Reexploring the concept of sexual desire

Sexual counseling for female sexual interest/arousal disorders: a randomized controlled trial based on the "good enough sex" model

BACKGROUND

Female sexual interest/arousal disorder (FSIAD) is the most common female sexual disorder with adverse effects on women's health and interpersonal relationships.

AIM

This survey evaluated the effects of sexual counseling based on the "good enough sex" (GES) model on the sexual health variables of women with FSIAD.

METHODS

A randomized clinical trial with a 1:1 allocation ratio was conducted among 80 women with FSIAD in Iran in 2021. Eligible participants were randomly assigned to group A (women) and group B (couples). Women attended 4 weekly online group sexual counseling sessions based on the GES model, each lasting 120 minutes. In group B, husbands participated in sessions 2 and 3.

OUTCOMES

Women's sexual health parameters-including sexual desire, sexual satisfaction, sexual function, sexual distress, sexual communication, frequency of sexual intercourse, and dysfunctional beliefs-were evaluated before and 3 months after counseling. The significance threshold considered P < .007 due to Bonferroni correction.

RESULTS

After the intervention, all sexual parameters except sexual dysfunctional beliefs showed significant improvement (P < .001) in both groups. During the follow-up period, the average scores for all sexual variables were slightly higher in group B vs group A. The between-group difference was significant only for frequency of sexual intercourse (P < .01).

CLINICAL IMPLICATIONS

This study reaffirms the impact of the GES model as biopsychosocial therapy in managing female sexual problems. Considering men's reluctance to accompany their wives to sex clinics, counseling for women alone can play a significant role in solving sexual problems, especially in the case of FSIAD. Online sexual consultation offers cost and time savings, provides a secure space for discussing sensitive topics, and facilitates group program coordination. It ensures universal access to counseling, thereby addressing gender incompatibility issues. It is a powerful, interactive, and acceptable alternative to in-person visits, providing convenience and confidentiality for clients seeking sexual health support.

STRENGTHS AND LIMITATIONS

The following were among the survey strengths: conducting a randomized controlled trial on women with FSIAD by applying an appropriate model and scales, involving spouses, and evaluating online group sexual counseling. However, the results of this study may not be generalizable to women without partners.

CONCLUSION

The GES model, emphasizing intimacy and sexual dialogue, reduces unrealistic sexual expectations and improves women's sexual desire and overall health. Our results showed that instead of insisting on the physical presence of husbands in counseling sessions, clinicians should emphasize their emotional support and companionship during the treatment process.

When the brain turns on with sexual desire: fMRI findings, issues, and future directions

INTRODUCTION

More than 2 decades of neuroimaging research has sought to uncover the neurologic basis of sexual desire. However, the lack of a clear conceptual distinction between sexual desire and sexual arousal or even a broadly accepted definition of sexual desire has led to confusion in the literature regarding brain areas uniquely associated with sexual desire.

OBJECTIVES

(1) To critically review the neuroimaging literature that seeks to identify brain areas and networks involved in sexual desire; (2) to identify and discuss those brain areas and potential networks that are most promising for providing insights to sexual desire; and (3) to offer recommendations for future studies.

METHODS

Existing meta-analyses were used as a starting point to identify relevant neuroimaging studies on sexual desire, arousal, and love. This base was then expanded via Google Scholar and forward citation tracking of already identified studies.

RESULTS

Brain areas that are commonly associated with sexual desire and arousal include the amygdala, hypothalamus, dorsal and ventral striatum, anterior cingulate, insula, and prefrontal and orbitofrontal cortex. However, because the same basic paradigm has been used to study sexual desire and arousal, unambiguous conclusions regarding areas uniquely involved in sexual desire cannot be drawn. Moreover, the lack of connectivity analyses and a failure to acknowledge negative BOLD (blood-oxygen level dependent) significantly limit conclusions on the neural basis of sexual desire.

CONCLUSION

Five recommendations are made. First, stimulus types (ie, erotic vs sexually explicit) should be selected by the meaningful theoretical conceptualization of the constructs of interest. Second, participants should be provided with definitions of sexual desire, mental sexual arousal, and perceived genital sexual arousal, so they can choose which terms best describe their experience. Third, event-related designs should be used with caution when investigating sexual desire. Fourth, time series analyses should be used to identify both positive and negative BOLD. Fifth, connectivity analyses should be performed to identify brain networks.

Fairer Sex: The Role of Relationship Equity in Female Sexual Desire

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 effects of sexual shame, emotion regulation and gender on sexual desire

Sexual desire is of importance to sexual health, functioning, and well-being. Although an increasing number of studies address disorders related to sexual functioning, there is still a limited understanding of the underlying individual factors affecting sexual desire. The aim of the current study was to investigate the effect of sexual shame, emotion regulation strategies, and gender on sexual desire. In order to investigate this, sexual desire, expressive suppression, cognitive reappraisal, and sexual shame was measured in 218 Norwegian participants using the Emotion Regulation Questionnaire-10, the Sexual Desire Inventory-2, and the Sexual Shame Index-Revised. A multiple regression analysis indicated that cognitive reappraisal predicted sexual desire, β = 0.343, (218) = 5.09, p < 001, CI [0.407, 0.920], whereas sexual shame and expressive suppression were unrelated to sexual desire. Men scored significantly higher than women on expressive suppression, F(1, 216) = 24.968, p < 0.001; partial η2 = 0.104. The current study did not find any significant differences between women and men on cognitive reappraisal, sexual desire or sexual shame, all p > 0.05. Results from the current study indicates that the inclination toward cognitive reappraisal as a preferred emotion regulation strategy may positively affect the strength of sexual desire.

