Public health is a highly political issue within nations, and is a frequent source of conflict in international relations. Although public health agencies are very concerned about infectious disease such as HIV and other STDs, and there is growing awareness of female genital mutilation in some countries, this article focuses on an epidemic of another type of sexual disease right here in the West that is not even acknowledged publicly due to its probable political impact: clitoral erectile dysfunction, which may reasonably be associated with anorgasmia and marital dissatisfaction, and which in turn may cause or contribute to eating disorders, substance abuse, depression, and suicide.
1. Scope of the problem.
There have been several surveys of female sexual satisfaction, relying on self-report to estimate the percentage of women who suffer from lack of desire or difficulty achieving orgasm. Most studies report sexual problems in a significant percentage of women, and in at least one survey a majority (nearly two-thirds) of subjects reported some form of sexual dysfunction (1). But I could find no study that even addressed the frequency of clitoral erectile dysfunction. Women I have asked personally or on blogs decline to answer me, or deny that clitoral erection exists, or deny that clitoral erection could be visible, even though descriptions, illustrations and photos of clitoral erections are available on the web, and I have personally witnessed clitoral erections on numerous occasions (described below).
2. Possible causes.
Some organic causes of erectile dysfunction in men have been recognized for a long time and include neurological trauma, hormone abnormalities, tumors, drugs, etc. But in women only oral contraceptives (and cardio-vascular disease) are suspected of causing organic sexual dysfunction. There are obvious psychogenic causes of sexual dysfunction in both men and women: active shame training or modeling of genital shame by parents or older siblings, a history of bed-wetting in childhood that leads to a strong sense of genital shame, and the recent hysteria over sexual abuse leading to hyper-vigilance against sex play and childhood masturbation.
I suggest that a possible organic cause of clitoral erectile dysfunction may be found in the well-known mechanism of neural atrophy due to lack of stimulation during development. The classic case is vision: if an eye is covered during development the person becomes blind in that eye. There is nothing wrong with the eye itself, but the relative brain areas that process signals from that eye atrophy due to lack of stimulation.
“The fine-tuning of circuits in sensory cortex requires sensory experience during an early critical period. Visual deprivation during the critical period has catastrophic effects on visual function, including loss of visual responsiveness to the deprived eye 1, 2, 3, reduced visual acuity 4, and loss of tuning to many stimulus characteristics 2, 5” (2)
That is why newborns are examined for cataracts: if cataracts in one eye aren’t diagnosed and removed quickly the baby won’t develop binocular vision. Removing the cataracts later will be too late for normal brain development. The same problem is recognized for hearing and language, and these functions are all processed by the same part of the brain responsible for genital erection.
“The neurologic pathways required for erection originate in the cerebral cortex where visual, auditory, and psychic stimuli are processed…” (3)
There is some evidence against a “critical period” in some cases, but only in terms of the eventual possibility of restoring lost function; there is no dispute that lack of stimulation during development impairs function. The typical response to my suggestion that these facts are relevant to female sexual dysfunction is either silence or complete denial, without any specific criticism of the evidence, or any offer of counter-evidence, as if my hypothesis is committing some form of unspeakable blasphemy.
3. Obstacles to public education.
My hypothesis could be disconfirmed by surveying women who report the presence or absence of sexual problems in adulthood, and inquiring how permissive their parents were about childhood masturbation (before puberty). Recognizing the limitations of self-report, preliminary studies should at least draw attention to the issue.
It’s also possible that excessive inhibition during childhood may be related to measurable genital vibratory perception thresholds compared to women who experienced less inhibition during development.
Such research might be opposed by groups with an ideological or financial interest in shame training or the sale of treatment services for sexual problems, but such opposition would be a confirmation of the political nature of sexual health.
4. Difficulty of treatment.
Some women who don’t experience clitoral erections can nonetheless experience orgasm by using a vibrator, just as some men with erectile dysfunction can achieve orgasm. The use of drugs (sildenafil) has not usually been demonstrated to be effective in women. There is some evidence for brain plasticity: when some functional parts of the brain are injured, adjacent brain areas can take over the function – especially before puberty. But there is no evidence yet that healthy clitoral function can be restored after neuronal atrophy in a part of the brain that never developed normally in the first place (in early childhood).
5. The hypothetical ease of prevention.
My long experience in naturist (nudist) resorts in several countries revealed that clitoral erections are common in children, but not in adult women. Long before puberty the immature clitoris often protrudes erect up to 5cm (2in), with the hood suspended from it like a curtain. It seems reasonable to infer that if little girls are not “inhibited” from self-masturbation and sex play their brains will maintain healthy clitoral function. Such natural exercise might even be encouraged through accurate, balanced and comprehensive sex education. A few successful authors of children’s books are already on that path:
“Girls and boys often start to masturbate at puberty, but many start before…Whether you masturbate or not is your choice. Masturbating is perfectly normal.” (4)
But many parents are currently terrorized by the threat of accusations of “abuse” and subsequent witch-hunts, so there also needs to be strong criticism of child sex abuse hysteria in the mass media, as well as a strong reaction against overzealous opportunists and profiteers in the sex abuse rescue business.
