In theory, all of these advances in sex drugs and genital surgery are tightly aimed attempts to satisfy our desires. In reality—as anyone in a relationship knows—desire and satisfaction are moving targets, adjusting to shifting circumstances.
Today perhaps the most consistent attitude toward perfect sex is anxiety about why we are not getting it. “We are susceptible to being convinced that whatever sex is going on in our lives is just not good enough,” says Julia Heiman, director of the Kinsey Institute and a professor of psychology at Indiana University. Marketing that preys on our feelings of insecurity is an old business, she notes, but pharmaceutical research is changing the nature of that business. “Suddenly medicine—which we’ve always taken to do something for a problem—is getting involved in pure enhancement, which is more like cosmetics,” Heiman says.
Suddenly, medicine is getting involved in pure enhancement.
“One of the things that go along with attempts to make a new drug is the attempt to make a new diagnostic category of illness,” Fishman of McGill University says. She suggests that, for some people at least, the definition of good sex has already shifted. “The fact that there’s now a pill to help with sexual problems definitely changed the arena of sexual performance,” Fishman notes.
Sex researcher Beverly Whipple of Rutgers University, one of the first scientists to discuss the G-spot, believes the word dysfunction should be dropped from the sexual lexicon and that surgeries to alter sexual pleasure or aesthetics should be dropped from medical practice. “I have a problem with surgeries on the vagina, because what is it for? If there is a medical condition, I can understand that. But why would somebody want to change what is natural and normal?”
Regarding the G-Shot, Whipple says: “It could be the placebo effect. They’re charging thousands of dollars for this, and it has never been tested in a double-blind, placebo-controlled manner.” (Surgeries do not have to undergo the same scrutiny as, say, medications that are under FDA regulations.) The American College of Obstetricians and Gynecologists has released a statement that cosmetic vaginal surgery could be dangerous and ineffective. Matlock admits that he often has to repair surgeries performed by untrained doctors. Yet patients keep paying for procedures, perhaps hoping that a better sex life means a better relationship, a better family, a better life in general.
Since the 1960s, sexual experimentation has been associated with a breakdown of social barriers. Some researchers, including Fishman, worry that the current fixation on youthful sexuality could build other barriers back up. There is no denying the benefits of recent medical advances: addressing long-hidden sexual dysfunctions while also broadening our reproductive opportunities (see “Beyond the Test-Tube Babies,” below). But as with so many aspects of expensive modern medicine, not everyone gets to benefit. “In the area of reproduction, some people are more eligible to have children than others are. Those who can’t afford any of this may be labeled as abnormal simply because they can’t afford these things,” Fishman says. “New advances could alter our perception of ‘old age,’ with 65 at some point being considered young and virile”—for people with access to treatments. With both sex drugs and sexual surgery, the line that divides what we consider sexually normal and abnormal could depend ever more on class and income.
Medical advances intended to be liberating may thus end up promoting a narrower, less realistic definition of human sexuality. Whipple notes that variability—not an idealized uniformity—is the most deeply human trait. “Each person is unique, every person is different,” she concludes. “Why even define what is normal?”
Beyond the Test-Tube Babies
As sex has become more technologically advanced in recent years, so has the process of conception. In 1978 the first test-tube baby, Louise Brown, was a medical sensation and a media curiosity. When the public saw that Ms. Brown was not only healthy but adorable, in vitro fertilization (IVF) quickly crossed over the yuck line ?and became an everyday procedure. Since then, reproductive advances have generated new bioethical concerns.
The reproductive years have been radically extended. The current record holder is a 67-year-old Spanish woman. According to news reports, she conceived via IVF and delivered twin boys—and did it nearly two decades past the average age for menopause. Procreating late in life may sound risky; in fact, there is evidence that babies conceived by older couples are at higher risk of autism, schizophrenia, and Down syndrome. Having babies may seem even more appealing to older parents when the improving technologies of long-term egg and sperm banks allow fresh 20-year-olds to freeze their sex cells and defrost them decades later. Freezing oocytes (immature eggs) is already an established, if not totally reliable, practice at some IVF clinics.
In the longer run, reproduction is likely to get only more mechanistic and remote from its biological origins. One potential result: babies grown entirely outside the human body. At Cornell University, reproductive endocrinologist Hung-Ching Liu? and her colleagues have devised an artificial womblike environment, designed to allow the implantation and nurturing of embryos. Researchers have grown a mouse fetus nearly to full term in this environment, although it was seriously deformed. The Cornell team will not permit a human embryo to develop past 14 days for legal reasons: IVF legislation in the United States forbids it.
A full-blown artificial uterus, able to sustain a more mature fetus, is on several researchers’ drawing boards (especially with preemies surviving at ever-earlier stages). One iteration of this concept, developed at Juntendo University in Tokyo, is a tank filled with warm amniotic fluid and strewn with catheters, which function like umbilical cords to provide nutrition. The contraption allowed midstage goat fetuses to develop to full term; however, because a muscle relaxant was injected to keep the fetuses from kicking off the catheters, the goats were too weak to breathe.
Nurturing an early embryo is a far cry from growing it to full term. Making the leap from laboratory conception to laboratory birth—that is, no mom needed—is a long way off. Nevertheless, many scientists believe that day will eventually come.
