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How do men and women define sexual desire and sexual arousal?
Abstract
The purpose of this study was to understand how men and women define sexual desire and
sexual arousal and how they distinguish between the two. We conducted 32 semi-structured
interviews with individuals in South East England, using a purposive sampling strategy to
maximise the variation in experience of sexual function across the group. We identified three
criteria that participants used to define and distinguish between desire and arousal: the
sequence in which they occurred; whether the mind or the body (or both) were engaged; and
the extent to which feelings of desire or arousal were responsive (in response to person or
stimulus) and motivational (orientated towards a goal). Most participants attempted to
distinguish between desire and arousal when prompted, but often with difficulty. Participants
commonly felt that desire preceded arousal; some felt that desire was ‘mind’ and arousal
‘body’; and many felt that both desire and arousal were responsive and motivational.
However, we identified numerous times when these distinctions were reversed or the
differences between terms were blurred. Our results support recent proposals to merge the
two diagnostic categories of Female Sexual Arousal Disorder and Hyposexual Desire
Disorder into a single diagnostic category.
Introduction
Sexual desire and sexual arousal are widely acknowledged as complex constructs and the
relationship between them as intricate (Ågmo, 2011; Janssen, 2011; Meana, 2010); despite
their ubiquity, there is little consensus on how best to define them (Janssen, 2011).
An understanding of patient and research participant accounts of sexual desire and
arousal is important because of the reliance on self-report in diagnosing and measuring sexual
dysfunction. Patient accounts of other types of dysfunction often differ significantly from
scientific or professional definitions and theories (Furnham, 1988) and this appears true of
sexual dysfunction (see Bancroft et al., 2003; King et al., 2007).
Although there is now a small qualitative literature on women’s (and, to a lesser
extent, men’s) sexual experiences, little work has been done on how men and women
understand the terms “sexual desire” and “sexual arousal.” In this paper we briefly outline
prominent expert definitions of desire and arousal in relation to sexual response. We then
present data from a qualitative study designed to address the following research questions:
How do men and women define sexual desire and sexual arousal? Do they make a distinction
between the two? In exploring participant accounts of sexual desire and arousal we seek to
contribute to a conundrum currently troubling experts: are these two concepts distinct or are
they different facets of the same construct? (Binik et al, 2010). By exploring the accounts of
men as well as women, we will also address the current paucity of research into men’s
understanding of desire and arousal (Brotto, 2010b).
Expert definitions
Sexual desire has been broadly described as “the sum of the forces that lean us toward
and push us away from sexual behavior” Levine (2003, p. 285). Regan and Berscheid (1999)
proposed that sexual desire is “a psychological state subjectively experienced by the
individual as an awareness that he or she wants or wishes to attain a (presumably pleasurable)
sexual goal that is currently unattainable” (p. 15).
Most expert definitions of sexual arousal are similarly broad, incorporating a number
of different components of arousal beyond genital response. For example, Bancroft (2005)
conceptualized sexual arousal as “a state motivated towards the experience of sexual pleasure
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and possibly orgasm” (p. 411). He proposed that arousal included a range of physical and
mental processes, including information processing of relevant stimuli, arousal in a general
sense, incentive motivation, and genital response. Bancroft’s definition incorporates ideas of
both mind and body, as well as the idea of motivation towards a goal. Janssen (2011) defined
sexual arousal as “an emotional/motivational state that can be triggered by internal and
external stimuli and that can be inferred from central (including verbal), peripheral (including
genital), and behavioral (including action tendencies and motor preparation) responses.” (p.
708). Ågmo (2011) recently suggested that the term “sexual arousal” should be abandoned, or
restricted in its use to refer only to genital arousal, arguing that “subjective sexual arousal” is
a vague and unhelpful concept.
In a recent conceptual review of sexual arousal in men, Janssen (2011) concluded that
sexual desire has traditionally been described as a motivational state, and sexual arousal
mainly as an emotional state (“an embodied affective state”), but that there is increasing
evidence of “considerable overlap” between the two.