The involvement of pharmaceutical companies in research on the treatment of sexual dysfunction has been criticized, but some critics take the unfortunate stand that sexual problems should be considered “difficulties” rather than medical conditions (5). Financial sponsorship by drug makers of conferences aimed at including female sexual dysfunction as a medical disease is certainly worrisome, since causation and prevention aren’t the topics that interest for-profit corporations; prevention of female sexual dysfunction conflicts with the sale of drugs and other forms of attempted treatment.
Clitoral erectile dysfunction should be researched to further our understanding of its causes and effects, and should be publicly acknowledged as an extremely important public health problem no less than female genital mutilation.
Edit: There is some evidence of brain differences that develop in boys and girls: Between age four and puberty there are interstitial nuclei of the anterior hypothalamus that become larger in males compared to females, due to apoptosis (neuronal cell death) [in females], and the functional significance (if any) is unknown (6).
The taboo against discussing the possible physiological cause of clitoral erectile dysfunction, or any explanation that implies childhood sex play might be a way to prevent female sexual dysfunction, leads to some bizarre attempts to explain female sexual dysfunction. One author has claimed that the reason many women have difficulty achieving orgasm during normal intercourse is because the clitoris is in the “wrong place” (7). Another author has claimed that since women don’t always have orgasm during intercourse, this “…must be seen as a design flaw” (8). I’m afraid the latter author is claiming a design flaw in anatomy or physiology, not a flaw in culture or education that leads to neural atrophy.
Edit: Even a federal government web site on brain development in childhood acknowledges that if children’s social, cognitive and emotional needs are neglected, they will suffer negative outcomes:
“For children to master developmental tasks in these areas, they need opportunities, encouragement, and acknowledgment from their caregivers. If this stimulation is lacking during children’s early years, the weak neuronal pathways that had been developed in expectation of these experiences may wither and die, and the children may not achieve the usual developmental milestones.”
Another section of the site repeats the same acknowledgement:
“The more babies are exposed to people speaking, the stronger their related synapses become. If the appropriate exposure does not happen, the pathways developed in anticipation may be discarded. This is sometimes referred to as the concept of “use it or lose it.” It is through these processes of creating, strengthening, and discarding synapses that our brains adapt to our unique environment… Researchers believe that there are sensitive periods for development of certain capabilities. These refer to windows of time in the developmental process when certain parts of the brain may be most susceptible to particular experiences. Animal studies have shed light on sensitive periods, showing, for example, that animals that are artificially blinded during the sensitive period for developing vision may never develop the capability to see, even if the blinding mechanism is later removed… It is more difficult to study human sensitive periods. But we know that, if certain synapses and neuronal pathways are not repeatedly activated, they may be discarded, and the capabilities they promised may be diminished.”
Although sexual function is not mentioned in these contexts, there is no evidence offered and no reason to believe that the same principle is not involved in sexual development.
1. Sammy Elsamra, Michael Nazmy, David Shin, Harry Fisch, Ihor Sawczuk, Debra Fromer. Female sexual dysfunction in urological patients: findings from a major metropolitan area in the USA. BJU International, 2010; DOI: 10.1111/j.1464-410X.2009.09091.x. Another survey: 60% of women never or almost never experience orgasm during intercourse. Cited in: Kamisaruk, Barry R. et al. 2006. The Science of Orgasm. Baltimore, MD: Johns Hopkins University Press, p. 17. See also: Laumann E, Paik A, Rosen R . Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281: 537–544
2. Arianna Maffei1, Kiran Nataraj1, Sacha B. Nelson1 & Gina G. Turrigiano1. Potentiation of cortical inhibition by visual deprivation. Nature 443, 81-84 (7 September 2006)
3. Jack Ende. Organic Impotence. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Walker HK, Hall WD, Hurst JW, editors. Boston: Butterworths; Chapter 187. 1990. See also: Yasin Temel1,*, Sepehr Hafizi2, Sonny Tan1, Veerle Visser-Vandewalle1 2006. Asian Journal of Andrology. “Evidence suggests that the most important structures [in penile erection] are the frontal lobe [of the cerebral cortex] , cingulate gyrus, amygdala, thalamus and hypothalamus.” Another author has written that sacral (pelvic) parasympathetic (involuntary) nerves that produce erection “originate in the brain – in the paraventricular nucleus of the hypothalamus…” Komisaruk, et al. op cit. p. 36
4. Robie H. Harris, Michael Emberley. It’s Perfectly Normal: Changing Bodies, Growing Up, Sex and Sexual Health 3rd ed. Candlewick Press, Somerville, MA, 2009. p. 48-49
5. R Moynihan. The making of a disease: female sexual dysfunction. BMJ 2003; 326 doi: 10.1136/bmj.326.7379.45 (Published 4 January 2003)
6. Swaab, D.F., & Fliers, E. 1985. A sexually dimorphic nucleus in the human brain. Science 228:1112-1115.
7. Maines, Rachel P. 2001. The Technology of Orgasm: Hysteria, the Vibrator, and Women’s Sexual Satisfaction. Baltimore, MD: Johns Hopkins University Press.
8. Lloyd, E.A. 2005. The Case of the Female Orgasm: Bias in the Science of Evolution. Cambridge, MA: Harvard University Press.