. Leipzig/Wien/Zürich: Internationaler Psychoanalytischer Verlag; 1925.
11. Feminine Psychology (reprints), Norton, 1922-37. 1967.
12. Irigaray L. Speculum of the other woman; 1974 (Eng. trans. 1985 by Gillian C. Gill).
13. Irigaray L. This sex which is not one; 1977 (Eng. trans. 1985).
14. The Global Gender Gap Report 2014, in http://reports.weforum.org/global-gender-gap- report-2014/
15. Leiblum S. Classification and diagnosis of female sexual disorders. In: Goldstein I, Meston C, Davis SR, Traish A, editors. Women’s sexual function and dysfunction. Study, diagnosis and treatment. 1st ed. London: Taylor.
16. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. DSM-I. 1st ed. Washington, DC: American Psychiatric Press; 1952.
17. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. DSM-II. 2nd ed. Washington, DC: American Psychiatric Press; 1968.
18. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. DSM-III. 3rd ed. Washington, DC: American Psychiatric Press; 1980.
19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. DSM-III-R. 3rd revised ed. Washington, DC: American Psychiatric Press; 1987.
20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. DSM-IV. 4th ed. Washington, DC: American Psychiatric Press; 1994.
21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. DMS-IV-TR. 4th revised ed. Washington, DC: American Psychiatric Press; 2000.
22. Basson R, Berman J, Burnett A, et al. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol. 2000;163(3): 888-93.
23. Basson R. Human sex-response cycles. J Sex Marital Ther. 2001;27(1):33-43.
24. Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J, Fugl-Meyer K, et al. Definitions of women’s sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynecol. 2003;24(4):221-9.
25. The ICD-10 classification of mental and behavioural disorders. http://www.who.int/classifica- tions/icd/en/bluebook.pdf.
26. Master WH, Johnson VE. Human sexual response. Boston: Little Brown; 1966. Masters WH, Johnson VE. Human sexual inadequacy. Boston: Little Brown; 1970. Kaplan H. The new sex therapy. New York: Brunner Mazel; 1974.
27. Mulhall JP, Incrocci L, Goldstein I, Rosen R. Cancer and sexual health. Springer; 2011. p. 93-102.
28. World Health Organization (SUI). Definition of sexuality and sexual health [Internet]. Switzerland: The World Health Organization; 2002.
29. World Health Organization (SUI). Definition of sexuality and sexual health: The World Health Organization; 2002. Sexual Health for the Millennium. A Declaration and Technical Document World Association for Sexual Health (WAS); 2008.
30. Harding ME. Woman’s mysteries. A psychological interpretation of the feminine principle as portrayed in Myth, story and dreams. New York: G.P. Putnam’s Sons; 1971, C.G. Jung Foundation for Analytical Psychology.