Correspondence and Requests for Additional Information:
Alison Hatch, Armstrong State University, Department of Criminal Justice, Social and Political Science
11935 Abercorn Street, Savannah, GA 31419
This research is a sociological investigation of the experiences of sexual side effects in a sample of young women who take antidepressants, and the impact of the sexual side effects on their sexuality. Based on interviews with 28 women, this study explores the ways in which women navigate gendered sexual scripts in the face of sexual performance difficulties. We found that women report a sense of sexual obligation both to their male partners and, more surprisingly, to themselves. While some women were primarily concerned with their inability to live up to their partners’ sexual expectations, illustrating that the traditional feminine sexual script continues to thrive, many women also felt considerable social pressure to live up to a contemporary image of feminine sexuality that enjoins women to embrace their own sexual desires and experience sexual pleasure. We suggest there has been a shift in our culture regarding our expectations of women’s sexual performance, in that women adhere to aspects of both traditional and contemporary sexual scripts, and that contemporary constructions of female sexuality that emphasize women’s sexual pleasure are often experienced not as an option, but an obligation.
The Centers for Disease Control and Prevention (CDC) states that the rate of antidepressant use among Americans has increased almost 400 percent over the last two decades (2011). According to the CDC’s U.S. National Health and Nutrition Examination Surveys, antidepressants are the most common prescription drug taken by Americans aged 18-44 and are the third most common prescription drug taken by Americans of all ages (2011). The popularity of these drugs is arguably a reflection of the pervasiveness of depression in our culture. An estimated 17% of Americans will suffer from a depressive disorder at some point in their lives (Kessler et al., 1994; Cockerham, 2003). At face value, these statistics obscure the gendered dimension of depression. In the U.S., women are twice as likely as men to be diagnosed with depression (Stoppard, 2000; Cockerham, 2003; Emslie, Ridge, Ziebald, & Hunt, 2005), and findings from epidemiological studies, community mental health surveys, and ethnographic research consistently reveal that women are more likely than men to experience depression across the lifespan (Stoppard, 2000). The National Institute of Mental Health estimates that women are 70% more likely to experience depression during their lifetime in comparison to men (2011). It is therefore no surprise that women are also more likely than men to be prescribed antidepressant medications. Additionally, two-thirds of all prescriptions for antidepressant drugs in the U.S. went to women (Stoppard, 2000) and according to the CDC, women are 2.5 times more likely than men to take antidepressants (2011).
Antidepressants have a variety of potential side effects, including fatigue, insomnia, nausea, weight gain, constipation, blurred vision, dry mouth, and problems with sexual functioning (Mayo Clinic, 2013). These unpleasant side effects are believed to be a major factor in many patients’ decisions to stop taking antidepressants (Bull et al., 2002). In fact, despite being commonly prescribed, patient compliance with antidepressant treatment regimens is remarkably low. The American Medical Association estimates that 50% of people who begin taking antidepressants stop taking them during the first six months of treatment (Bull et al., 2002).
Despite the high percentage of women prescribed antidepressants, very little is known about women’s experiences with antidepressants and their side effects. The small body of sociological scholarship on women’s experiences with depression has yet to specifically address women’s experiences with prescribed medication. Of specific interest to us is how little is known about how women experience the sexual side effects of these medications. Indeed, with regard to both depression and sexual functioning, women have been understudied relative to men (Stoppard & McMullen, 2003; Tiefer, 2004). Research indicates that the prevalence of sexual side effects among people who take antidepressants may be seriously underestimated by both pharmaceutical companies and physicians (Clayton et al., 2002; Hensley & Nurnberg, 2002). Thus the original intent of this research was to investigate the disjuncture between physicians’ estimates of antidepressant drug- induced sexual dysfunction and women’s self-reports of the same. However, over the course of this study, what became most interesting from a sociological standpoint was how the sexual side effects experienced by women who took antidepressants were experienced and negotiated in the daily lives of female patients. What was especially illuminating was how the respondents discussed their experiences with sexual side effects and how those experiences impacted their perceptions of their romantic relationships and their sexuality.
This study is based on qualitative interviews with 28 young women who identified themselves as having experienced sexual side effects while taking medication for depression or anxiety. Some of the respondents took a single medication to treat either depression or anxiety; some took a single medication to treat both disorders. Others took multiple medications, or switched from one medication to another, seeking relief from their symptoms. We do not attempt to make any claims about the effects of specific antidepressant or anti-anxiety medications on sexual functioning. Instead, we were interested in how women who self-identified as having experienced sexual side effects while taking their medication negotiated these experiences, regardless of their own personal diagnoses or the exact type of medication used.
