Sex Tech and the Orgasm Trade: A Q+A with Liz Canner

Filmmaker Liz Canner wasn’t always interested in the business of women’s orgasms. It was only after years of documentary filmmaking—on subjects like Nicaragua and the World Bank—that she began to focus her lens closer to home. After accepting a job editing together erotic footage for clinical trials of an arousal enhancing drug made by the pharmaceutical company Vivus, Canner got permission to document the drug’s slow passage through FDA approval.

The drug company wasn’t testing another new male enhancement drug, but instead a drug that treated “Female Sexual Dysfunction,” a disorder Canner was unfamiliar with. She was intrigued and set about gathering information on the disorder, its treatments, and the women who believe themselves to be affected by FSD.

The resulting film, Orgasm, Inc., isn’t just a raw look at the development of a new pharmaceutical, but a thorough existential dissection of FSD, from its origins to its strange implications. Consider how we view women’s sexual pleasure, for instance, and how that determines how we define a women’s sexual disease. Canner’s investigation reveals some fundamental truths about the pharmaceutical industry and its ability to, in effect, create the diseases it wants to treat. As Canner puts it, “there’s a lot of money to be made telling women there’s something wrong with them.”

Through Canner’s lens, we see an industry that maximizes profits when it maximizes the number of individuals “suffering” from a disease or disorder. And, when the disorder is as broadly defined as Female Sexual Dysfunction, plenty of perfectly healthy women end up undergoing treatment—from drug treatment to frightening, invasive surgical treatments—for a disorder they don’t have, or could never.

Motherboard: Tell me a little bit about how you first became involved with Vivus?

Liz Canner: I first became involved with Vivus through my friend, she was hired to curate erotic videos for them to be used in clinical trials for their new drug, and I had worked with her on past projects so she brought me in as an editor-producer on the project. She recommended me to them, and then they hired me to put together these videos for them.

So, some background on that company. They were on the forefront of developing chemicals to treat all sorts of sexual dysfunction. They had treated male erectile dysfunction before they began to treat female sexual dysfunction, right?

Correct. Well they had developed a drug that causes genital engorgement, and they thought this drug would work on women. So it’s basically the same compound.

When you first started working there, was female sexual dysfunction considered a disorder or disease by the FDA yet? How skeptical were you?

When I first started to work for Vivus, I had not heard of the term female sexual dysfunction. It was only through working with them that I discovered this disorder existed. It was not something that was talked about at that point.

I don’t think I was skeptical initially. I was more curious about it. I had done all this research on this topic about female sexuality. I had read Freud, Foucault, Thomas Laqueur, more theory-based work, and I’d never come across this term and I was really curious about it. Was it a scientific discovery, or something else? I didn’t take this job to expose the pharmaceutical industry. I took this job because I needed the job, and I wanted the contemporary thinking about women and pleasure from a scientific perspective. I was already shooting a film that looked at similar subjects, but with more of a historical approach.

There was a clip that you included from Oprah, where she cites a study that says that 43% of women suffer from sexual dysfunction. But when you read through the actual questionnaire the researchers used, many of the questions were things that everyone experiences at some point, like, “Do you ever have difficulty becoming aroused?”

That study was done by sociologists in the early 90s. It was never meant to look at female sexual dysfunction; it was meant to look at people’s sexual habits and their complaints. It was never something to look at as a medical condition. The questionnaire was never made for that.

In this film, one of the most extreme uses of technology is the orgasmatron, a device that requires an electrode be inserted into a woman’s spine. There were a lot of risks involved, and only ten women took part in the study. Where did this idea come from?

Dr. [Stuart] Molloy believed that he had found the spot on the back that, when triggered with an electrode, would cause an orgasm. He was a pain management doctor and this was an off-label use of a medical device used to treat chronic pain. One woman, when using the device had experienced a great deal of pleasure and had said to the doctor, “Can you teach my husband that?” He thought he had found this magic spot. He was trying to reproduce the effect in other women.

Did he?

He claims that he did.

But with your subject, Charletta, he did not have success.

Not with her. I repeatedly asked him if I could interview someone that it had worked on, and he never produced anyone. I did this over quite a few months and I was never able to talk to anyone or interview anyone for my film that it had actually worked on.

All the footage you include of Charletta was really interesting. She claims that she’s never had an orgasm, and she’s very hopeful that she can achieve one during her clinical trial. And then when the trial doesn’t help her achieve orgasm, you feel a lot of sympathy for her. But in the last scene that you filmed with her, you asked if she could achieve orgasm in ways other than sex with her husband. And then she said yes, she was able to. So it seems like she defined an “orgasm” as solely the result of penetrative sex with her husband.

