**1. Introduction**

There is a widespread belief that doctors are the "real" experts on women's health, sexual health included, and that biomedicine holds the key to improving it. This paper is going to demonstrate the limitations of such an approach, challenging the common perception that medicine alone holds the key to understanding women's sexuality. In considering women's sexuality we have to step outside the biomedical model to explore the ways in which some theories and practices are silenced and others are (re)produced.

The paper will seek answers to the fundamental question about the bond between women and medicine from the perspective of the everyday life of the modern woman: What does medicine have to do with female liberation, particularly in the field of sexuality? We are dealing with complex questions; it is a challenging task to maintain the tension of the controversies and avoid over-simplification. We are particularly interested in the idea of the regulation of female sexuality, and hence the patriarchal management of female bodies through the State and its institutions. This paper will elaborate the idea that one important part of modernization is the regulation, management and surveillance of the human body, with sexuality a particularly prominent feature. Medicine plays an important role in those processes. We are going to explore our topic from multiple points of view, historical, sociological and cultural, with use of concepts like sex/gender, knowledge, power, embodiment, and medicalization. Female sexuality and its controversial bonds with medicine have to be in the centre of interest for those who are dedicated to women's well-being, especially in times of life transitions such as puberty, childbirth and menopause.

© 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **2. The sexualization of everyday life**

Let us begin with a short overview of the sexualization of various aspects of everyday life, followed by a look into the controversial links between female sexuality and medicine. Considering the proliferation of sexual messages surrounding us and their use as bait to get consumers to purchase products, whether they are needed or not, it is tempting to see the sex lives of modern individuals as being free from any and all taboos, as if reservations no longer apply – satisfaction and instant gratification are made freely available and cater to every taste, every kind of sexual desire. Sexuality is marketed as a commodity, bought *en masse* and sold on a grand scale.

On the surface, sex and sexual activity are presented as a private matter of individuals and a question of personal choice. The achievements of second-wave feminism [1], along with the accomplishments of the "sexual revolution" (a mass movement of the younger generations in Western Europe and the US between 1964 and 1975, which advocated for "free love", free from traditionalist patterns of sexual behaviour and some of its taboos) have gone down in 20th century history [2] as significant events for women's equality, including in terms of sexuality. For the subject at hand, we can mention specific areas such as violence, including rape [3] (as a form of specific sexualized violence used, among other things, for the reproduction of power relations between genders in the patriarchal family and society), and productive rights (especially safe and reliable birth control, safe abortion and the accessibility thereof to a wide range of women), as well as the questioning of myths about motherhood [4]. This primarily involved the pursuit of the conditions for an active heterosexual life for women, unaffected by unwanted, involuntary motherhood. At the same time, prejudice about socially undesirable or unlawful sexual practices of the time, such as sex before marriage, teenage sexual activity and homosexual love, was being dismantled. The revolutionary undoing of inhibitions in favour of freer sexual expression also meant the undermining of patriarchal sexual attitudes, which signalled a chance for greater autonomy of women, and was supported by the women's health movement in its attempts to establish a body of knowledge different from oppressive medical discourses and practices, including on women's sexuality [5].

Where do we stand now? It seems that we have gone from prohibiting certain aspects of sexuality to imposing sexuality in many aspects of our lives, that sex has been incorporated into the general wave of consumerism and hyper-spending as one form of escapism for the modern individual in today's consumerist society [6]. Modern individuals who are incapable of sufficient self-reflection are exposed to compulsory consumption of all kinds of sexually informed messages, from enormous billboards to short commercial text messages, which use imagery and words to arouse desire solely in order to make consumers spend more and be easier to manipulate. Clever pop mimicry of free, genuine and primal sex, purported to be the essence of free sexuality, has lured in those seeking an escape. They face constant temptation to answer the persistent call to "Choose and enjoy yourself!" based on the nihilist principle of "Everything is permitted" – albeit with the caveat "Only if you have money" in the small print.

What has been proclaimed as liberating has also created new potential for fresh forms of control and subjugation. It is not too much of a stretch to say that the potential of free sexuality to enable and embody social progress has been overstated or, at the very least, skilfully diverted. The accomplishments of the sexual revolution have been exploited by neoliberalism to gain new, previously inconceivable profits on the pornography market for example [7], as well as by the proliferating global sex trade, ranging from prostitution to sex trafficking, which treats particularly vulnerable groups, including children, women, the economically disadvantaged and other individuals whose very existence is under threat, as goods, and ruthlessly subjugates them to the logic of the market. At the same time, new technologies have provided new channels for sexual messages, in particular via the Internet, which advances the spread of compulsory sexuality and aggravates phenomena like sex addiction [8].

