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Elucidating Women's (hetero)Sexual Desire: Definitional Challenges and Content Expansion

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Elucidating Women's (hetero)Sexual Desire: Definitional Challenges and Content Expansion

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The literature on women's sexual desire is reviewed with an emphasis on definitional challenges, an assessment of the empirical basis for the distinction between spontaneous and responsive desire, a reconsideration of the extent to which women's sexual desire is relational in nature, and an exploration of the incentive value of sex for women as a factor partially independent from the experience of sexual desire. Nine recommendations are made regarding research and diagnostic directions. The article concludes with an appeal for the inclusion of eroticism in research and clinical work on sexual desire.
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Elucidating Women's (hetero)Sexual Desire: Definitional Challenges and
Content Expansion
Marta Meana
a
a
Department of Psychology, University of Nevada, Las Vegas
Online publication date: 30 March 2010
To cite this Article Meana, Marta(2010) 'Elucidating Women's (hetero)Sexual Desire: Definitional Challenges and Content
Expansion', Journal of Sex Research, 47: 2, 104 — 122
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Elucidating Women’s (hetero)Sexual Desire: Definitional
Challenges and Content Expansion
Marta Meana
Department of Psychology, University of Nevada, Las Vegas
The literature on women’s sexual desire is reviewed with an emphasis on definitional
challenges, an assessment of the empirical basis for the distinction between spontaneous
and responsive desire, a reconsideration of the extent to which women’s sexual desire is
relational in nature, and an exploration of the incentive value of sex for women as a factor
partially independent from the experience of sexual desire. Nine recommendations are made
regarding research and diagnostic directions. The article concludes with an appeal for the
inclusion of eroticism in research and clinical work on sexual desire.
As the most subjective and acutely amorphous
component of sexuality, it is hardly surprising that
desire was bypassed by Masters and Johnson (1966) in
their quest to operationalize and measure the sexual
response. Yet, without the construct of desire, ill-defined
though it may be, the sexual response seems incomplete
and automatic. It lacks agency, and it does not align
well with the observed and self-reported complexity of
human sexual experience. As such, desire is increasingly
the focus of popular, scholarly, and clinical attention. It
has also become a battleground for differing theoretical
and political perspectives.
The attention, however, is focused almost exclusively
on the sexual desire of women, or supposed lack thereof.
As Maurice (2007) argued, desire problems in men are
‘‘simply off the radar’ (p. 182). The idea of men unin-
terested in sex is perceived to be an oxymoron by the
general public and many health professionals. Inaccur-
ate and unfortunate though these perceptions may be,
the recent focus on women appears to emerge from
the accumulation of data supporting the existence of
quantitative an d qualitative gender differences in desire.
Both in terms of self-report and behavior, men
consistently indicate that they have a greater interest
in sex than do wom en (see a review by Baumeister,
Catanese, & Vohs, 2001). This interest has been docu-
mented in terms of time spent thinking and fantasizing
about sex, in self-reports of desire, masturbation,
initiation of sex, and a number of other attitudinal
and behavioral indices. Women also perceive men’s sex
drive to be stronger (Regan & Berscheid, 1995, 1996).
Perhaps consequently, women report low desire much
more frequently than do men in multiple large-scale sur-
veys, including the National Health and Social Life Sur-
vey (NHSLS), the National Survey of Sexual Attitudes
and Lifestyles (Natsal), and the Global Study of Sexual
Attitudes and Behaviors (GSSAB). In the NHSLS, 27%
to 32% of sexually active women (n ¼ 1,749) and 13% to
17% of men (n ¼ 1,410) in the United States aged 18 to
59 reported lack of interest in sex over several months
or more in the prior year (Laumann, Paik, & Rosen,
1999). In the Natsal, 40.6% of 5,530 women in Britain
aged 16 to 44 reported low desire of one month’s
duration over the prior year, in contrast to 17.1% of
men surveyed (Mercer et al., 2003). Low sexual desire
was the most common complaint in women in the
Natsal, as well as in the GSSAB. The latter found a
prevalence of 26% to 43% for lack of interest in sex
among those sexually active in their sample of 13,882
women from 29 countries, aged 40 to 80 years (Lau-
mann et al., 2005), compared to a prevalence of 13%
to 28% in men. In their review of 11 studies inquiring
about desire, arousal, orgasm, and pain, Hayes, Bennett,
Fairley, and Dennerstein (2006) found that 64% of all
women with any sexual difficulty specified low sexual
desire to be the culprit.
Although the questions about sexual desire in these
non-clinical surveys were insufficient to diagnose
hypoactive sexual desire disorder (HSDD), data also
suggest that the most common presenting sexual
complaint in women attending clinics is low desire. In
contrast, men most often present with erectile difficulties
(see a review in Bancroft, 2009). Bachman (2006)
surveyed 1,946 health professionals attending four
major specialty conferences (the American College of
I am very grateful to James Cantor for his comments on an earlier
draft of this manuscript and to Daniel Watter for the helpful
discussions about women’s desire. I also thank the University of
Nevada, Las Vegas for their support of this project.
Correspondence should be addressed to Marta Meana, Depart-
ment of Psychology, University of Nevada, Las Vegas, 4505 Maryland
Parkway, Las Vegas, NV 89154-5030. E-mail: marta.meana@unlv.edu
JOURNAL OF SEX RESEARCH, 47(2–3), 104–122, 2010
Copyright # The Society for the Scientific Study of Sexuality
ISSN: 0022-4499 print=1559-8519 online
DOI: 10.1080/00224490903402546
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Obstetricians and Gynecologists, the Endocrine Society,
the North American Menopause Society, and the
American Society for Reproductive Medicine) and
found that 67% of respondents reported that low sexual
desire was the most common type of sexual dysfunction
among their female patients. Of note is the fact that 85%
of these health professionals believed HSDD to be a
medical disorder.
In addition to the gender differences in desire
reported in community and clinical samples, there also
appears to be a gender difference in the extent to which
arousal aligns with desire or with the intent to have sex.
Until recently, the assumption was that physiological
arousal, as indicated by erections in men and by
vasocongestion and lubrication in women, was inher-
ently connected to the subjective experience of sexual
feelings—‘‘interdependent aspects of the same under-
lying construct of arousal’’ as described by Rellini,
McCall, Randall, and Meston (2005, p. 116). The
assumption was premature. Women evidence a much
lower concordance rate than men between physiological
arousal and feeling ‘‘turned on.’’ In their meta-analysis
of 132 laboratory studies reporting a correlation
between self-reported a nd genital measures of sexual
arousal, Chivers, Seto, Lalumie
`
re, Laan, and Grimbos
(in press) found a statistically significant gender differ-
ence. Men (r ¼ .66) showed a greater degree of agree-
ment between self-reported and genital measures of
arousal than did wom en (r ¼ .26). Although there have
been suggestions that this gender difference may be a
function of measurement artifacts or socially desirable
responding on the part of women, the bulk of the data
generally does not support these possibilities (Chivers
et al., in press; Laan & Janssen, 2007).
Building on the work of Laan and Everaerd (1995),
an elegant series of studies by Chivers and colleagues
(Chivers & Bailey, 2005; Chivers, Rieger, Latty, & Bailey,
2004; Chivers, Seto, & Blanchard, 2007) confirmed the
comparative dissociation of genital and subjective
arousal in women. More pointedly, they suggested
that, in contrast to men, women’s genital arousal had
a weaker relation to their sexual preferences. Women
showed substantial, and not significantly different,
genital arousal to both preferred and non-preferred
stimuli. In other words, women showed signs of genital
arousal to stimuli that they subjectively reported to be
arousing, as well as to stimuli that they reported did
not ‘‘turn them on.’’ Men’s genital arousal, on the
other hand, more closely reflected their preferen ces.
In terms of stimulus features, sexual activity was a
stronger predictor of women’s genital arousal than was
the gender of the actors in the sexual films shown to
them, whereas the opposite was true for men (Chivers
& Bailey, 2005; Chivers et al., 2004; Chivers, Seto &
Blanchard, 2007). The partial independence of sexual
feelings from genital arousal is also supported by clini-
cal anecdotal evidence of women reporting lubrication,
vasocongestion, and even orgasm without any sexual
desire or even in the midst of unwanted or coercive
sex (Levin & van Berlo, 2004).
There may also be another dissociation in the story of
women’s desire: Even when desire is accompanied by
physiological arousal, it may still not have as strong a
connection to the wish to actually have sex as it has in
men. In Regan and Berscheid’s (1996) study about the
goals and objects of sexual desire, significantly more
men than women (70% vs. 43.1%) endorsed that sexual
desire was aimed at sexual activity. For many women
in that study, sexual desire was often aimed at a goal
other than having sex.
The high percentage of women reporting low desire,
their overrepresentation compared to men in the HSDD
diagnostic category, and the tenuous relationship of
desire to genit al arousal and (perhaps) to sexual action
tendencies (i.e., the intent to have sex) all raise questions
about the dominant conceptualizations of women’s
desire. In the past two decades, a number of researchers,
theoreticians, and clinicians have proposed that the
model of sexual response propagated by Masters and
Johnson (1966), by Kaplan (1974), and by the third
and fourth editions of the Diagnostic and Statistical
Manual of Mental Disorders (DSM; American Psychi-
atric Association [APA], (1987; 2000) has problematized
women’s sexual experience through the damaging appli-
cation of a male analog (Basson, 2000; Tiefer, 1991,
2001; Wood, Koch, & Mansfield, 2006). More specifi-
cally, this purportedly male analog makes erroneous
structural assumptions and omits important contextual
factors that result in the pathologizing of women’s sex-
ual desire and response. First, it assumes that sexual
desire is a spontaneous urge to engage in sexual activity.
Second, it assumes linearity in the sexual response, with
desire as the starting point and orgasm as the end point.
Third, it ignores the relational context that envelopes
sexual interactions. Fourth, it ignores the socioeconomic
and political forces that might shape and inhibit the
experience and expression of women’s sexual desire
and behavior.
These concerns have led to a reconsideration of
women’s sexual response as (a) more frequently respon-
sive rather than internally generated (Basson, 2001;
Diamond, 2006); (b) circular, with desire potentially
appearing at various points in the cycle and overlapping
with arousal (Basson, 2007; Laan & Both, 2008); (c)
relationally focused, with emotional intimacy both as a
generator of sexual desire (Diamond, 2004); and (d) a
reinforcer in the form of satisfaction (Basson, 2007;
Working Group, 2000). The larger social context is
explicitly stated to be a central feature (not just a
mediator) of the phenomenology of all aspects of the
sexual response and desire (Diamond, 2005; Tolman &
Diamond, 2001; Working Group, 2000). The explicit
aim of these approaches is to conceptualize women’s
desire in a way that more closely mirrors women’s
WOMEN’S (HETERO)SEXUAL DESIRE
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experiences and accounts for the restrictions placed
on the expression of their sexuality (Tolman, 1994;
Wood, Mansfield, & Koch, 2007).
