What You Need to Know About Female Sexual Desire

In the February 2014 issue of Contemporary Sexuality, we took a look at the latest research on testosterone. This led, inevitably perhaps, to the question of whether or not testosterone levels affect sexual desire. Pharmaceutical companies, especially, have been pushing to develop a cure for hypoactive sexual desire in women, focusing in on testosterone-based creams and patches.

So why don't we yet have the "female Viagra"?

Because questions of female sexual desire — how it's defined, how it differs from sexual arousal, what levels of desire could be considered problematic, etc. — are still very much up in the air.

Dr. Russell Stambaugh, a psychologist and certified sex therapist explains why this is so: "One of the great problems for researchers on low sexual desire," he says, "especially for women, is that it defies operational definition. For women, clitoral engorgement does not correlate well with conscious self-reports." This problem has shown up most often in cases of plethysmography research, which has shown that study participants do, in fact, physically react to a broad variety of sexual stimuli, but may or may not report subjective sexual desire despite this physical response.  

For this reason, Dr. Lori Brotto — a psychologist best known for her work on female sexual desire — seeks to look beyond the purely physical when it comes to defining desire and arousal. "It's a complex construct to define," she says, "and is experienced differently by different people. In general, it may be a motivation. An incentive to be sexual in some way. Other people may see it as more of an innate pole, but I see it as something that emerges."

Only adding to the confusion are the ways in which sexual desire and sexual arousal are often conflated. As mentioned by both Stambaugh and Brotto, using the physical signs of genital arousal as a means of defining desire itself can be problematic, because the physical and the subjective don't always match up with each other. While they can have a connection to or effect on each other, this connection is still being explored by researchers.

"When we say 'sexual arousal,' do we mean a subjective state of sexual excitement?" asks Meredith Chivers, an associate professor and clinical psychologist at Queen's University. "Perception of a physiological response? Genital sexual response?"

Chivers also lists out the varying number of ways in which sexual desire itself can be measured, including action tendency, motor preparedness, motivation to engage in sexual activities, actual sexual behaviors (thoughts, masturbation, partnered sex, etc.), sexual intensity, sexual frequency, and more. "We also need to consider the person's experience of their sexual responses," says Chivers.

Chivers's research team at the Sexuality and Gender Laboratory in Ontario, Canada is working to examine these questions of which aspects of sexual response are actually associated with the experience of sexual desire. And they're finding that there can be correlation between the two. 

She mentions a study published in The Journal of Sex Research back in 2004 by Dr. Stephanie Both and her Dutch research team, showing that when study participants observed sexual stimuli in the lab, and consequently reported the physical signs of sexual arousal, there was increased sexual behavior in the 24 hours that followed participation. This suggests that exposure to sexual stimuli and/or experiencing sexual arousal is associated with kindling sexual desire, and can lead to motivated sexual behavior. 

The research Chivers and her team are now conducting extends this work. Still, she is quick to point out that, despite these findings, we shouldn't be so quick to equate arousal and desire. For example, Chivers has sometimes been quoted as saying that genital arousal does not mean consent. 

"This is an important message," she says, "because, in some sexual assault cases, evidence that women were physically sexually aroused, or experienced orgasm, can be misinterpreted as a woman's tacit consent for sexual activity."

Chivers mentions that some female victims of sexual assault have reported experiencing physical signs of arousal during their assault. This experience of physical arousal has made these women feel tremendously conflicted. They believe their bodies have betrayed them... that they really did want the sex that was forced upon them. 

"We reconceptualize the genital response as protective," says Chivers, "lubricating the genitals and reducing the likelihood of injury and pain during sex acts. A physiological response is not the same thing as wanting or liking. If you want to know what a woman wants sexually, ask her. If you want to know how a woman feels, you ask her; what her body is doing is irrelevant in a dialogue about consent."

Echoing Chivers research is a study published in 2011, in Psychological Science. This study explored men's and women's sexual response to various stimuli and found that, while men's genital arousal occurs in response to a very limited number of sexual stimuli, women's genital arousal occurs in response to a much wider range of sexual stimuli, including imagery involving violence and non-consensual sex. In other words, female subjects showed physical arousal when viewing depictions of rape despite the fact that these images did not result in feelings of desire.

