Aline is afraid of failing in a relationship, and goes to a therapist to see if their lack of interest in sex comes from repressed trauma.
Aline is afraid of failing in a relationship, so they go to a therapist to make sure they’re not repressing any trauma that “blocks” their sexuality. Aline explores the misconstruction of asexuality by medical and therapeutic communities and how it affect the mental and physical health of asexual people. Angela Chen, Kate Wood, and David Jay, a legendary asexual activist, all explain that asexuality is still widely perceived, not as a sexual orientation, but as a disorder to be cured.
Aline: I’ve been dating Marie for four months. We’d often go on weekend getaway and for the summer we decided to go to Berlin for a week. It was a great trip. We had good food, we went to museums, we laid on the grass in a beautiful park, we danced.
But after we got back, I broke up with her. It was eating me up that I wasn’t giving her what I was supposed to, what she deserved. If it didn’t work with her, how could it ever work with anyone else?
This situation had to change. I had to change. So, I decided to go to therapy. I was hoping it would help me uncover a suppressed sexual trauma.
I know, it’s not something one should hope for. But back then, people would often tell me: “Maybe you have a trauma. Like you’ve been assaulted or something, and that’s what’s blocking you!”
It wasn’t just random people at parties. I’ve read or heard this many times in the media. Experts would explain that it’s unlikely that one would feel no sexual attraction.
For example, I remember reading a question from a reader in a popular French psychology magazine from 2009.
Female voice: I've never had sexual intercourse. I don't feel the desire or the need for it. If I'm attracted to certain men, this attraction is more "spiritual" than physical. I don't understand if I am unconsciously scared of having sex or if I really have a problem of asexuality. This frightens me because I don't want to end up alone.
Aline: She was about my age at the time. The response from the expert was:
Male voice: The difficulty can come from the way you learned sexuality. It’s as if sexuality is a foreign language that you don’t speak. Like any learning process for a foreign language, you need help, and a therapist could teach you how to rediscover this sexuality in you.
Aline: Everywhere I looked, the consensus was: I needed to get professional help. Up until then, I’d found this advice ridiculous. I’ve been like that since I was a teenager. So what would that mean? That something happened to me during childhood? That’s insane, I felt like I’ve had a perfect childhood, loving and drama free. But my romantic future was in danger. I had to try everything
OPENING SONG—FREE FROM DESIRE
Aline: The first time I went to see the therapist, she suggested I’d say anything that comes to mind. I had no idea what could have caused me sexual trauma, so I talked about everything: how terrible middle school was, my relationship with my parents, my past experiences with men, my anger, my sadness, Marie. Everything. And it helped.
When I started to work on this podcast, I knew I had to talk to David Jay. He’s one of the first asexual activists in the world, a pillar of the community. He told me that the assumption that an absence of sexual desire is due to trauma has its origins in psychiatry.
David Jay: For a long time, there was something called hypoactive sexual desire disorder that was listed in the DSM…
Aline: The DSM is a manual that classifies mental disorders. It was created after WWII and is now revised every 10 to 15 years by the American Psychiatric Association. It’s used by clinicians, researchers, insurance companies, pharmaceutical companies, the legal system and even politicians. It has massive influence over psychiatry in the U.S. and the rest of the world.
David Jay: …and it basically said you have a problem if you don't like sex enough and if you are distressed by that. And not liking sex enough was defined by the clinician. And also that under hypoactive sexual desire disorder, it was a disorder if it costs patient or partner distress. So if you were comfortable with your sexuality but your partner was uncomfortable, so there was tension in your relationship, then you had this disorder.
Aline: It was exactly the feeling I had with Marie—her sexual desire was normal, mine was broken. I was one who had to make it work, to find the solution.
David Jay: Clinicians were learning that this was a problem. So if someone came into their offices and said that they identified as asexual, the clinicians first instinct was to say, oh, you must have this disorder that we need to treat.
Aline: Thankfully, my therapist never mentioned this hypoactive sexual desire disorder. She didn’t say much in general, she was the kind of therapist that lets you go on and on for exactly one hour and then says our time is up. I wanted her to talk more, to guide or reassure me, but she didn’t.
She let me think for myself, come to my own conclusions. And eventually, it worked.
Thanks to her, I came to have a better understanding of my feelings. And I realized something: my absence of sexual desire is not the consequence of a traumatic experience. I was distressed because I had a hard time accepting that I wouldn’t have a so-called normal life, with a spouse and a traditional family. And that’s what I focused on for the rest of my therapy.
I’m lucky. I met many people for whom therapy didn't work quite as well. I was also lucky that I wasn’t asked a question many therapists and doctors ask when meeting people like me:
Female voice: Are you sure it’s not your hormones? Maybe it’s because of the pill? Or the side effect of a drug you take?
Aline: I talked to Angela Chen about it.
Angela Chen: Sexual desire does have a biological component. And so when you are aware of that then I think is completely natural and normal to think, oh, maybe this is a hormonal condition, maybe I'm sick and this is a sign that something is wrong with me
Aline: Sometimes, certain medications, like antidepressants, can lower your libido, and changing a treatment, consulting an endocrinologist or switching your contraception can indeed boost it. But it’s far from always being the case.
For Angela, the problem is that we live in a society that loves to find solutions. And so people tend to think that an absence of sexual desire must be fixed. This vision dominates the medical discourse, and society at large. There’s no room for another approach, one that would say that it’s okay not to feel sexual attraction.
Angela Chen: And without that counterbalance, it's so easy to say, well, here's the available information. I must be sick.
