Comparing Measurements of Female Sexual Dysfunction - An Article I Read

Welcome back to An Article I Read. In this series I read a peer reviewed journal article that relates to female orgasm, and then I write a summary of it for you. I do my best to be thorough, but I also try to make it shorter and more comprehensible than reading the actual article. I do way too much googling and re-reading in my attempt at achieving that, but still this is by far my favorite series in this blog. I wish I had more time for these. I will also give you my opinion about the article, but when I do, it will be clearly marked under a heading ('My opinion' for instance might be one such heading) or I will put them into these brackets [me: ] so that you know it's my opinion and not something in the article. Otherwise, everything I write will be as best a summary of something said in the article as I can do, and all things quoted are from the article.

What is the "true" prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact?
Hayes RD, Dennerstein L, Bennett CM, Fairley C. J Sex Med. 2008 Apr;5(4):777-787.

My opinions about why this is being studied
Female Sexual Dysfunction (FSD) has a history of being a bit of a contentious thing - from hysteria to Freud's clitoral vs. vaginal orgasm ridiculousness to modern concerns about if drugs can help with FSD. The particular contentiousness I want to point out in relation to this article, though, is one that's gained a lot of traction in recent years. I'll summarize it as I understand it:

Are we defining Female Sexual Function based on our understanding of male (and not female) sexual functioning? Particularly, are we assuming that the sexual response cycle of desire - arousal - orgasm - recovery that's been used for years is as accurate for females as it is for males when it may not be?

some background
Now this article I'm summarizing is really about seeing if the way we measure the percentage of women suffering from FSD will change depending on the method that is used. However, I think the interest in researching this (outside of simply being a fabulous and I would say necessary type of scientific investigation into anything one is studying) is that there has been a slow push in the field to consider that maybe women are just naturally not going to "automatically" have desire pop up that induces physical arousal the way men are. There is a growingly popular idea out there - that some people's (but mostly women's) sexual cycle tends to be different, where desire more arises from physical arousal than the other way around. There's a whole book on this that people love, but the gist I'm getting at here is that if women aren't really going around with a bunch of sexual desire and arousal the way men are, then maybe that's not dysfunction - maybe that's normal.

So in this article I'm summarizing here, one of the ways that the researchers use to determine FSD is with a questionnaire that only classifies a woman as having FSD if she has low sexual function and sexual distress. So whereas traditionally questionnaires (and all the methods tested here to look for FSD in these women are types of questionnaires) tended to look merely at low sexual functioning (i.e. not feeling sexual desire, not being able to get wet, not being able to orgasm, sexual pain during sex), they included one that found out if a woman also had distress about the lack of desire, wetness or orgasm or pain during sex. If she wasn't distressed about it, she wasn't classified as having Female Sexual Dysfunction (SFD). When that extra criteria is added, and the American Psychiatric Association does now say that criteria should be added, the % of women identified as having FSD is much less.

It's a little subtle, but important. If women aren't distressed by their sexual functioning, why would we call it a dysfunction at all? Why doesn't it make more sense to adjust our understanding of FSD than to force women into dysfunction who don't feel dysfunctional (think how psychiatrists used to think about gay people. It was a dysfunction because they said it was - not because it necessarily felt dysfunctional to the gay person).

I'm just giving you some background and context as I understand it because I think it's interesting. I actually like the thinking out of the box here that this type of consideration brings. I think we should continue to deeply consider in what possible ways women's sexuality and sexual function is being measured and researched and judged based more on our understanding of male experience as opposed to the reality of female sexual functioning.

That said, I also want to throw in that I worry a little about settling with the idea that a lot of women's desire tends to be 'different' from a lot of men's in that it doesn't happen quite so often or spontaneously and that desire often follows physical arousal rather than preceding it. I applaud backing away from tagging women that don't meet our traditional understanding of how and when desire arises as dysfunctional if they don't feel dysfunctional. However, I do think it's worth considering more deeply why there might be this tendency in women.

I think stepping back a bit and saying, 'why might women's desire tend to follow this pattern and men's tend not to?' is important. If we don't step back and consider that, I think it'd be easy to assume it's just a innate biological difference, and I imagine that is what a lot of people believe at least to some degree. I also imagine there is comfort in believing it is an innate difference because it seems non-problematic if it's 'just our nature.' However, there's lots of reason to assume that how women experience our sexual culture deeply affects how we express and understand our desire, arousal, and orgasm.

I mean, it's a cold hard fact that women don't orgasm during sexual interactions nearly as much as men - and not because women's bodies are less capable of orgasm than men (They are not. Women can orgasm as quickly and reliably as men during masturbation). So, that really simple reality alone gives me pause about attributing female desire patterns to our innate qualities. I mean, clearly many past experiences of sexual encounter + orgasm (a lot of male experiences) are WAY better at training you to be aroused when considering the possibility of a future sexual encounter than sexual encounter + NO orgasm (a lot of female experiences). Also just consider for hetero folks how much more common it is to see a woman sexualized vs. a man. Life itself is just kinda less sexy for hetero women in general.  My point is, I don't want this very important inquiry into how we define sexual dysfunction in women to also act as a way to cover and sanitize a very nasty reality; that female orgasms are at a disadvantage in our culture and the effects of that ripple out and negatively affect all aspects of sexual culture  - including women's ability to feel desire.