Sexual Satisfaction Mediates the Effects of the Quality of Dyadic Sexual Communication on the Degree of Perceived Sexual Desire Discrepancy

Difficulties related to sexual desire discrepancy are among the most common complaints in people seeking help in therapy. The aims of the current study were to test a mediation model using a bootstrapping procedure where the quality of the dyadic sexual communication plays a key role in increasing or diminishing the degree of perceived sexual desire discrepancy through sexual satisfaction. An online survey was administered through social media to N = 369 participants involved in a romantic relationship, measuring the quality of dyadic sexual communication, sexual satisfaction, the degree of the perceived sexual desire discrepancy, and a series of relevant covariates. As expected, the mediation model showed that a better quality of dyadic sexual communication is related to a lower degree of perceived sexual desire discrepancy through increased sexual satisfaction (β = -0.17, SE = 0.05, [95% CI = -0.27, -0.07]). The effect held over and above the effect of the relevant covariates. The theoretical and practical implications of the present study are discussed.

Sexual Desire in Women: Paradoxical and Nonlinear Associations with Anxiety and Depressed Mood

The aim of the present study was to expand previous findings regarding paradoxical effects of negative mood on sexual desire. This was done by considering the full range of depressed mood and anxiety symptoms and using methods that are unaffected by recall bias and that don't require participants to infer causal associations between their mood and sexual desire. A convenience sample of 213 university students completed daily questionnaires for approximately two months. Multilevel random-effects models were used to estimate average effects for the entire sample and to test for variability across participants in the associations between negative mood and sexual desire, controlling also for potential influences of the menstrual cycle. Previous findings showing that some women report decreased sexual desire and others increased sexual desire when depressed or anxious were confirmed. More importantly, for both depressed mood and anxiety, results demonstrated the presence of within-person paradoxical associations, whereby there were some women for whom both low and high levels of negative mood were associated with the same change (an increase or a decrease) in sexual desire. Related to these diverse response patterns, paradoxical associations between negative mood and sexual desire were also present at low levels of negative mood. The discussion underlines the importance of considering individual variability and multifactorial nonlinear models when studying sexual desire.

Reduced Sexual Desire in Young Norwegian Women: A Mixed-Methods Study

Sexuality has become an area of social competence in which individuals strive to be recognized as sexually competent performers. However, a large proportion of young women experience reduced sexual desire. In this study, both quantitative and qualitative methods were applied. Using data from a questionnaire, the aim of this study was to explore the prevalence of, and the factors associated with, lack of sexual interest and desire among young women in Norway. Further, with the help of in-depth interviews, we investigated how young women with reduced sexual desire experience living with their desire problems and what they experience as the cause of their problems. The sample in the quantitative study consisted of 505 Norwegian women between the ages of 18 and 29 years. ANOVA was employed to explore differences in scores on psychological factors and relational factors, as well as between participants who experienced a lack of sexual interest and desire, and those who did not. The results indicate a high prevalence of lack of sexual interest and desire among women (37.1%), while low appearance satisfaction and low relationship satisfaction were central predictors of lack of sexual interest and desire. The sample in the qualitative study consisted of ten Norwegian women with reduced sexual desire between the ages of 18 and 29 years. Through thematic analysis, four themes emerged as experiences of living with reduced sexual desire: (1) physical and mental health, (2) being a young woman in today's society, (3) relational factors, (4) negative experiences, personal expectations toward sexuality, and sexual trauma.

Associations between Fluctuating Shame, Self-Esteem, and Sexual Desire: Comparing Frequent Porn Users and a General Population Sample

In the present study, we explore the proposed cyclic models for problematic hypersexuality (PH) that involve shame, self-esteem, and sexual desire. These cyclic models are characterized by temporal associations but have not been investigated previously with intensive longitudinal designs. In this study, we collected up to 70 measurements per participant within a period of seven consecutive days, which allowed us to investigate associations between fluctuations of shame, self-esteem, and sexual desire. Participants were divided in four subgroups: (1) women (n = 87); (2) men (n = 46) from a general population convenience sample; (3) men watching porn >2 times per week, showing non-problematic hypersexuality (NH; n = 10); and (4) men watching porn >2 times per week, experiencing PH (n = 11). Multilevel analyses, including cross-level interactions, were used to investigate between-group differences in intraindividual processes. Results showed that prior increases in shame forecasted higher current sexual desire for men with PH, but not for the other groups, suggesting that men with PH use sexual desire to downregulate dysphoric feelings of shame. Differences between groups in associations between self-esteem and sexual desire were also found. Based on our results, we propose the Split Pleasure/Shame model, which represents emotion dysregulation in PH, and juxtapose this with the pleasurable experience of sex by non-PH groups. Further intensive longitudinal research is necessary to test this model and, more generally, to investigate the fluctuating nature of sexual desire.

Discrepancy in Dyadic Sexual Desire Predicts Sexual Distress over Time in a Community Sample of Committed Couples: A Daily Diary and Longitudinal Study

In long-term relationships, sexual desire discrepancy (SDD) occurs frequently between partners. For many, this discrepancy is persistent and significant, and a source of distress. However, the dynamics of SDD in couples and, specifically, its implications for sexual distress have received scant empirical attention. This study examined the associations between SDD and sexual distress from one day to the next and over a 12-month span, in a community sample of 229 same-sex/gender and mixed-sex/gender couples. Two datasets were collected: A 35-day daily diary and a 12-month longitudinal survey. In both, dyadic sexual desire and sexual distress were measured, and SDD was calculated as the absolute value of the difference in sexual desire between partners. Directional associations between SDD at one time point and sexual distress at the next time point were assessed using multilevel, 2-pane autoregressive cross-lagged models, controlling for within-variable changes, dependencies between partners, and partner age. Results were consistent with the study's hypotheses: Couples' SDD on one day predicted sexual distress on the next day. Similarly, SDD at baseline predicted sexual distress 12 months later. Participant gender, partner gender, and couple type did not significantly moderate these associations, nor did differentiating partners based on higher and lower average sexual desire. The reverse associations (i.e., sexual distress predicting SDD) were non-significant. The associations' directionality and the fact that they remained significant over days and months were consistent with the proposal that SDD is a precursor of sexual distress. The present study provides support for dyadic conceptualizations of sexual desire. Clinically, findings suggest that therapeutic approaches should address issues with sexual desire and sexual distress by focusing not on the individual, but on the couple.