The definition of “sexual dysfunction” has evolved over the years and from edition to edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association. The most recent edition, the DSM-5, was released in 2013. It classifies female sexual dysfunction into three categories: (i) sexual interest/sexual arousal disorder; (ii) orgasmic disorder; and (iii) genitopelvic pain/penetration disorder (IsHak & Tobia, 2013). For women, sexual interest/sexual arousal disorders include low libido and/or lack of vaginal lubrication; orgasmic disorders include persistent delay or absence of orgasm following the sexual excitement phase; and genitopelvic pain and penetration sexual disorder include painful intercourse and involuntary spasm of the muscles of the vaginal wall (Schweitzer, Maguire, & Ng, 2009).
As a diagnostic category, “sexual dysfunction” has been the subject of scathing feminist critique, especially as it has been applied to women (for example Irvine, 1991; Kaschak & Tiefer, 2002; Hartley, 2003; Tiefer 2004, 2006). Feminist critics argue that, as a category of disease, “female sexual dysfunction” is an example of “disease mongering,” an illness created by the pharmaceutical industry and other “agents of medicalization” (Tiefer, 2006). For example, critics point to the desire of pharmaceutical companies to create a new market for their products following the success of the erectile dysfunction medication Viagra, (Loe, 2004; Moynihan, 2003; Tiefer, 2001). These scholars criticize female sexual dysfunction as yet another example of the medicalization of women’s bodies, an attempt to standardize women’s sexual performance and profit from the insecurities women are likely to experience when they are unable to meet those standards (for example, see Tiefer, 2006).
One element missing from the recent feminist work on female sexual dysfunction is a sociological explanation of how this “dysfunction” actually affects the women to whom the label might be applied. Women commonly report sexual problems as a side effect of antidepressant medications, yet we can find very little research about how they experience and negotiate those difficulties in their daily lives. Past research indicates that the prevalence of sexual side effects among people who take antidepressants is seriously underestimated by both pharmaceutical companies and physicians (Clayton et al., 2002). Currently, more doctors are encouraged to proactively discuss the sexual side effects of antidepressants with their patients because many are embarrassed to raise the issue (Schweitzer, Maguire, & Ng, 2009), and female patients are especially unlikely to broach the subject with their doctors (Stulberg & Ewigman, 2008). As mentioned previously, patient compliance with antidepressant medication regimens is low, and sexual side effects cause many patients to cease taking their antidepressants prematurely (Mitchell & Selmes, 2007; Schweitzer, Maguire, & Ng, 2009).
A variety of newer antidepressant medications were introduced within the last few decades. Selective serotonin reuptake inhibitors (SSRI’s, such as Celexa, Lexapro, Paxil, Prozac and Zoloft) are the most common class of antidepressants prescribed (Mayo Clinic, 2013). Serotonin and norepinephrine reuptake inhibitors (SNRI’s, such as Effexor and Cymbalta) are also commonly prescribed (Mayo Clinic, 2013). Both SSRI’s and SNRI’s have the potential for sexual side effects, though SSRI’s are more likely to cause sexual side effects than are other antidepressants (Mayo Clinic, 2013). The most common sexual side effects of SSRI’s in women are decreased desire and delayed or absent orgasm (Frank, Mistretta, & Will, 2008).
In 1973, Gagnon and Simon applied social scripting theory to human sexuality in their influential text Sexual Conduct to help explain what motivates individuals to engage in sexual behaviors. They identified three levels of sexual scripts: cultural (messages at the societal or cultural level), interpersonal (interactions between people) and intrapsychic (people’s thoughts and desires). These scripts provide individuals with a way to determine the appropriate sequence of sexual events and interactions (Gagnon & Simon, 1973; Gagnon, 1990).
Sexual scripts are gendered, and men and women are expected to behave differently. Specifically, the traditional heterosexual sexual script rests on a double standard that encourages men to be the initiators of sexual encounters and women to be the “gatekeepers” who employ strategies to avoid sexual encounters (LaPlante, McCormick, & Brannigan, 1980; Wiederman, 2005). Additionally, traditional gendered scripts encourage women to have few sexual partners and experiences, whereas men are encouraged to have many partners and varied experiences (Rose & Frieze, 1993; Wiederman, 2005).
Thus, the traditional cultural script for feminine sexuality emphasizes the idea that sex is “for men;” that is, sex is something that women provide for men in committed relationships (Barbach, 1982; Strong, DeVault, Sayad, & Yarbar, 2006). Women are constructed as sexual nurturers who put the desires of their male partners ahead of their own needs. According to this script, when women have sex, emotional security trumps pleasure as the desired outcome. Participation in sexual activity is a form of relationship maintenance rather than an expression of desire.
