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SUMMARY. This paper analyzes the emergence of two FDA-approved
products to treat “sexual disorders”: Viagra, a drug prescribed for the treat-
ment of erectile dysfunction, and the Eros, a device prescribed for the treat-
ment of female sexual dysfunction. Through an analysis of advertising and
promotional materials for Viagra and the Eros, we argue that these pharma-
ceutical devices and the discourses they circulate reinforce normative gen-
der ideals by enacting dominant cultural narratives of masculinity,
femininity, and male and female sexuality. These cultural narratives of nor-
mative gender structure sexuality in such a way that reinforces certain kinds
of masculinity, femininity, and (hetero)sexuality, thereby rendering “atypi-
cal” gender and sexual expressions, desires, and appearances invisible and
marginal. We argue that these constructions reify cultural ideologies about
“what counts” as legitimate and appropriate sexuality and that these con-
Jennifer R. Fishman and Laura Mamo are affiliated with the University of California.
Address correspondence to: Jennifer Fishman, Doctoral Candidate, Department of Social and Behavioral Sciences, Box 0612, University of California, San Francisco,San Francisco, CA 94143-0612 (E-mail: lmamo@itsa.ucsf.edu or jfishma@ itsa.ucsf.
edu).
Selections of this paper are drawn from “Potency in all the right places: Viagra as a technology of the gendered body,” Mamo and Fishman. Body & Society, 7(2), 2001.
[Haworth co-indexing entry note]: “What’s in a Disorder: A Cultural Analysis of Medical and Pharma- ceutical Constructions of Male and Female Sexual Dysfunction.” Fishman, Jennifer R., and Laura Mamo. Co-pub-lished simultaneously in Women & Therapy (The Haworth Press, Inc.) Vol. 24, No. 1/2, 2001, pp. 179-193; and: ANew View of Women’s Sexual Problems (ed: Ellyn Kaschak, and Leonore Tiefer) The Haworth Press, Inc., 2001,pp. 179-193. Single or multiple copies of this article are available for a fee from The Haworth Document DeliveryService [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: getinfo@haworthpressinc.com].
 2001 by The Haworth Press, Inc. All rights reserved.
A NEW VIEW OF WOMEN’S SEXUAL PROBLEMS structions have profound implication for social actors, sexologists, and ther-apists. [Article copies available for a fee from The Haworth Document DeliveryService: 1-800-HAWORTH. E-mail address: <getinfo@haworthpressinc.com>Website: by The Haworth Press, Inc. Allrights reserved.] KEYWORDS. Sexuality, gender, medicalization, sexual dysfunction,
discourse, pharmaceuticals
INTRODUCTION
This paper analyzes the emergence of two FDA-approved products to treat “sexual disorders”: Viagra, a drug prescribed for the treatmentof erectile dysfunction (ED), and the Eros, a device prescribed for thetreatment of female sexual dysfunction (FSD). Through an analysis ofpromotional materials for Viagra and the Eros, we argue that these phar-maceutical devices and the discourses they circulate reinforce norma-tive gender ideals by enacting dominant cultural narratives ofmasculinity, femininity, and male and female sexuality. These culturalnarratives of normative gender structure sexuality in such a way that re-inforces certain kinds of masculinity, femininity, and (hetero)sexuality,thereby rendering “atypical” gender and sexual expressions, desires,and appearances invisible and marginal.
The appearance of Viagra and the Eros on the market as treatments for sexual dysfunction signals a shift away from psychotherapeutic inter-ventions toward pharmacological ones (Tiefer, 2000). Of concern here isthat this “magic bullet” approach to sexual problems both effaces largercultural and social phenomena and reinforces dominant ideals of gender.
