Gender differences in sexual motivation

Abstract

This article describes the ways in which arousal and sexual urges in women and men reflect sex differences in the links between brain responses and genital changes. Boys are more sexually motivated from puberty on, whereas girls tend to seek emotional connections as a precursor to sexual contact. Although feelings and thoughts are important for both sexes, women are not always psychologically aroused by genital vasocongestion, while the opposite tends to pertain to men. Lack of subjective arousal commonly leads to loss of sexual interest in women: negative emotions in the current relationship are often involved. For men, the causes of sexual withdrawal are more variable, and childhood family dynamics are a frequent, but unconscious, factor. The role of the neuropeptides oxytocin and vasopressin, synthesised from oestrogen and testosterone respectively, is described as a biological underpinning for some observed gender differences. Oxytocin is released at orgasm by both women and men and promotes sexual pleasure and emotional bonding. Vasopressin, secreted during the male arousal phase, is linked to men's drive for sexual expression. This peptide may have the opposite effect on women and impair arousal and motivation due to the link between vasopressin release and aggression. Psychological treatment needs to explore the meaning of lack of sexual motivation for each person, and to address individual and couple issues. An integrated psychosexual model combining behavioural and psychodynamic approaches can alter feelings and relational patterns, and facilitate the return of sexual desire between partners in a committed relationship.

Full text

Practicing medicine
Keywords
Sexual motivation
Gender
differences
Oxytocin
Vasopressin
Arousal
Anger
Janice Hiller, BSc, MPhil
Psychological Services in
Sexual Health, Goodmayes
Hospital, Essex UK
E-mail:
janicehiller@hotmail.com
Online 27 July 2005
Gender differences in
sexual motivation
Janice Hiller
Abstract
This article describes the ways in whicharousal and sexual urges in women and men reflect sex differences in
the links between brain responses and genital changes. Boys are more sexually motivated from puberty on,
whereas girls tend to seek emotional connections as a precursor to sexual contact. Although feelings and
thoughts are important for both sexes, women are not always psychologically aroused by genital
vasocongestion, while the opposite tends to pertain to men. Lack of subjective arousal commonly leads
to loss of sexual interest in women: negative emotions in the current relationship are often involved. For
men, the causes of sexual withdrawal are more variable, and childhood family dynamics are a frequent, but
unconscious, factor. The role of the neuropeptides oxytocin and vasopressin, synthesised from oestrogen
and testosterone respectively, is described as a biological underpinning for some observed gender
differences. Oxytocin is released at orgasm by both women and men and promotes sexual pleasure
and emotional bonding. Vasopressin, secreted during the male arousal phase, is linked to men’s drive for
sexual expression. This peptide may have the opposite effect on women and impair arousaland motivation
due to the link between vasopressin release and aggression. Psychological treatment needs to explore the
meaning of lack of sexual motivation for each person, and to address individual and couple issues. An
integrated psychosexual model combining behavioural and psychodynamic approaches can alter feelings
and relational patterns, and facilitate the return of sexual desire between partners in a committed
relationship. ß2005 WPMH GmbH. Published by Elsevier Ireland Ltd.
Introduction
Male sexuality has been the focus of much
popular and scientific interest since oral med-
ication for the erectile response was first intro-
duced. When used as part of a planned
therapeutic approach, pharmacological inter-
ventions can clearly be beneficial for a range of
erectile problems. But from the perspective of a
clinical psychologist working with individual
people and couples who are distressed by issues
of sexual motivation, it is also clear that sexual
behaviour between people is far more complex
than neurophysiology and endocrinology, for
men as well as for women. In particular, the loss
of desire, or motivation, for sexual contact with
a partner in an on-going relationship is a com-
mon presenting complaint, and remains one of
the most difficult to treat.
For effective clinical practice the ability to
respond sexually must be differentiated from
the motivation to be sexual with a specific
partner. Sexual interactions occur in social
and interpersonal settings that are mediated
by emotions and cognitions: what we feel and
think (consciously and unconsciously) about
a partner before and during love-making will
influence psychophysiological mechanisms
and alter our perception of sexual experiences.