Expert models of sexual response
Where attempts have been made to establish the chronological order of the two terms,
desire has generally been held to precede arousal. Kaplan (1979) and Lief (1977), for
example, both positioned sexual desire as the first stage of Masters and Johnson’s Human
Sexual Response Cycle, before sexual arousal. Kaplan (1979), for instance, defined sexual
desire as “a sensation that moved the individual to seek out, or become receptive to, sexual
experiences” (p. 10). These traditional models have characterised sexual response as
essentially a linear progression from sexual desire to sexual arousal, orgasm, and ultimately
resolution.
Although this linear model has received much criticism, particular with regard to its
relevance for women (Levin, 2008; Mitchell & Graham, 2008; Tiefer, 1991), it nevertheless
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forms the basis of the current Diagnostic and Statistical Manual classification of discrete
desire, arousal, and orgasm disorders (DSM-IV; American Psychiatric Association [APA],
2000). More recent models of sexual response have not conceptualised sexual desire and
arousal as discrete “stages.” Basson (2000, 2001) proposed instead a circular model of sexual
response, in which sexual neutrality is the starting point, and desire is primarily responsive
(for instance, to cues from a partner or other stimulus) rather than spontaneous. A second
model - the Incentive Motivation model (Laan & Both, 2008; Laan & Everaerd, 1995; Laan
& Janssen, 2007) – argues that desire actually reflects early stages of arousal in response to a
sexually relevant stimulus, and this model has received considerable empirical support
(Toates, 2009). These models see arousal and desire as closely interlinked, and allow that the
experience of sexual desire may follow rather than precede sexual excitement (Laan & Both,
2008).
Reviewing the evidence for linear vs. circular models of female sexual desire and
arousal, Hayes (2011) concluded that although there was better support for linear models of
sexual response than for circular models, there was also growing evidence that “responsive
desire” (desire in response to a sexual stimulus) is a feature of many women’s sexual
experiences. To our knowledge, there have been no comparable studies involving men.
Much of the existing literature has involved “fitting” expert models to participant
experiences (e.g., Giles & McCabe, 2009; Sand & Fisher, 2007). In this study we took a more
inductive approach, allowing participants to define and describe their experiences of desire
and arousal without reference to any expert models. The data presented here come from a
larger qualitative study whose overall aim was to explore the meaning of sexual (dys)function
for individuals with and without sexual problems.
Method
Sampling strategy
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We used a purposive sampling strategy that sought to maximize variation in
experience of sexual function by recruiting individuals from three groups, each with a
different likelihood of experiencing sexual difficulties. Our sampling strategy was designed
to capture roughly equal numbers of those with and without significant problems; as Table
one shows, this aim was achieved. The first group consisted of those who had sought
professional help for their difficulties. The group comprised consecutive patients attending an
NHS sexual problems clinic in London (n=6)), who were introduced to the first author by the
doctor, following their appointment. Those expressing interest were given a recruitment pack
and interviews were arranged with those who chose to take part. The second group comprised
individuals who, because of underlying health conditions (diabetes, depression and HIV),
were likely to be experiencing some difficulties but not necessarily to have sought help for
them or to have self-identified as having problems (sub-clinical). On behalf of the authors,
staff at a London general practice (GP) practice selected names randomly from their diabetes
and depression clinic lists, and invited these patients to participate by letter (n=13). This
group also included three HIV-positive participants, recruited via a staff member from an
HIV charity in a regional town. The third group served as a proxy to the general population,
with some individuals experiencing difficulties and others not. These individuals were
recruited in person by the first author from the waiting room of the same GP practice (n=10).
The waiting room was small, such that during a series of recruitment sessions, every
unaccompanied individual was approached. Non-English speakers and those under age 18
were excluded. All those taking part were given time to consider their decision and were
reassured that they could change their mind at any point. Written informed consent was
obtained prior to each interview. Although we expected, and were prepared for, some
participants to feel upset when relating their experiences, this only happened once. In this
case, and in several others, the experience of relating personal stories appeared therapeutic
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for the participant.