Revisions to a reductionist view of women’s sexual
desire as a pure drive divorced from its relational and
social context were long overdue. Questions about the
validity of a diagnosis that could capture up to 40% of
women were also timely. However, we need to be mind-
ful of the momentum to over-correct. We could find
ourselves caricaturizing both male and female sexual
desire with the former portrayed as an unshakable,
appetitive drive with a near exclusive penchant for
novelty and anonymity, and the latter as a fragile intra-
psychic and interpersonal phenomenon requiring a deli-
cate calibration of love, intimacy, and multiple other
prerequisites. Neither biology nor social forces support
so stark a division, and there are enough available data
to keep our future deliberations on track.
Definitional Challenges
What is Sexual Desire?
Evocative though the word desire is, attempts to
define it have remained unsatisfying, especially in
disciplines concerned wi th operationalization. The clo-
ser one gets to operationalizing, the more behavioral
the definition. Levine (2003), for example, defined desire
as ‘‘the sum of the forces that lean us toward and pus h
us away from sexual behavior’’ (p. 285). Others have
opted for more inclusive definitions, such as Regan
and Berscheid (1999), who described it as ‘‘a psychologi-
cal 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). Note that in the latter definition,
sexual goals are not defined behaviorally or otherwise.
The problem remains that the very subjective experience
of desire has few reliable cognitive, physiological, or
behavioral referents, especially for women.
From a cognitive standpoint, subjective arousal
seems nearly indistinguishable from desire. A distinction
one could reasonably make involves the dimension of
distance (temporal or phy sical), as implied by the Regan
and Berscheid (1999) definition. Desire is separated
from its goal to a greater extent than is subjective
arousal, which may be experienced in closer proximity
to the desired stimulus. Alternately, others have sug-
gested that sexual desire is the awareness of sexual arou-
sal (Everaerd & Both, 2001). Basson (2007) proposed
that subjective arousal and desire overlap in the female
sexual response, without ever really distinguishing
between the two. The fact is that, currently, there is no
empirical basis for any of these distinctions between
subjective arousal and desire. The literature, however,
continues to use these terms as if they were empirically
differentiable constructs. They are simultaneously invoked
in models of desire, with specifications of the temporal
sequence in which they might occur. Subjective arousal
and desire may well be separate constructs, but
research has yet to support the division. Not surpris-
ingly, women make little distinction between subjective
arousal and desire (Brotto, Heiman, & Tolman, 2009;
Graham, Sanders, Milha usen, & McBride, 2004). If
women themselves do not distinguish between the
two, it is ha rd to imagine what type of data will sup-
port a distinction of two concepts that are nothing if
not subjective.
Another possible cognitive referent of desire might be
sexual fantasies. The data on the connection between
fantasies and desire in women, however, is scarce. In
the Beck, Bozman, and Qualtrough (1991) study,
women were asked to identify which of the following
most accurately reflected their level of sexual desire:
sexual dreams, sexual fantasies, sexual daydreams,
frequency of intercourse, frequency of masturbation,
number of sexual contacts not ending in intercourse,
and genital arousal. Only 6% identified sexual fantasies
as the most reflective of desire, and 17.9% endorsed sex-
ual daydreams. Purifoy, Grodsky, and Giambra (1992)
found sexual daydreams to be related to sexual drive
in their sample of 117 Danish women aged 26 to 78.
Forty-three percent of Ellis and Symons’s (1990) sample
of women endorsed excitement as accompanying their
sexual fantasies. This may directly relate to the finding
that women report willfully fantasizing in order to aug-
ment their arousal (Brotto et al., 2009; Lunde, Larsen,
Fog, & Garde, 1991; Purifoy et al., 1992). The findings
on the link between fantasies and sexual desire are
few and mixed; thus, it is reasonable to assert that
there are no consistently empirically validated cognitive
referents for sexual desire in women. Yet, part of the
definition of HSDD rests on the absence or deficiency
of fantasies.
The story is even shorter in relation to physiological
referents of desire. As discussed earlier, lubrication
and vasocongestion often occur in the absence of desire
or subjective arousal. These physiological changes are
even evidenced when women are exposed to stimuli they
decidedly do not identify as arousing (such as bonobos
copulating; Chivers & Bailey, 2005). Although women
do report physiological changes (genital and otherwise)
when they are ‘‘turned on,’’ the data suggest that it is
the desire or subjective arousal that cues them to recog-
nize the physical responses rather than the other way
around (Laan, Everaerd, van der Velde, & Geer, 1995).
The last in the list of unreliable referents for sexual
desire is behavior. There is a substantial body of
research indicating that women have sex for many rea-
sons unrelated to sexual desire (e.g., Hill, 1997; Hill &
Preston, 1996; Impett & Peplau, 2002, 2003; Meston &
Buss, 2007). Among young women engaging in consen-
sual sex that they do not actually want but agree to, the
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most commonly reported reasons given were to satisfy a
partner’s needs, to promote intimacy in the relationship,
to avoid rejecting a partner, and to avoid relationshi p
conflict (Impett & Peplau, 2002). In a sample of over
1,000 undergraduate women, the most commonly
endorsed nonsexual reasons for engaging in intercourse
were the expression of love, escalating the depth of the
relationship, curiosity or seeking new experiences, and
marking a special occasion for celebration (Meston &
Buss, 2007). Although desire may have occurred in these
interactions, the goals could conceivably be achieved in
ways other than through sexual activity.
Thus, considering that there are no consistent refer-
ents to sexual desire in women, it is not surprising that
the definition of HSDD in the DSMIVTR (APA,
2000) is almost necessarily tautological. With the excep-
tion of the mention of sexual fantasies, HSDD is defined
as deficient or absent desire for sexual activity. Conse-
quently, as Pfaus (2006) noted, ‘‘sexual desire is the pres-
ence of desire for, and fantasy about, sexual activity’’ (p.
465). The circularity is understandable but not helpful.
The emphasis on sexual activity may be additionally
problematic when it comes to women.
Desire for What by Whom?
Flummoxed though we may be in our attempts to
define and describe desire, the insertion of the adjective
sexual seems to clearly imply that what is desired is sex.
Yet, much of the literature already mentioned suggests
that, for women, sex may not always be the goal of sex-
ual desire (or the goal of behavior that looks indicative
of desire). This raises several important questions.
First, when women give love, intimacy, or relationship
promotion and maintenance as reasons for engaging in
sexual activity, should we consider these part and parcel
of female sexual desire, or are these non-desire-based
reasons for having sex, even if desire or subjective
arousal ensues? Does the cognitive and emotional experi-
ence of this type of sex differ from more pleasure- or
arousal-motivated encounters? If yes, how? Finally, if
subjective arousal and pleasure result from these nonsex-
ual motivations for sex, why would that ensuing pleasure
not become the reason for engaging in sex more fre-
quently than it does? More specifically, why do women
in long-term relationships who report pleasure when they
have sex, despite their low desire (e.g., Sims & Meana,
2009), not want to repeat the experience more often
than they do? This is a difficult set of questions, and
the answers would probably vary by situation and by
woman. Qualitative and experience-sampling research
might be best suited for their investigation.
Second, what if sexual desire is sometimes its own
end? What if being desired and desiring are turn-ons
for women, in and of themselves, without any necessary
further action? Women report that being desired is
arousing (Brotto et al., 2009; Graham et al., 2004).
Women also report that neither sex, nor intercourse,
nor orgasm are necessarily the goal of sexual desire
(Brotto et al., 2009; Regan & Berscheid, 1996). Could
it be that sometimes the feeling of desire is enough?
Although appetitive behaviors generally lead to consum-
matory behaviors in animal motivation models (Pfaus,
2006), there is also animal research that supports the
rewarding nature of evoking desire in potential mates.
Bancroft (2009, pp. 132–133) deftly reviewed research
suggesting that in the proceptive phase, female rats are
in control, darting and hopping around the interested
male, thereby pacing the frequency of his mounts. These
sexual contacts have been shown to be rewarding (as
evidenced by the conditioning of place preference) to
the female rat, quite apart from intromission. Further-
more, intervals between intromissions increase the
likelihood of conception. The generalization of these
results to women is, of course, speculative but not
unreasonable. Perhaps women also enhance their ability
to select a partner and pace the course of relationships
through the enactment of parallel behaviors. That they
would find these behaviors to be rewarding and arousing
would logically follow. This biological explanation
would, of course, have to be considered in light of
objectification theory. The latter would also predict that
being an object of desire would have arou sal value, yet
attribute it to a social order in which women are primed
almost exclusively for the role of sexual object rather
than sexual subject (Fredrickson & Roberts, 1997).
Regardless of theoretical explication, the role of
sexual object has its own important version of agency
and control.
Finally, we also have to consider the question of
‘‘desire for desire’’ (the extent to which a woman wants
and is motivated to feel desire when she does not feel
it). In a study of patient–clinician communication about
desire problems in the United States, Germany, and
France, clinicians and women both stated that the most
important goal of treatment was an ‘‘improvement in
levels of desire,’’ rather than an increase in the frequency
of sex or pleasure (Goldstein, Lines, Pyke, & Scheld,
2009). This may seem obv ious—the inference being that
higher desire would lead to more frequent and pleasur-
able sex. There are women, however, who have low or
no desire (whether lifelong or acquired) and feel no wish
or inclination to increase it for its own rewards. Either
they do not yearn to feel a desire they have never felt
or they do not miss the levels of desir e they used to feel.
When motivated to seek treatment, it is primarily
because of the relationship threat posed by the desire
discrepancy with their partners (for discussions of
discrepancy problems, see Clement, 2002; Zilbergeld &
Ellison, 1980). Perhaps women who never had a high
level of desire are less likely to mourn normative (age
and relationship longevity related) declines in desire. In
any case, we need more research on the factors that influ-
ence the experience of distress with declines in desire.
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Thus, what exactly is being desired is a central
question. If we conceptualize desire as a goal-driven
state having sex as the endpoint, we may be overlooking
the rewarding nature of desire itself. It is possible that,
for some women at some times, the very experience of
desire does not actually require any fulfilment in terms
of sexual activity. It could be that sex is judged not to
be worth the risk, effort, or other investment —that is,
there may not be sufficiently high incentive to act out
the desire. The large diff erences evidenced between
men’s and women’s interest in sex may be a function
of differences in the propensity to feel desire, but also
in the value placed on the fulfillment of felt desire. Only
research will sort this out, but these alternate theoretical
formulations first have to be considered.