Arousal and desire are interwoven in different
ways for women and men, neurochemically
and psychologically, as will be elaborated later
in this article. My aim here is to show that a
notion of sexuality occurring in an emotional
context between people, constructed in the
social environment, and also dependant on
biological underpinnings, can inform theore-
tical models and thereby guide our treatment
of sexual motivation issues.
How do our feelings and thoughts (brain
responses) interact, via bodily (genital) changes,
to lead to sexual expression? Although complex
connections are poorly understood in humans,
there is a wealth of literature on attachment
ß2005 WPMH GmbH. Published by Elsevier Ireland Ltd. Vol. 2, No. 3, pp. 339–345, September 2005 339

patterns and sexual bonding in other mam-
mals, which deserves consideration. As
humans we are, of course, able to reflect on
sensations, to consciously experience feelings,
and to make choices. At the same time our
sexual urges emanate from primitive subcor-
tical areas of the emotional limbic brain,
which are hormonally regulated and very simi-
lar to that of other mammals. Panksepp [1] has
described how neuropeptides released from
the pituitary gland, which are manufactured
from gonadal hormones, are essential for ero-
tic mood states, and suggests that cross-species
comparisons can be made, albeit with caution.
In contrast with the subcortical systems that
govern sexual urges, and can be investigated by
way of animal models, the evolutionarily mod-
ern neocortex (unique to humans) has been
shown by Damasio [2] to be the structure where
conscious reasoning, planning and mindful-
ness take place. Damasio [3] has also argued
that the neural patterns thatconstitute feelings
are based on the brain’s perception of emotions
(visceral states), and this occurs through a pro-
cess of dynamically updated evaluations of bod-
ily states including the musculoskeletal system,
the viscera and the internal chemical milieu.
Conscious decision-making about sexual beha-
viour will therefore interact with current bodily
states, personal history and the social context,
to varying degrees at different stages of the life
course, within a biopsychosocial model [4].
Recent neuroscientific evidence adds weight
therefore, to the need to integrate psychology
with biology, for a broader appreciation of
human sexual responsiveness. To what extent
do men and women differ in the links between
feelings (neocortical activity), genital responses
and sexual urges, and how can an understand-
ing of these inform clinical practice ? Simila-
rities and differences between men and women
which link psychological concepts or arousal
and motivation with the neuroendocrine sys-
tems that underpin sexual feelings and beha-
viours will be discussed.
Loss of sexual desire: disease entity
or psychological phenomenon
Since the concept of problems with sexual
desire was first described by Kaplan [5],low
or absent motivation to be sexual has become a
well recognised and common presenting
issue. Generally it occurs in the context of a
committed relationship, when one partner
becomesreluctantorrefusestoengagein
sexual contact. The rejected partner often
feels hurt and confused and may withdraw
emotionally or become attacking, so that the
difficulty is further compounded by dishar-
mony. The partner who has lost sexual interest
is diagnosed with hypoactive sexual desire
disorder according to DSM IV [6]. For clinicians
who provide therapeutic approaches based on
psychology, the notion of incompatibility of
sexual need [7] is more helpful. This shifts the
focus from a disease entity within one person
to a problem constructed between two people,
and indicates the necessity for a thorough
assessment of the psychological and relational
issues. Bancroft [8] pointsoutthatalossof
sexual interest often occurs with couples in an
unsatisfactory or damaging relationship, so
that withdrawal by one person represents an
adaptive response to couple difficulties and is
psychologically understandable, rather than a
medical dysfunction. Moreover clinical prac-
tice indicates that sexual withdrawal in both
men and women is associated with negative
emotional states such as disappointment,
anger and fear. Although these emotions often
originate in conflictual relationship issues or
current life stressors, they can also represent
unresolved experiences in the family-of-ori-
gin, that later become projected onto an
intimate relationship. Whether consciously
experienced as feelings that can be named
or remaining as unconscious factors, negative
emotions nevertheless exert a powerful influ-
ence on sexual urges and desire for intimacy
[9].