In short, lots of women have particular patterns of desire and arousal different from men and it doesn't mean we are lesser or wrong, but it very well might mean that we were forced to develop our desire in the way we do because we existed in a shitty sexual culture that ignored our clit for our vag-hole. We ladies are making lemonade out of lemons, but maybe we can use this knowledge to just give the next generation of ladies pre-made lemonade instead of giving them lemons and telling them it's just as good as getting the lemonade already made.

So that was a lot of background. I think it's interesting though, so I wanted to touch on it before I summarized the article. BTW - enjoy the summary below.

  • The true prevalence of  Female Sexual Dysfunction (FSD) is contentious. Studies have tracked it at anywhere from 8% to 55%. Although these differences could be due to the different populations studied, it also very well may have to do with differences in how FSD is studied.
  • For instance, when researchers ask for only longer lasting difficulties in studies, FSD rates tend to be lower
  • Also "the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorder fourth edition stipulates that both low sexual function and sexual distress need to be present in order for a diagnosis of FSD." However validated measures of sexual distress were only created recently and a lot of previous studies don't include it, so there is a problem with lack of standardization in FSD rates.
  • Previous research indicates incorporating sexual distress measures in these FSD surveys shows a lower prevalence of FSD.

To compare in detail the results of 4 different surveys on the same group of Australian women in order to determine if the differences in the surveys help explain the differences in FSD rates. The surveys used will help determine the impact of multi-item instruments (meaning questionnaires), simple questions, different recall periods, and the inclusion of a sexual distress component.

  • The questionnaire used for this study was the 2005-2006 Australian Study for Understanding Women's Sexuality and Health (ASUWSH).
  • Self-administered questionnaire to collect information on sexual function and sexual distress along with demographic and risk factor data
  • 1002 randomly selected women ages 20-70 with basic English literacy, and registered to vote (in Australia 98% of people are registered) received a package with a cover letter, participant info sheet, the questionnaire, brochure about related medical services, and a return slip.
  • Participant details were included on return slip but not questionnaire, and they were returned separately so that the questionnaires remained anonymous but researchers could identify who completed a questionnaire
  • Participants had option of receiving a cinema ticket and/or a report of the study's final findings
  • Those that didn't wish to participate indicated on the return slip and were not contacted further
  • If they didn't receive a return slip within a month a 2nd package was sent. For 100 women who hadn't responded to 2 packages a 3rd was sent, but the return rate was so low, they didn't send a third to any others that were not heard from
  • Packages sent to 102 randomly selected women also included a delivery confirmation to see how many packages did not make it to the destination.

Main Outcome Measures
The survey included a variety of sub-questionnaires with question styles that are typical of questionnaires in previous FSD studies. These are the styles included in the Survey (followed by the reasoning for including it in parenthesis)
1. Questions asking participants to report sexual difficulties that happened within the previous month (to represent simple questions where respondents are asked to report 'problems' or 'difficulties' within a recent period of time)
2. Questions asking participants to report sexual difficulties that happened for at least a month within the previous year (to represent simple questions where respondents are asked to report 'problems' or 'difficulties' but within a longer time frame)
*both 1 and 2 asked if participants had experienced any of the following for each of the time frames
lacked interest in having sex
had trouble with vaginal dryness
were unable to come to orgasm (a climax)
experienced physical pain during intercourse
3. Included an 18 question abbreviated version of the Sexual Function Questionnaire (SFQ), a "validated, self-report, multi-item scale that employs a cut-off scale to determine if women have experienced low sexual function in the previous month" (to represent a multi-item scale questionnaire used to measure sexual functioning that classifies those scoring low sexual functioning as having FSD)
4. Included the Female Sexual Distress Scale (FSDS) questionnaire, a "validated, multi-item scale that employs a cut-off score to classify women with sexual distress experienced within the previous month." (This combined with the SFQ, together they call it SFQ-FSDS, represents questionnaires that only classify women experiencing both low sexual functioning and sexual distress as having FSD.)

The SFQ was first in the survey, followed by the FSDS, and then the two versions of the simple questions. Demographic and risk factor questions were dispersed throughout.