I think there’s a misconception that women are supposed to have an orgasm every time they have heterosexual sexual intercourse. The fact is that 70% of women need direct clitoral stimulation to achieve orgasm. The figure varies, some studies say even more, some studies say less.

Unfortunately this is not something that’s taught in sex education, and if people are getting ideas of what their sex life is supposed to be like from the media, and from porn, a lot of women at this point are under the impression that they’re supposed to be constantly orgasmic in that way. Charletta happened to be one of them. When I told her the statistic she was really happy to hear it because she realized she was “normal.” I think that’s one of the things that the public is not very educated about it, and it leaves the door open for the pharmaceutical industry to plant the seed of what our sex life is supposed to be like. They’re basically taking advantage of our lack of education.

Since ultimately Charletta was perfectly capable of having an orgasm, what are your thoughts about how rigorous the screenings for these clinical trials could be? She was convinced she was diseased, and she went through this invasive surgery thinking she had a profound physiological problem, but then she finds out she’s like 70% of women. It seems like this information should have been imparted to her at some point during her screening.

I would have hoped. I was incredibly shocked to find she was enrolled in a clinical trial when she was perfectly healthy. I wasn’t aware that she could achieve orgasms while filming her so when I was discovered that I was incredibly disturbed. It shows that a perfectly healthy woman can be made to think that they have a disease. There’s s certain trust that we place in medical experts, if that means that healthy women are part of clinical trials, she was perfectly healthy, so it’s certainly possible.

This procedure looked incredibly invasive. Even hormonal drugs, while not perfectly safe, at least seem safer than something being threaded through your spine. The woman who you interviewed in the beginning of the film, the one who had an orgasm on film, she spoke about her own experiences with her sexuality and body. I remember she said something that was really interesting and resonated with me. She said often when she had sex she would be thinking, Do my breasts look okay? Does my body look okay? I read this study last week about how men and women experience their sexualities, and women are apparently much more likely to be looking at themselves through this third person perspective, from the outside, judging their own sexual performance. It’s possible this contributes to difficulty in reaching orgasm, as they’re so concentrated on how they look visually to their partner. Do you think pornography has contributed to or even created this phenomenon?

Yeah, I think it’s pornography and objectification in general. We as women grow up and are constantly surrounded by images of women who are objectified, and we ourselves are objectified, and so it’s hard not to look at yourself through this third person perspective. And we’re constantly given messages that we’re not pretty or thin enough, whatever enough means. So we buy the products or whatever it is to make ourselves prettier and thinner towards this ideal model that often isn’t even human. And unfortunately these messages that we get through the media or advertising have an effect on how we have sex and it makes it hard for women—not all women—to enjoy sex. They think, Oh, I look a little fat or I don’t want him to look at me with the lights on, which is a response to how women are so objectified.

The film explores how the pharmaceutical industry is essentially creating diseases in order to treat them. Though you focus on Female Sexual Dysfunction, you bring up Restless Leg Syndrome and other diseases that are perhaps, in part, created by the pharmaceutical industry.

I think a prime example of that is premenstrual dysphoric disorder which used to be called PMS or an extreme version of PMS, which came about when Eli Lilly was about to lose their patents on Prozac. There were some beliefs that some women suffered from extreme PMS, though it wasn’t something that was figured out in a clear way. Eli Lilly didn’t want to lose their patent so they got together with their doctors and came up with this disorder PMDD which was treated with Prozac, but of course they realized that most women wouldn’t want to take Prozac for premenstrual problems so they painted it purple and called in Serafem. However, if you look at the ingredients in Serafem, they’re the same as in Prozac.

There’s a great article that was written by people who used to work at Ogilvy, the public relations firm. It goes through disorders, and teaches marketers techniques on how to accomplish the sort of thing that was accomplished with PMDD and Serafem. The article is called Building Strong Condition Brands, and it advises that conditions need to be named with good acronyms, and they need to be framed in a purely physiological way. It’s by reducing everything to a physiological problem that you can introduce a drug that can “cure.” Then you want to brand the drug with the condition so that you market the disease and this drug together in a certain way. There’s the example of erectile dysfunction, which was called “impotence.” But it was renamed “erectile dysfunction” as a way to make it easier for men to have, to not affect their whole being or their own identity. Impotence is a serious thing; erectile dysfunction is purely physical.

Do you think that female sexual dysfunction exists? Perhaps it just affects a much smaller proportion of women than what these pharmaceutical industry people would say it affects.