Aline: Sometimes, doctors who worry that something could be wrong with their patients’ sex life can create real damage. That’s what Kate Wood realized. She’s the Australian activist we heard from on the last episode
Kate Wood: There are a lot of cases of medical issues where there's an attempt to cure or fix the asexuality. And this often happens at the expense of treating actual medical problems. So I had one case of someone who the doctor insisted on taking them off their antipsychotic medication because the antipsychotics lowered your libido and the fact that they were asexual before they were put on the antipsychotic medication didn't seem to bother the doctor. He felt that this woman not having a libido was of more seriousness than her psychotic symptoms.
Aline: It’s an extreme case, but it highlights how far compulsory sexuality can go. Being asexual doesn’t impact health. What can impact health is being refused treatment, doing an excessive amount of testing, being forced to go to therapy, or simply believing you are sick and broken when you’re not.
Kate Wood: The majority of asexual people, don’t have a medical problem to start with, but the toll that it takes on your mental health by believing that there is something wrong with you, you may well end up with a medical problem because the mental health implications of being told constantly that you are sick, that you are broken, that there is something wrong with you, that you need to be fixed. You need to be cured. That is the real problem that you're going to have.
Aline: I agree. All those years worrying I was late have cost me, physically and mentally. I’ve spent a lot of my energy searching for an explanation and a solution to my difference. I was so scared of what people would think of me, so scared of people in general, that I was in a permanent state of anxiety. Always on the lookout. And later, I forced myself to have sex, and this led me to have vaginal pain.
Only a few studies have paid attention to the mental and physical health of asexual people or aces, short for asexuals. But those who have, agreed that aces are at higher risk of having anxiety.
Every year, an organization called The Trevor Project studies the mental health of LGBTQ+ youth in the US, and it includes aces who identify as queer. In 2020, the survey showed that young aces have higher rates of depression and anxiety than the rest of the LGBTQ+ youth. And that they are at a higher risk of attempting suicide.
For ace activists, this anxiety could be relieved or even disappear if society would stop considering asexuality as a disease. To get there, they needed to get to the source of the problem: the treatment of asexuality in the DSM. Back in 2007, an opportunity presented itself.
David Jay: We learned that they were releasing a new edition of the DSM, which happens like once every 15 years. And we started lobbying really seriously to have asexuality taken out, we put together a task force, we interviewed anyone who was researching asexuality, we reviewed all the academic literature on asexuality. And we put it together into an 80 page document that really laid out the case that asexuality was not a problematic condition, but was a normal part of human sexual variance, and also that it was normal for asexual people to feel distressed.
We also had to explain, look, people in our community are going to feel distressed as we come to terms with ourselves. And that's normal. That's okay. Like that should not be seen as a reason why we need to be treated. And why our asexuality should be considered problematic.
We were really lucky in that one of the people on that committee, Dr. Lori Brotto, was one of the leading researchers on asexuality in the world. And so between her efforts and what we'd put together, we were able to get them to change it pretty seriously.
Aline: In the latest edition of the DSM, that was published in 2013, the hypoactive sexual desire disorder has disappeared. It wasn’t a perfect victory though. The disorder has been replaced by a new one: the female sexual arousal and inhibition disorder.
David Jay: This is about, specifically women who used to be interested in sexuality, who have lost their interest and the reason that was there is that the pharma companies want to sell drugs to women.
Aline: Since the release of the DSM-5, a couple of companies have indeed released libido booster drugs for women.
And David isn’t the only one to think the DSM is influenced by the pharmaceutical lobby. Prominent psychiatrists and psychologists have criticized the DSM for conflicts of interests. And that’s because, almost 70 percent of the DSM-5 authors have reported financial relationships with pharmaceutical companies. So there were a lot of mixed feelings around that victory.
Removing a definition from a dictionary doesn’t change how people think. Not overnight at least. And even if it did, many don’t even know that hypoactive sexual desire disorder has been removed from the DSM. And you can still find its definition pretty much all over the internet.
ACT Aces, the association Kate Wood is a member of, started a collaboration with the Australian National University, to educate future doctors about asexuality.
Kate Wood: Although there are services out there, there are groups out there that can support you when you're asexual, you have to know that you're asexual. And how are you going to know if you've never heard of it? And to have a doctor aware of asexuality, and to have a doctor say okay we can look at your hormones, we can do this, we can do that, but are you aware that there's actually a sexual orientation? It’s called asexual and it’s perfectly normal.
Aline: This program it’s still in its initial stages, but it could have a large impact.
Kate Wood: I'm hoping certainly that with more informed doctors, it can maybe filter through the community more in that way. A doctor doesn't just share their knowledge in a surgery or in the hospital, a doctor shares what they know in the general community. A doctor tells what they know in all kinds of social situations and people listen to a doctor.
Aline: Such training programs should also be available to psychologists, couples therapists, and sex therapists. Ideally, they would stop saying to someone who’s ace to make efforts to have sex in their relationship, and they would focus instead on helping them accept who they are, and improving communication with their partners.
David Jay: A really good example is Dr. Lori Brotto, who I mentioned, who's this leading researcher on asexuality. The way that she would treat people was with mindfulness. She would give people exercises around meditation and getting in touch with their own body. She would give them exercises around communicating their desires in a way that was open without shame. That doesn't turn us into a sexual person that turns this into a happier ace person. If we want to cuddle, we’ll have better cuddling. And so I think the best treatments are like that. Right? They work for sexual people. They work for ace people. They put us more in touch with ourselves in an authentic way.
Aline: Over the years, I learned to listen, and understand, my body.
I got to a point where I mostly knew what I liked and what I didn't like, and I could say so to my partners. They’ve actually been a great help.
But I was still afraid to use the right word to describe who I am. The real turning point was yet to come.
OUTRO MUSIC