We examined each participant account closely and categorized them subjectively
according to their reported experience of sexual difficulties (see Table 1). Individuals who
did not describe any significant frustration or difficulty were categorized as “functional;”
those who expressed minor frustrations and/or difficulties but no significant concern about
these experiences were categorized as “dissatisfied;” and those who described significant
problem(s), some level of distress and had also either sought or considered professional help
were categorized as “problematic.”
[Table 1 about here]
Data Collection
Interviews lasting between 45 minutes and two hours were carried out by the first author
(30) and second author (2) and were audio-taped (with permission). Interviews were held in a
private room in the clinics from which participants were recruited, except if the participant
requested an interview at home (2) or by phone (1), because of poor health. The interview
was guided by a topic guide that sought to draw out an individual’s priorities for a functional
sex life, and included the following questions:
•What do you understand by the term sexual desire (wish for sex/sexual drive/libido)?
•What do you understand by the term sexual arousal (readiness for sex)?
•Is arousal different from desire? In what way?
Analysis
The interviews were transcribed verbatim by an audio-typist. The first author listened
to all the tapes and checked the transcripts as part of the familiarization process. The data
were then indexed and charted according to broad themes (Ritchie & Lewis, 2003).
Following principles of grounded theory analysis (Charmaz, 2006), the first and second
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authors then undertook intensive open coding of excerpts of transcripts that had been charted
under the themes of sexual desire and sexual arousal. We generated a set of provisional codes
that conceptually labeled the ways in which participants talked about desire and arousal.
Through discussion, and with the aid of a mind map (diagrammatic representation of linkages
between codes) we began to develop categories (made up of interlinked codes), each of
which described a key criterion that participants used to distinguish between desire and
arousal (whether explicitly or implicitly). We then used these categories to selectively code
the data. The analysis developed iteratively; clarifications and refinements to categories
continued into the writing stage, through discussion between analysts, feedback on successive
drafts and by returning regularly to the transcripts.
Ethical approval
Ethical approval for the study was obtained from Camden and Islington Local
Research Ethics Committee and the London School of Hygiene and Tropical Medicine Ethics
Committee. Governance approval was obtained from Camden and Islington Primary Care
Trust and Camden and Islington Mental Health and Social Care Trust.
Results
Difficulty making a distinction between sexual desire and sexual arousal
Participants were asked what they understood by the terms sexual desire and arousal,
and some spontaneously proffered a distinction between the two. Most attempted to do so
when prompted, but with often with difficulty (“I find that a very difficult question to
answer”; man aged 78).
Man aged 39: [Pause]… linguistically you could just as well say one is totally
interchangeable for the other, but if I had to make a distinction in English language I
would probably separate them [out as follows….].
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For these participants, difficulty in distinguishing between concepts stemmed from
the view that they were intertwined, and the difference was “very subtle; it’s a matter of
degree really” (woman aged 54).
I: I’m interested a little bit in the relationship between these two – arousal and desire.
How do you see the relationship between those two?
Woman aged 47: I would see them as very closely linked. I’m not sure if you can
unpick them.
Temporal sequence
Desire before arousal
Amongst those participants who referred to a time dimension to distinguish between desire
and arousal, many saw desire as occurring before arousal. For some, the sequence – desire
first, arousal after – was clear. A sense of chronology was conveyed by terms such as
“preceding” or “coming before” in the case of desire, or as “following” or “coming after” in
the case of arousal.
P (participant): I think the arousal comes after the desire. The desire is there first
and then if the touching goes on any longer…
I (Interviewer): So you experience desire first and then that can lead to…?
P…arousal.
I: A sort of second stage.
P: I think so yes. I might not have thought too clearly about it, but I think so.
[Woman aged 64]
Woman aged 51: Well I suppose desire is a little twinge that would be followed up
by something … If you saw a bloke and you thought “oh”… and you want to get to
know them..., or there would be something physically that you wanted to see more
of ... you get the little bit of interest and then you build on that to see if there’s
anything to stoke it up with.
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For some participants, desire was seen not only as a precursor but as a prerequisite to arousal.