  • The SFQ employed both arousal-sensation questions and arousal-lubrication questions, but the sets of simple questions only included vaginal dryness questions in relation to arousal disorder. So, the arousal-lubrication questions in the SFQ were used for comparison and the arousal-sensation questions were ignored.
  • All women were asked to answer all sections of the questionnaire even if they had not had any sexual activity (sexual activity includes masturbation) during the period in question.
  • Women with no sexual activity during the period could be classified as having a desire problem but could not be classified as having arousal, orgasm or sexual pain problems. The exception to that is women who had no sexual active because of sexual pain worries. These women (if they didn't have desire or pain problems) were kept in the study and classified as free of FSD instead of being classified as missing data points.
  • prevalence estimates (the percentage of women displaying these FSD sub-catagories) and 95% confidence intervals produced by each questionnaire style for the following: hypoactive sexual disorder disorder (HSDD) aka low sexual desire, female sexual arousal disorder (FSAD) (using vaginal lubrication answers as indicators), female orgasmic disorder (FOD), and dyspareunia aka sexual pain problems.
  • The SFQ-FSDS results (results that used both low sexual functioning and sexual distress to classify a woman with SFD) were compared to the other styles of questioning in all the above categories. The SFQ-FSDS was used as a 'gold-standard' to compare against because it has been well validated and also reflects the current recommendations for diagnosing SFD.
  • If a question related to one of those categories was left empty on an otherwise completed questionnaire, it was simply not used, which lowered the answer rate for some categories, but never lower than 95% of the total number of questionnaires included in the study.
  • The 2 types of simple questions, each employing a different recall time range, were also compared
  • In addition, the previous month recall version of the simple question was compared with the SFQ (which also employed a month recall). Both of these did not include questions about sexual distress

  • The researchers were able to estimate the number of women that did not ever receive their packages (due to out-of-date address, lost mail, or recipient being deceased), by investigating the package fate for the 102 random women that were chosen to have Postal Service Delivery confirmation. From this, it was estimated that 756 women actually received their package 
  • Based on above estimate, 45% (356) of respondents completed and returned the questionnaire 
  • The table below (table 2) shows the results for prevalence estimates (%) among the respondents across the 4 types of questionnaires for each of the different sexual dysfunction types studies: hypoactive sexual disorder (HSDD) aka low sexual desire, female sexual arousal disorder (using vaginal lubrication answers as indicators), female orgasmic disorder (FOD), and dyspareunia aka sexual pain problems. 
  • It also shows the 95% Confidence Interval in the parenthesis next to the Prevalence % 

  • The SFQ-SFDS questionnaire showed lower prevalence % estimates than the other types of questionnaires for all 4 types of sexual dysfunctions. 
  • Comparing the 2 versions of the simple questions indicated that questions asking to recall if something occurred during the previous month showed lower prevalence % estimates in all 4 of the sexual dysfunction categories than if asked to recall if something occurred for 1 month or more from the previous year. 
  • Comparing the simple set of questions with a 1 month recall vs. the multi-item scale questionnaire (SFQ) which also had a 1 month recall, the multi-item scale showed higher prevalence % estimates for low sexual desire, low arousal (lubrication), and female orgasm disorder, but not for sexual pain. 
  • In total, 32% of women with low desire, 31% with low arousal (lubrication), 33% with orgasm difficulty, and 57% with sexual pain were also sexually distressed. 
  • [Me: the researchers also report kappa statistics, negative and positive predictive values, specificity and sensitivity statistics when employing the SFQ-FSDS as the gold standard questionnaire against the other types of questionnaires. I don’t feel knowledgeable enough about stats to speak much on them, but you can check it out in Table 3 below.]    

  • "This is the first time that this range of instruments, frequently used for assessing FSD has been compared directly in the same study."
  • Including "sexual distress" as a necessary element for diagnosing Female Sexual Dysfunction (FSD), as in the FSQ-FSDS questionnaire, reduced the prevalence estimates of FSD by 2/3 or more for all 4 categories. "In additions, these results indicated that only a portion of women with low sexual function (31% -57%) experienced sexual distress."
  • "Changing the recall period from the previous month to one month or more in the previous year approximately doubled the prevalence estimates of all sexual disorders investigated."
  • When comparing the FSQ-FSDS, the questionnaire that incorporated both low sexual function and sexual distress with the other questionnaires, the FSQ-FSDS "displayed a broad range of sensitivities and specificities across the different domains of FSD."
  • "positive predictive values indicated that less than 60% of women classified as having FSD by alternative instruments [me: questionnaires] were experiencing FSD according to our gold-standard instrument (FSQ-FSDS)."

