Bellamy et al.'s (2013) excellent paper on women's understandings of sexual problems is important for a number of reasons. It opens up debate, begins to fill a gap in knowledge, namely the psychological and social dimensions often lacking in biomedical paradigms of sexual health, and locates women's sexual health within a feminist framework. Their paper reports on 23 in-depth interviews with women from the general public and a psychosexual clinic and draws out four pertinent themes: physical versus psychological understandings of sexual problems: a disparity of esteem; sexual problems as physically and psychologically complex; women's sexual problems as context dependent; sexual problems as male-centric. These themes were analysed, in part, through identifying discourses that reproduced the dominant biomedical paradigm. However, analysis was refined by identifying the psychological and social aspects apparent in participants' narratives. They highlight the experiences of women by bringing into focus their lived experiences, including psychological affects of current and previous intimate relationships; their social roles, context and responsibilities – as well as the somatic or physiological representations of sexual problems. These are then situated within feminist theory, which allows for a deeper analysis and paints a fuller picture.
One limitation of the study was recruiting participants from the public as well as psychosexual clinic service users. This is problematic as it is unclear within the paper's quotes, which group participants belong to. The same problem continues therefore into the analysis and creates confusion around who is talking. It is likely that differences exist in the language and discourses used in each group. Those participants who attended a psychosexual clinic will be more familiar with their associated professional discourses (Foucault 1972) and might be more likely to use them than would members of the general public.
The argument running through this paper is the need to take into account biological, social and psychological factors, along with patriarchal and historical precedents. In this way, women's voices are heard, and more nuanced understandings of women's sexuality are developed (p. 3256). This is not so much a new argument, rather it has not made as much headway into the sexual health arena as it could have done. Indeed, Engel (1977) was arguing for a very similar biopsychosocial model decades ago. What the authors highlight is the need for a biopsychosocial model of sexual health, set within a gendered framework that takes into account feminist theory and research practice.
However, critical theories of masculinity are also necessary. The authors point out that some women in their study felt they had to manage their male partner's sexual problems, both emotionally and physically. Some women also defined their own inorgasmia in terms of a dominant male sexual imperative, as one participant stated: “it's made the men in my life unhappy” (p. 3245). Critical studies on men theorise how heterosexuality is symbiotic with the social construction of hegemonic masculinity (Carrigan et al. 1985). Femininity and masculinity are mutually dependent, and bringing masculinity theory into the mix would bring an added dimension to understanding women's sexual health.