As we go about trying to understand what women’s
desire is aimed at, culture will also have to be closely
examined. Currentl y, we have very little information
about the ways in whi ch non-Western women concep-
tualize or express sexual desire, as most of our data ema-
nates from North American and European populations
and is of an epidemiological nature. Laumann et al.’s
(2006) cross-cultural study of sexual well-being in men
and wom en aged 40 to 80 years across 29 countries
was one of the few studies to include non-Western
samples. Although not inquiring abo ut sexual desire
directly, that study revealed some similarities and differ-
ences across three clusters of nations, stratified by the
extent to which they represented male-dominated
cultures. All three clusters showed a gendered pattern
of response, with physical pleasur e, emotional pleasure,
satisfaction with sexual function, and importance of sex
reported as lower by women throughout, although these
differences were larger in the male-centered cultures. In
the multisite, multiethnic Study of Women’s Health
Across the Nation, Cain et al. (2003) investigated sexual
functioning in ethnic women aged 42 to 52 in the United
States. They found that Caucasian, African American,
and Hispanic women were more likely than Chinese or
Japanese women to endorse that sex was quite or
extremely important. The combined prevalence of ‘‘no
interest in sex’’ was close to 30%, but almost 50% of
Japanese women reported this to be a reason for not
engaging in sex.
Although these studies are important, they remain
epidemiological in nature and tell us little about how
sexual desire is defined and expressed by women in
different cultures. That would require a more qualitative
approach which would surely pose significant chal-
lenges, especially in cultures in which sexual topics are
taboo. In addition, culture and race are often proxies
for a number of other culture-re lated variables such as
socioeconomic status, education, acculturation, rural–
urban, and so forth (Helms, Jernigan, & Mascher,
2005). Finally, the cross-cultural validity of Western-
developed and normed measures of sexual desire
remains a question.
Thus, mindful of the indeterminacy of the construct
of desire or its goals and of the fact that almost all of
our data is Western based, I now turn to two prominent
issues regarding the characterization of sexual desire:
spontaneous versus responsive, and the primacy of
relational factors for women.
Linear Spontaneity or Circular Responsiveness?
As aforementioned, consistent reports of women
reporting fewer sexual fantasies or thoughts (Laumann,
Gagnon, Michael, & Michaels, 1994; Leitenberg &
Henning, 1995), less desire (e.g., Beck et al., 1991; Jones
& Barlow, 1990), and initiating sex much less frequently
than men (e.g., Byers & Heinlein, 1989; O’Sullivan &
Byers, 1992) have contributed to the development of
a theory of women’s desire as being substantially differ-
ent from that of men (Basson, 2007; Leiblum, 2007).
Although Basson’s (2001a) original article describing
her circular model of the sexual response was written in
reference to both men and women, the ensuing focus
has been almost exclusively on the model’s particular
applicability to women, especially in terms of desire
(e.g., Basson, 2000, 2001b, 2002, 2003a, 2003b). Briefly,
men’s sexual desire is conceptualized as more frequently
spontaneous and their sexual response as primarily linear.
Their desire often emerges in the absence of apparent
stimuli, and this urge leads in a sequential fashion to
arousal and then orgasm. In contrast, women’s desire is
conceptualized as, more often than not, responsive, and
their sexual response as circular. Given their supposed
lower frequency of an ‘‘innate sexual neediness’ (Basson,
2001b, p. 396), women are less likely than men to seek out
sexual stimuli. Their desire is more likely to be instated in
response to sexual stimuli. The two primary sexual stim-
uli are partner advances (the strongest and most available
sexual stimulus, especially for women without the spon-
taneous desire to seek out stimuli) or sexual activity
initially agreed to for nonsexual reasons. As such, desire
does not necessarily precede subjective or genital arousal,
although arousal can lead to desire. Emotional intimacy
is privileged as a central reinforcer (although not the only
one) that will facilitate (in a circular fashion) the
recurrence of sex. On the surface, this seems a reasonable
proposition that aligns suitably with a fair amount of
data; however, it is not without some problems, which
Inextaddress.
The Narrowing of Responsiveness
The inevitable, even if unintended, emphasis in this
model on responsiveness as receptivity to a partner’s
advances or arousability to sex once it has been initiated
(under the right conditions) is quite constricting. Sexual
stimuli come in many shapes and sizes and can be
both internal and external, biological, or situational.
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Yet, responsiveness to fantasies or erotica or novel
sexual stimuli or one’s own body as a sexual stimulus
(autoeroticism) are usually omitted from discussions of
responsiveness as a defining feature of women’s sexual
desire. The currently dominant version of female
responsiveness requires a very strong stimulus (i.e.,
partner initiation) and the calibration of numerous con-
textual factors (i.e., conditions have to be just right).
Sex is initiated via the sexual advances of a partner
or via a non-arousal-based motivation (e.g., intimacy
enhancement) on the woman’s part. If she proceeds to
have sex, despite an initial lack of sexual desire, there
is a second chance for desire to be triggered during
sex. Given sufficient and appropriate stimulation, the
desire may then kick in. This process is also purportedly
contingent on a number of relational and contextual
atmospheric factors.
According to Basson (2003b), a diagnosis of HSDD
would only be made if the woman in question could
not become aroused and feel desire once sex was under-
way with the right stimulation and in the right context.
There seems little question that prevalence rates for
HSDD would plummet under this definition of desire.
However, this construction of responsive desire invites
the following question: ‘‘Could the supposed spon-
taneous–responsive dichotomy not be a dichotomy at
all, but a rather a continuum of arousability wherein high
desire leans more toward the spontaneous end and lower
desire leans more toward the responsive end?’’ Maybe the
only difference between ‘spontaneous’’ desire and
‘‘responsive’ desire is the strength of the stimulus needed
to provoke desire and arousal. Maybe the spontaneous–
responsive distinction is related to excitation–inhibition
and reflective of the dual control model of sexual
response (for a review of the sexual control model, see
Bancroft, Graham, Janssen, & Sanders, 2009). This
model proposes that individuals vary in their neuro-
biological propensity for sexual excitation and inhibition
and that the multiple interpersonal, contextual, and cul-
tural influences on sexual arousal in a given instance
are mediated by psychological and neurophysiological
characteristics, which, in turn, have been influenced
by genetic factors and early learning experiences. The
spontaneous end of the desire spectrum may be associa-
ted with higher levels of excitation and the responsive
end with higher levels of inhibition. Women have been
found to score higher than men on sexual inhibition
and lower on sexual excitation using a version of the
Sexual Inhibition=Sexual Excitation Scales modified
for women (Carpenter, Janssen, Graham, Vorst, &
Wicherts, 2008).
The Relationship Between Narrow ‘‘Responsiveness’’
and Sexual Problems
The second problem with the drift toward a narrow
responsiveness theory of women’s sexual desire is that
it may be a more inclusive descriptor of women with
low desire than of women with no such co mplaints.
After all, Basson (2001b) developed her model of the
female sexual response partly by assessing 47 women
with a referral diagnosis of low sexual desire. Fifty
percent were assessed to have insufficient emotional inti-
macy and inadequate sexual stimuli (with an emphasis
on factors outside the bedroom such as an appropriate
atmosphere, partner’s consideration, respect , warmth,
and physical affection). The responsive model is also
often endorsed as particularly appropriate for women
who are older and women in relationships of long
duration (Basson, 2002; Leiblum, 2007). Declines in
sexual desire happen to be associated with these groups
(e.g., Dennerstein, Dudley, & Burger, 2001; Hayes &
Dennerstein, 2005; Laumann et al., 1994; Liu, 2003).
Maybe as desire declines, it becomes more ‘‘responsive’’
and less ‘‘spontaneous’ in nature; that is, it becomes
more fragile.
The association between this highly conditional type
of responsive desire and the existence of sexual problems
is also supported by findings relating to the development
and testing of the Se xual Excitation=Sexual Inhibition
Inventory for Women (SESII–W; Graham, Sanders, &
Milhausen, 2006). Its factor analysis with a sample of
655 women yielded two higher order factors, one related
to inhibi tion and one related to excitation. One of the
three lower-level factors related to inhibition was arousal
contingency, defined by the authors as the potential for
arousal to be easily inhibited or disrupted by situational
factors. Arousal contingency seems pretty similar to the
‘‘everything has to be just right’’ depiction of responsive
desire. In a later study investigating the relationship
between women’s scores on the SESII–W and sexual
problems, arousal contingency was a particularly strong
predictor of both current and lifetime sexual problems in
regression models, with a strong and positive correlation
with low sexual interest ratings (Sanders, Graham, &
Milhausen, 2008).
In relation to excitation, Graham et al. (2006) ident-
ified one of the related five sub-factors as sexual arou-
sability, defined by the authors as the tendency to
become aroused in a variety of situations. This factor
seems to reflect less specific arousal conditionality—
things did not have to be ‘‘just so’’ for desire to happen.
Relatedly, McCall and Meston (2006) found that
women with higher levels of sexual dysfunction had
lower scores on three of the four factors of their inven-
tory to identify cues that trigger sexual desire in
women. In other words, women with sexual problems
were characterized by lower sexual arousability—fewer
cues triggered desire.
Additionally, Sand and Fisher (2007) found that
women who scored in the sexually dysfunctional range
on the Fema le Sexual Function Inventory (FSFI)
were more likely to endorse a ‘‘responsive’’ model of
sexual response as reflective of their experience. This
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model was described as starting with neutral feelings,
progressing to desire according to either partner
advances or physical stimulation. Women who commu-
nicated that their experience fit this model scored
significantly lower on the desire, arousal, and orgasm
domains of the FSFI, relative to women who endorsed
models more descriptive of a ‘‘spontaneous’ process
that started either with excitement or desire. In another
similar study, Giles and McCabe (2009) also found the
linear model to be a better fit for the sexual response
of women without sexual problems. Basson’s (2000) cir-
cular model was, again, a better fit for the sexual
responses of women with sexual difficulties. Interest-
ingly, the fit of the Basson (2000) circular model was
improved for the combined sample of women with and
without sexual problems when desire and arousal were
collapsed into a single phase of the sexual response (a
further indication that the desire and subjective arousal
distinction may be spurious).
Can We Make the Spontaneous–Responsive Distinction?
The third, and most important, issue to consider in
our attempt toward a lucid conceptual ization of desire
for women is the problematic distinction between
spontaneous and responsive desire. Levin (2005) pro-
posed that the sexual response model for women should
incorporate two desire phases: The first phase (D1)
occurs before arousal or excitement, and the second
(D2) is concurrent with arousal. It is assumed that D1
is spontaneous, and D2 is responsive. Levin clai med that
we know little about the genesis of D1, but that D2 is
generated by either visual or physical stimulation. In this
configuration, D2 and arousal appear indistinguishable,
and we find ourselves back to the definitional con-
undrum we have already encountered—the distinction
between this supposedly ‘‘responsive’’ desire and
subjective arousal.
The motivational approach to sexual desire proposed
by a group of Dutch researchers (Both & Everaerd,
2002; Both, Everaerd, & Laan, 2007; Laan & Everaerd,
1995) posits that there is no such thing as Levin’s (2005)
D1, and that all desire occurs in response to stimuli
(either internal or external). Sexual stimuli are pro cessed
and propel emotional systems that result in physio-
logical changes (in the body and in the brain) that,
in turn, prepare the individual for sexual activity.