Attachment Orientation Moderates the Sexual and Relational Implications of Sexual Desire Discrepancies

We examined the degree and direction of sexual desire discrepancies (SDD) between partners and how this relates to sexual function, sexual satisfaction, relationship satisfaction in 100 Saudi Arabian couples, taking into account both partners' attachment orientation. Men and women reported better outcomes when they matched on higher levels of sexual desire. In case of a mismatch, women reported higher sexual satisfaction when their partner's level of sexual desire was higher than their own. Attachment anxiety and avoidance moderated the associations between SDD and the outcome variables. This study offers unique information on SDD in couples with strong gender role expectations and cultural restrictions regarding sexuality. Therapeutic interventions should be directed at understanding the attachment meaning of sexual desire.

Decreased Sexual Desire among Middle-Aged and Old Women in China and Factors Influencing It: A Questionnaire-Based Study

Objective

This survey was designed and conducted with an aim to present data on sexual desire and activity in Chinese women.

Methods

Between October 2013 and December 2013, we surveyed 3000 women (aged 40–65 years) at Beijing No. 2 Hospital and the Yuetan Community Health Service Center using a questionnaire. The primary outcomes included determination of sexual desire in the past 4 weeks, reasons for stopping sexual activity, and postmenopausal syndrome. The secondary outcome was determination of factors for low sexual desire.

Results

A total of 2400 women (mean age 54.33 ± 6.25 years; mean menopausal age 50.11 ± 3.31 years) returned the questionnaire, with 58% of women reporting lowered sexual desire and 39.3% reporting stoppage of sexual activity. Compared with the postmenopausal group, the incidence of anxiety, depressive, somatic, and vasomotor symptoms was higher in the perimenopausal group. Muscle and joint pain (45.8%) and vaginal pruritus (21.5%) were the most commonly reported menopausal and vulvovaginal symptoms, respectively. The odds of decrease in sexual desire were significantly higher with older age, menopause, presence of gynecological disease, menopausal depression symptoms, menopausal vasomotor symptoms, and vulvovaginal atrophy; only cesarean delivery (odds ratio = 0.887, P=0.018) was associated with lesser reduction in sexual desire compared with the aforementioned factors.

Conclusion

This survey showed that a high proportion of Chinese middle-aged and old women have lowered sexual desire and activity. Lack of sexual desire is associated with multiple factors and affects the quality of life of women.

I Want You to Want Me: A Qualitative Analysis of Heterosexual Men's Desire to Feel Desired in Intimate Relationships

Current sexual scripts for heterosexual relationships in the Western world stipulate that men should be the ones to initiate sexual activity, push to the next level of physical intimacy, and to desire women (and not be desirable themselves). However, there is building evidence that sexual scripts and gender roles are not only limited, they may be evolving and shifting over time. The purpose of the current study was to explore the degree to which feeling desired is considered important to heterosexual men in intimate relationships as well as how heterosexual men feel desired by their partners. Three hundred men between the ages of 18 and 65 were recruited from the online platform Reddit. Using Thematic Analysis, we determined that the vast majority of men in this study felt that feeling desired was very important to their sexual experiences. Men in this study listed several ways they felt desired, many that fell outside of traditional gender roles such as romantic, non-sexual touch and having women initiate sexual activity. The findings add to a growing body of literature which suggests traditional sexual scripts for heterosexual men may be limiting and not accurate for all men's sexual experiences.

When Desire Fades: Women Talk About Their Subjective Experience of Declining Sexual Desire in Loving Long-term Relationships

Women's sexual desire has been shown to decline over the course of loving long-term relationships. Yet, accounts of partnered women's subjective experience of this occurrence are rather limited. In order to broaden the examination of this topic, the present exploratory qualitative study extended it cross-culturally to explore how women in Israel are impacted by, perceive, and experience this decline in their sexual desire, with the objective of sketching an account of the experiences of women who share this reality. Semi-structured interviews were conducted with 15 women, aged 25 and over, in fulfilling long-term heterosexual relationships. The participants reported a sharp decline in sexual desire in comparison to the early stages of the relationship, experiencing it as quite perplexing given their love and affection for their partner. All also described their intimate connection as based on much more than sex. Additionally, while the reduction in desire did not result from difficulties in the relationship it did create some. These included frustration, conflict, and pressure from partner, which often led to sexual compliance on the women's part. Suggested solutions included open and honest dialogue, thoughtfulness, and mutual respect. A critical discussion of the findings outlines implications for partnered women's and couples' wellbeing.

Associations Between Pornography Use and Sexual Dynamics Among Heterosexual Couples

BACKGROUND

While links between pornography use and couple relational well-being have been the subject of multiple research studies, less attention has been paid to the associations between pornography use and specific sexual behavior within the relationship.

AIM

This study aimed to explore associations between each partner's pornography use, sexual desire, sexual satisfaction, and intercourse/non-intercourse sexual behavior. The confounding and moderating role of religiosity was also explored.

METHODS

A dyadic sample of 240 heterosexual couples was used. Measurement assessed pornography use, sexual desire, sexual satisfaction, and sexual behavior.

OUTCOMES

Sexual satisfaction as well as intercourse and non-intercourse sexual behaviors were examined.