From a biological perspective, both women
and men require an adequate level of free
testosterone, which fuels the drive (or biologi-
cal) component of sexual desire. The willing-
ness to be sexual with a given partner is
influenced by psychological and interpersonal
factors [10]. Men have 10–20 times more tes-
tosterone than women and this androgen has a
clear role in male sexual interest and arousal
mechanisms [8]. Although circulating testos-
terone is related to women’s sexual thoughts
and needs [11], research into the correlation
between women’s sexual behaviour and testos-
terone levels has shown contradictory results
[8]. In the absence of organic causes, viewing
low or absent sexual motivation as emanating
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340 Vol. 2, No. 3, pp. 339–345, September 2005

from a negative emotional state that has
intrapsychic and interpersonal significance is
consistent with conceptualising the problem
as psychological in origin, rather than a dys-
function in the medical sense.
Motivation for sexual activity over
the life course
That women and men tend to differ in their
motivation for sexual activity, particularly in
the context of a long-term relationship, is a well-
observed phenomenon. Incompatible need for
sexual contact can occur despite partners
experiencing similar levels at the start of a
new relationship. More frequently it is a change
in the female partner’s desire for sex that causes
conflict and tension, and leads the couple to
seek treatment. For example, 40% of the female
referrals at a London sexual problems clinic
were for low or absent sexual desire, compared
with 6% of the male referrals [12].
Boys and girls both recall their first sense of
romantic attraction at around 10 years of age
whether for the same or opposite sex [13]. But
from puberty on, young men as a group are
more erotically motivated than women in
every area of sexual activity. Adolescent boys
masturbate more frequently than girls, mas-
turbate from a younger age, start having sex-
ual intercourse earlier and are more interested
in casual sex [14,15]. Sexual fantasies, which
imbue the situation with meaning, appear to
be equally frequent for girls and boys, but the
content of imagined sexual scenarios indicates
significant gender differences. Whereas boys
are preoccupied with sexual acts, conquests
and achievements, girls fantasise about sex
as part of an emotional, faithful and romantic
relationship [16]. Evidence indicates that
women and men have similar levels of sexual
needs when they do occur, but men are more
likely to experience spontaneous and consis-
tent sexual urges irrespective of the nature of
the relationship. For women, feelings about a
particular partner tend to be more relevant for
sexual desire [17]. Discussing this gender dif-
ference can be helpful with couples for whom
the woman‘s loss of sexual motivation is caus-
ing distress and conflict. Clinical evidence
indicates that men who lose sexual motivation
feel embarrassed and confused at this atypical
pattern, and partners frequently blame them-
selves for being undesirable and can become
very depressed.
Difference in arousal stimuli for men
and women
Whereas the human sexual response cycle was
originally conceptualised as consisting of three
phases –desire, followed by arousal, leading to
orgasm [5] –recent advances in understanding
the complexity of sexual responding has high-
lighted the centrality of arousal in organising
sexual behaviour. For men, the erectile
response generally leads to subjective feelings
of arousal. By contrast a series of studies have
shown that women’s subjective experiences of
arousal are not automatically linked with geni-
tal changes [18]. Blood flow to the genitals and
vaginal lubrication (unconscious physiological
responses) are necessary for comfortable penile
containment, but Basson [19] has demonstrated
that mental arousal and genital vasocongestion
are readily disconnected in women. Three sub-
types of female arousal disorders have now been
described. In ‘‘subjective sexual arousal disor-
der’’ a physical response is present with no
feelings of mental arousal; in ‘‘genital sexual
arousal disorder’’ subjective excitement occurs
with absent or impaired genital changes. The
third category of ‘‘combined genital and sub-
jective disorder’’ entails impairment of both
mental and genital responses [20]. Without feel-
ings of sexual arousal (brain responses) a desire
for sex will not be experienced, even if there is
genital vasodilation. Consequently, a difficulty
with subjective arousal will often be a more
accurate explanation than ‘‘desire disorder’’
for a woman’s withdrawal of sexual interest.
Male arousal phase difficulties, in the form of
erectile problems, are linked psychologically to
the intrusion of anxiety on arousal mechan-
isms. These have always been considered the
most prevalent sexual difficulty for men,
whereby subjective arousal and the subsequent
desire for sex are present when erectile capacity
is not.