One man (aged 56), for example, referred to sexual desire as the “physical and psychological
requirement/need to experience sexual satisfaction” and so for him desire was a condition
without which, sine qua non, arousal could not occur. This sense is echoed in descriptions of
desire as “potential” (man aged 56) and “opportunity” (man aged 78). For some, however,
sexual desire was a necessary, but not always a sufficient - condition for arousal. The not
infrequent use of the conditional tense “ I would like to... ,” in the context of desire,
indicated that sexual arousal was seen as not only in the future, but as conditional on other
favourable conditions occurring before arousal could take place:
Man aged 65:“...the attraction that you’re seeing ... That comes first and after that
there has to be something else… to continue your desire. It doesn’t happen – it could
be cut off immediately”.
By contrast, arousal was seen as more proximate to sexual activity, and contingent on sexual
activity occurring. Where desire was expectant or hopeful, arousal was in the moment, and
contiguous with sexual activity.
Woman aged 42: Desire would be wanting to have sex, and arousal or being turned
on is the act of being with somebody where sex is imminent and they were doing… if
I was attracted to them and they were doing the things that would make me feel I
wanted to have sex.
Man aged 56: [Pause]. Sexual desire is physically thinking “I would like to have
sex”. Sexual arousal is actually when sex has begun to take place – your changed,
altered state.
Woman aged 23... for me, it’s more the there and then… yes – there and then, being
aroused. (Emphasis added)
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Arousal before desire
A smaller number of participants saw the order as reversed; arousal preceded, and in one case
at least, was a prerequisite to desire: “You get a total sense of desire for a person because
you’re totally aroused” (man aged 55; emphasis added). A woman aged 47 described the
reciprocal relationship between the two, desire increasing with heightened arousal and vice
versa:
I: Some people argue that they happen sequentially, so you desire sex and then you
become aroused. Would you agree with that or would you think they can happen in
all sorts of order?
P: I think I might say I desire sex because I am aroused. I might become more
aroused.
I: So for you there isn’t a particular order necessarily?
P: … I think maybe there is, to the extent that desire can probably proceed from quite
a low level of arousal. If there was absolutely no arousal I don’t think the desire
would be there… and as the desire sets in you become more aroused.
[Woman aged 47]
Temporal sequence - blurred distinction
By no means all participants, however, saw the temporal order of desire and arousal
so unequivocally. For some, the two conditions were seen as occurring simultaneously and,
at least in terms of sequence, were therefore indistinguishable. For others, there was no clear
pattern:
I: Do you think these happen in sequence – the sexual arousal and desire – or does
one happen before the other, or might they happen at the same time, or does it
change?
P: I think it can change. I think it can happen… [pause]. It comes in different ways I
think.
I: There’s not necessarily an order to it?
P: No, no.
[Man aged 33]
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Factors influencing temporal sequence
A key factor determining whether desire was seen as preceding or following arousal appeared
to be the nature of the relationship. One man, whose sexual script emphasised the erotic (see
Mitchell et al., 2011), described the sequencing of desire and arousal in the context of the
social distance between the self and the object of desire. He saw arousal as subsumed by
desire when the person is less familiar:
Man aged 55: Arousal on that scale is not there with someone that you just don’t
know, because that’s instantaneous. The arousal’s gone in desire, it doesn’t come into
it – that is just pure sexual desire.
By contrast, this man felt that with a familiar partner, a gradual build up of arousal leads to
desire, rather than the reverse:
P: “... you know the person – you feel more at ease with them and I’d include
foreplay but not a sexual foreplay. It’s the evening – making the dinner, sitting down
just touching the person, and sitting there just talking to them. You’re looking at
them and maybe you just touch them, so you’re just slowly, slowly building up to it.
I: Would [desire and arousal] happen at the same time or one before the other, or in
different circumstances?
P: I think the arousal could go on through the evening, and then maybe you just walk
into the bedroom and she might just drop whatever and be stood there – stocking and
suspenders. For my age that was the normal, and that is how I picture most women –
to be like that. Then you get total sexual desire for the person because you’re totally
aroused.
I: So, in a way, arousal comes first and then the desire?
