Leonore Tiefer

Introduction

Leonore Tiefer (born February 5, 1944) is an American clinical psychologist, sexologist and activist who became the most visible public critic of what she calls the medicalization of sex: the recasting of variations and difficulties in sexual life as diseases requiring pharmaceutical treatment. Trained first as an experimental psychologist working on hormones and animal sexual behavior, she retrained as a clinician in middle age and spent a New York career in urology and psychiatry departments before turning to full-time criticism and organizing. In 1999 and 2000 she convened the New View Campaign, an international collaboration of clinicians and social scientists that testified before the Food and Drug Administration against drugs promoted for female sexual dysfunction and proposed a woman-centered alternative to the medical model. Her position has drawn organized opposition from sexual medicine advocates and has been criticized within sexology as conceptually too broad to be clinically useful.

Early Life and Education

Tiefer was born in New York City and raised in the Bronx. Her mother, Rosalind Crost, was a professional musician of Dutch Jewish Sephardic background who performed widely on piano, clarinet and cello; her father, Abraham David Tiefer, of Austro-Hungarian Ashkenazi background, worked for the city's board of health. She graduated from Hunter College High School in 1961 and attended the City College of New York from 1961 to 1963 before transferring to the University of California, Berkeley.

She received her A.B. with honors from Berkeley in 1965, elected to Phi Beta Kappa, and completed a Ph.D. in experimental psychology there in 1969 with a dissertation on hormones and sexual behavior in hamsters. In her own later accounts she described the route into psychology as partly accidental: she began as a history major, switched to psychology on advice that it would make her employable, and found that the discipline offered answers that philosophy, which she had read closely through her first husband, did not.

Academic and Professional Career

Tiefer joined Colorado State University as an assistant professor of psychology in 1969 and was tenured in 1973, the only woman in a department of twenty-seven people. She later recalled that a graduate advisor had not hired her for laboratory work because she was a woman and had advised her toward a position at Johns Hopkins, which replied that the student sounded excellent but "we don't hire women."

A colleague at Colorado State gave her feminist reading in 1972, and she has said that afterwards animal research no longer made sense to her: watching rats in boxes could not answer the questions she had about human sexuality. She took a sabbatical to study human sexuality, left academia, and moved back to New York, where she worked as a sex therapist and, by her own account, felt fraudulent because she had never taken a course in abnormal psychology. She therefore returned to graduate school, completing an American Psychological Association-approved postdoctoral respecialization in clinical psychology at New York University in 1988, with a clinical internship at Bellevue Hospital Center.

Her New York career included the Downstate Medical Center from 1977 to 1983, Beth Israel Medical Center from 1983 to 1988, and Montefiore Medical Center and the Albert Einstein College of Medicine from 1988 to 1996, where she was based in the urology department and co-directed a sex and gender clinic. She was a clinical associate professor of psychiatry at the New York University School of Medicine from 1981 to 2017 and has maintained a private psychotherapy and sex therapy practice in Manhattan since 1982. She was national coordinator of the Association for Women in Psychology in the mid-1980s and was elected president of the International Academy of Sex Research in 1993.

Alongside the clinical work she built an organiser's résumé. In 1972 she co-founded the local chapter of the National Organization for Women in Fort Collins and the Colorado State University Commission on the Status of Women. She served on the board of the International Society for the Study of Women's Sexual Health, then called the Female Sexual Function Forum, from 2001 to 2002, reviewed small grants for the National Institute of Mental Health, and in 1992 was an invited speaker at the only National Institutes of Health consensus development conference ever held on a sexual topic, on impotence. She was associate editor of the Journal of Sex Research from 1992 to 1996 and held editorial posts with several other journals, and she served as vice-chair of the board of the National Coalition Against Censorship. Her papers are held in the Leonore Tiefer Collection at the Kinsey Institute Library at Indiana University, and in 2003 she spoke at the Chautauqua Institution.