### **3. Is female sexuality now free of any and all taboos and coercion?**

**2. The sexualization of everyday life**

on a grand scale.

144 Sexology in Midwifery

Let us begin with a short overview of the sexualization of various aspects of everyday life, followed by a look into the controversial links between female sexuality and medicine. Considering the proliferation of sexual messages surrounding us and their use as bait to get consumers to purchase products, whether they are needed or not, it is tempting to see the sex lives of modern individuals as being free from any and all taboos, as if reservations no longer apply – satisfaction and instant gratification are made freely available and cater to every taste, every kind of sexual desire. Sexuality is marketed as a commodity, bought *en masse* and sold

On the surface, sex and sexual activity are presented as a private matter of individuals and a question of personal choice. The achievements of second-wave feminism [1], along with the accomplishments of the "sexual revolution" (a mass movement of the younger generations in Western Europe and the US between 1964 and 1975, which advocated for "free love", free from traditionalist patterns of sexual behaviour and some of its taboos) have gone down in 20th century history [2] as significant events for women's equality, including in terms of sexuality. For the subject at hand, we can mention specific areas such as violence, including rape [3] (as a form of specific sexualized violence used, among other things, for the reproduction of power relations between genders in the patriarchal family and society), and productive rights (especially safe and reliable birth control, safe abortion and the accessibility thereof to a wide range of women), as well as the questioning of myths about motherhood [4]. This primarily involved the pursuit of the conditions for an active heterosexual life for women, unaffected by unwanted, involuntary motherhood. At the same time, prejudice about socially undesirable or unlawful sexual practices of the time, such as sex before marriage, teenage sexual activity and homosexual love, was being dismantled. The revolutionary undoing of inhibitions in favour of freer sexual expression also meant the undermining of patriarchal sexual attitudes, which signalled a chance for greater autonomy of women, and was supported by the women's health movement in its attempts to establish a body of knowledge different from oppressive

Where do we stand now? It seems that we have gone from prohibiting certain aspects of sexuality to imposing sexuality in many aspects of our lives, that sex has been incorporated into the general wave of consumerism and hyper-spending as one form of escapism for the modern individual in today's consumerist society [6]. Modern individuals who are incapable of sufficient self-reflection are exposed to compulsory consumption of all kinds of sexually informed messages, from enormous billboards to short commercial text messages, which use imagery and words to arouse desire solely in order to make consumers spend more and be easier to manipulate. Clever pop mimicry of free, genuine and primal sex, purported to be the essence of free sexuality, has lured in those seeking an escape. They face constant temptation to answer the persistent call to "Choose and enjoy yourself!" based on the nihilist principle of "Everything is permitted" – albeit with the caveat "Only if you have money" in the small print. What has been proclaimed as liberating has also created new potential for fresh forms of control and subjugation. It is not too much of a stretch to say that the potential of free sexuality to

medical discourses and practices, including on women's sexuality [5].

We assert that the aforementioned issues do not affect both genders to the same degree; answers need to be provided to questions about how female sexuality and procreation in general should be perceived and experienced, and about the role played by medicine in these issues. Living a fulfilling life often involves the ability to decide how to express one's own sexuality in all its shifts throughout life cycles, and to find opportunities to live out that sexuality in relationships on a personal and interpersonal level. The question is, however, whether our personal, intimate and individual sex lives really exist within the sphere of freedom. Many things we may see as spontaneous are not truly spontaneous – we are born into a certain environment which shapes our idea of female and male sexuality through cultural, social, domestic and religious convictions. Beliefs, moral judgements, preferences all shape a number of key relationships between individuals and culture(s) as a consequence of a variety of complex and interconnected factors permeating families, institutions concerned with education and health, the media and so on. The (self-)perception of individuals and their relationship to their own gender, the gender of others and sexuality are linked to responsibility and respect felt for oneself and other human beings – what I (do not) like about myself and others, what I (do not) appreciate myself and others, what I am worth, what is male and female sexuality, what is sexually (un-)appealing, what a sexually (un-)appealing body looks like, what the relations between pleasure, gratification, passion, a sense of belonging, validation and love are.