Yes, there are dysfunctions that affect a very small percentage of the population that are caused by medical, physiological conditions. If you’ve had a medical hysterectomy, then some women find that affects their libido, but not all women. If you have diabetes, then some women find this affects their orgasmic function because of blood flow issues, but not all women. Some women find as they age their libido goes down, but not all women, and in fact, often, if you change partners you find your libido goes sky high. I think it’s hard to say across the board, but we do know that some medical conditions can affect sexual function for some women.

Many women might fall into the category where they’re having sexual problems or issues achieving orgasms that are not caused by medical issues. In your opinion, what’s the best ways in to address this type of sexual problem?

The most common causes of sexual problems tend to be relationship issues, communication problems, and stress due to overwork. If you’ve been sexually abused in the past, that can affect your sexual experience. And poor sex education is also a big factor here. If you look at all of these variables, one of the key things we could improve is sex education. If we had a more equitable society, women would have fewer sexual problems. It would be great if we could develop a pill that ended sexual abuse, that created equality in the workplace and in relationships. That’s the kind of pill we need to take. Those are some of the best cures.

The funny thing about all this is that the only treatment that’s been FDA-approved for female sexual dysfunction at this point in the United States is a very overpriced vibrating, sucking device that you place on your clitoris. It costs $300 or $400 and you get it with a prescription from your doctor. Or you could go to your local sex store and get a vibrator. That’s been shown to work very well on women since the Victorian era. Good clitoral stimulation is pretty critical.

The FDA didn’t approve the testosterone patch for treatment of FSD here, but it was approved it in the EU, correct?

Only for women who had radical hysterectomies and who were taking replacement estrogen. I actually went to the EU to see if it had become the “Viagra for women” that they said it would. There was a two week period where there was a flurry of articles saying, “Love is a patch on the bottom, the female Viagra is finally here,” and that was it, because they don’t allow direct consumer advertising in the EU. So they couldn’t keep pushing this idea that women have to have a certain level of libido to be healthy. Which is of course bogus. There’s no level of libido to be healthy, it’s whatever you feel comfortable with. You’re not supposed to have twenty sexual thoughts a month to be healthy, that’s ridiculous.

So I also went to visit a bunch of pharmacies in France and England and asked them how may prescriptions they had filled. Most of them had only done one or two over the year, and some of them hadn’t filled any. Doctors in the EU do not do as much off label prescribing because they have national healthcare systems. So the government doesn’t want to pay for all this off label drug use unless they’re sure the drugs are going to work. So they only prescribed them for women who had radical hysterectomies and who were taking replacement estrogen. They’re also a lot more cynical about female sexual dysfunction there.

So here in the United States prescribing off-label medication is far more common than in Europe?

Oh, it’s rampant here. That’s what the pharmaceutical companies were banking on. Once you get it approved for one group, it can be prescribed, off-label, for lots of women. They try to get it approved for as broad of a group of people as they can, but eventually they just have to find a group that will show enough efficacy to actually approve the drug.

In this case they kept reducing the group until they were left with women who had radical hysterectomies, who were taking replacement estrogen, who then had one satisfying sexual event without placebo. But they knew if they got it approved for that small group, then a lot of other women would get in on it.

I love all the interviews you did with the different sex shop workers. One woman went to a medical convention with her vagina puppet and all her toys to educate the doctors. It was really very de-stigmatizing.

I think these things should be considered part of our everyday lives. We live in a very sexually repressive society on some level. It’s almost class-based, this idea that proper society doesn’t talk about pleasure, doesn’t engage in pleasure. But at the same time we start looking at pornography at age eleven, yet we teach abstinence in school.

We’ve very schizophrenic when it comes to sex. In fact we couldn’t place our film advertisement in the New York Times. They made us get rid of the image of the woman who looks like she’s having an orgasm, even though she’s completely covered. You can’t see any breasts or other body parts that would be offensive. We weren’t allowed to place that ad; we had to use a photo of a woman holding a pill. I think that speaks to our culture. You can have incredibly violent images in the New York Times of the war, but you can’t have a woman’s face looking like she’s enjoying herself.

That’s so interesting, especially when you consider all the very sexual fashion advertising they print. I think Dolce and Gabbana came under fire for having a mock of a gang rape that was about to occur in this fashion spread.

I know what you mean. Was that Calvin Klein? But they published it all over the place.

It’s worse when it’s a fashion aesthetic. And when it’s an image representing an orgasm for a film that’s talking about orgasms, for some reason that’s not OK.

And it’s also a woman having pleasure, it’s all about her pleasure, there’s no man in the picture. There’s no other human in the picture. It’s been fascinating trying to get this film out in this country.