Major Contributions to Psychology

Critique of medicalization and disease mongering

Tiefer's central argument is that sexual difficulties are ordinarily produced by context, not pathology. She holds that there is no standard for "normal sexual desire," that desire varies enormously with age, relationship, health and culture, and that framing ordinary variation as a disorder serves manufacturers rather than patients. She has documented how prevalence estimates, industry-funded conference series, and definitions drafted by researchers with company ties constructed the category of female sexual dysfunction, and she has argued that the same process earlier produced an "epidemic" of erectile dysfunction.

The New View Campaign

The campaign she convened brought together feminist clinicians and social scientists to propose an alternative classification. Its 2001 document defined women's sexual problems as discontent with any emotional, physical or relational aspect of sexual experience and organized causes into four groups: sociocultural and economic factors such as inadequate sex education, partner and relationship factors including abuse, psychological factors, and medical factors. The campaign held five scholarly conferences, produced teaching materials, maintained an archive website, and testified at FDA advisory hearings on Intrinsa in 2004, flibanserin in 2010, and drug development for female sexual dysfunction in 2014. She closed the campaign with a capstone conference in 2016, saying the group had said everything it had to say.

Critique of the Masters and Johnson model

Tiefer also attacked the dominant laboratory model of sexual response. She argued that the research sample was self-selected for people who could respond sexually under observation, which likely excluded women with low desire, that the response model had been formulated before the data were collected, and that reducing sexual response to a fixed sequence of physiological changes obscures the meanings, values and relationship context that women themselves report as decisive.

Major Publications

Human Sexuality: Feelings and Functions (1979)
Sex Is Not a Natural Act and Other Essays (1995; second edition, 2004)
A New View of Women's Sexual Problems (2001, edited with Ellyn Kaschak)
A New View of Women's Sexual Problems: A Teaching Manual (2003)

Impact and Legacy

Tiefer's writing and organizing shifted the terms of the debate. Her work is cited in the feminist and social constructionist literature on sexuality, and the New View archive remains a standard resource for journalists and clinicians. She received the Alfred C. Kinsey Award in 1994, the Distinguished Lifetime Scientific Achievement Award from the Society for the Scientific Study of Sexuality in 2004, and a lifetime career award from the Association for Women in Psychology in 2004. Her arguments influenced the shape of the DSM-5 revisions, in which female sexual interest and arousal difficulties were separated from the male category.

Critics have pressed two objections. The first is conceptual. The New View definition is so inclusive that, as one reviewer put it, it is hard to find a woman or a man who does not experience some discontent with some aspect of sexual experience; a category that broad makes epidemiological estimates and treatment decisions harder, not easier, and a framework that accuses medicine of over-pathologizing risks widening the net rather than narrowing it. The second is practical. Sexual medicine clinicians and patient advocates argue that distressing loss of desire is real, that biological contributors are genuine, and that refusing pharmacological options removes choices from women who want them. The Even the Score campaign, which she accused of hijacking feminist language of choice and fairness while being funded by the manufacturer of flibanserin, made exactly this case, pointing out that men had dozens of approved treatments and women none; its organizers credited it with influence when the FDA reversed itself and approved flibanserin in August 2015.

Tiefer's responses are on record. On breadth, she argues that the point is to relocate the problem in a life rather than in an organ, and that a broad definition is preferable to a false one. On drugs, she notes that company-funded trials of flibanserin showed on average less than one additional satisfying sexual event per month over placebo, with nausea, dizziness and sedation common and roughly fifteen percent of participants dropping out, and that an FDA analysis found neither pivotal trial met its own agreed criteria for success. On anecdote, she says that in forty years of sex therapy she has never seen a patient complaining of low desire who did not also have physical, emotional or relationship issues, and she recommends reading, conversation and knowledgeable counseling over pills. When the FDA approved bremelanotide in 2019 with little opposition, she described the mood among critics as exhaustion rather than agreement.

Her legacy is therefore a live dispute rather than a settled consensus: she established that the category of sexual dysfunction is made rather than discovered and forced regulators and clinicians to defend it, while the medical model she opposed has continued to expand.

Learn More

References

Tiefer, L. (1995). Sex Is Not a Natural Act. Westview Press.