In the non-clinical population, men are able
to choose not to engage in sex despite genital
arousal and subjective excitement. Women, by
contrast, are able to choose to engage in sex for
reasons other than feeling psychologically or
physiologically aroused initially, such as avoid-
ing upsetting a partner or to become pregnant,
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Vol. 2, No. 3, pp. 339–345, September 2005 341

and can then feel subjective arousal when
intimate contact has begun.
How do we understand this contrast
between men and women? As secondary sex-
ual characteristics develop at the start of pub-
erty, adolescent boys become aware of strong
genital responses to visual stimuli, accompa-
nied by a sense of urgency and craving for
sexual expression. They may also become
more aggressive and combative in their gen-
eral behaviour. Girls‘sexual feelings more
often derive from their emotional reactions
to a partner, which are heightened by the
romantic themes in films and magazines,
ubiquitous in our culture, to which adolescent
girls are often drawn. Notwithstanding cultu-
ral norms, testosterone and oestrogen clearly
accompany these psychological changes. The
influence of neuropeptides manufactured from
these gonadal hormones on feeling states will
be described below.
Whereas in our society the pace for sexual
contact is more often set by the contingencies
of male persistence and assertiveness (except
when the woman wants to conceive) it is gen-
erally the case that limit setting and emotional
closeness are predominantly female concerns.
For biological and evolutionary reasons this
makes sense, as women need to be aware of
careful partner selection for reproductive and
child-rearing purposes, rather than feeling dri-
ven by a pressing need for sexual contact when
physiologically aroused. Genetic predisposi-
tion and individual psychology will of course
vary, and for each individual person these will
interact with the broader sociocultural factors
that determine specific behaviour patterns
and the nature of each person’s sexual expres-
sion over the lifecourse [4].
Neuropeptides, feelings and sexual
behaviour
Central to current thinking on the links
between gender differences in sexual beha-
viour, brain chemistry, and feeling states are
the neuromodulators vasopressin and oxyto-
cin. These peptide hormones, which are
synthesised in the hypothalamus and released
into the bloodstream during sexual activity,
are found exclusively in mammals. They can-
not pass the blood- brain barrier if taken orally.
Men and women secrete vasopressin and oxy-
tocin, (manufactured from testosterone and
oestrogen, respectively) in different amounts
during the sexual response cycle.
Two main areas of research have indicated
that vasopressin and oxytocin could provide
the neurochemical underpinnings that link
psychological experiences with physiological
responses in women and men. Firstly, labora-
tory studies with individual subjects found
that women secreted more oxytocin than
men during arousal (self-stimulation) and at
orgasm [21]. Moreover, increased oxytocin cor-
related in both groups with the intensity of
muscle contractions and the ratings of plea-
sure from sexual experiences [22]. In a study
with male subjects only, oxytocin was again
found to increase significantly from baseline
to orgasm/ejaculation, but vasopressin showed
a different temporal pattern. Vasopressin rose
during the erectile response, then dropped
back to baseline levels at ejaculation, when
oxytocin remained elevated [23].
The significance of these neuropeptides for
complex human interactions is indicated by
thesecondareaofresearch,namelysexual
activity and mate attachments in rodents.
Numerous studies have confirmed gender dif-
ferences in peptide secretion during copula-
tion and partner selection in prairie voles,
who form monogamous heterosexual attach-
ments for mating. Females release oxytocin
during cohabitation and mating, without
which they do not form attachments to a
mate, whereas males release vasopressin dur-
ing copulation, which is crucial for inter- male
aggression and mate-guarding [24,25].Vaso-
pressin is also associated with male persis-
tency for sexual behavior [1].Oxytocinhas
been identifiedastheneuropeptideassociated
with the close emotional bonds that provide a
secure base for child-rearing purposes, and
for sexual pleasure in both women and men
[26,1].
Sexual responses, aggression and
vasopressin
What do we know about the effect on women’s
sexual feelings when vasopressin is secreted?