RESULTS

Results suggested consistent gendered differences where female pornography use was directly associated with higher reports of female sexual desire, whereas male pornography use was directly associated with more male but less female partner desire and lower overall male sexual satisfaction. Male pornography use was also indirectly associated with sexual satisfaction for both partners and non-intercourse behaviors within the relationship through sexual desire. Overall, religiosity had little impact on the results of the study.

CLINICAL TRANSLATION

The complex associations between pornography use, sexual desire, and sexual behaviors suggested by our results highlight the importance of comprehensive and systemic assessment and education around sexuality when working with individuals and couples.

STRENGTHS & LIMITATIONS

The main strength of this study is the use of dyadic data. The main limitation is the cross-sectional nature of the data CONCLUSION: The associations between pornography use and a variety of outcomes are highly nuanced. This study provides an important step forward in more fully accounting for the complications of pornography use in a relationship. Willoughby BJ, Leonhardt ND, Augustus RA. Associations Between Pornography Use and Sexual Dynamics Among Heterosexual Couples. J Sex Med 2021;18:179-192.

Ebbs and Flows of Desire: A Qualitative Exploration of Contextual Factors Affecting Sexual Desire in Bisexual, Lesbian, and Straight Women

Previous research has found that sexual desire ebbs and flows over time within and across relationships, leading to instances of desire discrepancy. The purpose of the present study was to understand factors that may contribute to desire and desire discrepancy and examine differences and similarities across women from diverse sexual identity groups. The present qualitative study involved semi-structured interviews with 31 women (10 bisexual, 8 lesbian, and 13 straight). We identified six main themes (changes across lifespan, hormonal influences, mental and physical health, objective of desire, partner dynamics, external factors) with 21 subthemes. The findings showed more similarities between the women than differences.

Extradyadic Behaviors and Gender: How Do They Relate With Sexual Desire, Relationship Quality, and Attractiveness

Recent years have seen an increasing number of studies on relationship extradyadic behaviors (Pinto and Arantes, 2016; Pazhoohi et al., 2017; Silva et al., 2017; Fisher, 2018). However, much is still to learn about the impact of these extradyadic behaviors on subsequent relationships that an individual may have. Our main goal was to study the association between past extradyadic behaviors – inflicted and suffered – and current relationship quality, sexual desire and attractiveness. Specifically, we aimed to: (i) Understand if past extradyadic behaviors are related to current relationship quality, sexual desire, and self-perceived and partner’s attractiveness; (ii) Identify possible gender differences in these variables. For that, 364 participants (251 females and 113 males) were recruited through personal and institutional e-mails, online social networks (e.g., Facebook), and the website of the Evolutionary Psychology Group from the University of Minho. All participants completed a demographic and relationship questionnaire, followed by questions related to extradyadic behaviors and self-perceived attractiveness, the Perceived Relationship Quality Components (PRQC) Inventory, the Sex Drive Scale (SDQ), and the Importance of Partner’s Physical Attractiveness Scale (IPPAS). For those currently involved in a relationship, results suggested that extradyadic behaviors (both suffered or inflicted) are linked with current low relationship quality and high sexual desire in the present. In addition, individuals who perceived themselves as being more attractive tended to have a higher sexual desire and higher relationship quality. Overall, men reported higher levels of extradyadic behaviors and sexual desire, gave more importance to physical attractiveness, and perceived their current relationship as having less quality than women. These results add to the literature by focusing on different variables that play an important role in romantic relationships, and have important implications.

Sexual Desire Discrepancy: A Position Statement of the European Society for Sexual Medicine

Introduction

There is a lack of theoretical and empirical knowledge on how sexual desire functions and interacts in a relationship.

Aim

To present an overview of the current conceptualization and operationalization of sexual desire discrepancy (SDD), providing clinical recommendations on behalf of the European Society of Sexual Medicine.

Methods

A comprehensive Pubmed, Web of Science, Medline, and Cochrane search was performed. Consensus was guided by a critical reflection on selected literature on SDD and by interactive discussions between expert psychologists, both clinicians and researchers.

Main Outcome Measure

Several aspects have been investigated including the definition and operationalization of SDD and the conditions under which treatment is required.

Results

Because the literature on SDD is scarce and complicated, it is precocious to make solid statements on SDD. Hence, no recommendations as per the Oxford 2011 Levels of Evidence criteria were possible. However, specific statements on this topic, summarizing the ESSM position, were provided. This resulted in an opnion-based rather than evidence-based position statement. Following suggestions were made on how to treat couples who are distressed by SDD: (i) normalize and depathologize variation in sexual desire; (ii) educate about the natural course of sexual desire; (iii) emphasize the dyadic, age-related, and relative nature of SDD; (iv) challenge the myth of spontaneous sexual desire; (v) promote open sexual communication; (vi) assist in developing joint sexual scripts that are mutually satisfying in addition to search for personal sexual needs; (vii) deal with relationship issues and unmet relationship needs; and (viii) stimulate self-differentiation.

Conclusion

More research is needed on the conceptualization and underlying mechanisms of SDD to develop clinical guidelines to treat couples with SDD.

Marieke D, Joana G, Giovanni C, et al. Sexual Desire Discrepancy: A Position Statement of the European Society for Sexual Medicine. J Sex Med 2020;8:121–131.