In women, these changes would include the relatively
reflexive genital arousal. As aforementioned, such
arousal occurs when women are exposed to sexual stim-
uli, regardless of their subjective evaluation of those
stimuli (Chivers, 2005). The changes would also include
neurobiological ones, such as pos sibly increased dopa-
minergic activity, especially when subjective arousal
is experienced (for a review, see Meston & Frohlich,
2000). Furthermore, the proponents of this model
present evidence that sexual stimuli are often processed
outside of consciousness (Both, Spiering, Everaerd, &
Laan, 2004; Spiering, Everaerd, Karsdorp, Both, &
Brauer, 2006). Accordingly, there is no such thing as
spontaneous desire, although it is quite possible for an
individual to have no sense of how the desire activated
and, therefore, to experience it as spontaneous. Perhaps
the spontaneous–responsive distinction is merely code
for ‘‘desire emerging from undetected stimuli’’ (as
opposed to desire emerging from identifiable ones).
The only remain ing ‘‘black box’’ is desire for desire
which, by virtue of our ignorance of whence it comes,
seems ‘‘spontaneous.’’
In this motivational iteration, desire always emerges
from the arousal that follows from exposure to stimuli.
The distinction between spontaneous and responsive
desire is moot. Compelling though this model is, the
continuing attempt to temporally separate desire from
subjective arousal remains an awkward glitch, an
unnecessary distinction in an otherwise solid theory.
Too often the distinction results in circular statements,
such as ‘‘feelings of sexual excitement and desire emerge
when motor responses enter consciousness through the
feedback of bodily and brain responses to the brain
[italics added]’’ (Both et al., 2007, p. 336). If desire is
awareness of subjective arousal, then it would be simpler
and more empirically valid at this stage, as discussed
earlier, to propose that, until proven otherwise, desire
is essentially a synonym for subjective arousal, for most
intents and purposes.
Broadly Defined Responsiveness and Diversity
Considering that the concept of spontaneous desire
appears, at the moment , mostly to reflect our
ignorance of the cues that gave rise to it, getting rid of
it altogether might be more useful to the research,
clinical, and social enterprises. The consideration of
all sexual desire as responsive, broadly defined, may
help to focus our efforts on the determinants of respon-
siveness and to provide a framework of desire that
includes the diversity of all women’s experiences of
desire. The focus on all desire as a response might also
forestall the entrenchment of a separate drive theory
for men, one that reduces their desire to an unstoppable
and indiscriminant force, untouched by context. The
data do not support that distinction (e.g., Janssen,
McBride, Yarber, Hill, & Butler, 2008; Meston & Buss,
2007) and, moreover, the division is a socially dangerous
one. Although the male sex drive in much research
appears to be hardier, it is indeed impacted by social
forces, relationships, and feelings of self-worth. A focus
on all sexual desire as responsive would go some way
toward respecting those data and contesting the
dangerous perception in both men and women (e.g.,
Regan & Berscheid, 1999; Wood et al., 2007) that men’s
supposedly spontaneous desire is a purely biological
force seeking an outlet.
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The Question of ‘‘Relationality’’ in Women’s
Sexual Desire
Another major component of the move toward the
reconceptualization of women’s desire is the contention
that it is primarily relationally driven and dependent.
There is indeed a great deal of empirical support for
the importance of relationship factors to women’s sexual
desire. The research on sexual fantasy has repeatedly
shown that women’s fantasies have higher romantic–
emotional content than those of men (Kimmel & Plante,
2002; Leitenberg & Henning, 1995; Zurbriggen & Yost,
2004). Women also commonly report that relationship
factors are arousing. Among these are feeling desired,
feeling accepted (Brotto et al., 2009; Graham et al.,
2004), open communication (Byers, 2001), and intimacy
(Regan & Berscheid, 1996). In one recent study of 356
Australian women (ages 20–70), relationship factors
were more important in predicting low desire than age
or menopause (Hayes et al., 2008). Some studies also
show that women with sexual problems tend to attribute
them to relationship difficulties (e.g., King, Holt, &
Nazareth, 2007).
In his review of the literature supporting greater
erotic plasticity in women than in men, Baumeister
(2000) suggested that women are willing to have sex
either with or without desire, in part, to develop or
maintain relationships. He further explained such flexi-
bility to be a function of their lower sexual desire, which
makes the suboptimal sexual outcomes seem more
acceptable (a finding contested by Lippa’s [2007] finding
that for heterosexual women, but not men, sex drive
correlated with attr action to both men and women). In
disagreement with Baumeister, Diamond (2006) argued
that women’s erotic plasticity is rather a reflection of
their wide-ranging sexual arousability or fluidity. This
fluidity allows for sexual desire to emerge from valued
relationships, which is why women are less constrained
by the gender of their sexual partners and more focused
on the person. In either Baumeister’s or Diamond’s
(2006) explication, relationships are posited to dominate
women’s sexual ch oices.
Unquestionably, sexual desire almost necessarily
implies an intrinsic yearning for the other (with the
exception of autoeroticism and certain paraphilias
characterized by what Blanchard (1991) has termed
‘‘erotic target location errors’’; for a review, see
Lawrence,2009).Inwomen,thisorientationtoward
the other appears to be m ore nuanced than in men:
The desired other is more often described by w omen
with attributes other than those pertaining strictly to
physical appearance (e.g., Ellis & Symons, 1990;
Regan & Berscheid, 1996). H owever, the purpose of
the oth er (nuanced or not) in any interaction needs
a closer look in our assessment of the true ‘‘relation-
ality’’ of any encounter. Relationship-focused though
women’s sexuality may appear, a number of questions
challenge the primacy of relationships in relation to
women’s desire. There are also sufficient data to
broaden this perspective so that we can encompass
all of women’s desires.
Is Responsiveness Strictly Relational?
Whether responsiveness is used to describe a
woman’s willingness to go along with a partner’s
advances or her ability to be aroused by that partner,
the sexual desire literature has imbued the term with a
relational quality. Responsiveness to an other is asso-
ciated with relationality, but there is a vexing lack of
reciprocity in the term that does not seem entirely
relationship focused. The focus is one-directional inso-
far as initiation of the activity is relegated to the other
and, by implication, so is the motivational aspect of
desire. The nature of women’s sexual desire may differ
from that of men, but it is hard to get away from the
fact that really wanting something is usually
accompanied by agency. As Pfaus (2006) put it in
relation to animal models, ‘‘Females (and males) that
want sex focus their attention on sex and work hard
to get what they want’’ (p. 474). If women do not
appear to be working that hard to get sex, what are
they working to get? One possibility mentioned
already is the rewarding nature of desire itself. In their
study of sexual fantasy, Zurbriggen and Yost (2004)
found that desire and sexual pleasure were two dis-
tinct factors in women’s narratives of their fantasies.
For men, however, desire and sexual gratification were
strongly correlated.
Being desired is very arousing to women (Brotto
et al., 2009; Graham et al., 2004), but how relational
is the wish to be desired? Certainly, being desired sug-
gests a regard for any one given woman’s unique per-
sonal characteristics rather than to an indiscrim inate
wish to have sex with anyone; however, the reciprocity
we tend to link with relational perspectives is, again,
missing. Arguably, wanting to be desired may privi-
lege the attention or advances of strangers who (at
least in fantasy) are free to choose anyone and choose
you. In his sample of 788 British men and women
(ages 17–57), Wilson (1997) found that one-fourth to
one-third of men and women fantasized about sex
with a stranger. Kimmel and Plante (2002) found no
gender difference in the prevalence of stranger
fantasies. External validation of desirability may be
an important part of desire for men and women,
and such validation may carry ex tra weight when it
emanates from individuals who are not institutionally
bound to them (as in marriage).
The Mixed Bag of Fantasies
Although romantic themes predominate in the
fantasies of women, there are at least three reasons to
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attenuate conclusions about the relationality of women’s
desire based on these findings. The first is the preponder-
ance of very young samples in the fantasy literature,
primarily college students (see a review by Leitenberg
& Henning, 1995). It is hard to know what bias this
youth introduces, but the proportion of romantic
themes in women’s fantasies may be one of these. It is
reasonable to posit that once a long-term partner has
been secured, ‘‘getting married’’ would no longer be a
‘‘sexual fantasy,’’ whic h it had been for 49% of women
and 27.8% of men in one sample (Hsu et al., 1994). In
contrast, in a sample composed of both college students
(average age of 19) and community members (average
age of 42.8), relationship length was significantly related
to extra-dyad ic fantasies. The fantasies became more
common the lon ger the men and women had been in a
relationship (Hicks & Leitenber g, 2001). In Wilson’s
(1997) older sample, there were indications of a conver-
gence of male and female fantasies toward middle age.
More research on the content of sexual fantasies in older
men and women is warranted.
The reporting of ‘‘being overpowered’’ or ‘‘rape’’
fantasies in 31% to 57% of women, 9% to 17% of whom
say these are a frequent or favorite fantasy (for a review,
see Critelli & Bivona, 2008), is another finding that
might indicate co mponents of some women’s sexuality
are not particularly relational. In their content analysis
of rape fantasies, Bivona and Critel li (2009) found that
45% of them were described as completely eroti c,
containing no aversive elements. Although not enough
data are available to explain the existence of these fanta-
sies, one of the more persuasive explanations for the
‘‘being overpowered’’ fantasy is that it arouses by virtue
of its assertion of the woman’s irresistibility (Critelli &
Bivona, 2008). Another instance of desirability without
implication of surrender featured prominently in
Strassberg and Lockerd’s (1998) study: 47% of women
reported the fantasy of ‘‘seeing themselves as a striptease
dancer, harem girl, or other performer,’’ and 50% had
fantasized about ‘‘delighting many men’’ and being an
‘‘irresistibly sexy female.’’ Out of a list of 16 fantasies ,
the latter had the fifth highest mean frequency per
month (5.3). It is important to note that men also find
being desired to be very arousing (Janssen et al., 2008)
and that a significant number of them also report ‘‘being
forced to submit’’ as a recent sexual fantasy (Hsu et al.,
1994; Morin, 1995).
A final interesting aspect of women’s fantasies in
terms of their deviation from the relationship focus is
the common finding that women’s sexual fantasies
appear to be more focused on receiving pleasure than
on giving it. In their revi ew, Leitenberg and Henning
(1995) found that women, more than men, fantasize
about something sexual being done to them than about
them doing something sexual to their partner. Ellis
and Symons (1990) found that women’s fantasies
tended to focus to a greater extent than those of men
on their own responses and on how their imagined
partners respond to them. Zurbriggen and Yost
(2004) concluded from their findings that, in fantasies,
women emphasize their own needs rather than those
of their partners. These fantasies may or may not
reflect how women actually behave during sex, but
it again challenges the near exclusive emphasis on
relationality as a characteristic of women’s sexuality
in the literature.