The female brain has fewer vasopressin neu-
rons than the male brain, but as with men,
vasopressin is linked with aggression, social
memories and focused attention. Despite the
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342 Vol. 2, No. 3, pp. 339–345, September 2005

lack of direct evidence from laboratory studies,
I have proposed that the central release of
vasopressin may have the opposite effect on
women’s sexual urges and could actively
impair arousal mechanisms [27].Supportfor
this hypothesis derives from clinical data as
well as rodent research. Women who request
help for a loss of sexual interest with a specific
partner commonly describe anger, resent-
ment and hostility, emanating from the cou-
ple’s relationship, but also connected to
family-of-origin issues that may not be con-
sciously linked with sexual withdrawal. What-
ever the causes of negative emotional states
(i.e. stress, chores, life-events) feeling devalued
and undermined can inhibit women’ssexual
functioning [17]. As mentioned above, lack
of a specific genital response is rarely involved
[20].
Loss of sexual interest after childbirth is
another common occurrence; a temporary
state that reverts with time and has obvious
evolutionary value. After female rats give birth
a natural increase in vasopressin is found in
brain circuits, which has been linked to the
neurochemistry of aggressive and hostile reac-
tions that enable the mother to protect her
offspring from danger [28]. Most significantly,
when vasopressin is artificially placed in a
precise area of the female rat brain the result
is an instant decline in acceptance of copula-
tion [29]. It is possible, therefore, that when
women have negative feelings such as disap-
pointment or anger in a couple relationship,
they are secreting vasopressin in the central
nervous system, which impairs sexual arousal
mechanisms and thereby inhibits the motiva-
tion for sex.
For men, rodent research is consistent with
laboratory findings indicating that vasopres-
sin secretion during the erectile response is
linked with men‘s awareness of sensations
and, importantly with the drive for sexual
expression. Other gender differences may also
be associated, neurobiologically, with these
peptides. From adolescence on, testosterone-
regulated vasopressin secretion in the preoptic
area of the hypothalamus may underpin the
greater response men have to visual stimuli in
the creation of genital changes and sexual
sensations. Sex and aggression circuits are in
close proximity in the brain of male rodents,
and boys often become more territorial and
hostile in their teenage years.
Sexual responses, emotional bonds
and oxytocin
Although both men and women release oxyto-
cin during arousal, sufficient oxytocin levels
seem particularly important for women’s
awareness of arousal mechanisms. If oxytocin
receptors are blocked in the ventromedial
hypothalamus of female rats, (the brain area
assocoated with many emotional and motiva-
tional processes), males who approach them
for copulation will be rejected or attacked [30].
When male rats palpate the flanks of females,
oxytocin secretion is stimulated and erotic
states are induced to prepare the female psy-
chologically for sexual activity [1].
In the clinical population, women who are
diagnosed with a desire disorder, whose pri-
mary issue is absence of psychological arousal,
not only describe negative feelings about their
relationship or about life-events, but also com-
plain of a lack of emotional intimacy and
affectionate physical contact. A woman’s sex-
ual needs are embedded in fulfilling emotional
attachments with an appreciative and loving
partner [26], and intimate sensual touch
and social closeness are stimuli that release
oxytocin [31]. Therefore a relationship with
positive thoughts, feelings and contact will
set the scene for psychological arousal and
sexual expression. Female arousal and hence
the motivation for sex may be significantly
impaired by insufficient oxytocin release
and/or a predominance of vasopressin. This
neurochemical balance is speculated to occur
when women feel neglected, undermined, or
hostile to a partner.
Loss of sexual interest and
negative emotions
Of particular relevance is the interaction
between oxytocin and the neurochemistry of
romantic attraction. Passionate feelings and
obsessivethinkingabouttheloveobject,
which often occurs when partners first meet,
have been identified as a neurotransmitter
balance in which dopamine (DA) and noradre-
naline (NA) are elevated and serotonin is
decreased [32].AsDAandNAcanregulate
the release of neuropeptides in the central
nervous system [25] strong romantic attrac-
tion at the start of a relationship constitutes
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Vol. 2, No. 3, pp. 339–345, September 2005 343

a brain state which facilitates sexual arousal
(in both sexes) through enhanced oxytocin
secretion. Arousal, pleasure and then motiva-
tion might, however, decrease in women if
initial passion and its neural correlates are
replaced by resentment and anger, the emo-
tional states (linked to lowered oxytocin and
increased vasopressin) that impair female
arousal responses.
From this perspective, changes to a relation-
ship over time are less likely to inhibit men’s
desire for sex, due to the many visual stimuli in
everyday life that cause mental arousal, and
the experience of sexual need linked to vaso-
pressin secretion during the erectile response.