There are differences between “traditional” sexual scripts and more “contemporary” sexual scripts. Contemporary scripts promote a more egalitarian approach to intimate life and include provisions for women’s pleasure and the cultural recognition of the existence of the female orgasm (Gagnon & Simon, 1987; Gagnon, 1990). These shifts can be attributed, at least in part, to feminist critiques of the traditional script, which has been criticized for its failure to empower women to actively participate and enjoy sex. Indeed, there is some evidence that for both heterosexual men and women sexual scripts are, at least in part, shifting towards a more contemporary model (Ortiz-Torres, Williams, & Ehrhardt, 2003; Dworkin & O’Sullivan, 2007).
However, despite the existence of more progressive contemporary scripts and constructions of female sexuality, research indicates that elements of the traditional sexual script continue to thrive. For example, many young adult women still experience sex as compulsory in heterosexual relationships (Cacchioni, 2007). Women also continue to do the majority of what Duncombe and Marsden (1996) call “sex work” (which is analogous to Hochschild’s  concept of “emotion work”) in intimate relationships. In the interest of preserving their relationships, women may feel pressured to feign desire and response where none exists or to seek medical treatment when lack of sexual interest becomes a problem in their relationships, even if they do not find it personally bothersome. Women engage in “sex work” by managing not only their own, but also their partner’s sexual desires.
Additionally, some scholars argue that the experience of sexual pleasure has become not simply a right granted to women under contemporary scripts, but often a requirement. As cultural recognition and acceptance of female sexual pleasure has developed, being able to bring a woman to orgasm has become another way for men to prove their sexual prowess and thus, their masculinity. A man who is incapable of bringing his female partner to climax may be considered a sexual failure (Roberts, Kippax, Waldby, & Crawford, 2005). It is therefore imperative that his partner be responsive. In this context, women’s pleasure becomes yet another sexual obligation for women in the service of heterosexual masculinity and becomes a demand similar to those found in traditional sexual scripts (Braun, Gavey, & McPhillips, 2003).
While there is some existing sociological research on women’s sexual problems (for example, Cacchinoi, 2007), we know of no sociological literature that looks specifically at the sexual side effects experienced by women while they take antidepressant or anti-anxiety medications. Our research attempts to fill this gap.
As mentioned previously, the original intent of this research was to investigate the disjuncture between physicians’ estimates of antidepressant drug- induced sexual dysfunction and women’s self-reports of the same. However, since we approached this study from the perspective of grounded theory, we continually analyzed the data for emergent themes, as opposed to starting the study with a particular hypothesis (for detailed description of grounded theory see Glaser & Strauss, 1967; Corbin & Strauss, 1990). As such, we changed the focus of our research because what was most interesting from a sociological standpoint was how the sexual side effects were experienced and negotiated in the daily lives of female patients.
In order to uncover the meanings that sexual difficulties hold for the research participants, we utilized qualitative, semi-structured interviews. This method allows for flexibility in the data gathering process while providing the interview with some structure, thereby enhancing the reliability of the results (Maxwell, 2005:80).
As stated earlier, according to the CDC, antidepressants are the most common prescription drug taken by Americans aged 18-44 (2011). In light of this finding, this study was limited to younger women. Ultimately, our sample pool included women ages 18-35. Additionally, we argue younger women have grown up in a Prozac-infused, post-“Our Bodies, Ourselves” generation. As such, we believe the cultural norms and meanings associated with both female sexual pleasure and antidepressants may be different for younger women than for older women, and these differences may impact their perspectives on, and experiences with, antidepressants and sex. Further research on the experiences older women have with sexual functioning and antidepressant use is warranted.
Despite the prevalence of antidepressant use, there are still social stigmas associated with these medications. Additionally, the stigmas surrounding “sexual dysfunction” meant that this was a difficult population to identify. As such, we used purposive and snowball sampling techniques. After receiving approval for the study from our university Institutional Review Board, we engaged in recruitment for study participants mostly within Darrouzet-Nardi’s social network. Additionally, some of the participants responded to a flyer or an internet post seeking female study participants who have taken medication for depression or anxiety and experienced sexual side effects while taking this medication. Ultimately 28 women, all but two of whom were located in Colorado, participated in this study. All of the participants had taken or were currently taking antidepressants and/or anti-anxiety medications, and all of them reported experiencing sexual side effects while taking the medications.
One potential consequence of snowball sampling is a homogeneous sample pool (Atkinson & Flint, 2001). This study is no exception. The majority of the 28 respondents were Caucasian (93%); 57% had college experience or a college degree, and the remaining 43% had a post-graduate degree or were attending graduate school. Two respondents identified themselves as bisexual, and the remaining respondents identified themselves as heterosexual. All respondents discussed their sex lives in terms of their current or past relationships with male partners, including the two that identified as bisexual.