P: Yes – in a long-term relationship. The desire is the erection; the arousal is
making sure everything’s alright beforehand; you might not have an erection but that
you know that something’s going on chemically inside yourself. (Emphasis added)
[man aged 55]
Mind/body engagement
Desire as mind, arousal as body
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Participants frequently defined desire and arousal in terms of what was happening both in the
mind and body. Where participants distinguished between the two, desire tended to be
associated with the mind (thinking about or wanting sex) and arousal with body (physical
signs and sensations). However, the distinction was often not clear-cut:
Woman aged 34: Desire I suppose is, not always, but it’s more of a mental process
and arousal is more of a physical thing. It’s not a strict demarcation but it’s
[something like that].
The “thinking” words that participants associated with desire often signified motivation and
aspiration (“wanting”, “fancy”, “liking”). In contrast, arousal was associated with an
embodied “altered state”; an “awakening of the senses” (man aged 56); and “a state of
perpetual readiness for sex” (woman aged 51). Several participants described being “turned
on,” a term that suggests a “switch” or a move to a new physical state. In contrast to desire,
arousal was associated with a set of distinct physical signs, of which the most salient were an
erection (for a man), and lubrication (for a woman):
Woman aged 27: For a man it’s getting an erection. For a woman it’s getting
lubricated. For both it’s… I don’t know, it’s everything else that happens –
quickened heart beat, and that kind of thing.
The woman quoted below describes both a change of state as well as distinct physical signs:
Woman aged 54: I suppose you feel some sort of inner tingling or whatever, if you
want to be very exact about it – you do. Your lips start to swell a little bit and all
these changes, but I think it’s a general openness in your whole stance…...
This woman expressed frustration at being asked to describe signs of arousal as she assumed
there was a normative set with which the interviewer would be familiar. She was surprised to
learn that the signs varied from one person to another. For some men, the erection became
the definitive sign, without which it was not possible to “achieve” arousal:
P: Oh well, of course in a man [the sign of arousal is] primarily erection isn’t it,
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which of course I can’t do.
I: Would you say that you’re no longer able to feel sexually aroused then?
P: Not properly.
[man aged 78]
Desire as body; arousal as mind
At times this distinction was reversed: desire was associated with body and action, and
arousal with mind and thinking. Desire was described by one man as “related to the loins […]
you can look at a woman and you maybe get a tingling around there…” (man aged 55).
Desire was associated with an altered embodied state: “something that wells up in you and
one gets into a heightened state” (woman aged 64). And the converse, a loss of desire, was
described by one man as “the loss of a physical drive, so it’s your body telling you that you
want to have sex” (man aged 39, emphasis added).
On the other hand, arousal was described as an altered state of mind: “a slight loss of
rational thinking, inability to concentrate on other things…” (man aged 39), or as an
aspiration, originating in the mind:
I: […] how do you know if you’re feeling sexually aroused?
P: Something happens in you so you feel that “God, actually I wouldn’t mind some
of that”.
I: So it’s a thought – it’s a thinking thing?
P: Yes it’s always in the mind isn’t it? It starts from the mind doesn’t it? I think it
starts in the mind.
[man aged 65]
Mind-body - blurred distinction
The accounts showed that the distinction between mind and body was not always easily made
For instance, terms such as “urge” and “impulse” were often used in association with sexual
desire and an urge might originate from the mind or the body or both together. Arousal was
also sometimes described as of both mind and body: “[you know you’re aroused because] the
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whole body is telling you – your mind, everything.” (woman aged 38). And when asked to
describe the signs of arousal, some definitions included both mind (aspirations/motivations)
as well as bodily signs:
I: What are the signs of that physical arousal?
P: Quickening heart rates, am…pure excitement, in some cases erectile function, a
draw towards another person – a real sort of want of that person ….
[man aged 48]
The view that both mind and body are simultaneously engaged is nicely illustrated by this
woman:
Woman aged 47: Sexual desire is physically thinking “I would like to have sex”
Motivational/emotional states
This final criterion relates to the extent to which desire and arousal are motivated
towards a goal, and the extent to which they are felt spontaneously or arise in response to
cues. These criteria were used, not so much to distinguish between the terms but to define
each one. Indeed, desire and arousal were usually both viewed as responsive and
motivational, and the distinctions between them on this criterion were particularly blurred.