Thus, this paper provides a close reading of the promotional materials forthese products in order to make explicit the normative cultural ideals em-bedded in these discourses–ideals which construct and reinforce unevenpower relations and dominant scripts about gender and sexuality. We ar-gue that Viagra and the Eros, as new technologies for the treatment ofsexual dysfunction, re-invoke normative assumptions about heterosexu-ality, what counts as “appropriate” sexual activity, and the desired out-comes of sexual expression. However, in addition, we find that beneaththese dominant scripts exist others that allow for alternative readings bypotential users to reconstruct these assumptions, therein creating newuses and new discourses about sexuality.
Jennifer R. Fishman and Laura Mamo THE MEDICAL LABELING OF SEXUAL DYSFUNCTION
It has been well established that biomedical knowledge, practices and techniques have found their way into people’s daily lives, labelingmore and more aspects of social life as “illness” or “dis-ease.” Sexualityhas not escaped medicalization. Since the nineteenth century,biomedicine has placed what it terms “perversions” under the medicalgaze; recently, however, a wider range of sexual “problems” have alsobeen placed under medical jurisdiction. These include reproduction, in-fertility, and now, sexual dysfunction. This shift represents a move toenroll previously “normal” populations into biomedical discourses andtreatments. Sexual dysfunction has become one such example, withViagra and the Eros representing this trend. It should be noted that thisis not as simple as it seems, for in many of these cases, it is the “pa-tients” themselves who request such designations, diagnoses, and bio-medical solutions.
Sildenafil citrate, developed, marketed, and sold by Pfizer, Inc. under the brand name Viagra, is an oral therapy for the treatment of male erec-tile dysfunction (ED). Viagra, approved by the Food and Drug Admin-istration (FDA) in March 1998, is considered the first noninvasive,non-surgical medical treatment for this health problem. A medical de-vice called the Eros-CTD (“clitoral therapy device”) received FDAclearance in April 2000. It is the only FDA-approved device for thetreatment of female sexual dysfunction (FSD), and is available by pre-scription only. It is a hand-held battery-operated device with a suctioncup to be placed on the clitoris that works as a vacuum to enhance bloodflow to the genital area. Clinical study results indicate that the devicecan measurably increase blood flow, which is important for both vagi-nal lubrication and clitoral sensation (Billups et al., forthcoming).
The emergence of these products at the turn to the twenty-first cen- tury takes place in light of FDA regulation changes regarding the advertis-ing of pharmaceuticals, and the increased penetration of pharmaceuticaland chemical devices into many aspects of modern life. In 1997, the FDAloosened its regulations for marketing prescription drugs to allow phar-maceutical companies to advertise their products directly to consumersthrough print advertisements in mainstream magazines and televisioncommercials (Terzian, 1999). In fact, the bulk of pharmaceutical adver-tising money has shifted to direct advertising to consumers themselves(Meyer, 1998). Prescription drugs are fast becoming popular consumerproducts, a capitalist fetish, where one is encouraged to think of suchdrugs as a means through which to improve one’s life. The shift to the A NEW VIEW OF WOMEN’S SEXUAL PROBLEMS biomedicalization of life itself is indicative of a cultural and medical as-sertion that one’s life can always be improved.
The pharmaceutical industry, one of the most profitable and competi- tive industries in the U.S. today (Angell, 2000), increasingly relies onlifestyle products like Viagra and the Eros in an attempt to bolster profitsand market share. That Viagra has been so profitable most certainly im-pacts the research priorities of pharmaceutical companies who are nowintently interested in women’s sexual health. The increasing privatizationof biochemical and biotechnological research through pharmaceuticalcompanies has meant that which research gets funded and supported isdetermined by the profitability of the end product, rather than by what isperceived to be most needed (Bloom, 1994; Muraskin, 1996), most lack-ing, or most overlooked. In addition, many of these drugs are most likelyto appeal to a certain demographic segment of potential consumers, com-monly thought of as “aging baby boomers,” (see, e.g., Terzian, 1999)who are more likely to try these drugs in an effort to maintain youthful ap-pearances, activities, and lifestyles. It is these intended users that we thinkthe developers and marketers had in mind with Viagra and the Eros. Onceaging is redefined in medical terms, a large-scale market becomes avail-able to ensure the success of the next up-and-coming “lifestyle” product.