Development of a Dualistic Model of Sexual Passion: Investigating Determinants and Consequences

In empirical research, sexual passion has frequently been conceptualized as the interdependent dynamics experienced with a partner and as following a unidimensional continuum of intensity. A recent theoretical model conceptualized sexual passion as an intrapersonal motivation, which can energize both partnered and non-partnered sexual behaviors (Philippe, Vallerand, Bernard-Desrosiers, Guilbault, & Rajotte, 2017). This model also departs from the typical unidimensional continuum by positing the existence of two types of sexual passion: harmonious sexual passion (HSP) and obsessive sexual passion (OSP). The purpose of the present research was to extend the development of such a dualistic model by examining key theoretical determinants and consequences of each type of sexual passion. Study 1 provided empirical evidence of discriminant validity for such a model with respect to key-related constructs in the sex literature (e.g., sexual desire, hypersexuality, self-determined motives). The results of Study 2 showed that both types of sexual passion were associated with a high engagement in various sexual activities, but that only HSP combined it with couple adjustment. Finally, Study 3 indicated that both HSP and OSP were associated with common as well as distinct determinants, while being conducive to different personal and interpersonal consequences. Overall, there were very few moderations by biological sex. The results of these three studies provide empirical support for the sexual passion model and pave the way for new research directions.

The Relational and Bodily Experiences Theory of Sexual Desire in Women

We review the theory and research on women's sexual desire and present a theory that incorporates internalized representations of relational and bodily experiences into our understanding of the full range of desire in women. To this end, we move away from the current tendency to focus on low sexual desire in women and instead consider desire on a spectrum or continuum from absent or diminished to high desire across multiple sexual orientations, including heterosexual, bisexual, and lesbian. We review definitions of sexual desire, as well as the epidemiology and etiology of hypoactive sexual desire, the most prevalent sexual complaint in women, including the biological, psychological, and relationship correlates of inhibited sexual desire. Subsequently, we examine the research on highly sexual women, who tend to experience high levels of sexual desire, sexual agency, and sexual esteem, and distinguish between high sexual desire and hypersexuality. We introduce two important constructs that are integrated into the Relational and Bodily Experiences Theory (RBET) of sexual desire in women: attachment and sexual body self-representations, suggesting that women's internalized representations of self and other that stem from childhood and their capacity to embody their sexual bodies are integral to our understanding of the phenomenology of sexual desire in women. RBET calls for further research into the links between attachment, sexual body self-representations, and desire, and suggests that clinical interventions for sexual desire difficulties in women should emphasize internalized working models of relationships (i.e., attachment) and integrate bodily based approaches.

Genito-Pelvic Pain Through a Dyadic Lens: Moving Toward an Interpersonal Emotion Regulation Model of Women's Sexual Dysfunction

Researchers and clinicians alike widely acknowledge the inherently interpersonal nature of women's sexual dysfunctions given that both partners impact and are impacted by these difficulties. Yet theoretical models for understanding the role of interpersonal factors in women's sexual dysfunctions are severely lacking and have the potential to guide future research and inform more effective interventions. The most widely studied sexual dysfunction in women that has espoused a dyadic approach by including both members of affected couples is genito-pelvic pain/penetration disorder (GPPPD). In this article we use the example of GPPPD to introduce a novel interpersonal emotion regulation model of women's sexual dysfunction. We first review current knowledge regarding distal and proximal interpersonal factors in GPPPD. Then, we describe our theoretical model and consider relevant pain and sex-related research on emotion regulation processes-emotional awareness, expression, and experience-in the context of GPPPD, including sexual function, satisfaction, and distress. Next, we review how existing theories from the fields of chronic pain and sex and relationships research have informed our model and how our model further builds on them. Finally, we discuss the implications of our model and its applications, including to other sexual dysfunctions in women.

Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire

INTRODUCTION

The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women.

AIM

To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research.

METHODS

A systematic literature review was conducted.

MAIN OUTCOME MEASURES

169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors.

RESULTS

We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire.

CONCLUSION

Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.

Sexual and Relationship Satisfaction: The Role of Perceived (Non)problematic Sexual Desire Discrepancy in Gay and Heterosexual Men

Sexual desire discrepancy has been associated with sexual and relationship dissatisfaction. Nonetheless, little is known regarding the role of desire discrepancy in gay men, as main research has been systematically conducted with heterosexual couples. Also, only one study has focused on problematic sexual desire discrepancies and sexual satisfaction with lesbian women. This study sought to understand if perceived sexual desire discrepancy influences sexual and relationship satisfaction in men, and to explore differences according to sexual orientation. A total of 346 men (245 heterosexual and 101 gay) completed an online survey and answered sociodemographic questions, a specific question about sexual desire discrepancy, and completed the Global Measure of Sexual Satisfaction and the Global Measure of Relationship Satisfaction. The main findings showed differences in sexual and relationship satisfaction according to sexual desire discrepancy groups, with men who experienced no desire discrepancy being more satisfied within their relationship and sex life compared to men who experienced both problematic and nonproblematic sexual desire discrepancy. Additionally, men who experienced nonproblematic sexual desire discrepancy reported being more sexually and relationship satisfied than men who experienced problematic sexual desire discrepancy. No sexual orientation differences were found. Overall, current findings emphasize the role of (non)problematic desire discrepancy in sexual and relationship satisfaction among heterosexual and gay men.

Sexual desire of French representative prostate cancer survivors 2 years after diagnosis (the VICAN survey)

PURPOSE

The prostate cancer impacts on the future life of survivors. The complexity of sexual health problems in prostate cancer survivors is underestimated or often reduced to the erectile dysfunction. Especially, factors influencing sexual desire of patients have to be more explored. This study aims to describe the therapeutic management of patients with prostate cancer and assess their sexual desire 2 years after diagnosis.

METHODS

This study is part of the National VICAN survey (Vie après le CANcer) implemented in France in 2012. This analysis was performed on a population of 414 men who had prostate cancer. The questionnaire dealt with several topics including socioeconomic status, treatments received, and sexual desire.