Desire and arousal as responsive and motivational
Participants frequently talked about desire and arousal as responsive (a response to a person
or stimulus) and motivational (orientated towards a goal). Desire was often described as a
response to a cue, such as an invitation from an intimate partner:
Woman aged 64: I think sexual desire is all to do with having a loving partner who
wants to touch you and when that person touches you, you experience sexual desire.
Equally, desire could be triggered in response to a stranger whose attributes or behaviour are
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attractive: “there can be a desire just with the movement of her bottom, the way she walks, or
the way she smiles…” (man aged 55). The stranger here does not necessarily intend to trigger
this desire, and although the felt desire may be motivational, it may be accompanied by an
acceptance that these feelings will not translate into action.
Desire was often defined in motivational terms (“wanting to have sex”; man aged 56).
The motivation might be orientated towards the physical rewards of sex (“a keenness to have
sex with penetration”; man aged 60); or might pertain to a relational goal (“there is this desire
to disappear into each other which I think is very important”; man aged 61). Arousal was also
described as a response. Again the trigger might come from a partner or from some subtle
attribute of a stranger (“something she’s wearing or the way she sits, the way she is playing
or her smile”; man aged 65).
Like desire, arousal was expressed as a motivational state, orientated towards a
physical goal (“getting to the point where they feel like they want to have sex”; man aged
60); or a relational goal (“a real sort of want of that person”; man aged 48). But the
motivation was often expressed with more urgency: “It’s an urgency of wanting to go to bed
with the person – either make love or have sex with them” (man aged 55).
Comparisons between the two terms sometimes depicted arousal as a response to a
partner or someone known well and desire as an instant and fleeting response to a stranger or
stimulus (such as an image). There was a sense in which arousal required more than just an
image; there needed to be “something to continue your desire” (man aged 65). As one woman
put it:
P: You see I wouldn’t think pictures of someone like Lucian Freud… they’re sexy but
they wouldn’t make me feel sexy. Sometimes I think you can see someone and you
can think “Cor blimey!” – just a glance or… a type of person.
I: Would that be desire or arousal?
P: That would be desire I think.
I: So when would the arousal…? What would need to be there for arousal to
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happen?
P: Well I think you’d have to know that person a bit deeper.
[Woman aged 51]
This association of arousal with someone known well was, however, by no means
universal. On several occasions, a sexual response to erotic images in magazines or scenes in
films was described in terms of arousal:
Woman aged 51: Have you ever seen that film ‘Don’t Look Now’? […]. There’s an
immensely erotic scene. That aroused me.
Desire as not motivational and not responsive
Desire was also talked about as an emotional state or an ongoing appetite that was
neither goal oriented (motivational) nor responsive. When talking about desire in this way,
participants used terms such as need, drive and urges.
Several participants talked about sexual desire in terms of a libido or drive, an
ongoing appetite, need or sense: “It’s like the sixth sense to me. You’ve got your natural five
senses and you’ve also got this other need within your body, and it doesn’t do any good to try
and suppress that need totally” (man aged 48). On several occasions, sexual desire was
expressed as “one of the constituents of the partnership” (man aged 61), or as an attraction
towards another that could grow, stay steady or wane (“I lost my desire for him”; female aged
35). And finally, it was described as an affective state - a mood or feeling of comfort:
Woman aged 54: [the] problem with sex was [my] level of desire – how much you actually
felt in the mood for sex and sexuality, or felt comfortable with being a sexual being yourself.
Several participants differentiated desire from arousal using the criteria of motivation
and responsiveness. Three of these participants described arousal as motivational and
responsive and desire as neither. One man contrasted his view of desire as an appetite with
his view of arousal, which he saw as of the moment and relating to a specific encounter:
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Man aged 39: I think if I could make a distinction, it would be the drive is the long
term… The arousal is the short-term case-by-case based situation you are in, on any
given night, and trying to build up these feelings. [ Pause]…
Another woman viewed arousal as a response to a person, but desire as an emotional state
that could arise in the absence of a partner:
Woman aged 46: When I’m with somebody and they kiss and cuddle you, then you
get sexually aroused, but you can desire sex without that. You can be on your own
and feel desire.