Declining Desire in Long-Term Relationships
Although emotional closeness and intimacy are much
vaunted for their role in women’s sexuality, the data
indicate that long-term relationships have a dampening
effect on sexual desire and satisfaction in both men
and women (e.g., Laumann et al., 1 994; Sprecher,
2002). Many studies point to a decrease in the frequency
of intercourse over the course of a relationship (for a
review, see Baum eister & Bratlavsky, 1999). Although
longevity does not ensure closeness, these qualities are,
at the very least, theoretically linked and should show
some positive association. Yet, as relationships mature,
sexual activity declines. Age is a factor, but it is not the
whole story: Reductions in sexual activity and satisfac-
tion are evidenced in the relatively young relationships
of college students, and sexual desire declines specifically
in women only (Klusmann, 2002). Furthermore, indivi-
duals who remarry show increases in the frequency of
sex (Call, Sprecher, & Schwartz, 1995).
In a qualitative study of highly educated married
women complaining of decreases in desire during their
marriage, Sims and Meana (2009) found that women’s
causal attributions for the decline could be organized
into three major themes: The first of these was the insti-
tutionalization of the relationship. Many blamed the
formalization of their union for having robbed sex of
a sense of transgression that they had previously fou nd
sexy with new lovers. Sex had become an obligation
rather than a suspension of the mundane. The secon d
theme was overfamiliarity, which related to the gradual
loss of individu ality and the devolution of sex into a
mechanical, rigidly scripted, orgasm-centered exercise.
The third theme was related to de-sexualized roles asso-
ciated with most of their daily activities. Enacting their
roles as mothers, homemakers, or professionals in the
workforce, felt largely incompatible with the sexual role
they felt expected to adopt in the bedroom. They had
stopped seeing themselves as sexual or as sexually
desirable, despite their husbands’ compliments and
assurances. These results resonate with Perel’s (2006)
theoretically and clinically derived contention that
intimacy and closeness can have a dampening effect on
sexual desire.
In line with this, McCall and Meston (2006) found
that married women had lower total scores than
unmarried women on the Cues for Sexual Desire Scale.
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Even more interesting, the only individual factor on
which they scored significantly lower was the love–
emotional–bonding cues factor. In comparison to
unmarried women, they were less likely to endorse items
such as ‘‘feeling a sense of love with a partner’’ and
‘‘experiencing emotional closeness with a partner’’ as
triggering desire for sexual activity. Although sexual sat-
isfaction and relationship satisfaction have been consist-
ently linked in women (for a brief review, see Byers,
2001), it has been difficult to establish a direct
association. In a longitudinal study involving two
questionnaire administrations (one at the start of the
study and one 18 months later), Byers (2005) investigated
whether changes in sexual satisfaction or relationship
satisfaction scores at Time 2 could be predicted by
existing scores at Time 1. She did not find evidence for
a causal direction. Relationship and sexual satisfaction
changed concurrently from Time 1 to Time 2. It thus
remains unclear whether relationship satisfaction engen-
ders sexual satisfaction, whether causality runs the other
way, or whether an altogether different (and possibly
more complex) dyn amic is in place.
In their analysis of sexually active 40- to 59-year-olds
from the NHSLS dataset, Carpenter, Nathanson, and
Kim (2009) found that women’s emotional satisfaction
was closely associated with bodily sexual practices
(a variable that combined sexual frequency, regularity
of orgasm, duration of most recent encounter, and
engaging in oral sex). Almost 20 years earlier, Beck
et al. (1991) found that correlations observed in her sam-
ple between love and sexual desire were low for both
men and women. Fifteen years before that, Heiman
(1977) found that romantic context in audiotaped stim-
uli did not facilitate arousal in either men or women.
Also contrary to the dominant narrative about male
and female sexuality, Carpenter et al. (2009) found that
men’s physical pleasure was associated with relational
factors (cohabitation status, duration of relationship
since first sex, and time partner known before first sex).
The importance of emotional and relational factors to
men’s sexuality was also highlighted by Meston and
Buss’s (2007) study investigating the reasons people give
for having sex. Although gender differences abounded,
men and women did not differ on two of the 13
sub-factors: love and commitment, and expression. As
many men as women endorsed items such as, ‘‘I desired
emotional closeness.’’ All of these data serve as reminders
that neither men nor women fit neatly into starkly gender
differentiated narratives, even when these pertain to sex.
Self-Focus
An increasing body of data is indicating that the
way women feel about themselves may be very impor-
tant to their experience of sexual desire and subjective
arousal, possibly even outweighing the impact of their
partners’ view of them. Most of this research has
focused on self-consciousness mostly related to physical
appearance. In one study, approximately one-third of
female college students indicated that they experienced
body imag e self-consciousness during physical intimacy
with a man (Wiederman, 2000). After controlling for
actual body size, body image, sexual anxiety, and well-
being, scores on a measure of women’s body image
self-consciousness during physical intimacy with a
partner were predictive, among other things, of sexual
avoidance. Meana and Nunnink (2006) found that
women reported more appearance-based distraction
during sex than did men and that they were more likely
to become distracted by negative evaluations of their
own bodies than were the men, as evaluated through
self-report. Sexual satisfaction was also negatively
correlated with appearance-based distraction in both
men and women.
However, a number of studies indicate that it is the
valence of self-focus during sexual activity that is the
greater predictor of sexual enjoyment. When that
valence is positive, self-consciousness can be a boost to
desire. In Graham et al.’s (2004) focus group study,
feelings about one’s body were identified as important
facilitators to arousal. In the words of one woman from
that study, ‘‘It’s much easier for me to feel aroused when
I’m feeling comfortable with myself.’’ Trapnell, Meston
and Gorzalka (1997) found that self-focused attention in
the women in their study correlated with positive body
image. Public self-consciousness was positively corre-
lated with flirtatiousness. Furthermore, an internally
consistent composite of three traits linked to disposi-
tional non-pathological narcissism (flirtatious,
seductive, and fashionable) significantly predicted sexual
experience among men and women. Thus, posit ive
self-focus may be a significant facilitator of desire. This
finding also raises the issue of autoeroticism or the
extent to which one’s appraisal of oneself as sexy is
arousing in and of itself. A recent study with a smal l
sample of 29 women reported that one-third to one-half
of them repo rted arousal to contemplating themselves
nude, wearing sexy lingerie or clothes, grooming activi-
ties, imagining that others find them irresistible, and so
on (Moser, 2009). A woman’s feelings about her own
sexiness and the extent to which she engages in
non-masturbatory autoeroticism may be important
arousal contingencies warranting more research and
clinical attention. Interestingly, men in Janssen et al.’s
(2008) focus group study themselves said that how the
woman felt about herself was an important inhibiting
or excitatory factor for them.
The potentially strong relationship between women’s
feelings about themselves and their sexual desire and
subjective arousal is not limited to their bodies. Lykins,
Janssen, and Graham (2006) found that women repor-
ted more negative effects of anxiety and depressed
mood on sexual interest and response than did men.
Negative mood was another major inhibition theme in
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Graham et al.’s (2004) study of women’s arousal. Kuffel
and Heiman (2006) showed that women with and with-
out depressive symptomatology who were asked to
adopt a positive sexual self-schema prior to viewing ero-
tic stimuli demonstrated significantly greater subjective
arousal and vaginal response than women in a negative
schema condition. Mood state also emerged as an
important theme impacting the sexual arousal of men
in Janssen et al.’s (2008) study, but there was a curious
difference. Janssen et al.’s men reported on the impact
of both their own mood and that of their partner’s on
their sexual arousal, whereas no partner factors emerged
as prominent themes in Graham et al.’s (2004)
analogous study on women.
Encompassing the ‘‘Relationality’’ Spectrum
Although it is unquestionable that relationship factors
are very important to women’s sexual desire and subjec-
tive arousal, the data include sufficient deviations from a
strict relational perspective to broaden our framework.
In and of itself, responsiveness is not necessarily rela-
tional; large minorities of women fantasize about decid-
edly non-relational themes; sexual desire declines in
committed long-term relationships—all of which cannot
be intimacy challenged; the way women feel about them-
selves is clearly emerging as an important component of
their sexuality, quite apart from how they feel about their
partners. A close look at the data also shows that signifi-
cant similarities between men and women are important
to note, lest we make a caricature of both.
The M issing Link : The Incentive Value of Sex
for Women
As we struggle with the definitional challenges posed
by sexual desire and the ways in which the nature of
women’s desire resembles or differs from that of men,
the fact remains that women do not express or report
or exhibit as much interest in having sex as men do. Some
dismiss questions regarding this sex difference as uninfor-
mative relative to other more nuanced questions (Tolman
& Diamond, 2001). Others fall back on the periodicity of
women’s sexual desire and assert that when women
have sexual desire, it is as intense an experience as men’s
desire (Wallen, 1995). Yet others wonder if those gender
differences would evaporate given some future ‘‘broad-
spectrum freedom’’ (Tiefer, 2001). The extent to which
this gender difference is biologically determined, adapt-
ive, or a function of the social suppression of women’s
sexuality are important concerns at the heart of much
current theorizing. Interestingly, the literature’s struggle
to wrestle with women’s comparatively low desire is
apparently not shared by women themselves, most of
whom who do not appear nearly as distressed about their
desire levels as sexology is.
Caring About Sexual Desire
In a Swedish study of 1,335 women (aged 18–74),
only 43% of those who reported decreases in sexual
interest ‘‘quite often’’ or ‘‘most of the time’’ viewed their
desire level as a problem (Fugl-Meyer & Fugl-Meyer,
1999). Bancroft, Loftus, and Long (2003) interviewed
987 American women aged 20 to 65 and found that
24.4% of them reported marked distress about their sex-
ual relationsh ip or their own sexuality. Younger wom en
(aged 25 to 36 years) were more likely to view their lack
of sexual thoughts as distressing compared to women
over 36. The best predictors of sexual distress were
general emotional well-being and emotional well-being
with partner during sex. Arousal, lubrication, and
orgasm were poor predictors of sexual distress. Leiblum,
Koochaki, Rodenberg, Barton, and Rosen’s (2006)
reporting of data from the pharmaceutically funded
Women’s International Study of Health and Sexuality
(WISHeS) on 952 American women found prevalence
rates for low desire to range from 24% to 36%, depend-
ing on age and menopausal status. In contrast, the rates
for combined low desire and distress ranged from 9% to
24%. Dennerstein, Koochaki, Barton, and Graziottin’s
(2006) analysis of the WISHeS data from a sample of
2,467 European women (aged 20–70) found similar rates
of low desire: 16% to 46%. These plummeted to 7%
through 16% if distress was added as a criterion, how-
ever. In a national probability sample of 2,207 women,
West et al. (2008) found an overall prevalence of low
desire of 36.2%, but the prevalence of low desire char-
acterized by distress about the low desire was only
8.3%. Fifty-five percent of Witting et al.’s (2008) sample
of 5,463 Finnish women reported low desire, but only
23% experienced dist ress associated with it. Shifren,
Monz, Russo, Segreti, and Johannes (2008) found a
prevalence of low desire of 38.7% in a sample of
31,581 American women with a mean age of 49. The
prevalence of low desire combined with distress about
it was only 10%, however. Rosen et al.’s (2009) further
analyses of this dataset indicated that 71% of partnered
women with low desire nonetheless reported being
happy with their relationship.