The respondents in this study all participated because they identified themselves as having experienced sexual side effects while using antidepressants or anti-anxiety medications. Interviews lasted approximately one hour and were conducted in settings of the respondents’ choosing, typically in their homes. Respondents were asked a variety of questions, including how they described their sex lives both before and after the use of antidepressants. Additionally, respondents were asked how they felt about themselves and their sexuality in the face of the sexual side effects they reported. The interviews were audiotaped and later transcribed and coded according to emerging concepts and patterns. Once the transcripts were coded, our analysis was “issue focused;” that is, focused on the recurring themes in the data rather than the particularities of each respondent’s account, which is a common approach in sociological research (Weiss, 1995). All participants were assigned pseudonyms to protect their confidentiality.
As mentioned previously, the women in this study reported experiencing a variety of sexual side effects while using antidepressants or anti-anxiety medications. It could be argued that it is difficult to differentiate between a sexual side effect of an antidepressant drug and a symptom of the depression itself. In other words, when someone reports having little interest in sex, it could conceivably be a result of the depression itself or simply natural variance in sexual desire (Tiefer, Hall, & Tarvis, 2002). On the other hand, the lack of interest in sex could be a symptom of the drug that is taken to treat the underlying depression or anxiety (Mayo Clinic, 2013). Furthermore, there are many factors that likely contribute to women’s sexual functioning, including sexual socialization and upbringing, past sexual abuse, body image issues, self-esteem, the current state of their relationships, depression, and the use of medications (Tiefer, Hall, & Tarvis, 2002). However, the majority of our respondents indicated that they saw a notable difference in their sexual functioning after they began taking antidepressants. Specifically, the respondents believed their experience of sexual problems (most commonly low libido and anorgasmia, which is consistent with findings on the use of SSRI’s and SNRI’s) was directly related to their use of medication.
The connection to medication was often suggested to the respondents by medical professionals, though our research confirmed that discussions of sexual side effects of antidepressants do not often occur during doctor’s visits. In fact, numerous respondents indicated that their doctors failed to inform them of the potential for sexual side effects when taking an antidepressant, and a few of the respondents said they were too embarrassed or did not want to “trouble their doctors” by asking about or discussing sexual side effects. Thus, some respondents came to the conclusion that their use of antidepressant or anti-anxiety medication was the cause of their decrease in sexual desire through research, media exposure, or experiences they had after stopping the medication. Also, for some, the sexual side effects were not a separate or discrete issue; instead, they linked their sexual difficulties to an overall feeling of emotional “numbness” or “deadness” that they attributed to their medication. However, as we mentioned previously, the question of whether or not the women’s sexual problems were the result of the medication or the underlying depression or anxiety is beyond the scope of this discussion. Additionally, as discussed earlier, it is too difficult to determine what specific medication caused the stated side-effect. Instead, what is interesting is how the women experienced and negotiated their lack of sexual desire in the context of their relationships and their own sense of self.
During the interviews, women continuously discussed how they believed the sexual side effects they experienced while taking antidepressants impacted their sex lives with their male partners. The respondents indicated they felt a sense of sexual obligation, both to their partners and to themselves. They feared sexual “failure” (or inadequacy) in both real and hypothetical scenarios. While some women were primarily concerned with their inability to live up to their partners’ sexual expectations, many women also felt considerable social pressure to live up to a contemporary image of feminine sexuality that enjoins women to embrace their own sexual desires and experience sexual pleasure. Thus, we highlight the two most salient themes that emerged from this research: first, many of the women felt as though they had sexual obligations to their male partners that they were unable to fulfill; second, many of the women also felt as though they had sexual obligations to themselves that they were unable to fulfill. In both cases, our respondents experienced the sexual difficulties as problematic rather than as harmless sexual variance.
Obligations to Partners
Many of the women were concerned that they would be unable to live up to their partners’ expectations, both in terms of the quantity of sexual activity and the quality of sexual activity demonstrated by their desire and enjoyment. In fact, several of the women in this study reported that their anxiety and distress surrounding the experience of sexual side effects was caused or exacerbated by the complaints of husbands or boyfriends. For example, Gretchen, 24, pointed to her first serious relationship as the turning point at which she began to experience her lack of interest in sex as a problem that needed to be addressed:
It really didn't become a big issue for me until I got into a serious relationship, and then it was mostly because I saw how my sexual problems affected him. Because it was really a serious relationship and I thought we were gonna get married... When it started becoming a big problem for him, that's when it started coming into the forefront of my mind.