Arousal as not motivational and not responsive
Arousal was talked about as not motivational and not responsive far less often than
desire. Occasionally, arousal was described as detached from a specific person or context. For
instance, it was described by two participants as integral to the relationship; and also as a
feeling of satisfaction with a partner (woman aged 23). For some men, the experience of a
waking erection contributed towards a view of arousal as not motivational and not
responsive:
Man aged 52: I think if you’re aroused, or you get aroused, I think it’s a natural
thing, a thing that happens on its own. It needn’t necessarily be anything to do with
sex. You can be aroused when you wake up in the morning and you can be on your
own, it doesn’t necessarily mean that you want sex.
Discussion
We found that both men and women had difficulty making a distinction between
desire and arousal although they could usually do so after some thought. This is consistent
with the qualitative findings of Brotto et al. (2009), who reported that women had difficulty
distinguishing between desire and arousal, and achieved greater clarity in their definitions
after thoughtful reflection. Consistent with Janssen and colleagues (2008), we found that men
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also struggled to disentangle the terms or gave definitions that differed from the expert view.
We identified three criteria that individuals used to define sexual desire and arousal or
make a distinction between the two: temporal sequence, mind/body engagement, and
motivation/responsiveness. Participants commonly felt that desire preceded arousal; some felt
that desire was ‘mind’ and arousal ‘body’; and many felt that both desire and arousal were
responsive and motivational. However, for each of the criteria, we identified numerous
instances of participants reversing distinctions or blurring differences between the two. The
overall picture was one of variable definitions and overlap between terms.
Several qualitative studies have supported the idea that women often do not
differentiate between sexual desire and arousal (Beck et al., 1991; Brotto et al., 2009;
Carvalheira et al., 2010; Ellison, 2000; Giles & McCabe, 2009; Graham et al., 2004;
Goldhammer & McCabe, 2011). One study found that women diagnosed with Female
Sexual Arousal Disorder (FSAD) were more likely to distinguish between desire and arousal
(Brotto et al. 2009), and women without a diagnosis were more likely to conflate the two
constructs. But a second study found the opposite: an overlap between sexual desire and
arousal was more evident among women reporting lower levels of sexual functioning (Giles
& McCabe, 2009). We did not detect any clear differences in the way that these terms were
defined across the three groups of participants, according to experience of sexual function
problems (see Table one). It is not possible to say whether this lack of difference was due to
the small and purposive sample, or whether in fact, the experience of sexual difficulties does
not change the way that individuals define these terms. Further quantitative work would be
required to explore this in detail.
Consistent with previous studies (Giles & McCabe, 2009; Sand & Fisher, 2007), we
found that a linear model of sexual response – in which desire precedes arousal – was
endorsed by some, but not all participants. We also found some support for the idea of a
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circular relationship between desire and arousal (desire feeding into arousal feeding into
desire, etc.). Several studies have indicated a lack of temporal pattern in women’s accounts.
In a focus group study involving women aged 18-84 years, women sometimes reported desire
as preceding arousal, at other times following it, and also sometimes perceived sexual arousal
without any experience of sexual interest/desire (Graham et al., 2004). These latter occasions
were often linked to physical triggers, such as ovulation. In an online survey of 3,000 women,
16% of respondents reported only engaging in sexual activity if they felt sexual desire at the
outset, but almost a third of women typically or always only recognized sexual desire after
they perceived that they were aroused (Carvalheira et al. 2010).
Although it is often assumed that the distinction between sexual desire and arousal is
more clear-cut in men than in women, there have been remarkably few studies on men’s
experiences of sexual desire (Kleinplatz, 2011). Apart from studies of hypogonadal men,
problems relating to desire in men have been also been under-researched (Brotto, 2010b;
Maurice, 2007). In one of the few qualitative studies focused on male experiences of sexual
desire and arousal (Janssen et al., 2008), men aged 18-70 years participating in focus group
discussions did not consistently or easily distinguish between sexual desire and arousal. Men
also described genital arousal (i.e. an erection) as sometimes occurring independently of
(subjective) sexual arousal and, conversely, feelings of sexual excitement were reported in
situations where they did not have an erection. These findings challenge some of the
stereotypes regarding men’s sexuality (Kleinplatz, 2011) as being more “straightforward” and
genital-focused than women’s sexuality.
