By Catherine Elton, published on May 1, 2010 - last reviewed on June 9, 2016
Ever since Viagra became man's best friend, pharmaceutical companies have been racing to find an equivalent for women. But the essentially mechanical boost to erection that the drug provides, by pumping more blood to the penis, doesn't do a thing for females; their most common sexual complaint—voiced by 40 percent of women in large-scale surveys—is low libido. Desire turns out to be a much more elusive companion to arousal. And that may be the best and worst thing about it.
While the push to discover a female drug for desire has so far yielded nothing comparable to the little blue pill, it has spurred considerable research into what is proving to be a very complex phenomenon. It has also spurred nearly as much ideological debate, some of which has actually helped guide research in productive ways.
There are clinicians and academics—many of them female and feminist—who contend that disorders of desire are manufactured by drug companies to create markets for products that are unneeded because women's libido problems come from the way society views female sexuality. Others believe that desire problems have real, if poorly understood, roots in biology and that more research might yield good treatments. Many feel that assumptions of male-female sexual equivalency have at best hampered research and at worst led to erroneous adoption of male experiences of arousal and performance as the standards for women as well.
But scientists do seem to agree on a few things. One is that gender stereotypes seem to hold. When it comes to desire, men have more of it, both in frequency and intensity. Among women, levels of desire vary much more than among men. They also vary more within individual women, depending on time of the month and across the lifespan. Sexual desire in women is less directly tied to physical arousal than it is in men; in fact, it often follows arousal, rather than precedes it. In women, desire is much more a matter of mind than mechanics and seems to be more affected by partner relationships, what's going on around them and, perhaps most important, how they feel about themselves. Female sexual desire is not just more complex but more fragile, too. But it may be something that women can learn to feel.
When in 1966 Masters and Johnson described what they called Human Sexual Response, they focused exclusively on the functioning of the genital equipment without even addressing the matter of desire. Following up with their 1970 book, Human Sexual Inadequacy, they viewed biological equipment problems as the cause of impotence and failure to achieve orgasm.
With women newly liberated by the pill to enjoy casual sex, attention gradually shifted to desire. In 1979, psychiatrist Helen Singer Kaplan, who opened the country's first sex therapy clinic in New York, put forth a model of sexuality in which genital excitement and orgasm were preceded by desire. At the same time, she introduced the idea of disorders of desire, and the term hypoactive sexual desire took up residence in the diagnostic bible, the DSM.
Critics have found many faults with the official DSM definition of hypoactive sexual desire, but the primary concern is that countless women have been deemed dysfunctional because their sexual response doesn't look like a man's—which is tied tightly to physiology and progresses sequentially to orgasm. What about the many women who enjoy sex without ever experiencing orgasm? And low desire compared to what?
At the University of British Columbia, where she directs the sexual medicine program, clinician Rosemary Basson put forth a new model of female sexual response. It depicts sexual response as more circular than linear, with many physical and contextual cues prompting desire and arousal and many points of entry. Her model accounts not only for spontaneous desire but also for the experience of the many women who report that they engage in sex feeling neutral and experience desire only after they are physiologically aroused.
The importance of relationships and emotional attachment to female desire emerges from many sources. Numerous studies show that women are far less interested in casual sex than men are. In 1996, researchers reported that 35 percent of women but only 13 percent of men cited love and emotional intimacy as goals of sexual desire; 70 percent of men, versus 43 percent of women, said that sex in and of itself was the goal of sexual desire. Men tend to have sex for sex's sake, research suggests, but women's sexual desire tends to aim at relationship outcomes.
Not everyone agrees things are quite so straightforward. Marta Meana at the University of Nevada Las Vegas contends it's possible to overemphasize the importance of relationships to desire in women. In fact, she finds, relationships can have a dampening effect on desire and sex for both genders—and as relationships progress, desire declines.
"It could be that relationships are very arousing to women at first, but there are not a lot of data showing that it lasts for long. The longer you are in relationships, the more fantasies steer away from touchy-feely concepts. I think relationships are important to sexuality. I think women probably care more about relationships than about having sex, but that doesn't mean relationships are what turn women on," Meana says. "If safety, comfort, love, and respect were as facilitative to female sexual desire as some of the relationally focused literature claims, then we should not see as many married women in happy relationships complaining of low desire," she notes.