Some men do lose sexual interest for a partner
in a committed relationship, despite adequate
testosterone levels. This change is less common
in men, but the psychological causes seem
more complex. Clinical experience and
research on the influence of thoughts and
feelings on men’s desire for sex shows that
some men lose sexual motivation with low
mood and others do not. A paradoxical
increase of sexual interest amongst men with
negative mood states was found in research
using both quantitative and qualitative mea-
sures [33]. This unpredictability points to the
need to look beyond the relationship context,
and highlights the importance of developmen-
tal history in the shaping of men’s sexual
response patterns. For women the research is
more clear-cut and reflects clinical practice. In
a study assessing the predictors and prevalence
of distress about sexuality in women, it was
negative mental states and negative feelings
during sexual activity with a partner that was
found to lead to sexual distress in most cases
[34].
Developmental history, sociocultural fac-
tors, individual personality and relationship
issues are all relevant to the understanding of
sexual motivation problems in women and
men. Anxiety and fear during childhood
may be particularly significant for the mean-
ing of sexual expression however, due to the
effect of stress hormones on the neural sys-
tems involved in sexuality, intimacy and
aggression. If circulating stress hormones (cor-
tisone and corticosterone) are consistently
high, the synthesis of receptors for oxytocin
and vasopressin may be impaired [25]:cogni-
tive and emotional links between intimate
contact and sexuality may be disrupted. Hence
a child who is exposed to situations such as
abuse, dysfunctional family dynamics or con-
sistent bullying may struggle to integrate
anxiety and anger into a later couple relation-
ship. Exploring this connection as part of a
therapeutic approach can increase under-
standing and alter feelings between partners,
facilitating the eventual return of motivation
for sexual contact.
Concluding comments
Within the framework outlined here, sexual
withdrawal is viewed as an adaptive mechan-
ism that protects from perceived threat or
harm. A review of the psychological conditions
that facilitate or impede sexual activity
between people points to the centrality of
negative emotions for women’s lack of sexual
arousal and desire. Less is known about the
predictors of men’s lack of motivation, but
clinical evidence suggests that damaging
developmental experiences (e.g. a boy’s inabil-
ity to cope with his mother’s intense emo-
tional needs) can be especially significant.
Unresolved issues from the family-of-origin
may be projected onto the current partner-
ship, and undermine desire [9].
Thorough assessment and psychological for-
mulation to uncover the meaning of sexual
withdrawal for each person is crucial for the
planning of appropriate treatment models.
Psychosexual therapy integrates behavioural
exercises using sensual and sexual touch and
stimulation with psychoeducation to help
partners understand the nature of the pro-
blem. In addition, object relations therapy
explores the re-enactment of past issues in
the present [9,35] and cognitive-behavioural
methods focus on dysfunctional beliefs and
assumptions about sexuality [36,37]. Other sys-
temic [38] and combined approaches [39] have
been described. An integrated psychosexual
model aims to develop understanding of the
difficulty whilst facilitating a gradual non-
threatening approach to increasing sexual
intimacy. Exploring misunderstandings and
conflict between people, and restructuring
emotional and physical contact may influence
underlying physiology, and thereby provides a
scientifically valid and clinically helpful
approach to sexual motivation problems in
women and men.
Practicing medicine
344 Vol. 2, No. 3, pp. 339–345, September 2005

Practicing medicine
For both men and women, feelings and thoughts affect sexual motivation.
Men and women differ in the links between brain responses (feelings and thoughts), genital changes and desire for sex.
Women are less easily aroused sexually because genital changes may not lead to subjective experiences of excitement.
Men’s sexual arousal and desire is more spontaneous than that of women, for whom relational factors are more central.
Lack of sexual motivation is frequently psychological in origin and reflects developmental and relationship issues.
Anger impairs sexual desire in women but not necessarily in men.
Oxytocin and vasopressin, neuropeptides that link brain and peripheral responses with sexual urges, may be associated
with gender differences in sexual motivation.
Psychological therapy aims to address partner-related factors and the meaning of sexual withdrawal for each person in
order to alter patterns of responding.
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