Limitations of the study
  • The true gold standard of FSD is a clinical diagnosis, but with these anonymous surveys, that could not happen.
  • The FSQ-FSDS was used as the gold-standard because it's well validated and reflects current definitions of Female Sexual Dysfunction (which includes having sexual distress). However, "the FSQ-FSDS is based on a current models of FSD," and "debate regarding which model best represents female sexual response and what constitutes FSD continues in scientific literature."
  • The FSQ was validated on women age 19-65 but the abbreviated version (used here) was only validated on women age 19-49. 
  • The FSDS has not been validated on Australian women with FSD.
  • "The America Foundation of Urological Diseases divides FSADs (Female Sexual Arousal Disorders) into genital, subjective, genital combined with subjective, and persistent sexual arousal subtypes. [me: see Puppo's take on the naming of persistent sexual arousal disorder] In our analysis, we only included the genital lubrication aspect of FSAD (as opposed to subjective arousal or the arousal sensation domain of the SFW). This was performed to allow us to make valid comparisons between instruments [me: questionnaires] as the simple questions we investigated (that were based on the questions from a frequently cited study by Laumann et al.) only asked about this particular aspect of sexual disorder. Not including subjective sexual arousal is a deficiency of both that earlier study and the present comparative analysis."
  • "A further limitation is that the order of the instruments [me: questionnaires] used to measure FSD was not randomized. As all the instruments we investigated were included in one questionnaire, it is possible that participant's response to one instrument may have influenced their response to another. This may have artificially increased the correlation between instruments. Consequently, the true difference between these methods of assessing FSD may be even greater than our results indicate."
  • Response rates for sensitive topics always tend to be low and seem to be decreasing over the years, but the overall response rate and prevalence estimates for FSD using the simple question section was comparable to previous studies of Australian women using the same simple question survey.

Strengths of this Study
  • There was a variety of questionnaire types used that showed the impact of question type, recall period and inclusion of the sexual stress component on prevalence estimates
  • The population was randomly sampled and the questionnaires employed have been extensively validated.
  • Included all women in the sample, not just women who were currently sexually active
  • These types of comparative studies for FSD diagnosis questionnaires are rare. 
  • Previous studies show that prevalence estimates are lower when the time period for a sexual difficulty is raised (for instance asking about a particular sexual difficulty that lasted for at least a month vs asking about that same sexual difficulty but only if it lasted for at least 6 months). "Our data indicate that in addition to the duration of sexual difficulty the length of time over which women are asked to recall sexual difficulties also affect reported prevalence."
  • That the inclusion of sexual distress in an FSD diagnosis has an impact on prevalence estimates is supported by previous research.
  • The type of questions, the recall time employed, and the inclusion of things like sexual distress in the questionnaires that researches decide to use have important impacts on the results. "Consequently, reported associations between risk factors and FSD may also change depending upon the instruments researchers employ to measure FSD."
  • "The absence of a standard, generally accepted, convention for determining the presence of FSD represents a major limitation in current research." However, there is still a lot of debate about what constitutes FSD and how to appropriately diagnose it, and researches would do well to keep this all in mind for future studies and as the definition of FSD evolves over time. 
  • "We envisage that this investigation will alert future authors to bias that may be introduced by the instruments they employ when conduction their own research. Also, we would like to make clinicians and researchers aware of the impact of instruments used to assess FSD when drawing conclusions based on published literature in this area."

Everything said in here was basically also said in the discussion.

[ME: As always, I'd like to point out something that should be way more obvious. Some (I'd venture to say most) Female Sexual Dysfunction (FSD) probably has to do with the fact that people don't truly realize that the clitoral glans area, and not the vaginal canal, is the female organ of sexual pleasure, just as the penis is for the male. And, because of that, way, way too many females are literally not getting sexual stimulation focused on the correct area of their bodies (like if males were mostly getting ball, not penis, stimulation) *and btw any penile or clitoral related organ on a body is the organ of sexual pleasure, so it's really no different for intersex folks that carry an organ more in between clit/penis.* Also, I'm just gonna throw this out there too - maybe some women don't describe themselves as distressed about their lack of orgasm, arousal, or desire because they live in a shit sexual culture that tells them and demonstrates to them all the time in all the different ways that women are less sexual, less capable of orgasm and harder to please - and maybe those ideas get internalized to a point where a woman might think that's just the way things are, so she settles into it...again, making lemonade out of lemons.]


Inside Amy Schumer S2 Ep7 - The SSL Review

Inside Amy Schumer 
This show makes me laugh, and here's the best part - Amy Schumer tends to bring it when it comes to realism and female sexuality. She brought it in her movie Trainwreck, in The Joe Rogan Podcast, and largely in the other episodes of this show I've SSL Reviewed so far. She has shown a strong willingness to give the clit the glory it deserves, speak some truths about lady sex experiences, rep for actual lady-gasms - all things largely absent in media and also incredibly important to Orgasm Equality.

As I often say, being a particular thing is only a first step in creating content that expresses a fresh and unique perspective of that thing. Just because she or anyone else is a woman doesn't mean that they automatically bring a thoughtful and unique lady-perspective to their work. I mean there's plenty of women that just regurgitate male-centric understandings of lady stuff as actual lady insight because, hey, I mean male-centric understandings of lady stuff gets soaked deep into all of us. It's hard to bring a new voice to the world when the world tries hard to define your voice for you. It takes something else in a person to parse that out and something even more to express the parsing and the unique perspective in an entertaining/relateable/interesting way. She has all that, and I think her voice has probably helped a lot of other ladies out there pull their own unique voice from below all the shit we soak from the culture we grew up in. To be fair though, I must say she could use some schooling and humbling when it comes to speaking about race though - but that's pretty true of a lot of us.