CULTURAL STUDIES AND DISCOURSE ANALYSIS
In this paper we centrally place biomedical developments within the ru- bric of cultural studies in order to expand current conceptions of the waysin which cultural discourses of gender, sexuality and biomedical technolo-gies (in this case Viagra and the Eros) mutually shape one another. Sincethese drugs are linked to gendered, sexualized users, they raise importantquestions regarding sex, sexuality and gender, as well as issues of “whatcounts” as legitimate behaviors, expressions, and identities.
Cultural studies is an interdisciplinary field that examines cultural texts, products, and discourses in an effort to reveal ideologies and lin-guistic arrangements which structure the meanings embedded in theproducts and practices of social institutions (e.g., mass media, medicine).
It looks critically at the ways in which the cultural practices of these insti-tutions are used to support dominant ideologies of powerful social groupsand reinforce social inequalities. Medicine, and its concomitant indus-tries, is a social institution that is both informed by and produces “cul-ture” through its products and discourses. A discourse is a social artifactthat provides a coherent way of describing, categorizing, and “makingsense” of the social and material worlds and the objects, persons, and in- Jennifer R. Fishman and Laura Mamo teractions within them (Foucault, 1981). Discourses, in turn, have effectson the constitution of both subjects and objects of knowledge through thisdescription and categorization, which is understood as the exercise ofpower through numerous, diffuse points and relations. It is our task in thispaper to analyze discourses as patterns of ideologies that structure mean-ings and are produced through the development and promotion of medi-cine’s latest sexual dysfunction treatments.
For our purposes, discourse analysis is useful for exploring how au- thority on the subject of “sexual dysfunction” is enacted (Terry, 1999) andfor locating the ideologies-in-progress that produce common knowledge andaccepted truths concerning its make-up and subjects. In other words, we ex-plore biomedical constructions of sexual dysfunction, particularly thosefound in the promotional materials for Viagra and the Eros, as “truth produc-tions” that reveal cultural assumptions, anxieties, and norms. Furthermore,we are suggesting that gendered norms and assumptions are both “inputs”and “outputs” of the social and cultural construction of Viagra and the Eros.
Our already inscribed attitudes and understandings of sex, gender, and sexu-ality influence the manufacturing and diffusion of the drug. With Viagra andthe Eros come preconceived ideas about the appropriate (heterosexual, part-nered) users and (intercourse-based) uses of these devices thereby reinforc-ing such normative standards in the promotion of their use.
We analyzed the initial promotional pamphlet about Viagra for distribu- tion by sales representatives, medical personnel, and pharmacists (Pfizer,1998) and the UroMetrics, Inc. patient information video for the Eros(Urometrics, 2000). As marketing sites to potential consumers, these textsreveal the “ideologies-in-progress” of these technologies.
In our analysis of these texts we ask: What is appropriate (and inap- propriate) sexual response and sexual expression? Who are constructedas the “ideal” consumers of the technologies? Under what conditionsshould these devices be used? And finally, what dominant and subordi-nate ideologies of gender and sexuality are invoked? ANALYSIS:
DE-SCRIPTING1 VIAGRA AND THE EROS
Viagra
Viagra (Re)configures Masculinity, or Viagra as Desire. One of the dominant cultural narratives that Viagra reinscribes is a hegemonicmasculinity that relies on normative ideas about male sexuality. The A NEW VIEW OF WOMEN’S SEXUAL PROBLEMS scripts of the Viagra user embody many of the valued characteristics ofmasculinity, including virility, sexual mastery and control, and unham-pered sexual desirousness for women, thereby appealing to potential us-ers’ aspirations of attaining (or maintaining) such ideal standards (Potts,2000). This contributes to a codification of knowledge claims aboutwhat is sex, how the male (and female) body “works,” and the parame-ters of appropriate male (and female) sexuality.