Further evidence for overlap between these constructs comes from studies that have
investigated the psychometric properties of self-report measures of sexual functioning among
clinical and non-clinical samples of women. These studies have documented significant
overlap between the sexual desire and arousal domains (Dennerstein & Lehert, 2004;
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Graziottin et al., 2009; Leiblum et al., 2006; Taylor et al., 1994; Sidi et al., 2008). Brotto et
al. (2010) reviewed studies reporting correlations between the FSFI Desire and Arousal
domains; across six studies, correlations between .52 and .85 were observed. High
correlations between desire and arousal have also been reported in studies employing other
questionnaire measures, such as the Profile of Female Sexual Function (Leiblum et al., 2006).
In a study of Australian women that utilized the Personal Experiences Questionnaire
(Dennerstein et al., 1997), Dennerstein and Lehert (2004) found that items related to sexual
“responsiveness” could not be separated from the construct of sexual interest or desire.
Overall, our findings support the view that there is diversity in women’s and men’s
experiences of sexual response (Carvalheira et al., 2010; Janssen et al., 2008; Tiefer et al.,
2002) and that no one model fully captures this diversity. These findings are supported by a
range of studies suggesting that sexual desire and arousal are not discrete categories and are
not always experienced in a uniform, temporal sequence, as traditional linear models of
sexual response assumed.
The methodological limitations of our study relate to qualitative approaches more
broadly. Qualitative methods are suited to exploring phenomena from the perspectives of
others. Semi-structured interviews provide rich and detailed descriptions but partly because
the data generated are cumbersome, the sample sizes are generally small. Our sampling was
purposive rather than probabilistic, with the aim of generating ideas and concepts that are
transferable to other contexts, rather than results that are statistically generalizable. A further
caveat is our focus on definitions rather than experience. An individual’s definition of sexual
desire and arousal may not accurately reflect how they experience the concepts (as
professionally defined). This may be particularly true where the terms are not often used in
everyday conversation. That said, participants often defined the terms by describing their
own experiences. And, for the purpose of achieving accuracy and reliability in clinical
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diagnosis and research, an understanding of how individuals define these terms is important
in its own right.
So what can we conclude from these findings? Our results have implications for
clinical consultations. They imply that a shared meaning of desire and arousal between
professional and patient cannot be assumed. Lack of shared understanding may unwittingly
hamper the accuracy of history taking and diagnosis. This is most likely to be an issue during
brief consultations where time does not permit discussion of meanings. Our findings are also
important for epidemiological research, particularly because of the reliance on self-report to
measure sexual dysfunction. There is good evidence that bias arises where participants
misunderstand terms, or understand them differently to the meaning intended by researchers
(Catania, 1996; Tourangeau, 1996). Localized usage of terms may be particularly important
here. For instance, a term such as “turned on” which is often employed in questionnaires as a
vernacular term for arousal, may have a different meaning among U.S. and British English
speakers.
Finally, these findings have implications for diagnostic classification of desire and arousal
disorders. We believe that the blurred distinction between these concepts among many lay
people provides further support to recent proposals to merge the two diagnostic categories of
Female Sexual Arousal Disorder and Hyposexual Desire Disorder into a new diagnostic
category (“Sexual Interest/Arousal Disorder”) for the upcoming revision of the DSM (DSM-
5) (Brotto, 2010a and b; Brotto et al., 2010; Graham, 2010). Because of the limited literature
on men’s sexual desire, the proposed DSM-5 criteria for diagnosing low desire in men are
largely preserved from the previous edition of the DSM (DSM-IV-TR; APA, 2000). We
found that men as well as women found difficulty distinguishing between desire and arousal.
We hope that in future, the literature on men’s desire will develop sufficiently to permit a full
re-appraisal of the diagnostic categories for men. Certainly, our data suggests that such an
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appraisal is warranted.
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