Goldstein et al. (2009) found that neither clinicians
nor patients in their study favored the word distress.It
seemed a little overwrought to them and implied a level
of severity that the condition of low desire did not
warrant. This interpretation of the word distress may
be a factor in women’s much less frequent endorsement
of distress accompanying low desire than their endorse-
ment of low desire alone. On the other hand, other
studies that have not used the word distress have
nonetheless found that women are less concerned about
sexual difficulties than are men. In King et al.’s (2007)
study of 401 consecutive female attendees of general
medical practices in London, 38% were assessed to have
at least one International Classification of Diseases–10
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diagnosis of sexual dysfunction (World Health Organi-
zation, 1992). That rate contrasts with 18% when it
included the criterion that the women perceive that they
had a problem . The rate fell further, to 6%, when the cri-
terion was that women also rate the problem as moder-
ate or severe. Interestingly, 19% of the women who were
not diagnosed as having a sexual problem perceived
themselves to have one. The GSSAB asked men and
women (aged 40–80) across 29 countries how important
they judged sex to be. Men rated sex as more important
than did women in all three clusters of countries, which
were classified according to culturally normative atti-
tudes toward sexuality (Laumann et al., 2006). Also
using the construct of importance, Lindau et al. (2007)
found that in their national probability sample of
3,005 ad ults (aged 57–85), 35% of women and 13% of
men rated sex as being ‘‘not at all important.’’
When women report low desire (with or without
distress), it is not always easy to know how they arrived
at that assessment (Segraves & Woodard, 2006). Are
they comparing their level of desire to an earlier, more
intense, one; or are they comparing their desire to that
of men and consequently judging their desire levels
accordingly, even when they do not care about the
difference? Nicolson and Burr (2003) argued that the
sexology literature has promot ed the existence of a
mythical standard of female sexuality against which
women measure themselves. Without this assumption
regarding how much desire is normative or ‘‘healthy,’’
perhaps fewer women would report low desire. Nicolson
and Burr also argued that sexology is focused on sexual
fulfillment, with the consequent pathologizing of sexual
experiences that do not end in such fulfillment.
What Price the Fulfillment of Desire?
Regardless of the nature of the biological and
situational excitatory and inhibitory forces determining
whether (and how much) sexual desire a woman will
experience, the question of the value placed on the ful-
fillment of that desire onc e it is engendered might be a
different one. We have already covered data suggesting
that, even when women feel desire, they do not always
feel compelled to fulfill that desire. By their account, it
does not always have to end in foreplay, intercourse,
or orgasm. Although the field is starting to accumulate
data about the factors that facilitate (or inhibit) sexual
desire in women, we do not know much about the
factors that lead from desire to sex. Mediators of desire
and mediators of action tendencies toward sex, once
that desire begins, may be strongly related, but
there may also be some significant differences between
the two.
Incentive motivation models may be particularly
useful in helping us understand action tendencies toward
sex. Sexual desire does not always lead to sexual action,
which may be attributable, in part, to a distinction
between sexual desire and sexual motives. In his study
of sexual motives and their relationship to global sexual
desire, Hill (1997) concluded that sexual motives were
independently correlated with sexual behavior in certain
situations. The prediction was that when the sexual
incentive is judged as likely to align with the motive,
action will take place. Hill further posited that reactions
to incentive-specific sexual situations will be more
strongly related to sexual motives than to sexual desire.
Although his study was limited to the measurement of
global sexual desire rather than of desire in any specific
situation, it was an attempt to test the partial indepen-
dence of sexual desire from sexual motivation.
Proponents of the incentive motivational model of
sexuality, Both et al. (2007) contend that interaction
with sexual stimuli generates an affective response. Part
of that affective response is the generation of an action
tendency. The action tendency thus requires (a) an inter-
nal state or disposition to respond to sexual stimuli, (b)
competent sexual stimuli (i.e., incentives), and (c) rules
of access to the desired object as dictated by social
mores and interpersonal politics (Everaerd & Laan,
1995; Singer & Toates, 1987). Thus, this group of
researchers equates incentives with sexual stimuli, strong
sexual stimuli being strong incentives. That certainly
seems a reasonable propo sition; but it is possible that,
at least for women, an incentive evaluation occurs
separately from and consequent to the evaluation of sex-
ual stimuli. In other words, a sexual stimulus can be very
competent and very arousing. Excitation may be stron-
ger than inhibition, and desire or subjective arousal may
be felt and enjoyed, at little cost thus far. However,
despite feeling a considerable amount of desire as a
function of exposure to the stimulus, the woman may
then decide not to engage that stimulus in action
because she assesses the cost of that action to be
excessive. Perhaps it involves an unacceptable level of
risk or, alternately, perhaps she does not assess a forth-
coming increase in benefits. Although the incentive
value of the stimulus was sufficient for experiencing
desire, the incentive value of the sex is not sufficient to
act on.
In his proposal of an integrative theoretical frame-
work for sexual motivation, arousal, and behavior,
Toates (2009) proposed that excitation and inhibition
act at various levels in a hierarchical structure. We have
covered how excitation and inhibition might function to
facilitate or dampen the experience of desire after
exposure to a stimulus, but this may happen again when
a decision to act on the desire takes place. Arguably, this
second level may be a more conscious process than the
first—that is, more of a strategic evaluation of the
incentive value of sexual action. ‘‘Putting on the brakes’’
was a theme identified by Graham et al. (2004) as a
common reaction of women to sexual situations that
were arousing, yet judged as not worth the cost of
action. Sometimes, the incentive evaluation can be
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negative because of significant safety concerns (i.e.,
going home with a man she just met at a club and knows
nothing about other than the fact that he is very sexy).
Sometimes the negative evaluation can be more mun-
dane, such as that of one married woman in the Sims
and Meana (2009) study who, even when she felt desire,
sometimes decided not to have sex because ‘‘It takes too
much time, and I’m tired, and I want to go to sleep.’’
Previous experi ences with the quality of the sexual
experience (i.e., satisfaction or eroticism) surely also
play a role in this process.
Liking Sex is Not Necessarily Wanting Sex
The instability of the relationship between sexual
desire and sex in women may be related to the distinc-
tion between ‘‘wanting and liking,’’ as reviewed by
Toates (2009). He reminds us that, although the motiva-
tional literature used to assume that ‘‘we like what we
want and we want what we like,’’ wanting and liking
are clearly dissociable. One could, for example, want
sex without liking it that much (nonsexual reinforcers
may be driving the wanting), and one could like sex
without wanting it very often, since social or interper-
sonal inhibitors may be at play. However, it can be
much simpler than that. Liking something does not
necessarily mean we yearn to repeat the experience.
Any number of satisfying activit ies do not beg for fre-
quent or even regular re-experiencing (e.g., eating a slice
of rich chocolate cake, a road trip, or a spa day). Cer-
tainly, it has been common enough in my clinical prac-
tice to see women who say they enjoy sex when it
happens, but do not much care if it ever happened again.
A related sentiment was expressed by wom en in Graham
et al.’s (2004) study, a number of whom said, ‘‘It’s
almost like you can turn it off and on when yo u want
to,’’ ‘‘It’s a lot easier for a girl to walk away from a situ-
ation,’’ or ‘‘You can just shut it off.’’
Toates’ (2009) work pointed to a literature indica ting
that wanting and liking are linked to different process es
in the brain, similar in men and women, but perhaps
differently calibrated. Quoting Symons (1979), Toates
suggested that gender differences in responsiveness to
sexual stimuli may not actually be as large as gender
differences at the level of wanting, rather than of liking.
Certainly, it is very common in therapy with desire-
discrepant couples to hear men express confusion at
what they think is the disconnect between their female
partners’ apparent enjoyment of sex when it happens
and their lack of desire to repeat the experience.
Teasing Apart What Turns Women on From
What They Value
The issue of incentive evaluation raises the possibility
that what turns women on and what they value in any
given situation, or even globally, may not always be in
synchrony. Sexual desire and romantic or other types
of love (e.g., companionate) can and do co-occur.
However, it may be quite common that these do not
align, and it may be important to distinguish between
what turns women on and what they value, if we are
to understand wom en’s sexuality. Sexual desire and sub-
jective arousal may be driven, to some extent, by unruly
and occasionally disturbing forces (e.g., anxiety, domi-
nation, or danger) that, though arousing, are not
assessed to be worth their poten tial cost. It is relatively
clear at this point that, although sexual desire and sexual
activity are related, it is rarely a beeline from one to
the other for women. If love and sexual desire arise
from two different systems, as Diamond (2004) and
Fisher (2000) proposed, it is possible that sometimes
they may constitute competing drives in which romantic
or companionate love exerts more of an influence on
women’s sexual choices than does sexual desire. Less
than optimally arousing sexual choices are likely often
made in exchange for relat ional qualities that are
more highly valued. Thus, focusing on women’s sexual
choices may not necessarily be informative about their
sexual desires.
Moving the Sexual Desire Research and Clinical
Enterprise Forward: Nine Recommendations
The indeterminacy of sexual desire has made it fertile
ground for the clash of different theories and political
positions. With barely lucid constructs guiding the
research and clinical effort, it is no wonder that con-
fusion reigns. In the name of women, some are genuinely
working hard to find effective treatments for women’s
sexual ‘‘dysfunctions,’’ whereas others are just as genu-
inely mobilizing to tell women that they may be victims
of a system that seeks to impose sexual standards that
serve patriarchal and economic hegemonies. Despite
good intentions on both sides, real-world women may
get caught in the crossfire of political theories. The medi-
cal approach can lead to feelings of inadequacy. Worse
yet, it can lead to pharmaceutical treatments that are
only later discovered to have adverse medical outcomes
for women’s healt h. The sociopolitical approach can
lead to the engendering of shame and guilt in women
who want a higher level of desire (for whatever reasons)
and seek help with this. Empirical research will probably
not entirely settle this debate, as the very politicization
of the research enterprise remains a problem (Cosgrove,
Pearrow, & Anaya, 2008). However, empirical research
can work to better address sociopolitical concerns, and
it can certainly improve the lucidity and operationaliza-
tion of the construct of desire. That researchers can
distill sexual desire and separate it from its historical,
cultural, and interpersonal context may be an illusion,
but striving to be conscious of this complexity is a
requirement. Even if the distillation were possible, the
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findings about this ‘‘pure’’ sexual desire would still not
dictate what any woman should want or how frequently
she should want it. Only in the context of all these
complexities can we chart a clinically reasonable and
empirically sound course.
As we continue in our collective struggle to understand
this most central, yet elusive, aspect of the sexual response,
our deliberations and investigations need to aim at increas-
ing the lucidity of constructs and remaining faithful to the
diversity of what women and men are telling us about their
desire and arousal. In the spirit of attempting to further
that effort, I offer nine research and clinical recommenda-
tions based on my reading of the literature.