The SSL Reviewable
There is plenty to SSL Review in this show. And for those that don't yet know, an SSL Review is a critique specifically of discussions or depictions of female orgasm, female masturbation, or the clit. I focus on that and really only that (unless I want to talk about something else). I'm looking mainly at realism and about how the depiction/discussion plays in the larger cultural conversation about female orgasm and women's sexuality.

All that said, this scene doesn't quite fit the SSL Reviewable criteria. However, it does make an insinuation about orgasm that I think is worthy of addressing.

Please, my friends, do enjoy more SSL Reviews for MOVIES and TV SHOWS.

Mine is Doggy! S2 Ep7
I'll describe this (kinda murky) SSL Reviewable scene and then discuss it a bit. 

This is the final scene of the show and as in many of her shows it's her doing stand-up in front of a live audience. She has a container of questions from the audience, and she's reading one.

Amy: What is your favorite sexual position?
(crowd laughs) 
Amy: Okay. Actually like eight people wrote the same one. But before she lets me answer, she wants me to know. 'Mine is doggy style, hits the G-spot!'
(crowd hoots and hollers and Amy points toward the crowd like she's answering back to something someone said out there) 
Amy: I know!
(Crowd continues to laugh)
Amy: This is what happens when you're a pretty girl. Everyone, like tells you what you say is interesting and important and you get really confused. No one ever did that to me. O, my favorite sexual position.  Well, I'm lazy, so it's usually I'm laying there like - like an actual slug.

Then she goes onto another joke.

My Thoughts (aka - fuck a G-spot)
The reason I'm doing an SSL Review on this scene is because the audience member's comment (let's call her Katelyn) insinuates that a penis hitting the 'G-spot' causes an orgasm. Granted, she didn't say it caused an orgasm. She just said she liked it because it hit the "G-spot." But, I mean, it's sex. Why would your favorite pozish not include an orgasm? Why would ol' Katelyn bring up the G-spot if not to insinuate that it made the position orgasmic to her? I mean maybe she's just saying she likes the g-spot hitting as an extra bonus, like saying you like 69 because you get to have something in your mouth - we can assume that's just a bonus to the best (and orgasmic) part- which is getting ate the hell out.

Cool, but either way Katelyn is still telling us she orgasms during doggy style - whether it be because of the G-spot hitting or because of the additional G-spot hitting during the basic situation of intercourse (i.e. getting a penis rammed in and out of your vagina). And to Katelyn I call bullshit - not on it being her favorite position, but on it being orgasmic. Straight up truth is that stimulation inside the vagina, whether it be basic ol' penis banging, specific G-spot stimulation (which I will define here as the female prostate which can be felt through the wall of the vagina), cervix stimulation, stimulation against the inner legs of the clit through the vagina, or anything else that sexperts might say gets stimulated in the vag - NONE OF THAT HAS EVER BEEN PHYSICALLY SHOWN IN SCIENTIFIC LITERATURE TO CAUSE ORGASM. It just plain hasn't. Go through the literature (here's some to start with). There are scientists who claim those things cause orgasm because a small percentage of women claim that it does, but even after half a century of physical testing for orgasmic response, not once has any scientist been able to prove it physically, and it's not like it's that hard. Women and men have been having physically recorded orgasms caused by penile and clitoral glans area stimulation pretty easily since the mid century.

Yet still, there are women who claim to orgasm from a good ramming - with no additional outer clitoral stimulation. They could be telling the truth. They could have physical qualities that other women don't have ...that are almost impossible to detect in scientific inquiry (because these 'special' qualities that cause 'vaginal/G'spot' orgasms absolutely have not been detected in scientific inquiry)....or, and hear me out, they aren't having orgasms from getting banged. There is no G-spot that exists as a mysterious spot in the vagina that causes orgasms when pounded on. Maybe, just maybe, a percentage of women say they orgasm this way because they wish they could, they think they are orgasming but are not, or they speak about pleasure sans orgasm during sex the same as orgasm - all of which are related to how confusing the information is around female orgasm.

I believe Katelyn's favorite pozish is doggy style. I also believe that all the sexpert advice out there telling women (without scientific basis) that g-spot stimulation is the ultimate in orgasm and that doggy-style can make it happen - influences us women and can twist our understanding of our orgasm and pleasure. Truth is G-spot stimulation (female prostate stimulation) has been shown to cause ejaculation in some women, but ejaculation and orgasm are different events - even in men where they tend to happen at the same time. It has not been shown to cause orgasm. So, maybe Katelyn likes to ejaculate. Maybe she's getting a reach-around on her clit that she's not speaking about. I can get behind all that.

I imagine though that her comment was really quite simple. She likes getting banged from behind because it 'hits the g-spot,' and she 'orgasms' hard from that - which to me is like a dude saying he gets banged hard in the ass with no reach around and comes hard from that. It's just not physically sensible.