The dominant model of male sexuality relies on notions of omnipres- ent sexual desire. The traditional script of male sexuality is that men al-ways want sex–desire is never the problem (Zilbergeld, 1999). Viagra“works” because desire is taken to be unproblematic for the male user.
Promotional materials are careful to posit that Viagra is not an aphrodi-siac, but will only work to produce an erection with sexual stimulation.
In other words, Viagra is only a techno-assisted erection, nottechno-implanted desire. The efficacy of the drug is never measured aswhether men want to be sexual after taking the drug, only that they areable to be. This not only assumes men possess omnipresent sexual de-sire, but Viagra’s effectiveness requires it. By extension, it therefore as-sumes that women are the object of men’s sexual desires, therebyconstructing normative gendered sexuality for both men and women.
This is evident in the closely linked assumption that the desired sex- ual activity is sexual intercourse or at least penetration. The clinical test-ing of the efficacy of the drug itself relied almost exclusively on themeasurement of whether or not “successful” sexual intercourse couldbe achieved after administration of Viagra (Pfizer, 1998). An erectionitself was measured through self-reports by subjects as to whether or notit was “sufficient” for sexual intercourse. In determining whetherViagra “is right for you,” the pamphlet asks: “When you have an erec-tion, is it usually hard enough to enter your partner?” This script reflectsand reinforces dominant cultural narratives about appropriate and legit-imate male sexuality.
Potency in All the Right Places. A photograph in the pamphlet de- picts a middle-aged white couple in bed, smiling and snuggling in eachothers’ arms. It carries the following caption underneath it: “There’smore to a good relationship than sex. But if you love someone, you wantto be able to show them [sic]. Viagra has helped us feel close again.” Asin this example, the pamphlet is generally careful to use gender-neutralterms for the sex of a man’s sexual partner, even if it means being gram-matically incorrect. Yet this seeming political correctness is belied byboth the accompanying photographs of exclusively heterosexual cou-ples and by other floating narrative quotes supposedly from Viagra us- Jennifer R. Fishman and Laura Mamo ers. For example, the following quote on page 11, “My wife helped mesee that the problem wasn’t that I was getting old. It was diabetes . . . ” isaccompanied by a picture of a middle-aged heterosexual couple takinga walk (Pfizer, 1998).
However, this may be a discursive strategy to appeal to traditional values while simultaneously alluding to alternative lifestyles. The useof the term “partner” instead of spouse raised anxieties among conser-vative “family values” representatives. Lou Sheldon, chairman of theTraditional Values Coalition, wrote a letter to Bob Dole, a spokesmanfor Viagra, objecting to Dole’s statement that Viagra can “help millionsof men and their partners” rather than “their spouses” (Garchik, 1999).
The use of the term partner instead of spouse could be used to signal thepossibility of heterosexual infidelity, a recognition of the high rates ofdivorced men (and women) in U.S. society, or potential consumers whoare men who have sex with men. Enrolling Bob Dole as a spokespersonfor Viagra is an ingenious marketing move, as Dole is seen to representall that is “right” in masculinity–courage, strength, success, and hetero-sexuality. Because Dole represents the hegemonic ideal of masculinity,the use of “partner” instead of “spouse” seems acceptable. It barelyeven registers as “alternative.” This juxtaposition of the representation of heteronormativity (nor- mative sexuality), and hegemonic masculinity with an opening avail-able for “alternative lifestyles,” indicates how the marketing relies on,and is perceived to need, the social legitimacy of Viagra as a drug formonogamous, heterosexual couples without limiting its potential con-sumer base. On one hand, the profitability of Viagra demands attractingas many customers as possible. On the other hand, the popularity andsocial acceptability of a drug for recreational sex in our current politicaland social climate depends on its alignment with cultural standards of“appropriate” sexual behavior. It is a delicate situation in which the dis-course reinforces normative behaviors and relationships, yet also leavesopen the possibility for other types of users.