1. Investigate whether an empirically validated
distinction can be made between desire and
subjective arousal: Until data support such a
distinction, there is little functionality in our
continued use of these terms as indicating separ-
ate phen omena. In fact , the continued use of
these constructs as being partly orthogonal
muddies the investigative waters and delays our
understanding.
2. Stop making ‘‘spontaneous desire’’ the default
explanation when we fail to identify a sexual
stimulus: There is a strong possibility that all
desire is essentially responsive and emanates
from exposure to sexual stimuli (with the possible
exception of ‘‘desire for desire,’’ the triggers of
which remain mostly unresearched). Some of
these stimuli may be more obvious than others,
and individuals may have varying levels of
awareness of stimuli; some stimuli may be pro-
cessed unconsciously; some stimuli may have a
delayed impact, with desire experienced hours
or even days after exposure to stimuli. Research
into the biological, psychological, interpersonal,
and sociocultural stimuli that act as triggers for
sexual desire will likely serve to elucidate whether
the spontaneous–responsive distinction currently
in vogue is justified. The findings of such a
research effort will likely also be clinically useful
in the treatment of individuals distressed about
their desire levels.
3. Investigate the construct of ‘‘desire for desire:’’
The assumption that all individuals who experi-
ence desire infrequently woul d like to increase
that frequency is unsupported. Understanding
the factors that predict desire for desire may be
useful in (a) our understanding of the link
between low desire and distress, or lack thereof;
(b) the treatment of individuals and couples
who present with desire problems—desire for
desire may be the strongest predictor of treat-
ment outcome; and (c) keeping in check our
assumptions about normal sexual functioning
and what women ‘‘should’’ want.
4. Beware of the theoretical drift from the construct
of responsiveness to the construct of relational-
ity: Responsiveness is not synonymous wi th
relationality. Responsiveness is applicable to all
manner of sexual stimuli, both internal and exter-
nal, consciously or unconsciously experienced.
Because of the salience of relational stimuli and
our general lack of knowledge of what constitute
competent sexual stimuli for women, there has
been a tendency to emphasize relational factors
in female sexuality to the near exclusion of other
triggers that are either not relational at all or only
marginally so.
5. Pursue an atheoretical approach to the investi-
gation of the phenomenological experience of
sexual desire in women: This type of open-ended
strategy is likely to better capture the diversity of
women’s experiences. If we start from the
theoretical premise that relationality is central
to women’s desire, we are likely to skew results
and engage in confirming interpretations. We
know that there is significant variation in the
relationality of women’s sexual desires across
and within individuals, and this variation is likely
to vary as a function of cultural, situational, and
lifespan variables.
6. Make sexual desire (rather than sexual activity)
the dependent variable in research on female sex-
ual desire: Sex is not always the goal of women’s
sexual desire. Sometimes, the experience of sex-
ual desire may be its own reward. If we always
look to sexual activity as the ultimate confir-
mation of desire, we may be entirely missing or
failing to accou nt for a great deal of women’s
desire.
7. Investigate factors that predict action tendencies
toward the fulfillment of sexual desire: The incen-
tive value of sex is likely to overlap with desire,
but some data indicates a partially separate evalu-
ation of the costs and benefits of sex. Achieving
a better understanding of sexual activity as
sometimes preceded by two separate processes
the experience of desire and then an appraisal of
the value of its fulfillment—will be helpful in
uncoupling desire from sex.
8. Engage in a balanced consideration of gender
differences in sexual desire: The consideration
of gender differences in desire and arousal has
greatly expanded our knowledge of women’s
sexuality, sensitized us to social influences and
constraints on its expression, and will hopefully
lead to the design of more effective interventions
for desire complaints in women. The consider-
ation of sex similarities, however, may be just
as important to the resear ch and clinical enter-
prises. Gender differences in frequency of
masturbation, attitudes about casual sex, and
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arousal to sexual stimuli proved exceptions to
Hyde’s (2005) gender similarities hypo thesis.
However, men and wom en resemble each other
more often than not, in many other areas that
are likel y to influence sexuality. It might be wise
to resist the understandable temptation to over-
correct after decades of male-analog-driven sex-
ology an d to heed Hyd e’s (2007) appeal for a
balanced reporting of both gender differences
and similarities. As the data in this review indi-
cates, the situation is not as polarized as it is
sometimes portrayed. Although gender differ-
ences are an important and undeniable part of
sexual desire, gender similarities are arguably
more ripe for the design of clinical interventions
that can capitalize on what men and women
share rather than on what divides them when it
comes to desire.
9. Make diagnostic criteria for HSDD as conserva-
tive as possible: In light of our ignorance about
(a) base rates of sexual desire; (b) our inability
to tease apart the biological and social determi-
nants of these base rates, even if we knew what
they were, and; (c) the doubtful usefulness of
these base rates even if they could be trusted, it
seems that our criteria for identifying sexual
desire problem s should ideally be as conservative
as possible. It is important that we not increase
the ubiquitous sexual pressure on women (e.g.,
Jones, 2006) through the therapeutic mandating
of sexual desire. As experts convene to review
and amend diagnostic criteria for HSDD in the
next edition of the DSM, it would seem that three
useful guidelines would be to (a) account as much
as possible for the divers ity of women’s experi-
ences of desires, (b) set the bar high for the diag-
nosis of HSDD, and (c) let the woman decide
whether her desire level is a problem. A person-
ally perceived lack of or low arousability to any
number of sexual stimuli, relational or otherwise,
that manifests itself in lack of subjective sexual
feelings, lack of initiation of solitary or dyadic
sexual activity, and lack of responsiveness to
sexually competent stimuli (relational or other-
wise), would fit such a definition. It woul d work
against the misdiagnosis of women who (a) have
no desire to feel desire, (b) feel desire but choose
not to have sex or masturbate, (c) choose to mas-
turbate instead of initiating partnered sex or
responding to partner advances, and (d) fail to
respond to incompetent sexual stimuli.
New diagnostic criteria could also specify that the
low desire persist in a majority of instances involving
exposure to competent sexual stimuli (e.g., on 75% of
instances) and for a period of at least six months.
Mercer et al.’s (2003) report of the Natsal study
indicated that lack of interest in sex over the prior
month (40.6%) was four times higher than lack of inter-
est lasting for six months (10.2%). Balon and colleagues
(see Balon, 2008; Balon, Segraves, & Clayton, 2007;
Segraves, Balon, & Clayton, 2007) consequently argued
that a duration of six months or more be added to
criteria for the sexual dysfunctions in the upcoming
edition of the DSM.
Finally, a number of well-reasoned arguments
exist to eliminate the distress criterion in the current
edition of the DSM (APA, 2000; see also Althof, 2001;
Everaerd & Both, 2001; Mitchell & Graham, 2008).
However, the elimination of the distress criterion or its
relegation to a specifier (as Althof, 2001, recommended)
may be dangerous, given the ubiquitous pressure on
women to have more sexual desire than they apparently
do. There is no perfect solution, but it seems safer to err
in the direction of letting the woman decide whether she
has a sexual problem or not. The interpersonal difficulty
criterion is also problematic in light of gender differ-
ences in sexual desire. With sexual desire discrepancies
being the norm rather than the exception, interpersonal
difficulty seems ill-placed as a diagnostic crite rion for a
dysfunction of one person rather than a dysfunction of
the couple. The lower desir e (more often the woman’s)
rather than the higher desire (more often the man’s) is
identified as the cause of the interpersonal difficulty
(Clement, 2002). Consequently, women often experience
the discrepancy as their problem (Davies, Katz, &
Jackson, 1999; Wood et al., 2007).
Conclusion
In a videotaped talk available on the FSD-Alert Web
site of the New View Campaign, Tiefer (2009) asked her
audience to consider the extent to which the way sex has
been studied resembles the way digestion has been
studied or the way musi c and dance have. She quickly
pointed to sexology’s use of the words normal and
healthy to provide her audience with the answer. There
is no such thing as normal or healthy music or dance.
Although this may seem a strained an alogy to some, it
is effective in communicating the emphasis that sexology
has had on function to the near exclusion of the
non-biological aspects of sexuality.
Music and dance, however, are also deconstructed
and analyzed. They have their theorists and techniques.
Tiefer’s (2009) is not inherently an anti-empirical argu-
ment, rather it is an appeal for the consideration of
the full richness of the human sexual response. This rich-
ness includes one construct glaringly omitted from most
research on sex and possibly quite centra l to desire:
eroticism, a pleasure-driven phenomenon with no end
other than itself. It has no function per se. Unlike many
words we use in sexology, eroticism is perhaps unused in
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the animal model literature, relating to the fact that
eroticism implies something uniquely human: the mean-
ing we attach to sexual acts that occur within a social
and relational context. In her use of the term erotic inti-
macy, Kleinplatz (in press) asserted that eroticism
entails arousal for the ‘‘sheer joy of it,’’ but added the
further reward of ‘‘having an entry point into the part-
ner’s inner world.’’ She believed that this requires toler-
ating the vulnerability engendered by such closeness.
French theoretician, Georges Bataille (1957 =1986), on
the other hand, argued that eroticism is associated with
the idea of transgression—that it is inherently disruptive
and disorderly (hence, the ensuing excitement). Jack
Morin (1995) defined it as ‘‘the interplay of sexual arou-
sal with the challenges of living and loving’’ (p. 3) and
specified its four cornerstones to be longing and antici-
pation, violating prohibitions, searching for power,
and overcoming ambivalence. Based on 20 years of clini-
cal experience, couples’ therapist Perel (2006) argued
that the security and closeness of long-term relationships
can work against the transgress ive erotic element she
also considers to be vita l to good sex. Heiman (1977)
wondered if perhaps ‘‘erotica must be socially unaccept-
able or norm-breaking, in order to be maximally arous-
ing’’ (p. 272), as she speculated on the results from
her study indicating women’s preferences for sexual
scenarios that went against comtemporary scripts.
Ultimately, however, eroticism is personally and indi-
vidually defined. The point is that sexual function is just
one part of the desire story. Functional sex that includes
arousal and orgasm can be boring, as the following
statement from one of the women in the Sims and
Meana (2009) study makes clear: ‘‘I call it his checklist.
I can tell you the movements he’s going to make step-by-
step. He can get me off, but it’s sex. It’s not making
love’’ (p. 15). The construct of satisfaction is getting
increasing attention in the literature (Rosen & Bach-
mann, 2008), and one could argue that satisfaction
may encompass eroticism. In my opinion, however, sex-
ology would better serve both men and women if it
placed a little more emphasis on a construct that has
pleasure rather than satiety at its heart.