RESULTS

Prostatectomy (42.8%), radiotherapy + hormonotherapy (17.6%), and radiotherapy alone (12.8%) were the main treatments used. 41.3% of men stated that their sexual desire was all gone since disease. The "satisfying" perceived financial situation was significantly associated to a sexual desire loss (p = 0.008). Radiotherapy + hormonotherapy treatment only is significantly associated with a loss of sexual desire (P = 0.003).

CONCLUSIONS

Two years after diagnosis, the sexual desire of prostate cancer survivors is deteriorated with the cancer experience. However, clinical characteristics do not seem to be decisive unlike a "satisfying" financial situation. Research about the impact of socio economics characteristics on sexual health should probably be engaged. Programs have to be developed in France to have personalized sexual support progressed for survivors and take spouses into consideration in this context.

Using spectral and cross-spectral analysis to identify patterns and synchrony in couples' sexual desire

Sexual desire discrepancy is one of the most frequently reported sexual concerns for individuals and couples and has been shown to be negatively associated with sexual and relationship satisfaction. Sexual desire has increasingly been examined as a state-like construct that ebbs and flows, but little is known about whether there are patterns in the fluctuation of sexual desire. Utilizing spectral and cross-spectral analysis, we transformed 30 days of dyadic daily diary data for perceived levels of sexual desire for a non-clinical sample of 133 couples (266 individuals) into the frequency domain to identify shared periodic state fluctuations in sexual desire. Spectral analysis is a technique commonly used in physics and engineering that allows time series data to be analyzed for the presence of regular cycles of fluctuation. Cross-spectral analysis allows for dyadic data to be analyzed for shared rates of fluctuation between partners as well as the degree of (a)synchrony (or phase shift) between these fluctuations. Men and women were found to exhibit fluctuations in sexual desire at various frequencies including rates of once and twice per month, and to have sexual desire that was unlikely to fluctuate over periods of three days or less and therefore exhibited persistence. Similar patterns of fluctuation were exhibited within couples and these patterns were found to be largely synchronous. While instances of desire discrepancy may arise due to differences in rates of sexual desire fluctuation and random fluctuations, such instances may be normal for romantic relationships. The results have important implications for researchers, clinicians, and educators in that they corroborate the supposition that sexual desire ebbs and flows and suggest that it does so with predictable regularity.

Sexual Satisfaction, Solitary, and Dyadic Sexual Desire in Men According to Sexual Orientation

Research on male sexual desire and satisfaction according to sexual orientation remains insufficient. An online survey was fulfilled by 415 men (142 gay; 273 heterosexual), and participants completed the SDI-2 and the GMSEX. Main findings suggested that gay men scored significantly higher on both solitary sexual desire and attractive person-related dyadic sexual desire subscales, but not on a partner-related dyadic sexual desire subscale, compared to heterosexual men. Despite sexual orientation, partner-related dyadic sexual desire positively predicts sexual satisfaction, whereas solitary and attractive person-related dyadic sexual desire negatively predicts sexual satisfaction in men. Overall, gay men appear to experience higher levels of both attractive person-related dyadic and solitary sexual desire. Also, experiencing sexual desire toward a partner predicts positively, whereas experiencing desire to engage in sexual behavior with oneself and toward an attractive person predict negatively sexual satisfaction in men.

The Impact of Attachment Style on Sexual Satisfaction and Sexual Desire in a Sexually Diverse Sample

Research has indicated that adult romantic attachment is influential and important to sexual and relationship satisfaction. Sexual desire, although not a direct focus of attachment literature, is highly related to sexual and relationship satisfaction, suggesting it may also be impacted by attachment style in romantic couples. However, the research conducted on sexual desire, sexual satisfaction, and attachment has been largely heterocentric, making it difficult to determine whether the findings documented in the literature thus far are relevant in a sexually diverse group of individuals. The current study aimed to better understand the way that attachment style may impact sexual desire, sexual satisfaction, and relationship satisfaction in a sample of sexually diverse men and women. In total, 955 individuals (63.4% cisgender women, 30.7% cisgender men, 6.0% genderqueer, 54.8% straight, 20.4% bisexual, 18.4% gay) participated in a web-based study examining relationship dynamics. Three multivariate regression models indicated that attachment style significantly predicted relationship satisfaction (29% of variance accounted for), sexual satisfaction (19% of variance accounted for), and sexual desire (4% of variance accounted for). Attachment style appears to be a more important contributing factor to satisfaction than desire among diverse sexual orientations. Clinical implications and future directions are discussed.

Understanding the Role of Serotonin in Female Hypoactive Sexual Desire Disorder and Treatment Options

BACKGROUND

The neurobiology of sexual response is driven in part by dopamine and serotonin-the former modulating excitatory pathways and the latter regulating inhibitory pathways. Neurobiological underpinnings of hypoactive sexual desire disorder (HSDD) are seemingly related to overactive serotonin activity that results in underactive dopamine activity. As such, pharmacologic agents that decrease serotonin, increase dopamine, or some combination thereof, have therapeutic potential for HSDD.

AIM

To review the role of serotonin in female sexual function and the effects of pharmacologic interventions that target the serotonin system in the treatment of HSDD.

METHODS

Searches of the Medline database for articles on serotonin and female sexual function.

OUTCOMES

Relevant articles from the peer-reviewed literature were included.

RESULTS

Female sexual response is regulated not only by the sex hormones but also by several neurotransmitters. It is postulated that dopamine, norepinephrine, oxytocin, and melanocortins serve as key neuromodulators for the excitatory pathways, whereas serotonin, opioids, and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Serotonin appears to be a key inhibitory modulator of sexual desire, because it decreases the ability of excitatory systems to be activated by sexual cues. Centrally acting drugs that modulate the excitatory and inhibitory pathways involved in sexual desire (eg, bremelanotide, bupropion, buspirone, flibanserin) have been investigated as treatment options for HSDD. However, only flibanserin, a multifunctional serotonin agonist and antagonist (5-hydroxytryptamine [5-HT]_1A receptor agonist and 5-HT_2A receptor antagonist), is currently approved for the treatment of HSDD.