As striking as the heteronormative scripts of Viagra is the recurrent emphasis of Viagra as a relational and coupled technology. As we dis-cuss below, this is strikingly different from the discursive scripts foundin the Eros. Another deeply engrained script of Viagra is an assumptionthat Viagra is going to be used during sexual activity with somebodyelse. The assumption of relationship use is revealed throughout the textof the pamphlet, and most prominently in the section entitled, “FacingED [erectile dysfunction] as a couple.” This section emphasizes the ne-cessity of “open and honest communication between partners.” It is A NEW VIEW OF WOMEN’S SEXUAL PROBLEMS nearly unfathomable to imagine a man taking Viagra for auto-eroticpurposes within the context of the pamphlet. Viagra is then constructedas a device that is not only sexually therapeutic but also therapeutic forthe overall health and well-being of the relationship. Viagra “fixes”erections and relationships too! There is a further assumption about thenature of a Viagra user’s relationship with his partner. The repetitiveemphasis on communication and “good” relationships carries with it ascript about not only appropriate sexuality, but also appropriate rela-tionship conduct. In many ways, the relationship between a Viagra userand his partner is assumed to be monogamous. Consider the followingtext: If you’re the partner of a man with ED, you may need to take thefirst step. Men with ED are often willing to try treatment optionssuggested by their partners . . . Understanding ED and knowing thatthere is a convenient, oral treatment available, can help the two ofyou to see a doctor and put the worry of ED behind you. (p. 13) This construction of Viagra as a drug for the “two of you” conveys a script about the appropriate Viagra user as monogamous, in a relation-ship where he has a partner with whom he wishes to and can discussthese problems, and having a partner who wishes to accompany him tothe doctor’s office. Alternative constructions of relationships (for ex-ample, men with a male partner, men with more than one partner, menwithout a regular partner, men without any partners, or men who do notwish to tell their partners about their sexual dysfunction) are suppressedin favor of the normative ideas of impotent men. Impotence itself is con-structed as a coupled phenomenon.
Nowhere is this more evident than in the print campaign for Viagra.
In the print advertisements for Viagra, the recurring image is of alate-middle aged, heterosexual couple dancing, with the woman in theman’s arms as he dips her across his body. The hint of sex appeal in ascene of an otherwise upstanding couple in a public space is a strategi-cally perfect representation of appropriate conduct and the “ideal” users(i.e., the couple). Furthermore, it illustratively shows the hegemonicpromises of Viagra. He is firmly in control of this “dance,” indicated byhis right arm placed firmly behind her back. The spinning movementcaptured in the ad lets us know that he still has a “spring in his step” andis still able to take his wife (note the large gold band visible on his lefthand) for a spin and put a satisfied smile on her face. The intimacy con-veyed through their close bodies and the gazing into each others’ eyes Jennifer R. Fishman and Laura Mamo reveals the effectiveness of Viagra not only for erections, but also forbringing couples closer together.
THE EROS
Through our analysis, the Eros likewise emerges as a gendered tech- nology, transmitting cultural scripts which serve as enforcers of norma-tively gendered expressions of sex and sexuality. Similar to Viagra,these scripts include normative assumptions of female (and male) sexu-ality, femininity (and masculinity), heterosexuality, and ideas of “ap-propriate” sexual relationships. However, the scripts found in the Erosrely on traditional notions of femininity which construct women as theprimary actor in the emotional/relational aspects of a relationship, butnot the sexual aspects, thus also maintaining hegemonic masculinityand the appropriate place for male potency.