I think Amy Schumer saw it in a similar way I did. I think when she said pretty girls think everything they say is interesting and important and they get confused, she was really saying, 'Fuck a fake-ass G-spot. That's some silly, naive shit this Katelyn just said.' That's the way I took it at least. 

The Vulva Rating
Just as it is, this scene showed a woman being excited about G-spot stimulation in a way that makes one assume that it caused orgasm for her. Although me and my minutely critical orgasm eye saw Amy's response as a criticism of Katelyn's G-spot hype, I don't think anyone else would have. So, realistically, Katelyn's statement just stands on its own and adds to the already strong pile of shit that is women and sexperts hyping of the G-spot as an orgasmic spot in the vagina. It's scientifically baseless, but the more women and men see other women and men hyping it, the more it seems like it should be real.

So, overall this scene increased the misinformation out there about lady-gasms. However, it was not really Amy's words. It was another person's, and this show's only sin here is that it didn't challenge it enough (although I kinda thought Amy made a small attempt to poo-poo it). Maybe if Amy had made mention of the G-spot doing nothing for her or the unlikeliness of the G-spot's reality - all of which she's done before, I would give this a high vulva rating, but she didn't. I'm not giving it a low one either. To me this just kinda stood in the middle holding the status quo. I give this a very average 3 out of 5 vulvas.



Chewing Gum S2 Ep5 - The SSL Review

Chewing Gum!
Like I said in the first SSL Review I did on this, you should check this show out on Netflix. I continue to love the shit out of it in the 2nd season. It's a top-quality comedy that you should definitely watch. It may have a tricky British accent to follow, but turn on the captions and get on with watching it. It's great. It's also progressive in the ol' female orgasm department, and I feel like it has a unique perspective - not just because her gender or color or anything like that, well it is a lot of that, but I don't think the way a writer or director identifies is enough to bring a truly unique voice to a work. It's how they use their craft as well. To me, it seems like Michaela Coel (writer/star) really unabashedly dives into her own perspective and brings things into her story that are new and unexpected. In short, she's just a great creator and people should watch this show.

Michaela Coel - Chewing Gum creator, writer and main actress
And it's SSL Reviewable
This means I will be critiquing only discussions or depictions of female orgasm, female masturbation, or the clit. For these reviews I'm mainly interested in physical realism (like are the things happening to the woman's body actually things that would realistically make a female orgasm?) and about how the depiction/discussion plays in the larger cultural conversation about female orgasm and women's sexuality.

Please, my friends, do enjoy more SSL Reviews for MOVIES and TV SHOWS.

Pillow Riding
As the show opens, Tracey (Michaela Coel) is on her knees with a pillow between her legs on her bed. It's up against her junk. She's got a laptop on the bed in front of her and she's watching porn. We bounce at first between seeing the porn scene and having Tracey talk directly to the audience.

Porn guy: (drives up to lady on the street) What are you doing on the curb? Shouldn't you be in college?
Porn gal: I was waiting for you to drive me to your house and play with all my tight holes.
Tracey: pfff, but why are you just waiting on the curb??...and how did you know that he'd be there, first thing?
Porn guy: I even got a daughter that looks just like you.
Tracey: Okay, well that's just 100% disgustingness, isn't it?
Porn gal: My feelings are so intense.
Tracey: 'Feelings are so intense?' You just met him and now you go and get feelings? My mum is away for the first night since I was like born, and this is what - pft. Nah, man. I can't watch this stuff no more, you know, because one day I was like, 'Rah, hold on. If there's a camera that close to her face, she must know it's there. Hold on. What does this mean? There's some kind of acting or something. And from the time I realize that, yeah, me and my pillow are losing interest. See, my mind, yeah, is woke. I don't even think they're actually having sex. It's some kind of motion graphics or something. And it's good as fake, yeah, 'cause she ain't even ugly. She look like that blonde chic from Homeland. Why is she messin' with this tired and retired brokeback, man? pffft. This more comedy than sex.

Gettin' Banged
Tracey's sister, Cynthia (Susan Wokoma) has decided to lose her virginity and in Cynthia fashion makes a plan and executed it.

We see her  is in a towel on her bed with the laptop out. She googles "becoming sexual" gets to a site that says 'masturbation.' She reads the first bullet point aloud to herself.

Cynthia: Make sure you lubricate the finger / fingers.

She pours a lot of oil on her hand, kinda leans over to squat on the floor in front of her bed and puts her hand up her towel. There's a quick montage of her really getting that hand up there. It looks to me like she's really just trying to get her fingers deep inside her. It doesn't really seem sexual, and she looks much more like she's concentrating and really making an effort to get her hand up there rather than this being sexually pleasurable. Then she queefs and laughs before the scene ends.