As the wild child of desire, eroticism may present
some considerable research challenges, but the study
of sexuality, and desire in particular, has never been
for the faint of heart. It will likely be useful to incor-
porate the construct of eroticism into our research on
desire as well as into our clinical work with clients dis-
tressed about its decline or loss. It will require, how-
ever, that we drop a number of doctrinaire positions
(‘‘-isms’’ and ‘‘-zations’’) that are currently plaguing
the study of desire. Eroticism does not align well with
the medicalization of sexuality and its emphasis on
vasocongestion, lubrication, orgasm, and ‘‘sexual
health.’’ It rebels against polit ical stances that prescribe
strict versions of egalitarianism and any number of
codes of conduct in the bedroom. It bristles at the
sanitizing imposed by a humanistic emphasis on the
reduction of guilt and anxiety and the nurture of safety
and comfort. The little data we have indicate that
eroticism just will not be told what to do. Conse-
quently, research and clinical forays into eroticism
may go a long way toward facilitating inclusiveness
and considering the diversity and full range of women’s
sexual desires.
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... These women might have learned to express their sexual desire to a greater degree than typically reported by heterosexual women. Also, findings from studies examining sexual concordance (i.e., the agreement between genital and self-reported sexual arousal; Suschinsky et al., 2017) point to the possibility that same-sex attracted women have learned to register their sexual arousal more precisely than heterosexual women and therefore experience more sexual desire (Everaerd & Both, 2001;Meana, 2010). ...
... In previous studies, women's sexual desire was higher in the context of a relationship, whereas male desire was unaffected by these circumstances (Impett et al., 2014;Petersen & Hyde, 2011). At the same time, enduring long-term relationships dampen the sexual desire of both genders/sexes, but especially so for women (Dawson & Chivers, 2014;Klusmann, 2002;McNulty et al., 2019;Meana, 2010;Murray & Milhausen, 2012). Using two large national samples in Finland (N overall = 3,682), Kontula and Haavio-Mannila (2009) found that relationship duration had no effect on men's and women's sexual desire when controlling for other factors, such as sexual functioning. ...
Article
Full-text available
While most studies on sexuality in later life report that sexual desire declines with age, little is known about the exact nature of age effects on sexual desire. Using self-reported dyadic sexual desire relating to a partner, dyadic sexual desire relating to an attractive person, and solitary sexual desire from a large (N > 8000) and age diverse (14.6–80.2 years) online sample, the current study had three goals: First, we investigated relationships between men and women’s sexual desire and age. Second, we examined whether individual differences such as gender/sex, sexual orientation, self-rated masculinity, relationship status, self-rated attractiveness, and self-rated health predict sexual desire. Third, we examined how these associations differed across sexual desire facets. On average, the associations between age and both men and women’s sexual desire followed nonlinear trends and differed between genders/sexes and types of sexual desire. Average levels of all types of sexual desire were generally higher in men. Dyadic sexual desire related positively to self-rated masculinity and having a romantic partner and solitary desire was higher in people with same-sex attraction. We discuss the results in the context of the evolutionary hypothesis that predict an increase of sexual desire and female reproductive effort prior to declining fertility. Our findings both support and challenge beliefs about gender/sex specificity of age effects on sexual desire and highlight the importance of differentiating between desire types.
... The second component of sexual subjectivity, i.e., a sense of entitlement to sexual pleasure, has also been linked to feelings of sexual desire. Its beneficial effects on sexual desire in women have been elaborated upon on theoretical level (Meana, 2010), while in the clinical field it is recognized as a prerequisite for sexual pleasure (Perel, 2006), and incorporated in psychosexual skill exercises aimed to address sexual desire problems (McCarthy & Wald, 2015). On an empirical level, research has revealed that adopting self-focused approach goals for engaging in sex (e.g., "I have sex because it feels good") significantly predicts daily sexual desire for one's partner (Impett et al., 2008a(Impett et al., , 2008b. ...
... While ODSC refers to one's appraisal of one's own desirability, it is a "reflected appraisal" as it entails the perception that one is attractive in the eyes of another (Bogaert & Brotto, 2014). This external validation of one's desirability, the perception of being the object of another's desire, although not always accurate , has been proposed as an important pathway to experiencing sexual desire (Meana, 2010). Feeling desired by one's partner has indeed been found to be positively associated with dyadic sexual desire in both women (Brotto et al., 2009;McCall & Meston, 2006) and men . ...
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In most theoretical models, sexual desire for one’s partner is predominantly conceptualized from an individual perspective. There is, however, a growing body of empirical evidence on the dyadic aspects of sexual desire. That evidence is as yet not well-integrated into theoretical conceptualizations of sexual desire. Aiming to fill this gap, we present the Dyadic Interactions Affecting DyadIC Sexual desire model (DIADICS), a new conceptual model inspired by systems theory that describes how dyadic interactions between partners influence dyadic sexual desire in romantic relationships. After defining dyadic sexual desire, we discuss (1) the structure of dyadic interactions, (2) their content, and (3) the process through which they affect dyadic sexual desire in a romantic relationship. Thereafter, we review theoretical, clinical, and empirical insights underscoring the relation between dyadic interactions and (dyadic) sexual desire, use DIADICS as a framework for understanding fluctuations in dyadic sexual desire in long-term relationships, and conclude by discussing implications of DIADICS for research and clinical practice.
... There is, however, little clarity on the nature of these correlations. Much of the existing literature is devoted to biological, emotional, and cognitive reasons women may experience low desire, with little consideration of social and interpersonal context (Meana, 2010). The present study was an exploration of those interpersonal contexts and how they are connected to FSD. ...
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Previous investigations into Female Sexual Desire (FSD) have been focused on women's biological, cognitive, and emotional processes, despite evidence that FSD is also responsive to relational contexts. Past research consistently demonstrates a general association between relationship satisfaction and FSD. There remains, however, a need to expound this connection. In response, this study explored the role of relationship equity in relationship satisfaction and FSD. For this cross-sectional study, 299 Australian women aged 18 to 39 years responded to an online questionnaire measuring relationship factors and dimensions of sexual desire. Two mediation models were tested to examine how relationship equity was associated with solitary and dyadic sexual desire, via a connection with relationship satisfaction. As expected, equality in relationships predicted relationship satisfaction, which, subsequently, was related to higher levels of dyadic sexual desire. No significant mediation was found for solitary desire, indicating that relationship factors may not play a critical role in this domain. This result also demonstrates a distinct divergence between the two domains of desire that requires further examination. These results solidify the notion of FSD as a multifaceted construct and present meaningful implications for theory, research, and clinical practice.
... The purpose of such outlined research was conceived on the basis of numerous reports in the literature that it is not only the fact of continuing sexual activity, but above all, a positive attitude and interest in the sphere of sexuality that affects the state of health, especially the cognitive performance of older people. Such a positive attitude and interest can be determined by the term "a high self-awareness of sexuality", or possibly the term "the level of libido"[18][19][20][21][22]. A high level of self-awareness of sexuality undoubtedly facilitates conducting sexual education. ...
... In other words, sexual desire may be considered a driving component of sexual fantasy life and activity (Levine, 2003;Pfaus, 2009). Furthermore, sexual desire and sexual arousal are widely acknowledged as complex constructs and the relation between them as intricate (Ågmo, 2011;Janssen, 2011;Meana, 2010). In fact, people with higher sexual desire may be mostly attended to sexual cues, increasing own sexual arousal, i.e. the momentary level of sexual excitement (Moholy et al., 2015;Whalen, 1966). ...
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Objective: Sexual desire is a psychological state that prompts individuals to engage in sexual activity. Although interest about this topic is constantly increasing, there are no validated instruments to measure sexual desire in Italy, making scientific studies difficult. This paper aims to provide a contribution to validation of the Sexual Desire Inventory-2 (SDI-2) for the Italian population, investigating factorial structure, invariance, reliability and validity. Method: The sample was composed of 389 Italian participants from a nonclinical population. The thirteen-item SDI-2 and the Barratt Impulsiveness Scale (BIS-11) for measuring impulsiveness were administered. Results: The results supported two dimensions, i.e. dyadic and solitary desire, and partially measurement invariance across gender. Furthermore, good validity and reliability indicators have been gained. Conclusions: the Italian version of the SDI-2 supports good psychometrics properties. It may be considered a valid and reliable measure for assessing dyadic and solitary sexual desire. Therefore, the present inventory may be used, in the research and clinical field, as an innovative instrument in order to investigate sexual desire and its relationship with clinical disorders.
... However, half the people who reported this said that it was not a problem, and very few men or women saw it as a major problem. Clearly the idea that one ought to be constantly interested in having sex is a social expectation (Richters, 2009) that not everyone shares, particularly women (Meana, 2010). Nonetheless, discrepancy in desired frequency of sex can be problematic in monogamous relationships, and congruence in desired frequency of sex has been found to be a predictor of sexual satisfaction and general relationship satisfaction in heterosexual couples (Smith et al., 2011;Willoughby et al., 2014). ...
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The Australian Study of Health and Relationships is a large national population-representative survey of sexual behavior and attitudes conducted every decade. We describe experiences of sexual difficulties lasting at least a month among Australians surveyed in 2012-2013 and identify changes since the previous survey in 2001-2002. Computer-assisted telephone interviews were completed by 20,091 people aged 16-69 (participation rate 66%) of whom 16,897 people had had sex with a partner in the previous year. We asked how long each difficulty lasted, whether it was a problem and whether they sought treatment. Half (48%) the men and 68% of women reported at least one difficulty. Lack of interest in having sex was common (28% men, 52% women); 21% of men reported coming to orgasm "too quickly," and women reported inability to reach orgasm (25%) and trouble with vaginal dryness (22%). Women were more likely than men not to find sex pleasurable and to have physical pain during intercourse. Some differences by age group were also apparent. Many difficulties were not seen as problems, especially lacking interest and reaching orgasm too quickly. People with erection/dryness problems, or with pain in intercourse, were more likely to seek treatment, as were people with multiple difficulties. Between 2001-2002 and 2012-2013 there was little change for men, but among women rates of all sexual difficulties fell by 4-10 percentage points. This change accompanied a drop in frequency of sex among people in ongoing relationships and an increase in masturbation and use of pornography. One explanation might be that, over time, fewer women were agreeing to "service sex" when they were not in the mood. Overall, the drop in prevalence of women's sexual difficulties since a decade earlier suggests a change towards more egalitarian sexual relations.
... (e.g., "my sexual desire for Sam would be strong"). Two items measuring strength of responsive desire, a dimension of sexual desire often omitted from measures of sexual desire (Basson, 2003;Meana, 2010), were also included using the same Likert response scale (e.g., "in response to Sam's advances, my own sexual desire would be strong"). Another item asked, "Overall, how would you describe your sexual desire for Sam?" with responses ranging from 1 (completely uninterested) to 7 (passionately desiring). ...
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Drawing from expectancy-value theory, the current study documented expected likelihoods (i.e., expectancies) of orgasm, non-orgasmic sexual pleasure, and emotional closeness during sex with a romantic partner, then tested their causal roles In sexual desire. Participants (N = 582, 50.3% women) were drawn from college student and online samples of young adults in the US. Expectancies were high overall; men reported much higher orgasm expectanci