Gretchen’s sexual difficulties became problematic for her only after she saw that they were problematic for her boyfriend. Some of the respondents’ boyfriends or husbands made their displeasure with their female partner’s sexual dysfunction abundantly clear. For example, Ellie’s (29) boyfriend threatened to leave the relationship because they were not having sex, and Eve’s (22) boyfriend got mad at her for not “stepping up” and initiating sex.
Whether the respondents had partners that were patient and understanding or impatient and demanding, many felt that their inability to respond to their partners sexually “cheated” or “robbed” their partners of an experience they deserved. When asked to reflect on the impact sexual side effects had on her sex life, Rachel, 24, said:
I feel like it cheats my partners to a greater degree than it even cheats me, because I'm OK with sex being whatever it is. But when your partner wants you to be able to orgasm, and that's a part of their sexual experience, and you either can't or it takes a long time, I feel like that cheats them.
Abby, newly married at 31, was concerned that her orgasmic difficulties might affect the development of her relationship with her husband:
I know that when I can make him climax, I feel awesome... And I wonder if sometimes I rob that feeling from him, because I'm like, “No, I can't go there tonight, it's just too much work.” So I guess my anxiety is that I'm blocking something in our relationship that could grow, that I'm-(Denying him something?) Yeah, and the relationship itself. I guess there’s some guilt…I feel bad about it.
Similarly, Kelly, 19, felt as though her inability to climax made her “an annoyance more than anything,” and that she “just felt bad…I’m just more work…And I don’t want to be that girl.” Kelly didn’t want to fulfill the stereotype of the “frigid” female who caused her partner to engage in too much sexual labor.
These responses illustrate the sense of sexual obligation women felt towards their male partners. They understood their inability to desire and/or enjoy sex as problematic for their male partners, and this led some women to attempt to manipulate and heighten their level of sexual desire. For example, Katie (20) would try napping or drinking alcohol before going out with her fiancé, and Angie (32) conducted research in order to increase her libido:
For me, because I felt - more so I felt bad for my husband. I tried different things. I got some books to try to increase my libido and try to feel more sexual myself, maybe that would help overcome the medication’s side effect. I was basically trying anything I could to make it happen.
When their efforts to produce authentic sexual feelings in themselves failed, a few women resorted to feigning sexual response, which corresponds with research on gender and sexual performance that asserts that women frequently “fake it” to spare the egos of their male partners (Roberts, Kippax, Waldby, & Crawford, 1995; Duncombe & Marsden, 1996; Jackson & Scott, 2007).
Like Katie and Angie, the majority of the women in this study made a conscious effort to feel authentically sexual rather than feign response. Some of the women resorted to faking desire and climax. A few women reported stopping or switching medications with the hopes to regain normal sexual functioning. Additionally, in the interest of preserving their relationships, many continued to have sex with their partners whether they were interested in sex or not. Susanna, 18, continued to have sex with her boyfriend despite her lack of desire to do so, and found that it felt “kind of like forced sex.” Kelly, 19, had sex with her boyfriend because she felt it was going to be “better for the long run,” but then she found she would be upset with him later because she knew she “didn’t want to have sex and [it] felt like he made me.” Similarly, Jessica (22), who reported experiencing a traumatic sexual assault at age 14 that consequently framed her ideas about sexuality, reflected:
I really thought that sex was for men and my not feeling any drive at all really didn’t matter, or this was the natural way. Women are supposed to have sex to please men…I pretended that I enjoyed it and that I was being pleasured and that I wanted to, because I felt that’s what they wanted. That’s what would make them like me more, and I thought that’s what would make them think I was attractive and special. Sex became like a performance to me. It was something I did for someone I liked so they would continue to like me.
Like Jessica, numerous respondents felt as though sex was something that, as women, they had to do or “perform” for their male partners, despite their own lack of desire to do so. Not only did they feel as though it was their duty as women, but for several respondents, sex was used as a means of establishing and maintaining intimate connections with their partners. One explanation for this is that the presence of sexual activity is a characteristic that distinguishes romantic relationships from friendships For instance, Alex, 26, expressed doubt that she would be able to form a lasting romantic relationship if her interest in sex remained low:
I do think that a romantic relationship without sex is not going to last very long. I think, just as I was speaking about the emotional component, I think there has to be a physical component. Those two combine in the romantic relationship, which is something that doesn't happen in friendships, doesn't happen in one-night stands, which is what makes the romantic intimate relationship unique.