She finds a dude out on the street, brings himhome talks to him for a short time and then they are in her bedroom standing and talking. He's a little cautious and wierded out by the whole experience so far.
Dude: Right, so you want to do sex? You're just going to give it to me.
Cynthia: Well, I'm not giving it to you, we're sharing it.
She hands him a condom.
Dude: This ain't a set-up? There ain't no cameras here?
Cynthia shakes her head no.
Dude: Alright.
Cynthia: Oh, great!, Well, I broke my hymen in preparation, so, I'll lie down...
She lies down as he's starts rapidly taking of his clothes
Cynthia: and you...
He hurriedly runs over kneeling between her legs
Cynthia:  at my pace please!
He's opening the condom, still kinda frantically
Cynthia:  Okay, and now just put it around my knicker area.
We are only seeing head shots of both of them, but it seems like he is following instructions.
Cynthia: Okay, you may now enter the dome, with your penis.
We see a shot from behind with the dude's bare butt on top of her missionary style. Then we get a close on his face again. He's starting slowish but strong pumps into her. We also see a close of her and she's fairly expressionless. She taps him on the shoulder.
Cynthia: Are you enjoying it?
Dude: Yes, but if you keep talking it will go down.
Cynthia:  Is it tight?
Dude: Okay, well, you can say stuff like that.
Cynthia: (straight) Is it tight?
Dude: yeeeaahh.
He smiles and continues pumping
Cynthia:  Let me tell you something Ryan. It's all a myth. Virgin tightness has been scientifically debunked. Intercourse does not stretch the vagina. Well, it does, but it just shrinks it down to what it was before. So that means if we do this again, we'll be having the exact same experience we're having right now.
Cynthia:  How do you think this is going ryan?
Dude: I'm gonna come! I'm gonna come!
Cynthia: (straight) I'm not coming at all.
Dude: I'm gonna come! I'm gonna come!I'm gonna come!
He starts coming, and she seems to take it as a cue awkwardly. She start moaning, but clearly trying to figure out how at first, and then starts screaming, but not sexy, almost scary, and he looks a little wierded out. Then she starts laughing, and he gets off her and falls down beside her on the bed.
Still laughing she says
Cynthia: (still laughing) I did a big come. My toes have gone all numb.
He takes his condom off, and she points to it.
Cynthia: Oh, do you mind if I give it a once over?
Dude: You're not supposed to let girls have your--
I need to check for holes because I don't want children right now. Oh, great. Tidy. Hmm. There's nothing there. Shouldn't you have...Then again girls don't always squirt, so the same must be true for boys. Good work, Ryan.
She puts the condom down and exhales.
Dude: Do you mind if I take a nap?
Cynthia: Why?
Dude: I just came, and also there is something very exhausting about you.
Cynthia:  Okay, I guess. but you have to stay here in my sister's room

The SSL Review

Tracey's Treatise On Porn
I LOVED her riding the pillow while fully dressed in her pajamas.

Firstly, it's not a style of lady-bation that often gets depicted. It's much more common to see a vibrator, shower head or hands/fingers directly on the vuvla/clit area. Those are fine and all, but you know what's quick and easy and awesome? Grinding against a pillow, that's what. You don't even need to take off your clothes. Just lay down, put a pillow under you, grind for a hot minute, come, fall asleep directly where you are. Perfect, and underrepresented. Thank you Chewing Gum.

Secondly, she speaks some truths of the female experience in a way. She stops masturbating because she's realized how gross and fake porn is. It turned her (and her riding pillow) off. In this show Tracey is incredibly naive, so the rather obvious recognition that porn is kinda 'fake' is a true revelation for her, and kinda funny for the audience.

I like this depiction of Tracey's naivety because I see it as a way to point out something a bit deeper and more universal. It seems like an obvious thing that porn is fake, but at the same time, I think her observation is not as obvious as we'd like to imagine, is it really? I mean, they are actually having real sex in porn -that's what makes it porn and not just a movie with sex in it. It's easy, I think, to know that the sex in porn is not like real life sex, but it's also really easy to just absorb the images in it and allow them to be a template for what sex is like...especially since few of us get to view actual people having sex in their bedrooms through a secret peephole. AND, even if we were able to do that I'd venture to say that 'real' sex might look more like porn than it should because porn images influence movie sex, TV sex, book sex, and ultimately how we all perform sex to some degree. So, my point is that I like Tracey's revelation and her point about it being a turn-off to her that it's so fake and silly.

I don't think all women come to it or express it the way Tracey did, but I imagine a lot of women have gone through a time when the initial newness and dirtiness of most porn wore off and revealed something that was a bit distasteful. So, in that way, I think Tracey's speech was both funny and poignant about women's actual experience with porn, and I appreciate that.