Much of the research is biased, she explains, because it surveys college students—people not yet likely to be in long-term relationships. Sure, their fantasies may have more romantic content than do the fantasies of men, but they are not representative of what happens in marriage.
"In the early stages of relationships, the infatuation stage, people can't get enough sex," says University of Texas sexologist Cindy Meston. "They can't stop thinking about that person." Meston, who coauthored with David Buss Why Women Have Sex, points to research showing that people in the early stages of falling in love have brain serotonin levels as low as those seen in people with obsessive-compulsive disorder. "That's why you can't stop thinking about that person and want to be close to them all the time. Of course, having sex all day or staring at each other all day isn't conducive to everyday living," and those levels settle down.
Over time, people settle into a normal pattern of sex—which means they simply aren't having as much sex as they were. Nevertheless, this is what couples sometimes complain about when they complain about low female desire. But which is normal—the level of desire a person experiences early in a relationship or what transpires later?
While the drop in desire that Meston describes affects both men and women, it often causes more problems in a relationship when it occurs in a woman, whose level of desire is generally lower to start with. Decades of data show that on average, men think more about sex, fantasize more about it, work harder to get it, place more importance on it, want to have it more, initiate it more, and masturbate more. Data also show that what ignites women's desire, regardless of any generalized decline in desire, is a new partner.
Domesticity itself undermines desire, contends Ester Perel, a couples' therapist in New York and author of Mating in Captivity. "Good intimacy doesn't always guarantee good sex," she says. "The very elements that nurture love—reciprocity, mutuality, protection, closeness, emotional security, predictability—are sometimes the very things that stifle desire. Love wants a certain kind of closeness; desire needs space and distance to thrive."
In committed relationships, and especially in the context of family, she explains, women tend to take care of men and so the men become a family member—and sex with family members is taboo. "In the discourse of desire, nobody is taking care of anybody. People take care of each other as an act of love; desire requires that they don't need you," she adds.
Marta Meana's research supports Perel's clinical observations. In a qualitative study soon to be published in the Journal of Sexual and Marital Therapy, Meana documented a decline in sexual desire among 19 married women. For some of the women, formalizing their relationship by marriage rendered sex so overly available and so sanctioned that it lost a forbidden and erotic quality that formerly turned them on. Among others, overfamiliarity with their partner led to a decline in romance and in sexual innovation, as well as to a loss of their own sense of individuality and desire to care for their appearance, which they felt promoted sexual desire.
A third group of women reported that their roles as wives, mothers, and professionals were not only overwhelming but highly desexualizing, and it was hard to shift into sexual mode from such roles. Some women specifically noted that while they were committed to their partner, they believed their desire would return if someone new entered their life.
Meana contends her data show that women want what men want. "In women," she says, "desire may be driven to the same extent as it is in men by novelty and excitement and a stranger thinking they are hot."
If relationships per se are not what turn women on, perhaps being desired is. Studies show that women often fantasize about being ravished or found irresistible. More than being desired, Perel and Meana say, women yearn to be uniquely desired—to be chosen as The One. Perhaps that's why they are turned on by relationships at the onset: Women want a commitment because it signals they are uniquely desired. But after a commitment has been made, its meaning changes.
"Once people get married, your guy is stuck," says Meana. "He can't sleep with anyone else. His advances to you no longer signal your unique desirability the way they did before you were married."
Much like wanting to be uniquely desired, women's vision of themselves may be more important to desire than relationships with partners. Meana points to research she did showing that women find it arousing to think of themselves in lingerie or nude. Thinking of themselves as sexy boosts desire. "Women have this sexual relationship with themselves that's integral to their sexual relationships, period," Meana argues. Feeling good about themselves emotionally and physically appears to be a bigger mediator of women's desire than men's. Over and above anyone else, women are their own point of reference for how sexy they are.
Such self-focus plays out most obviously in women's body image. Research shows that women are often distracted during sex by their own negative evaluations of their physical appearance. "These women were with guys who are in the throes of ecstasy and not for a moment were the men focused on whether the woman's breasts were sagging. They probably didn't even have their eyes open. Yet the women are thinking, 'Oh, my god, I better change positions; I don't look good in this position,'" says Meana about a 2006 study she conducted. "That has zero to do with the guy; it's about their own evaluation of themselves."