Gaining Legitimacy: The Eros as Therapy. “Forty-three million women or four in 10 women experience some type of sexual disorder.”This is how the patient information video for the Eros-CTD device be-gins. This statistic, taken from a study recently published in JAMA(Laumann et al., 1999), has been used to justify biomedical research andtreatment for the widespread “disease” of “female sexual dysfunction”(FSD). The video, entitled An Answer to FSD, proposes that the Erosmay help women suffering from FSD symptoms which include de-crease in vaginal lubrication, pain during intercourse, difficulty achiev-ing orgasm, and decreased sexual satisfaction. In its promotion andinformation of its product, the Eros video also promotes certain norma-tive discourses about female sexuality, sexual pleasure, and “appropri-ate” sexual behavior in its instructions for use and claims of“successful” treatment. It encourages consumer use of the Eros (whichcosts approximately $375 by prescription and is covered by some insur-ance plans) by invoking and therefore reifying dominant cultural ideol-ogies. First of all, it promotes FSD as a medical problem and thereforein need of a medical solution. The Eros is offered as just such solution.
Secondly, the Eros reinforces the idea that there is a universal, homoge-neous female sexual response cycle. By depending on this model, thevideo claims its product to be effective. Thirdly, the Eros, like Viagra,relies on discourses that promote certain forms of appropriate sexual ac-tivity, that is, heterosexual intercourse, as the desired outcome of FSDtreatment. The following cultural analysis reveals that, similar to A NEW VIEW OF WOMEN’S SEXUAL PROBLEMS Viagra, these cultural ideologies rely on and reinforce cultural narra-tives of normative gender.
After we learn about the scope of women’s sexual “problems,” the video switches to an interior setting with a woman, seemingly a doctor,in a white coat who tells us that the Eros-CTD is the first and only FDAapproved treatment for female sexual dysfunction. While the device it-self seems to resemble an over-the-counter sex toy in shape and func-tion, it is carefully constructed as a device for “treatment” rather thanfor “pleasure” (Urometrics, 2000). This definition is important in anumber of ways. First of all, the Eros-CTD is a “recreational” device,just as sex is (mostly) a recreational activity; however, in order to mar-ket it as a prescriptive product, it, like Viagra, had to be packagedthrough medical terminology. Just as female sexual dysfunction has it-self been medicalized (see Tiefer in this issue), the Eros follows similarprescriptive patterns, billing itself as a “safe and effective” treatmentsuch that “with regular use” a woman will see “an improvement in over-all sexual satisfaction . . . within several weeks.” With your Eros devicecomes detailed instructions for use which tells a woman “how often touse the device and for how long” (Urometrics, 2000). In other words,just as drugs come with a “take two pills every four hours” prescription,the Eros too has prescriptions for use–“the Eros may be used daily.” (Thisbegs the obvious question, can it be used more often?) Therefore, the Eros,while capitalizing on the medicalization of women’s sexual problems,contributes to this very process through prescriptions and proscriptionsfor its use.
This brings to light an interesting paradox within the Eros’ promo- tional campaign. On one hand, it wishes to make itself a marketableproduct, appealing to a broad consumer base (at least 43 millionwomen!) in order to turn a profit. On the other hand, its legitimacy as aconsumptive device depends upon its alignment within the medical dis-courses of other restricted, prescription treatments. Its producers mustfind a way to market the Eros widely, yet simultaneously be taken seri-ously as appropriate for clinical treatment. In this sense, it seems to wishto differentiate itself from fetishized sex toys that look remarkably simi-lar and function in similar ways to the Eros (and sell for about one-tenthof the cost). This is accomplished through medical language as well asthrough alluding to the Eros as a device for “stimulation” but not for di-rect sexual satisfaction. The Eros video is careful to claim that with pro-longed use it will allow for an “enhanced ability to achieve orgasm,”rather than being able to produce techno-assisted orgasms through its Jennifer R. Fishman and Laura Mamo use. This may seem like a minor difference, but a “clitoral therapy” de-vice needs all of the social legitimacy it can get.