Human sexuality cannot be reduced to the mere sex act; it involves more than just genitals and procreation. The history of sexual desire tells us that the desire to experience sexual pleasure and total body sex – that is, the expansion of sexuality from a limited focus on the face and genitals to include the entire body – has been known since antiquity [9] and was, disregarding the period of the repression of sexual desire in Christian Europe, kept alive up to its renaissance in the 19th century, which continues to this day. Sexual activity is also importantly affected by sexual desire, which goes beyond a mere instinct: the sex act, be it heterosexual or homosexual, is never a mere spontaneous, instinct-driven biological act; it is necessarily a socially condi‐ tioned, complex act with its own symbolic value [10]. Researchers of sexuality have yet to agree on the question of whether there are any differences in sexual desire between men and women, and if so, whether they are caused by nature or nurture. On a hormonal level, sexual desire is linked to androgens, which are produced in testicles, in men, and androgens and oestrogen in women, produced in ovaries, as well as testosterone and oxytocin. According to some studies, how we experience sexuality may also be gender-specific, but although the belief that men are more sexual than women, and the principal initiators of sex, while women are more passive, and recipients, is still prevalent in some places, it has become increasingly clear that the differences are differences in the expression of sexuality, which is informed by the culture and social (gendered) roles as well as the expected sexual behaviour for men and women. The belief that women's erogenous zones are more widely dispersed on the body than in men is also prevalent. The way women perceive themselves and their own sexuality is also influenced by prevailing culture – women learn to be passive. They respond to visual and other impulses and become aroused as quickly as men, but being sexually liberated is much more socially acceptable for men. Myths persist about female sexuality in relation to the idea that women have a greater need to form an emotional bond.

Where do we currently stand with regard to female sexuality, socially speaking? There are, of course, multiple types of discourse, and we can highlight the abuse of female sexuality on multiple levels, including devaluation, objectification, the focus on the physical female body in the media, and the propagating of a certain ideal female appearance, which currently means a slim body with no cellulite and the right curves in the right places, with shifting ideas of how much curviness is still acceptable. In addition, female sexuality is constantly being redefined, still seen as goods to be traded in order to survive, to provide protection or sometimes to climb the social ladder; in traditionalist environments, female sexuality is the expression of a woman's worth or worthlessness, as evidenced by the revival of the cult of virginity, which must be maintained until entering a monogamous relationship [11]. Even today, the myth of supposedly passive female sexuality as opposed to active male sexuality persists in popular culture; at the same time, female sexuality is perceived as mysterious, or demonized and regarded as a threat to men. Messages in the media reinforce the chosen model of female sexuality through culturally selected behavioural patterns for each gender and selected sexually informed images that only emphasise certain kinds of sexual expression. This model is perpetuated through various types of discourse about the necessity of maintaining health, beauty and youthfulness through self-discipline and through the simultaneous popularization of the post-modern commandment of "Enjoy yourself!"

It is vital to continuously recollect relevant thoughts of feminist authors about the female body, sexuality, health, and motherhood, which take issue with the culturally prevalent "selfevident" and "common-sense" concepts of sex, which are frequently based on the idea of duality and opposition and on the inequality and imbalance of both sides: nature vs. culture, woman vs. man, sex vs. gender. To mention some: Simone de Beauvoir, Adrienne Rich, Shulamith Firestone, Gena Corea, Evelyn Fox Keller, Emily Martin, Ann Oakley, and Barbara Katz Rothman. We must work towards fighting this amnesia, for to forget the findings about the cultural basis of the dominant understanding of sex, bodies and sexuality, which are the result of numerous excursions into these topics in history, sociology, anthropology, cultural studies and the social history of medicine (Edward Shorter), the history of the body (Thomas Laqueur), the history of the family and birth (Phillip Ariès, Jacques Gélis) and the sociology of the body (Bryan S. Turner) in particular, would be to accept shallow thought and a super‐ ficial reflection of everyday life, the breeding grounds for the myths of a passive masochistic female sexual nature, lower sexual needs of women and monogamous femininity, as opposed to the male, biologically dictated polygamy whose representation has seen a recent revival in some popular media, for example.