Self-consciousness doesn't just inhibit desire. It can subvert women's view of their whole sex life. In a study of 154 women just published in the Journal of Sexual Medicine, Cindy Meston concluded that women who had low esteem and thought about physical appearance during sex had less satisfying sex and were more distressed about their entire sex lives.
Body consciousness is not the only distraction women experience during sex. Women often worry whether the kids are asleep, if the dog has been fed, or what's on their to-do list. Such distractibility may reflect the multiple roles women fill today. But evidence suggests otherwise; women generally experience less concordance than men do between what goes on in their heads and what goes on in their loins.
Until recently, physical arousal and subjective arousal were thought to be mutually dependent—that a man who has an erection or a woman who has increased blood flow to her genitals also feels sexual desire. But such linkage is more the case for men than for women. University of Toronto sexologist Meredith Chivers recently analyzed 132 studies in which men and women's level of genital arousal was measured while they watched erotic videos. Men's reports of how aroused they felt closely correlated with genital measurements. Not so with women.
Which may explain why Viagra doesn't work for women; it increases genital blood flow and puts genitals in an aroused state—but women didn't subjectively feel sexual desire, and they care more about subjective arousal. It also corroborates the experience of men who report themselves confounded when they touch their partners and feel them aroused only to hear their partners say that they just aren't feeling that into it.
Chivers's meta-analysis showed that women with any of various types of sexual dysfunction had lower concordance between genital and subjective arousal than did the control group of sexually functional women. Other studies have found that women reporting high rates of orgasm during sex have high concordance rates of genital and subjective arousal. The more that mind and genitalia are in sync, the less problematic a woman's sex life seems to be.
But the relationship between subjective and genital arousal is not static. The longer women watched erotic videos, Chivers found, the more concordance they experienced. Women may just need more time for their minds to catch up to their bodies—perhaps explaining why they want more foreplay. Also, the more the videos varied the levels of eroticism—heated up and then cooled off—the more concordance women reported. All that waxing and waning of genital responses just may force women to notice them more.
Says Cindy Meston. "Most women aren't very in tune with their genitals; we are socialized to not pay attention to them. The female genitals are smaller, less intrusive, and the changes in them are more subtle, not enough to give a woman intense feedback and a feel-good urge. If men have a raging erection they are going to notice it. And follow through."
The differences in arousal concordance between men and women may be purely a matter of biology, says Chivers, who points out that they echo more generalized gender differences. She cites studies showing that men are more in tune with what is going on in their bodies than women are; they have more so-called interoceptive awareness. For example, they are more aware of their heart rate than women are. Perhaps the higher male concordance in arousal exists because men take their cues primarily from what is going on in their bodies whereas women are attuned to more—the context as well as their beliefs and attitudes about sexuality.
The need for mind and body connectedness in sex has prompted some new liaisons. At the University of British Columbia, sex researcher and therapist Lori Brotto is encouraging women to bring Buddha into bed with them. "We know a desynchrony exists where the genitals are doing one thing and the mind another, and this has a bearing on sexual response. So if we can teach women to bridge the gap between mind and body" by cultivating mindfulness, she says, "we should be able to improve that response."
Mindfulness also has its benefits for men, Brotto notes, but might be especially pertinent for the distractibility women experience. Women relearn to appreciate their body and its capacity for sensual pleasure.
In the Journal of Sexual Medicine, Brotto reported that 150 women experienced higher levels of sexual desire after being trained in her 4-step program of mindfulness specificallygeared to enhancing sexual pleasure. Tested in the lab while watching erotic videos, the women reported feeling more lubricated, even though there was no measurable increase in lubrication from watching such videos before training. The results suggest the women had become more aware of their genital lubrication.
It turns out that the surest approach to problems of desire in women is something no pill can do. It's bringing the mind in synchrony with the body. And that has benefits for women that go way beyond the bedroom. —Catherine Elton
Lori Brotto has devised and tested a program to increase sexual responsiveness in womenwith sexual complaints, including low desire. A major component draws on Buddhist principles of mindfulness to reconnect the mind with the body's sensations.