I'd like to take a sec and go a little further with this line of women getting a distaste for porn because I think there's more to it, though, than porn not being like 'real' situations or 'real' sex. I think porn's greatest sin against ladies' sexual sensibilities is that it's acutely focused on male fantasy, desire and orgasm and not much at all on ladies'. The truth is the fakest part of all about porn is the fake-ass female orgasms. The stimulation of the inside of the vagina  (i.e. a penis banging into the vag without any extra clitoral glans stimulation) is not a way one would expect a female to physically orgasm (seriously), but for fuck sake if it isn't just about the only way women orgasm in porn. Ladies watching ladies fake orgasmic pleasure during sex acts that are actually orgasmic for penises but not for us might not be something we consciously find appalling (because honestly that type of faking is so common it might not even seem weird), but I truly believe we must feel the absurdity and unfairness of that deep inside and it must at least be a piece of the type of distaste we see Tracey displaying.

Thirdly, as always, I simply appreciate seeing a female character acknowledge that she masturbates and that she likes it and is not ashamed. It helps to normalize jerking it for the ladies. Women overall are super susceptible for not giving masturbation a try or feeling overly destructive guilt if they do and that sucks because: hetero partner sex sucks for lady-gasms, the cultural knowledge about lady-gasms is the worst (it's the clit, ya'll not the vagina), and the only way a lady is really going to get orgasms on the regular when she's having partnered sex is if she figures out on her own how to get herself off. Thems just the truths, and so it's nice to have anything in our media that helps women get past hang-ups about masturbating.

Cynthia's wierd-ass first time
Okay, I'm pretty into this scene.

1. It's so Cynthia. You'd have to watch the show - which I highly recommend - but the strange mix of straightforward as fuck, naive, uber-determined, and wanting to fit-in is perfecto in this scene.
2. I wasn't sure exactly what she was intended to be trying at when fumbling around her junk with her oiled fingers. Was it actually masturbation? I mean maybe, but when later she said she already pre-busted her hymen, that seemed more like what the outcome of all that would be. Either way, it clearly wasn't pleasurable to her - at least not sexually or orgasmically pleasurable, and so even if her character was attempting masturbation, she was not depicted as doing it well. She was just trying to ram her finger(s) up her hole, and that does not an orgasmic masturbation session make. I appreciate that the writers didn't act like that was actually good technique.
3. During the sex act, there was just a dude pushing his dick in and out of a pus-hole, no hands touching the clit, no grinding her clit against him...like, she was completely still. It was in no way a sex act that would be expected to make a woman come, and indeed it did not. As he said he was coming, she quite clearly and calmly says, "I'm not coming at all." She wasn't coming, but she did fake one, and I feel pretty confident in saying that it was written as being her specifically faking it because of how she so awkwardly moved into it as soon as he started coming.

But saying she faked it is a little too simplistic, I think, and I like that about this scene. It's real in a way we don't often see. Cynthia does some research and she thinks she's got this. She tries to act as if she's knowledgeable and in charge, and in a way she is. She gets to lose her virginity like she wants and she does control what is happening, but she doesn't actually 'got this.' She is very unclear about how this all should work in relation to her body, her pleasure, her arousal or her orgasm. In the end, the dude is the only one that gets to come. And like so many feamles before her, instead of seeing that this intercourse thing isn't all it's cracked up to be, she simply makes do. She adjusts her perspective, moving from "I'm not coming at all" to screaming like she's seen women are supposed to do at that moment in sex and saying she "did a big cum" and that ever so stereotypically her "toes have gone all numb." I'd go so far as to say she kind of believes it, and I'd go further to say that story is not uncommon. Faking happens for a lot of reasons, and one of those, I think, is because we don't know what's happening exactly so we make the sounds and motions we believe we should be making and feel okay believing in retrospect that was an orgasm.

Vulva Rating
Here's the things I thought reflected our sexual culture or female orgasms realistically, put out into the world things that positively affected our cultural understanding of lady-gasms, or helped create a world where female orgasms were as prevalent and understood as male orgasms:

  • The PJs on pillow grind type of masturbating, which is a physically legit way a woman might orgasm, was depicted. It says to the world - women can masturbate unabashedly and and that grinding in the vulva area is key to masturbation/orgasm (not getting poked in your holes).
  • Tracey's porn speech both normalized a woman's interest in using porn for masturbation and also pointed out how fake it is. Both are important because women deserve good porn and lots of masturbation (AmIRight, yall?), and when porn depicting authentic female fantasy, pleasure and orgasm is as hard to come by as it currently is, it's problematic for everyone. 
  • The sex Cynthia was having was physically unlikely to ever bring a female to orgasm - no clit stimulation and all pumping into a vagina....which is bullshit for lady-gasms, and I appreciate that she wasn't shown actually orgasming from it.
  • When Cynthia did fake, I felt like it was clearly acted and written to be fake, and I appreciate that. 
  • The way Cynthia faked was interesting yet, I believe, incredibly realistic. It didn't seem to be malicious or premeditated in any way. It seemed to me like she thought she should do it, then did it, then stuck to her guns that it was an orgasm. She's naive, but I'd say not much more naive in that department than any of the rest of us.

For the realistic depictions and overall positive impact on our cultural understanding of lady-gasms, I give this episode a 5 vulva rating.