Clinical Review ABC of sexual health

Female sexual problems I: Loss of desirewhat about the fun?

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7175.41 (Published 02 January 1999) Cite this as: BMJ 1999;318:41
  1. Josie Butcher.

    Loss of desire for sexual activity is the commonest presenting


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    female sexual dysfunction and often the hardest to treat. Whether this loss of sexual desire should be seen as abnormal or simply as a variation of normal has long been debated. Much literature is available on female loss of desire, considering sexuality for women from various angles. The American PsychiatricAssociation's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which gives our working classification of psychosexual dysfunction, would classify it as hypoactive sexual desire disorder and sexual aversion disorder.

    Masters and Johnson's original “human sexual response curve” helps us to understand loss of desire in the context of the normal sexual response. This diagrammatic representation describes increasing sexual pleasure against time —(desire for sexual activity followed by arousal, orgasm, and finally resolution. It is important to remember, however, that the physiologies of desire, arousal, and orgasm are separate entities and therefore are not dependent on each other. Women with loss of desire (hypoactive sexual desire disorder) can have good sexual functioning. In essence, they will not initiate sexual contact.


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    The normal female sexual response. (Adapted from Masters WH, Johnson VE. Human sexual response. Boston, MA: Little, Brown, 1966)

    Is desire a thought or a feeling? The answer is not clear, and, certainly early in loving relationships, physical arousal closely follows any sexual thought. Initially, we have a sexual thought, which then facilitates the arousal mechanism through neurological pathways. The thought could be anticipation of the evening ahead or a memory of a previous sexual encounter. Women who do not desire sexual activity can operate quite well sexually once engaged in the sexual encounter. Touch around the clitoris and genital area facilitates neurological pathways, producing good arousal, good lubrication, and on to orgasm.

    Causes of loss of desire

    Much research into sexual desire is being undertaken, but …

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