CLINICAL IMPLICATIONS

The central serotonin system is 1 biochemical target for medications intended to treat HSDD.

STRENGTHS AND LIMITATIONS

This narrative review integrates findings from preclinical studies and clinical trials to elucidate neurobiological underpinnings of HSDD but is limited to 1 neurotransmitter system (serotonin).

CONCLUSION

Serotonin overactivity is a putative cause of sexual dysfunction in patients with HSDD. The unique pharmacologic profile of flibanserin tones down inhibitory serotonergic function and restores dopaminergic and noradrenergic function. Croft HA. Understanding the Role of Serotonin in Female Hypoactive Sexual Desire Disorder and Treatment Options. J Sex Med 2017;14:1575-1584.

Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men

BACKGROUND

The literature lacks studies of the male sex drive. Most existing studies have focused on hypoactive sexual desire disorder in coupled heterosexual men, highlighting some of the main related biological, psychological, and social factors.

AIM

To evaluate the role of selected psychological and social variables affecting male sexual desire such as quality of life, sexual function, distress, satisfaction, psychological symptoms, emotions, alexithymia, couple adjustment, sexism, cognitive schemas activated in a sexual context, sexual dysfunctional beliefs, and different classes of cognitions triggered during sexual activity about failure anticipation, erection concerns, age- and body-related thoughts, erotic fantasies, and negative attitudes toward sexuality.

METHODS

A wide self-administered survey used snowball sampling to reach 298 heterosexual Italian men (age = 32.66 ± 11.52 years) from the general population.

OUTCOMES

13 questionnaires exploring psychological and social elements involved in sexual response were administrated: International Index of Erectile Function, Short Form 36 for Quality of Life, Beck Depression Inventory-II, Symptom Check List-90-Revised, Toronto Alexithymia Scale, Premature Ejaculation Severity Index, Sexual Distress Scale, Sexual Satisfaction Scale, Dyadic Adjustment Scale, Ambivalent Sexism Inventory, Sexual Modes Questionnaire, Sexual Dysfunctional Belief Questionnaire, and Questionnaire of Cognitive Schema Activation in Sexual Context.

RESULTS

Results showed lack of erotic thoughts (β = -0.328), fear (β = -0.259) and desire to have a baby (β = -0.259) as the main predictors of the level of sexual desire in this group. Energy-fatigue, depression, premature ejaculation severity, sexual distress, compatibility, subjective sexual response, and sexual conservatism had a weaker effect on sexual desire. Sexual functioning (13.80%), emotional response (12.70%), dysfunctional sexual beliefs (12.10%), and negative automatic thoughts (12.00%) had more variable effects on sexual drive.

CLINICAL TRANSLATION

Analyzed variables could represent important factors that should be considered in the assessment of desire concerns and discussed in therapy.

STRENGTHS AND LIMITATIONS

The strength of this study is the analysis of novel psychological and social factors on male sexual desire. Recruitment and sample size do not allow generalization of the results, but some crucial points for future research and clinical practice are discussed.

CONCLUSION

Our findings showed that male sexual desire could be affected by many psychological and social elements. Other factors remain to be explored, in their direct and interactive effects, aiming to better explain male sexual desire functioning. Nimbi FM, Tripodi F, Rossi R, Simonelli C. Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men. J Sex Med 2018;15:230-244.

A Qualitative Exploration of Factors That Affect Sexual Desire Among Men Aged 30 to 65 in Long-Term Relationships

Few empirical studies have explored men's experiences of sexual desire, particularly in the context of long-term relationships. The objective of the current study was to investigate the factors that elicit and inhibit men's sexual desire. Semistructured interviews were conducted with 30 men between the ages of 30 and 65 (average age 42.83 years) currently in long-term heterosexual relationships (average duration 13 years 4 months). Analysis was conducted using grounded theory methodology from the interpretivist perspective. A total of 14 themes and 23 subthemes were identified to capture men's descriptions of eliciting and inhibiting factors of their sexual desire. The six most integral themes are presented in the current article, all of which reflect the perspectives of the majority of participants, regardless of age or relationship duration, specifically (a) feeling desired, (b) exciting and unexpected sexual encounters, (c) intimate communication, (d) rejection, (e) physical ailments and negative health characteristics, and (f) lack of emotional connection with partner. The findings suggest that men's sexual desire may be more complex and relational than previous research suggests. Implications for researchers and therapists are discussed.

Controversies of Women’s Sexual Arousal and Desire

Abstract. The past three decades have seen an unprecedented increase in empirical research on women’s sexual response. In this review, we critically examine current controversies and assumptions associated with the nature of women’s sexual arousal and desire. We focus specifically on four assumptions: (1) the assumption that women should be aroused by stimuli that align with their stated preferences, (2) the assumption that women’s physiological and self-reported arousal should perfectly align, (3) the assumption that sexual desire precedes sexual arousal, and (4) the assumption that a single pharmaceutical compound will adequately restore women’s sexual response to her level of satisfaction. Engaging a gendered psychological framework for conceptualizing women’s sexuality, we emphasize the need for models of women’s sexual response to be sensitive to the sexed biological processes and gendered psychosocial factors that contribute to a woman’s unique sexual experience.

Is High Sexual Desire a Risk for Women's Relationship and Sexual Well-Being?

