Is It Sex Worth Wanting?

Though sexual activity clearly has ancient roots, research studies on the important aspects of women’s sexual functioning, including comprehensive models of how women experience sex, are a relatively recent phenomenon.

4 Key Components of Sexual Health

When we begin discussing sexual health, as I do with women in my psychiatry practice, there are four key components I want to review with them: 1) sexual desire; 2) arousal, both physical and subjective; 3) orgasmic ability; and 4) pain-free sexual activity.

In the 1960s, researchers Masters and Johnson studied sexual functioning by observing people in the act of sexual intercourse as well as masturbation, creating their linear model of sexual intercourse: 1) excitement, 2) plateau, 3) orgasm, and 4) resolution. If we substitute arousal for excitement, this still leaves out desire, or the wanting of sexual contact.

Understandably, it was difficult to study desire in a clinical lab, with volunteers asked to perform sexual acts in front of an audience. This model, though a beginning, is an oversimplification of the complexity of women’s sexual functioning.

Another model was the Basson model of sexual response, developed by psychologist Rosemary Basson, which was much more circular, suggesting there are actually times when sexual arousal, or the liking, can actually come before sexual desire, the wanting

Women may have the mindset that they need to be experiencing desire, specifically spontaneous desire, to be doing it “right.” For example, in this type of desire, they're seeking sex just because it’s on their mind, rather than stimulated by something specifically sexually exciting in their environment. Yes, this type of desire exists, but it’s not the only type.

2 Key Types of Desire: Spontaneous and Responsive

I try to help women understand that there are two kinds of desire: spontaneous desire, or anticipating pleasure, and responsive desire, in response to pleasure.

In this latter case, perhaps a woman was not thinking about sex at all, but when she put on some sexy music, smelled her partner’s smell, or even something overtly erotic such as a long, passionate kiss, she had the response of desire. “Ooh, now I want that!” Again, some may believe only spontaneous desire is “real” but this can limit a potential positive sexual experience. The two different types are both absolutely normal.

Perhaps you and your partner have been together for many years, or due to certain stressors, you are experiencing less spontaneous desire for sex with your partner. That doesn't mean you truly desire them less; it just means that you're not having spontaneous anticipation of sexual activity. Working with women reporting low sexual desire, we discuss the difference, and highlight possible ways to trigger responsive desire, even with physical touch, or keeping erotic material closer to the front of the mind.

The Dual Control Model

A more recent model for sexual functioning is the Dual Control Model, developed by scientists at the well-known Kinsey Institute. Essentially, their research suggests that our sexual response is a mix of excitation, referred to casually as accelerators, and inhibition, often called the brakes.

Throughout our life, we learn to associate certain thoughts, feelings, and experiences with sexual activity, and the opposite, as well. We weren’t born with our particular accelerators or brakes, but rather prior positive and negative experiences affected our learned response to these.

For example, if you always listened to a particular song during sex, and the sex was pleasurable, the song can become an accelerator. Alternatively, let’s say, you have sex with a partner who had a unique scent, and you found the sex painful or otherwise unpleasant; that smell could hit the brakes in the future.

Research has suggested women may have a stronger inhibitory system than men, meaning more numerous and sensitive brakes.

This is really important. Many women, and their partners, believe they can boost their sexual desire or arousal by adding more accelerants: lingerie, sex toys, erotic material, etc. However, it may actually be more powerful if they remove some of the brakes. Maybe this means lowering stress in the environment, so she isn’t worrying about work, thinking about all of the dishes in the sink, or remembering an argument she just had with her partner.

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Essentially, it’s the balance of accelerants and brakes that push you in a certain direction. If the brakes win out, sex really loses its appeal.

Research has also demonstrated that we all have a “sexual temperament,” meaning our own unique mix of accelerators and brakes, distributed across a spectrum of normal. You may be someone who has a number of accelerators and it doesn’t take much to feel aroused, or perhaps this was your experience as a young woman but has changed over time. Data suggests women may experience a decrease in accelerators with aging, but not necessarily a change in the brakes.

Self-Check: Take a moment to consider your own experiences: What are some of my accelerants? What are some of my breaks? Have these changed recently?

One of the most common issues individuals and couples describe when they seek out sex therapy is a mismatch in the level of sexual desire between the two partners. One or both of them may come in and ask, “OK, what's the normal amount? How often do most people have sex? On average, do your other patients have more sex than us?”

These are questions I can’t answer because there is no “normal” level of sexual activity. I really want to focus on what works for you and your partner. Do you feel like you are able to have the number and type of sexual encounters that you really want? If not, let’s try to understand why, and help you make some changes.

So two points regarding the Dual Control Model: We all have a sexual temperament, and the triggers for our accelerants and breaks are learned throughout our lives.

Stay tuned for future posts about diagnoses of female sexual dysfunction, and, importantly, how they can be treated.