In addition to distinguishing a relationship as romantic, for many couples, sex serves as a gauge of relationship quality. Research on the performance of sexual desire suggests that both men and women view regular sexual activity as an indicator that a romantic relationship is going well (Duncombe & Marsden, 1996; Cacchioni, 2007; Elliott & Umberson, 2008). The rate at which couples engage in sex carries significant symbolic weight for the individuals involved. Its presence signifies that a relationship is stable and loving while, a decline or lapse in sexual activity indicates that something has gone awry. Natalie, 26, described feeling alarmed when she and her husband engaged in sex less frequently than she considered normal: “It's kind of, for me, it's what assures me that I'm loved by [her husband]. That plays a huge role for me. I often get worried if we haven't been together for awhile.”
Because it is “increasingly taken for granted that ‘successful heterosexuality’ is contingent upon having ‘normal’ and ‘healthy’ sex lives” (Cacchioni, 2007: 299), couples may feel compelled to maintain a certain level of sexual activity in their relationships, despite the fact that decline in sexual activity over time is normal (Call, Sprecher, & Schwartz, 1995). In this regard, some respondents like Alex and Natalie, were concerned that their lack of sexual desire and activity would be problematic in their relationships, and that it could harm or impede the couple’s success.
In sum, many of the respondents felt a sense of sexual obligation to their partners. The sexual problems they experienced were interpreted as obstacles to being able to please their male partners sexually. In the face of this pressure, the women engaged in activities that exemplify Duncombe and Marsden’s (1996) concept of “sex work.” The women in this study made a conscious effort to bring their own sexual feelings and desires in line with perceived cultural norms. They employed a variety of tactics to do so, including attempting to heighten their own sexual desire (e.g. by drinking), feigning sexual desire, having sex despite not wanting to, or stopping and/or switching medications. Ultimately, the fact that so many of the women understood their inability to respond to their partners sexually as “cheating” or “robbing” them of an experience the men deserve aligns with traditional gendered sexual scripts. In these scripts, men’s desires are privileged as normative, and romantic sexual relationships are structured so that the brunt of the emotional labor required to maintain them falls on women (Duncombe & Marsden, 1996; Elliott & Umberson, 2008).
Obligation to Self
That the respondents felt sexually obligated to their male partners is not surprising in light of traditional sexual scripts. However, what is more surprising is that numerous respondents also felt a sense of sexual obligation to themselves. Many indicated that they believed that they should enjoy sex and that it should be an experience that brings them happiness apart from their partners’ satisfaction. Additionally, many respondents believed that it is abnormal not to experience sexual desire or pleasure and that their lack of enjoyment indicated something was wrong with them. Utilizing common slang for sexual talent, Julia (27) protested,“Something is wrong. I feel like a human with that essence that’s not there…Something’s broken. The drugs broke my mojo. I’ve lost my mojo!” Similarly, Katie, 20, reflected:
I used to be very happy with the way that I looked and felt, not only sexually, but just period. And when I started losing – I almost feel like I was losing the sexual side of myself for a while with (the medication), and I kind of lost that positive self-image. That was just shitty. That’s part of who you are, part of your essence, what you think of yourself, and I was losing that because of something I was taking.
For respondents like Katie and Julia, the experience of sexual difficulties was interpreted as the loss of a core piece (an “essence”) of themselves. Other common reactions to the sexual side effects the respondents experienced included disappointment and frustration, feeling “disconnected” from their bodies and their sexuality, and feeling like a “sexual failure” due to their inability to meet the expectations they held for themselves. Thus, several respondents considered their inability to experience sexual pleasure to be personally problematic, regardless of how they believed it affected their sexual partners.
Several of the women in this study reported feeling that they were not only entitled to sexual gratification, but that it was an experience they should be having, regardless of their life circumstances. For example Jessica (22), introduced earlier in this paper, believed for a long time that sex was for men, and that women had to do it to please them. However, her thoughts on the subject changed over time. She explained:
I definitely embrace my womanhood and my sexuality, and I definitely have a sexual drive, and I definitely have the ability to be pleasured during sex. I definitely want to enjoy sex. I don’t want to have sex for somebody else any more.
Gretchen, 24, also introduced earlier in the paper, at first only sought to rectify her sexual difficulties because they were problematic for her boyfriend. In retrospect, she argued:
And I kind of hate now that it was only when it bothered him that it bothered me.
[Why do you hate that now?]
Because I feel like...I feel like being comfortable with my sexuality and enjoying it is really important and it shouldn't depend on how it affects someone else. It should be about me. This is one area where I should be happy! I should be enjoying myself... It should be enough that it bothers me.
Jessica and Gretchen's accounts embody key beliefs that emerged as prominent themes in the data. First, they both believed that they should enjoy sex - it should be an experience that brings them personal happiness, and that sexual fulfillment did not have to be defined solely in the context of their partner’s enjoyment. Second, Gretchen believed that it was her responsibility to recognize and address her sexual problems—the fact that it bothered her “should be enough” to spur her into action. Many respondents shared similar beliefs, indicating that their inability to experience sexual pleasure was personally problematic whether or not they had a sexual partner. They believed they owed it to themselves, as well as to their partners, to overcome their sexual difficulties.
