The Science Of Women & Sex

For Ellen, a 45-year-old college professor in rural Maryland, the music of the bedroom has never been as harmonious as it is in magazines. She cannot reach orgasm with her husband, and has only tepid interest in sex. "Frankly, it's the one fly in the ointment of our marriage," she says. Sexual couples counseling didn't help; her gynecologist, "eminently unhelpful," told her nothing could be done. Then she heard about a Baltimore urologist named Toby Chai who was conducting a small trial of Viagra among women with sexual complaints. She'd read of the miraculous results in men and thought this might finally dispel the "iceberg" intruding on her marital life. "It's not something we talk about every day, but it's always there." Returning home with six pills--three placebo, three Viagra--Ellen became a pilgrim in the increasingly frenzied search to unlock the mysteries of female desire.

Women's sexuality, Sigmund Freud opined, is the "dark continent" of the soul: an uncharted netherworld receding behind folds of flesh and muscle. Among the Big Ideas of the last century, few were as asinine as Freud's on sex and women, most notably his theory of penis envy. Yet in the decades that followed, science has continued to put forward as much ignorance as bliss. Until the late '20s, doctors manually stimulated women as a treatment for "pelvic disorder"; the vibrator, originally coal-fired, caught on as a way to shorten office visits.

In the 1950s and '60s, Alfred Kinsey and the team of Masters and Johnson began exploring female sexuality through the prism of its male counterpart. "We are still in a culture which has defined sexuality, sexual pleasure and [sexual goals] in male terms," says Dr. John Bancroft, current head of the Kinsey Institute. "Then we apply the same paradigm to women. That is a mistake." The male paradigm is simple: erection and release. Women's satisfactions and drives are more complex, organized as much around the health of the relationship as the majesty that is orgasm.

Add science to this simple insight and it becomes a program for revolution. Sparked by the stunning success of Viagra, and the prospect that it might be duplicated with women, a new era of sexual experimentation is now taking shape--this time not in the bedroom, but in the laboratory. "It's such a Wild West frontier of new discovery," says Dr. Irwin Goldstein, the media-friendly Boston urologist and pioneer in research on men and women. (Like many doctors interviewed for this article, Goldstein is a paid consultant and gets research money from one or more of the drug companies, but does not own stock in any.)

As many as four in 10 American women experience some form of sexual dissatisfaction, a figure likely to grow as the 41 million women of the baby boom, for whom unencumbered sex seemed a birthright, make the passage through menopause. The shadow cast by dysfunction can spread far beyond the bedroom, darkening a woman's entire sense of well-being. "It was probably in some ways more devastating than breast cancer," says a 55-year-old college professor who lost her ability to become aroused after hysterectomy. "This huge piece of who I am had just gone." Drug companies, research clinicians and traditional therapists are all leaping into the fray. Their work, still in its embryonic stages, is already starting to yield a radical new understanding of anatomy, dysfunction--and even the evolutionary meaning of orgasm.

A dozen drug manufacturers, including Pfizer, the maker of Viagra, are rushing headlong into research and development, mostly on drugs originally intended to treat impotence in men. Both male and female genitals have smooth muscle tissue that engorges with blood during arousal. Researchers hope Viagra will relax this tissue in the clitoris, as it does in the penis, allowing the vessels in the organ to swell with blood. The early prognosis, though, is less than thrilling. In the most comprehensive female trial of Viagra to date, released this week, the drug proved no more effective than a placebo. Nonetheless, Cheryl Bourque, an analyst at Decision Resources, projects that by 2008, the market for treatments for women, including testosterone and estrogen (sidebar), could hit $1.7 billion. Drugs conceived specifically for women, still perhaps decades away, could make this figure seem minuscule.