But returning to the subject of desire in particular, what do we mean when we talk about "low" desire? Exactly what makes a person feel as if their level of desire is "low" or "problematic"? What inspires them to seek out help in this area?

Stambaugh considers low desire to be a subjective thing. "Sometimes low sex desire is a couples problem," he says. "Someone thinks someone else's desire is too low. But this is really a desire difference problem, communication problem, or something else."

Brotto agrees that the issue can be subjective... more of a self-diagnosis than a definitive clinical diagnosis. Looking beyond desire discrepancies among couples, she notes that, as an individual, "you're just going to have this sense of oh, this is different from what it was before. They notice they don't want sex anymore. They used to think about it, initiate it, be responsive, but not anymore, or to a lesser degree."

But low — or lower — desire isn't always a problem. Sometimes, a woman may just be going through a stressful period in her life. Sometimes, she may be dealing with a medical issue. Or a relationship issue. These are all things that affect a woman's desire to have sex. "Often, loss of desire is a consequence of how loss, anxiety, money, work/life balance, dominance or submission, household chores, or family crisis have been managed," says Stambaugh.

Your mood in general can also affect your levels of desire. Anxiety, for example. Or depression. "Depression and low desire are highly comorbid with each other," says Brotto.

Brotto also mentions the many ways in which we might feel distracted. "We've lost the ability to be in the here and now and feel pleasure," she says, "and that has had a dramatic impact on desire."

"Half of women will have a period where their desire is significantly lower than they're used to," says Brotto. "We're looking for persistent problems of desire that create a lot of distress for that person. If it's getting in the way or interfering with their quality of life, it might be a significant issue."

There are a number of myths floating around out there right now about low sexual desire, myths that are only perpetuated by messages in the media. Many women believe there's something wrong with them if they're unable to feel spontaneous desire. They think it's unsexy if they have to plan or make an effort to prioritize sex. It feels contrived to them. They also believe that only intercourse truly counts as sex.

Another myth, mentions Stambaugh, is that sexual desire naturally declines with age, so there's no need to take its loss seriously after menopause. 

"Sex is about a great deal more than orgasm and procreation," he says. "The uses we put sex to change over the lifespan, so changes are going to happen with age. But these do not simply evaporate over 50."

Stambaugh also wonders if a woman's post-menopausal loss of desire is a function of hormonal change or, rather, a result of social expectations that menopause isn't sexy. He wonders if a general intolerance of aging affects a woman's desire to have sex. He muses that perhaps, as time passes, a partner may not be as attentive or affirming. "Often, more than one of these is going on," he says.

So where can sex therapists, sex educators, and their clients and students find answers and advice that reflect the most recent research?

"There are some great books out there," says Brotto, "such as Barry McCarthy's Enduring Desire." She also mentions that referring students to a sex therapist can be useful, even if just for debunking myths. "We don't want to be caught up in media portrayals," says Brotto, "which convey that if you don't feel horny, there's something wrong with you. Don't get caught up in those kind of beliefs. These portrayals can make us feel broken, as if there's something wrong with us." 

Brotto also says that educators could suggest self-exploration of one's physical and mental health at the time. "Good health is correlated with better / higher sexual satisfaction."

She also believes that mindfulness can be useful when it comes to boosting female sexual desire. "Mindfulness improves mood and anxiety, which are highly concurrent with low desire. Women can be distracted during sex. Mindfulness is a way of refocusing on oneself. Mindfulness can also put women in touch with sensations they weren't aware of and allow them to communicate that to their partners."

After all, she mentions, there's no medication out there proven to effectively treat low sexual desire.

What You Need To Know About... is a new, regular column in Contemporary Sexuality that looks at the latest evidence-based research on a single topic. For those sexual health professionals who often hear the same questions over and over, and don't know how to respond,  What You Need To Know About... will be a space where one can seek out those answers. If you are a sex educator or other sexual health professional with questions you feel science has not yet addressed — or addressed well — please send them along to steph.auteri@gmail.com for possible inclusion in a future column.