“I have always thought there was something wrong with me as I never really think about sex. I enjoy it when it happens but I never feel the desire to initiate it. My partner thinks this means I have no interest in sex, which I don’t agree with but I guess that is how it seems.”
This is an example of what I often hear from clients. As a couples therapist, I often hear women report feeling a lack of sexual desire and thinking that there is something wrong or “broken” with them. I see this among cancer patients and their partners, as a common side effect of the treatment of cancer is low libido. But, I also see this among individuals and couples who aren’t affected by cancer.
The reality is that sexual desire is complex – there are a number of factors that influence a person’s interest in sexual intimacy including (but not limited to): sleep, relationship dynamics, cultural messages about sex, body image, vulvar pain, other physical and mental health conditions and the medications used to treat them. It’s very common that couples are mismatched in their interest in sex. While some couples navigate this well and figure out ways of creating a sexual relationship that works for both of them, for other couples this discrepancy can create significant relationship distress. Based on my clinical experience, having accurate information about the varied ways sexual desire can emerge is critical to helping women and their partners navigate low desire and desire discrepancies.
Spontaneous sexual desire is typically described as experiencing spontaneous sexual thoughts, fantasies and desires. This type of desire has long been considered an indicator of healthy sexual desire. So, it is not surprising that when someone experiences a lack of spontaneous sexual desire, that one or both partners think something is “wrong.” However, we now know that spontaneous desire is only one version of healthy sexual desire (Basson 2000, 2002; Basson et al., 2003; Brotto, Heiman & Tolman, 2009; Brotto, 2010) and is a more common experience for men and for women during the early stages of a relationship. There is so much evidence to support this fact that a woman can no longer be diagnosed with a desire disorder based on the absence of sexual fantasies or spontaneous desire for sexual intimacy. To be diagnosed with a desire disorder, she must also experience an absence of responsive desire (DSM-5; American Psychiatric Association).
Responsive desire is sexual desire that is triggered in response to a particular situation – typically low stress, high connection, and sexual and/or physical stimuli. For example, responsive desire happens when I am lying with my partner at the end of a long day, feeling close, his hand resting on my breasts and I start to feel open to sexual intimacy. Many women, especially those in long term relationships, report experiencing responsive desire but little to no spontaneous desire. This is what responsive desire can look and feel like:
I don’t yearn for sex with my partner in the way that he/she wants me to, but I notice that after we have enjoyed a night together and I am feeling more emotionally connected, I feel more open to sexual intimacy. Once we get started I am able to get aroused, feel desire and derive pleasure from the experience and I often wonder why I don’t desire this more often!
In my work, I help women and their partners by educating them about responsive sexual desire. I’ve seen women transform from seeing themselves as “broken” to realizing there is nothing wrong with them.
I feel normal for the first time in my life and now my husband is starting to believe that my lack of spontaneous desire is not a reflection of his lack of desirability. We are starting to figure this out and pay attention to the contexts that help me feel open to sex.
I understand her better now and for the first time ever I feel hopeful about our sex life.
Although these differences are typically discussed as gender-specific with women experiencing more responsive desire and men experiencing more spontaneous desire, I have worked with same-sex couples where one partner experiences responsive desire while the other experiences more spontaneous desire. I’ve also worked with heterosexual couples where the typical experiences are reversed. From my perspective, it comes down to this—when couples (and we as a society) understand that there is normal variability in the experience of sexual desire, it moves us away from the idea that there is any single way that we are supposed to feel and experience desire. It moves us toward a more realistic and truer idea: people can experience sexual desire differently and this experience can fluctuate over time.
I have worked with many clients who are in treatment for cancer or coping with the long term consequences of their cancer treatment. For some of these clients, this new way of understanding sexual desire has validated their experience and fostered hopefulness for them and their partners. Is it possible that in the right context – with low stress, high connection and some physical touch – that you might experience a little more openness to sexual intimacy? Is it possible that the stress that you and your partner are experiencing related to the challenges of navigating cancer is making it hard for you to find moments of low stress and high connection? Is it possible that your partner’s lack of initiation is not because of your physical desirability, but rather because he/she also experiences desire in a more responsive way? These are questions worth reflecting on next time you find yourself wondering what is wrong with you (or your partner’s) libido.
I am not proposing that all women who report an absence of desire actually experience responsive desire. There are some woman whose loss of libido is both a loss of spontaneous and responsive libido. However, I do know that there are a lot of woman (and their partners) who see themselves as “broken” when in fact, in the right context, their desire emerges. Responsive desire is healthy and normal.
Emily Nagoski, PhD, has worked as a sexual health educator since 1995 and has dedicated her academic career to understanding the science of sexual well-being. As an educator, researcher, and writer she is committed to spreading accurate information about women’s sexuality including responsive desire. She has written an excellent book on women’s sexuality that is worth a read: Come As You Are: The surprising new science that will transform your sex life. If you don’t have the time or energy to read a full book, her 10-minute talk at Chicago Ideas Week provides a good overview of the difference between spontaneous and responsive desire.
If you would like to talk to a professional about sexual desire or how to navigate a desire discrepancy with your partner, visit aasect.org or sstarnet.org to find a sex therapist near you. If you have a new concern about your sexual desire, especially if you have a new physical or medical problem or recently started a new medication, we recommend you also check in with your medical doctor.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Basson R. The Female Sexual Response: A Different Model. Journal of Sex & Marital Therapy. 2000.
Basson R. Rethinking low sexual desire in women. BJOG: An International Journal of Obstetrics & Gynaecology. 2002.
Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J, Fugl-Meyer K, Weijmar Schultz W. Definitions of women’s sexual dysfunction reconsidered: Advocating expansion and revision. Journal of Psychosomatic Obstetrics and Gynaecology. 2003.
Brotto LA, Heiman JR, Tolman DL. Narratives of Desire in Mid-Age Women With and Without Arousal Difficulties. Journal of Sex Research. 2009.
Brotto LA. The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Archives of Sexual Behavior. 2010.
Edited by Chenab Navalkha