This sense of self-obligation implies that the women in this study interpret their sexual capacities in ways that contradict traditional sexual scripts and constructions of female sexuality, which depict women's sexuality as dormant in nature, something that must be activated or “awakened” by a male presence (Barbach, 1982; Martin, 1991; Roberts, Kippax, Waldby, & Crawford, 1995). The traditional feminine sexual script suggests that it is only through men that women can access sexual feelings. In contrast, the respondents in this study perceived themselves to be not only capable of accessing their own sexual feelings and desires, but obligated to enjoy their sexuality as a means of self-fulfillment.
Although their claims of sexual agency subvert hegemonic heterosexual gender roles and the sexual double-standard, many of the accounts of the women in this study also suggest that being in touch with one's sexuality is a cultural imperative rather than an option. This sense of obligation is illustrated in the respondents’ repeated claims that if they were unable to experience sexual desire or pleasure, something must be wrong with them. Feeling that one should enjoy sex—that it is an obligation—is different than feeling free to enjoy sex. Indeed, several respondents indicated that they felt considerable social pressure to live up to an image of feminine sexuality that enjoins women to embrace their sexual desires and actively seek gratification.
This contemporary sexual standard was omnipresent in respondents' day-to-day lives. They pointed to television shows such as Sex and the City (which, despite its strict adherence to hegemonic narratives of femininity and romance, is widely perceived as ground-breaking1, magazines and Internet media that proffer sex advice and sell products meant to enhance women's sexual experiences, and the sexual talk of female friends as evidence of this imperative. As Callie, 24, noted, “As horrible as it sounds, when you watch things, whether it's TV or porn, or you're talkin' to friends, like, the woman always seems to be enjoying herself. She's just like, 'Oh, yeah!' And you're like, 'Crap, that's not me, I feel like a loser.’” Gretchen had a similar experience with her college roommates:
They were very comfortable with themselves. I was jealous of them that they were so comfortable with themselves and seemed to enjoy (sex) so much. I was like, what's wrong with me that I don't want this?
Even within this group of young women, age emerged as a factor that influenced our respondents’ interpretations of and responses to this imperative. The younger women in the sample—particularly those who were in college—understood that they were supposed to be enjoying sex. However, unlike the women in their mid-to-late 20's and early 30's, the college-aged women experienced this more as a subcultural (college) norm than as a personal obligation. For example, Sadie an 18-year-old college sophomore, described the pressure she felt to enjoy sex as a normal part of college life:
And there’s also some sort of societal norm about it. Not that I should be running around having sex with everybody, because then I’d be a slut but at the same time I shouldn’t be in my room in a chastity belt. So there’s definitely some sort of – like, it’s college, go out there and have fun.
In contrast, the older women seemed to have more fully integrated the imperative to experience pleasure into their sense of themselves as sexual beings. For some (like Gretchen and Jessica), this process involved first shedding a negative sexual self-construct and adopting a sexual ethic that recognizes women's sexual desire and pleasure as positive forces. This transformation sometimes occurred in a social context in which the respondents were exposed to positive constructions of feminine sexuality, often for the first time. For example, Ellie, 29, described the way her self-image changed when she became involved in teaching a progressive sexuality course as a first-year graduate student:
Prior to teaching sexuality, I was kind of like, my sexuality doesn’t define me. Like, I don’t relate to my sexuality, it’s just this other part of me that I don’t really think about, I don’t know, that I don’t relate to... After teaching sexuality, it became a part of who I am. In particular, that I was a sexually free person. I identified as somebody who was sexual, which is something I don’t think I identified myself as for a long time in my life.
Regardless of where the women learned about the contemporary expectations for female sexuality, be it from friends, media, the classroom, or another source, it became clear in the course of this research that women understood their sexual difficulties as personally problematic. The respondents indicated that they felt both entitled and obligated to experience sexual fulfillment. In other words, they had integrated aspects of contemporary feminine sexual scripts, including the obligation to want and enjoy sex, into their sense of who they should be sexually, and what they should be experiencing. While society still demands that women fulfill the traditional requirement of providing sex for men and doing “sex work” in heterosexual relationships, women must also authentically desire and enjoy it – not simply for their partners’ edification, but also for themselves. Whether this new sexual script has a greater potential for liberation or for continued oppression is debatable.
