During the winter holiday, I finally had a chance to screen Liz Canner’s Orgasm, Inc., a documentary which examines the development of “female sexual dysfunction” (FSD) as a disease in need of medical intervention, and the pharmacological and surgical remedies being marketed to the public in often unethical ways.

The full documentary is available via Netflix streaming.

I thought Canner’s documentary was engaging, thoroughly researched, and managed to be harshly critical of unethical medical practices while not dismissing women’s desire for sexual satisfaction. I realize that the issue of medical intervention for women unsatisfied with their sexual response is a highly contentious issue within feminist circles, and I want to say up-front that I am not against medication or surgery per se if it is proven to be effective, responsibly marketed and prescribed, and offered not as a magical fix but as one of a wide array of possible solutions.

The problem with medication and surgery to heighten women’s sexual pleasure is that sexual response is complicated and variable (in human beings generally, not just women) and the medical “fixes” so far on offer are high on risk while potential benefits remain unknown. In addition, patients are often seeking medical treatment for something they perceive as broken or wrong with their bodies which, in fact, are well within the range of human variation — and the doctors treating these patients are (I would argue unethically) using medicine to treat a non-disease. For example, one woman whom Canner follows in the documentary signs up to be part of a clinical trial for an electrical implant in her spine that is supposed to help her achieve orgasm. Let me be clear: invasive spinal surgery.* The potential side-effects and risks are numerous. The woman is physically healthy, not suffering from any sort of nerve or spinal column damage that would cause a loss of feeling in her genitals. In fact, Canner interviews the woman and discovers that she is perfectly capable of reaching orgasm just not during intercourse. Which is a “dysfunction” that roughly 70% of people with clits share. In other words, this woman was accepted as a participant in a clinical trial to a physical deficiency that wasn’t actually there.

Canner’s perspective as a film-maker is clearly sympathetic to the anti-medicalization camp, whether it’s authors skeptical of Big Pharma advertising or activists fighting against the over-medicalization of women’s sexuality and elective genital surgery. Her visual technique highlights the production not only of the film but of the medical industry’s media message concerning women’s sexuality. The company spokespeople, medical talking head “experts” pushing pharmacological and surgical solutions, and other advocates of medical intervention are consistently shown off-balance, evasive, unable to answer critical questions, and glib about women’s “choices,” even as they admit to uncertain outcomes. In contrast, the sex educators and activists who advocate a more comprehensive approach to sexual pleasure — one that takes into account emotional well-being, trauma history, relationship health, and sexual knowledge — come across as trustworthy, knowledgeable and comfortable with the variety of human sexual experience. As the founder of Good Vibrations observes in an interview, many of the women who visit Good Vibes store are so unfamiliar with their own bodies that they can’t locate their own clitoris. “Is a drug going to help them?” She asks rhetorically, “Maybe if it has a sex map of the clitoris on the box!” Before we resort to medical intervention — particularly unproven medical intervention — Canner’s film argues, we might do better to explore non-medical ways of improving our sexual well-being.

On the downside, I feel like this film in some ways perpetuated the widespread belief that Women’s Sexuality Is Confusing, in contrast to men’s sexuality which can be reduced to erection/orgasm. This framing is somewhat inevitable given that the drug companies developing medical solutions to “female sexual dysfunction” have Viagra as their model for success. And Viagra is marketable precisely because our culture views the ability to reach and maintain an erection as the be-all and end-all of satisfying men’s sexual desire. In contrast to this measurable goal of sustaining erections, women’s bodies have culturally legible markers of sexual satisfaction. When it comes to women we’re going for the much muddier category of “higher sexual satisfaction” rather than “stronger pelvic contractions” or “more vaginal secretions” or “engorged labia.” The research surrounding sexual satisfaction is highly subjective, recalling the medical discourse around what is to be considered “normal looking” genitalia. The so-called experts Canner interviews are evasive about their standards of measurement, and when pushed often fall back on the language of proprietary trade secrets. In other words, women are being told they’re “normal” or “not normal” based on tests developed by an industry invested in providing (expensive) treatment for women who fall outside the “normal” range.

I would also have been interested in information about the population of women seeking treatment for “female sexual dysfunction.” While several individual women are profiled, there is little discussion of the demographic as a whole. I found myself wondering, as I watched, if one would find differences based on age, sexual orientation and/or sexual relationships, and the other usual markers such as race/ethnicity and class background. Obviously the people able to afford medical treatment for sexual difficulties are likely to be economically secure-to-well-off.  But I wonder if women in same-sex relationships, for example, are less likely to seek medical solutions to perceived abnormality, then women in heterosexual relationships — and if so, what we could discover by exploring that difference. I was also disappointed in the invisibility of trans* women from the narrative, though I understand that this adds a whole different level of complication to the story of women’s sexuality. At one point, when an ob/gyn is interviewed about elective genital surgery she says, “I can’t think of any rational reason for it,” a statement which either puts gender confirmation surgery in the non-elective/medically necessary category or dismisses trans* women’s particular needs as “irrational.” Likewise, I feel like the discussion of pharmacological treatment might have benefited from a discussion of hormone treatment for trans* folks and their experience of evolving desires as they transition. It seemed, from the documentary itself, that the doctors and companies involved in treating women’s sexual dissatisfaction were highly un-interested in gender, sex, or sexual variance of any kind — and therefore would probably resist learning from the trans* community. On the other hand, I imagine trans* folks might represent a potential market for the medical entrepreneurs, and I found myself wondering if there was any overlap in treatment of women diagnosed with FSD and trans* people. And, if so, what that overlap looks like.

Overall, at a brief 78 minutes I found this a highly watchable documentary that would be a really good jumping-off point for further discussion in a classroom, discussion group, or other discursive setting.