Use the Eros: No need for foreplay! If we look carefully at this differ- ence, the Eros differentiates itself from sex toys therein assuring its po-tential consumers (and their husbands) that the device is not intended toreplace one’s partner, but rather to “ready” oneself for the “mainevent”–that is, intercourse. The Eros then is purposely designed and pro-moted to fit into popular cultural understandings of “appropriate” (het-ero)sexual activity and the “appropriate” roles and behaviors associatedwith it. These are developed through dominant discourses about the se-quence of events of the sexual response cycle, which activities producethis sequencing of events, and who is responsible for which events. Al-though it seems rather daring for a product to market itself as a “clitoraltherapy device,” this can actually be read as a way of assuring that it is notinterpreted as a penis replacement. Men are still constructed as necessaryfor women’s sexual fulfillment. Within dominant discourses of femalesexuality, while the clitoris has been mostly accepted as a site for sexualstimulation and arousal, it is still perceived as an organ which allows forsufficient arousal for other forms of stimulation and activity to take place.
The Eros is a “treatment” which allows for the “gold standard” of (het-ero)sexual satisfaction–that is, orgasm through “normal” sexual inter-course with a male partner. The Eros campaign, assuring us that it is nottrying to rock the heteronormative boat, instead reifies this refrain inmaking the clitoris an organ for foreplay (an essential step in promotinglubrication), rather than for satisfaction in and of itself. The recom-mended use for Eros is either “for before intercourse or as self-stimula-tion” (but not satisfaction), therein curtailing other possible uses, forexample with intercourse, instead of intercourse, for use on a woman byone’s partner, in between or in conjunction with other activities. In fact, itis unclear what the Eros can do that a partner’s mouth cannot.
Unlike Viagra which is touted as a technology for couples’ use, the Eros’ instructions are for use without (but not instead of) one’s partner.
Where ED in general is constructed as a coupled phenomenon, FSD is a“woman’s” problem, and likewise her problem to “fix.” The Eros isused on one’s own time or before sexual activity, such that then one canachieve sexual satisfaction and satisfy one’s partner through traditionalmeans, namely intercourse. This assures the hetero-couple that theproblem was not one of his sexual performance, but a physiological,medical problem of her own. Once a woman “fixes” her “arousal prob-lem,” and blood is flowing to the appropriate places, he can still “give”her sexual satisfaction. A quote appears on the screen at the end of the A NEW VIEW OF WOMEN’S SEXUAL PROBLEMS video, purportedly by a “patient’s husband”: “This is a great device andmy wife is now as happy as I am.” She, in turn, fulfills her feminine andwifely role of satisfying her partner through traditional means and byextension, healing their relationship. In another text quote at the end of avideo, a “patient” says, “After 40 years, I’m so glad that there’s finally asolution to the problem that ended my marriage.” CONCLUSIONS
Viagra and the Eros emerge as gendered technologies, active in the construction of male and female sexuality and appropriate male andfemale behaviors. In fact, the promotional materials both rely on ideol-ogies of masculinity and femininity for their legitimacy as medicaltreatments. In other words, Viagra constructs appropriate masculinityvia its relationship to femininity and the Eros performs the same discur-sive move in the reverse. Our analysis reveals that both technologiesemploy similar ideologies-in-progress through their use of culturalscripts about the nature of (hetero)sexual relationships and heter-onormative sexuality.
Viagra relies on hegemonic masculinity in such a way that appeals to potential users’ aspirations of attaining (or maintaining) ideal male om-nipresent sexual desire and reaffirms the desired sexual activity as fe-male receptive sexual intercourse. Viagra provides men with atechno-assisted erection, not pharmaceutically-derived desire. TheEros is similarly promoted as a product to enable sexual intercourse.
But what is important for women’s roles in this activity is her receptiv-ity, or “readiness.” This is evident in the construction of the Eros as adevice for private “stimulation” preceding sexual satisfaction, not assatisfaction. Finally, while both of these technologies are constructed asa coupled phenomenon, unlike Viagra, which is touted as a technologyfor couples’ use, the Eros’ instructions are for use without (but not in-stead of) one’s partner. This is an interesting discursive move in that theEros, like Viagra, is constructed as a technology that can save relation-ships with women’s use of it. The distinction is not unimportant; thetechnologies reaffirm the dominant gendered meanings of masculinesexuality as omnipresent desire and feminine sexuality as fulfilling re-lational responsibilities.