The use of antidepressant and anti-anxiety medications is a widespread phenomenon in our culture. Given the high rates of both depression and antidepressant use by women and the frequency with which they experience sexual side effects while taking these medications, this research originally sought to fill a gap in the sociological literature about women’s experiences with sexual side effects as a result of anti-depression medication. However, in the course of the research, what became most interesting is how women understood their sexual difficulties in terms of their relationships with men and their sense of themselves as sexual beings. We found that both the traditional feminine sexual script and elements of a more contemporary sexual script informed the ways in which our respondents experienced sexual difficulties. In this regard, this study adds to the literature on sexual scripts.
The women’s responses indicate that elements of the traditional feminine sexual script continue to structure their sexual experiences and relationships. They felt sexually obligated to their male partners and they worried that their sexual difficulties “robbed” or “cheated” the men out of something that was rightfully theirs. Correspondingly, many of the women felt pressured to engage in “sex work” (Duncombe & Marsden, 1996) to ensure their male partners were satisfied. This work included feigning sexual desire, engaging in sex despite reluctance to do so, and attempting to manipulate their own sexual desire (e.g. by drinking). On the other hand, there was also evidence that the women in this study felt pressured to live up to a more contemporary feminine sexual script, one that tells women they not only are entitled but obligated to experience sexual fulfillment and that their sexual “dysfunctions” are problematic not only in the context of a heterosexual relationship, but also at the level of personal, individual experience. While all of the women felt as though they should find sex personally fulfilling, the college-aged women recognized the influence of college norms as playing a role in the pressure to live up to this contemporary sexual script. In contrast, the older women more fully integrated the imperative to experience pleasure into their sense of themselves as sexual beings.
Ultimately, as these women negotiated the experience of sexual difficulties, both traditional and contemporary sexual scripts were at play. While the scripts are contradictory on many points, the respondents in this study were able to integrate aspects of both in a way that they did not overtly recognize as incongruous.
As discussed previously, Gagnon and Simon (1973) identified three different levels of sexual scripts: interpersonal, intrapsychic and cultural. On a cultural level, the women in our study cited the influence of their peers, families, faiths and the media in the formation of their own ideas about female sexuality. Their peers and the media appeared to be particularly influential in the development of the belief that women are not only entitled to sexual pleasure, but that they should be experiencing it. Additionally, once internalized, the new scripts informed and structured the respondents’ interpersonal and intrapsychic experiences, in that they influenced not only how the women engaged sexually with their partners, but also their own desires and sense of what is sexually “normal” for young women.
The contemporary construction of female sexuality, as both capable of and entitled to sexual pleasure, is important and revolutionary in many ways. However, it also has the potential to limit women’s sexual options and responses. If women must desire sex and must be sexually responsive, variance in either of these areas is likely to be experienced as personally problematic, and the women who embody this variance may be labeled “dysfunctional.” Furthermore, understanding variance in sexual desire and response as a personal or medical problem may exacerbate feelings of sexual inadequacy or failure, thus creating even more sexual pressures for women.
This research has a few notable limitations. First, the participants are homogeneous in their race, age, sexual identity, geographic location, and educational attainment. Future research should seek to include a more diverse group of respondents. Secondly, the actual relationship between the use of antidepressants and sexual side effects needs to be investigated further. Additionally, the impact of sexual side effects (in general or caused by antidepressant use) on men should be further explored in sociological literature (see Loe, 2004 for an example of notable research on this topic).
Last, a good comparison study would investigate how women who do not report suffering from sexual problems integrate traditional and contemporary scripts in their sexual lives, with special attention paid to how the sense of sexual obligation identified in this study is present in populations that do not report sexual difficulties.
This study illustrates that some elements of the traditional sexual script, which constructs female sexual desire and response as things that exist in the service of masculine heterosexuality, continue to thrive. It was disheartening to hear many women speak of their sexual difficulties primarily as problems for the men in their lives. Most discouraging, however, was hearing women tell us they felt they had to have sex, even if they didn’t want to, and that the sex felt obligatory and forced. This illustrates the continued existence of an unequal power dynamic and a culture of coercion that is frequently present in heterosexual relationships and supported by the traditional sexual script (Byers, 1996). On the other hand, this research also shows that women are integrating contemporary sexual scripts that emphasize women’s sexual pleasure in their relationships and self-concepts. That many respondents felt social pressure to live up to an image of feminine sexuality that encourages women to embrace their sexual desires and experience sexual pleasure suggests there has been a shift in our cultural expectations with regards to female sexual performance. It is a step forward for women to be concerned about their own sexual fulfillment and enjoyment. However, the finding that this concern is often rooted in a fear of being “abnormal” or “sick,” or out of sense of obligation rather than choice, means troubling vestiges of the traditional script remain.
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1. See Brasfield 2006 for a critical discussion of the series.
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