EDITORIAL: My Turn . . . Finally


It is finally my turn. I have waited in line, watching friends being asked and no one asking me. I have watched their excitement, their energy, their joie de vivre, what about me? So it is finally my turn. What am I talking about?

Think within your lives how many times this statement could apply. At work? At home? At play? At the doctor? For me, as editorial assistant, I am involved in a significant portion of the daily maintenance and monthly content required to produce The Journal of Sexual Medicine (JSM) on a regular basis. To finally be authoring an editorial is a great honor and opportunity. An editorial, by definition, expresses an opinion, and anyone who knows me knows I am rarely without an opinion. About what do I want to opine? About it being my turn (the metaphorical me).

For those of you my age or older, you would remember when drug studies were performed solely on men, fearing the harm the drugs could potentially cause to a fetus or a future fetus. Physicians and researchers assumed that whatever happened in a man happened in a woman, therefore results including side-effect profiles could be extrapolated from a man to a woman. If the problem did not occur in a man, it did not in a woman. Then along came premenstrual syndrome (PMS). Suddenly the world knew what women knew all along—we had our own medical conditions and medical needs. I—me—we could now seek treatment for PMS without being ridiculed by a male health care provider. Then along came depression. A topic that had been swept under the table for so many years, a burdon carried disproportionately by women, was discovered to be in so many cases a mental illness that was in fact a medical illness. We did not need to hide anymore.

The advent of PDE5 inhibitors for men allowed one gender to talk more openly about sexual health, albeit in closed circles. Sexual health is the last taboo. Health-care providers are hesitant to discuss the topic with their male patients, despite there being a plethora of available treatments in the 21st century. But where are we? Are women the same as men? Do we either use their treatments or deserve equal attention?

For those of you who are regular readers of the JSM you have seen the number of articles on women's sexual health grow exponentially including our first Festschrift [1–3] with some papers on female sexual dysfunction pharmacotherapy scattered along the way [4,5]. Although other less-esteemed journals have called this “medicalization,”[6] taking their evidence from an economics reporter looking to promote a book he wrote on the topic [7], the JSM publishes evidence-based manuscripts rather than conjecture. Authors such as Dennerstein [8] and Shifren [9] have determined the prevalence of women with symptoms of sexual dysfunction who are distressed, whereas naysayers use the revised numbers of 17% and 12%, respectively, as fodder for their anti-treatment campaign. The reality is that no one claims medicalization for other health problems effecting 12% of the female population. Would anyone consider ignoring breast cancer because it affects the same number of women as female sexual dysfunction? I am postmenopausal and I would no more think of not trying to maintain my hormonal health than I would think of ignoring my heart health. Prophylaxis or treatment is not owned by any one medical specialty. Would anyone deny a man the right to an erection? Would anyone deny a woman the right to have her breast cancer or heart disease treated? So why the hoopla when we want our sexual health maintained or restored? I have taken my turn, sought and received treatment but I am part of a very small group. I have had to use an FDA-approved medication off-label as part of my regimen—back to the old days of preferential treatment for one gender. When is it really my turn?

My turn refers to papers like the review in this issue by Traish et al., explaining the use of testosterone therapy in women over the last century. Women now have a government approved testosterone therapy in some of the European countries, whereas the rest of the world waits in line, saying it is my turn [10,11]. The Journal of Sexual Medicine provides a resource for providers to learn what is available both on and off label.

Men have a virtual potpourri of pharmacotherapies for erectile dysfunction [12]. Looking at the breakdown of sexual dysfunctions, it is no wonder there are companies developing therapeutic options for men with premature ejaculation [13]. In this issue Gonzalez-Cadavid discusses animal models for Peyronie's disease. Well, it is finally my turn. In the drug pipelines (do you not love that expression?) there are products that are expected to help us with our sexual dysfunction [14,15]. It is finally my turn. We know enough about current products approved for men to be able to use them in a safe and effective manner, albeit off-label, in women. It is finally my turn. . . . 

Are you listening? Are you reading? Are you learning? One of these days I am going to show up at your door demanding sexual health care. Will you be ready to take of me? And if not, why not? What will you say to the millions of women demanding their turn? Read your journal, write for your journal, review for your journal, cite your journal. You might have someone very close to you saying, “it is my turn now!”