While these more dominant constructions are obvious, it is also true that alternative readings of these scripts are available and construct ad-ditional types of users and uses of these devices then envisioned by their Jennifer R. Fishman and Laura Mamo developers. For example, we believe that on the flipside of theheteronormative ideologies of the marketing materials are possibilitiesfor new representations to emerge. Both technologies can fulfilltransgressive possibilities even though they are co-constituted withgendered inscriptions that long preceded them. It is not hard to seetransformative possibilities created with the use of these devices, alter-ing our understandings of “appropriate” sexual activities, compulsoryheterosexuality, and masculinity and femininity. In fact, there is muchevidence to show that the destabilization of Viagra’s normative scriptsis happening already. We have all heard rumors, anecdotes, and mediastories (e.g., Trebay, 1999) of: Viagra used for male performance en-hancement, or in conjunction with, illicit drugs; women and gay menusing Viagra; and of course, older men using Viagra to return to the het-ero-social scene. The Eros is a newer product and thus popular storieshave not yet surfaced. However, alternative readings are possible. It isnot difficult to imagine alternative uses for a product like this: sex toy,engorgement for clitoral insertion, nipple stimulator, oral sex enhancer,penile pump. These stories indicate that while the promotional materi-als enact certain truth effects on our patients, they are not the only“truths.” Therefore, the potential resistance to and liberation from nor-mative scripts of sexuality lies in the heterogeneous users and uses ofthe technologies themselves. In order to uncover this potential, impor-tant questions to ask include: who are the alternative users of Viagra(e.g., gay male users, disabled users, transsexual users, interssexual us-ers, female users, etc.); and under what circumstances is Viagra usedand for what purposes (e.g., recreation, procreation, intimacy, perfor-mance enhancement, penile penetration, masturbation, size, clitoral in-sertion, etc.).
Discourse analysis is one strategy that can be employed in an effort to read the ideologies-in-progress at work within particular texts and so-cial institutions. These have consequences for patients, sexologists, andtherapists. As we move into the twenty-first century, biomedical inno-vations designed to “treat” sexual dysfunction will continue to flood themarketplace increasing consumption “choices.” These will continueto promote and rely upon standard measurement tools and dominantcultural constructions of what counts as appropriate sexuality, and byextension, as ideal users. This type of analysis, then, plays an importantrole in evaluating and countering such constructions through uncover-ing the “scripts” that lie just beneath the surface.
A NEW VIEW OF WOMEN’S SEXUAL PROBLEMS 1. The term “de-scripting” is from Akrich (1992), and effectively describes the pro- cess by technoscience studies scholars of deconstructing the inscripting mechanisms oftechnologies on the bodies of users.
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Nº 133, quarta-feira, 14 de julho de 2010 PORTARIA No- 219, DE 13 DE JULHO DE 2010 I - formação generalista, humanista, crítica e reflexiva, ca-Art. 8º A prova do Enade 2010 terá, em seu componentepacitado a atuar em todos os níveis de atenção à saúde, com base noespecífico da área de Fisioterapia, 30 (trinta) questões, sendo 3 (três)A Presidente, Substituta, do Instituto N

Prophylactic cerclage in twin pregnancies from art: obstetric outcomes

Survival and development after ICSI of eggs from sequential donation cycles. S. Hernandez, P. Dıaz, J. Sepulveda. Reproductive Biology, Instituto para elEstudio de la Concepcion Humana (IECH), Monterrey, Nuevo Leon, Mexico. OBJECTIVE: To compare the obstetric outcomes of twin pregnancies af-ter ART with and without prophylactic cerclage (McDonald technique). MATERIALS AND METHODS: A tota

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