Historically, women's sexual desire has been deemed socially problematic. The growing popularity of the concept of hypersexuality-which lists high sexual desire among its core components-poses a risk of re-pathologizing female sexual desire. Data from a 2014 online survey of 2,599 Croatian women aged 18-60 years was used to examine whether high sexual desire is detrimental to women's relationship and sexual well-being. Based on the highest scores on an indicator of sexual desire, 178 women were classified in the high sexual desire (HSD) group; women who scored higher than one standard deviation above the Hypersexual Disorder Screening Inventory mean were categorized in the hypersexuality (HYP) group (n = 239). Fifty-seven women met the classification criteria for both groups (HYP&HSD). Compared to other groups, the HSD was the most sexually active group. Compared to controls, the HYP and HYP&HSD groups-but not the HSD group-reported significantly more negative consequences associated with their sexuality. Compared to the HYP group, women with HSD reported better sexual function, higher sexual satisfaction, and lower odds of negative behavioral consequences. The findings suggest that, at least among women, hypersexuality should not be conflated with high sexual desire and frequent sexual activity.

Romantic Passion as Output from a Self-Regulating, Intimacy-Seeking System: A Model for Understanding Passionate Love

This article presents a model of why individuals experience the feeling of passionate love in intimate relationships. Previous models have been limited because they do not describe the purpose and function of passionate love, do not incorporate basic emotion and personality theory, or are not applicable to help couples in distress. The present model reinterprets and integrates previous findings. New predictions are made about the functioning of passionate love in relationships by hypothesizing a self-regulating, intimacy-seeking system that produces passionate love as its outcome. A self-regulation model proposed by Carver and Scheier in 1998 is the template on which this model is based.

The Relationship between Sexual Cues and Sexual Desire in Women

Sexual desire is one of the most studied dimensions of sexual response. There is extensive research on bio-medical, psychosocial, and relationship predictors of desire particularly in women. Despite this accumulated knowledge, there is a lack of studies investigating the ability of sexual cues to predict sexual desire. A sample of 546 heterosexual and premenopausal Portuguese women, aged between 18 and 53 years old, completed a web survey assessing socio-demographic variables, medical conditions, psychopathology, relationship dimensions, sexual cues and sexual desire. Findings from hierarchical regression analyses indicated that sexual cues significantly predict sexual desire. In particular, explicit/arousal cues (β = .321, p < .001) were the most significant predictor of female sexual desire. Additionally, somatization (β = .188, p < .001), relationship satisfaction (β = .159, p < .001), anxiety (β = -.165, p = .006), and antidepressant medication (β = -.094, p = .014) were also significant predictors. Results emphasize the strong ability of explicit/arousal cues to predict sexual desire in women above and beyond other known factors. These findings suggest that the assessment of sexual desire problems in women as well as treatment approaches should take into consideration the role of sexual cues and particularly explicit/arousal cues.

A Streetcar Named "Derousal"? A Psychophysiological Examination of the Desire-Arousal Distinction in Sexually Functional and Dysfunctional Women

Research indicates that desire and arousal problems are highly interrelated in women. Therefore, hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and a new diagnostic category, female sexual interest/arousal disorder (FSIAD), was created to include both arousal and desire difficulties. However, no research has tried to distinguish these problems based on psychosocial-physiological patterns to identify whether unique profiles exist. This study compared psychosocial-physiological patterns in a community sample of 84 women meeting DSM-IV (American Psychiatric Association, 2000 ) criteria for HSDD (n = 22), FSAD (n = 18), both disorders (FSAD/HSDD; n = 25), and healthy controls (n = 19). Women completed self-report measures and watched neutral and erotic films while genital arousal (GA) and subjective arousal (SA) were measured. Results indicated that GA increased equally for all groups during the erotic condition, whereas women with HSDD and FSAD/HSDD reported less SA than controls or FSAD women. Women in the clinical groups also showed lower concordance and greater impairment on psychosocial variables as compared to controls, with women with FSAD/HSDD showing lowest functioning. Results have important implications for the classification and treatment of these difficulties.

Is committed desire intentional? A qualitative exploration of sexual desire and differentiation of self in couples

The question of what heightens or diminishes sexual desire has long been a passionate theme across cultures in literature, arts, media, and medicine. Yet, little research has been conducted to determine what affects level of desire within couples. The degree of differentiation of self has been suggested as an important variable in shaping partners' level of desire. Through a qualitative analysis of dyadic couple interviews, this study provides an account of characteristics, processes, and trajectories of sexual desire and differentiation in 33 heterosexual couples of varying ages and relationship duration. Factors associated with high desire were change and autonomy, whereas conflict and children were reported to be desire-diminishing factors. Innovation, sharing, autonomy, and effort emerged as desire-promoting strategies, while fostering personal interests, investing in a positive connection, and enhancing personal integrity were identified as couples' strategies to promote and preserve differentiation of self. The results also shed light on couples' perceptions of whether and how sexual desire changes over the course of the relationship and challenge common cultural assumptions about desire in committed relationships-namely the myth that the only authentic expression of desire is that which occurs spontaneously and without intention and planning. Implications for couple therapy are discussed.

Trajectories of intimate partnerships, sexual attitudes, desire and satisfaction

This research addresses the interrelations existing between trajectories of intimate partnerships and attitudes toward sexuality, sexual desire, and sexual satisfaction. It is based on a dataset of 600 adults aged 25-46 living in Geneva (Switzerland) and uses innovative multivariate techniques for clustering life trajectories. The results emphasize the diversity of men's and women's trajectories of intimate partnerships. Trajectories with frequent and short-term partnerships are associated with recreational attitudes and higher solitary and dyadic sexual desire. In contrast, trajectories featuring few or no intimate partnerships are associated with traditional sexual attitudes and less sexual desire. Women's attitudes toward sexuality are more strongly associated with their intimate trajectories than men's. This suggests that men and women do not develop their sexuality in the same relation with intimacy. The results are referred to the gendered master status hypothesis.