Are you never in the mood for sex? Does your partner complain that you never initiate? Do you find yourself wondering “what’s the big deal about sex anyway”? Do you find that you see things in the media about how you are "supposed" to feel about sex but you just don't feel like it reflects your experience? Do you find that during sex you don't experience any heightening of arousal or pleasure? If these questions resonate with you, you might be experiencing female sexual interest/arousal disorder.
Before we jump into female sexual interest/arousal disorder (FSIAD), let’s try to understand a few key terms:
Arousal
Arousal refers to the physiological response to sexual stimuli. These physiological responses include both genital and non-genital reactions. When one is aroused, vasocongestion occurs where blood flow increases and various tissues in the body, such as the penis or clitoris, swell. Arousal is often accompanied by vaginal lubrication. Importantly, there is a distinction between genital arousal and subjective arousal and these things are often nonconcordant in women. Genital arousal is exactly what I’ve just described: engorgement in the genitals, vaginal lubrication, etc. It’s what society tells you arousal looks like. But arousal is not just physiological, it’s also subjective, and research shows that women often experience a disconnect between what they report arouses them and what their genitals respond to. This is called “arousal nonconcordance.” Research suggests that women will often experience a genital response to sexually relevant stimuli simply because it is just that: sexually relevant. However, this genital response is not an indication of what you find sexually appealing or a turn on. Something can elicit a genital response–and therefore be sexually relevant to you–but not be subjectively experienced as sexually unappealing. (As a side note, this is why “female viagra” pills aren’t so effective–sure they increase blood flow to the genitals, but they don’t necessarily lead to increased subjective arousal.) While nonconcordance is common and sometimes genital arousal has nothing to do with subjective arousal, this high nonconcordance in women might also mean that women just have a harder time noticing and feeling their own genital arousal. If this is the case, many women might benefit from learning to recognize their own physical arousal and learning to link that sensation with their own erotic thoughts and feelings.
Desire
Although people throw around the words “sexual desire” quite frequently, “desire” is actually a construct that’s not easily defined and has little agreement within the research and clinical communities. Desire is often described as a “wanting” or “wishing” for something to happen. Desire is often thought of as an appetite or a drive, but thinking about sex as a drive is actually both inaccurate and unhelpful. I spoke a little bit about this here, but I’ll add a few more important points. Thinking about sex as a drive likens it to other automatic drives we have that are necessary for survival: food, water, air. If we continue to think of sex as a drive that is necessary for survival, then of course if you have a low desire then something is seriously wrong with you, in the same way as if you never eat we would treat that as a serious problem that needs to be addressed immediately. Viewing sex as a drive often means we pathologize low desire when it isn’t something that is necessarily bad or wrong to begin with. Furthermore, seeing sex as a drive creates space for sexual entitlement. ”If I don’t have sex, I’ll die! So of course I can do whatever it takes to make sure I’m sexually satisfied, just as you would understand I could do whatever it takes to make sure my need for air is satisfied.” Seeing sex as a drive that needs to be satisfied right now also undervalues the inherent worth of the partner. Rather than seeing your partner in sex as a whole human being worthy of respect and dignity, it likens the partner to food, something to be consumed and digested, perhaps savored and appreciated at times, but food nonetheless. I will talk more about this idea in a future post, but suffice it to say for now that desire is more accurately thought of as an “incentive motivation system”, or a push toward an attractive external stimulus rather than a propulsion away from an internal discomfort. If you re-conceptualize desire as an incentive rather than a drive, then we move away from categorizing sex as something that we need in order to survive, toward understanding it as something we want in order to thrive.
Desire is complex because it is so personalized. What you desire will not be the same as what someone else desires, which in fact might be something that you find quite aversive. As described in a previous post, desire can be motivated by physiological arousal states, the wish for emotional closeness, the reduction of stress, or many other factors. Desire often fluctuates throughout life and throughout one’s relationship. Often, spontaneous desire will mark the beginning of a new relationship, but will settle into a more responsive desire pattern as the excitement of a new relationship wanes. In this way, physiological arousal might feel more linked to desire in early stages of relationships while context and relationship cues might take prominence in directing sexual activity as the relationship progresses.
Interest
Given the complexity associated with the word “desire”, there has been a recent shift away from the word desire, toward the word “interest, “ although in practice, interest and desire are often used interchangeably. Like desire, interest refers to a willingness to engage in any sexual activity. It is also associated with paying attention to your awareness of sexual feelings that could then lead to or result from sexual activity
Now that we understand these key terms, let’s get back to female sexual interest/arousal disorder (FSIAD). Keep in mind that sexual desire or interest is not necessarily the primary motivation for having sex (see more about this here in our discussion of spontaneous and responsive desire). Recent research indicates that there are 4 main categories for the reasons people have sex:
1) Physical reasons, like being attracted to someone, to reduce feelings of tension or stress, to experience pleasure, to satisfy a need for excitement, etc.
2) Emotional reasons, like wanting intimacy, an expression of commitment, feeling romantically close with someone, etc.
3) Utilitarian reasons, like wanting to increase your social status, bragging rights, for revenge, to get resources (like a free dinner), etc.
4) Insecurity reasons, like feeling bad about yourself and wanting external validation, feeling obligated to have sex because you’re told it’s “the right thing to do,” feeling pressured by a partner or society, to prevent your partner from seeking sex elsewhere, etc.
In short, having an interest in sex doesn’t always lead to sexual activity, and sexual activity isn’t always prompted by sexual interest. In fact, sexual interest may not even be associated with sexual frequency. So, just because someone might have sex very often, doesn’t mean they have a strong interest in sex, as there are many other reasons they might be engaging in this activity. Similarly, just because someone might have sex very rarely, doesn’t mean they have a low interest in sex, as there are many contextual reasons they might refrain from engaging in this activity. Overall, there is significant complexity in understanding women’s interest in sex.
In order for FSIAD to be diagnosed, there must be an absent or reduced interest in sexual activity and/or sexual thoughts, limited or no initiation of sex and limited response to a partner’s initiation, reduced or no sexual excitation or the experience of pleasure from sex, absent or reduced arousal (genital and non-genital) in response to internal and external sexual stimuli. These experiences must be present for a minimum of six months, and, most importantly of all, cause the individual significant distress. This last point is worth repeating. In order to have FSIAD, it must cause you, not your partner, significant distress. If your distress is “my partner is upset at me” and not “I’m upset I have no interest,” then you don’t have FSIAD. Sure, you may have a relationship stressor, which is worth understanding and working through, but not a sexual problem.
Reduced interest in sex can stem from many different things. Sleep, physical and hormonal changes in pregnancy and breastfeeding, some medical conditions such as diabetes, thyroid issues, and chronic pain can all cause fluctuations in a woman’s sexual interest. Psychological factors including self-esteem, body image, anxiety, depression, inaccurate beliefs about sex and pain (see more about this here), difficulty with intimacy, mental fatigue, fear of abandonment, a trauma history, obsessions or compulsions, and many other emotional and psychological concerns can also interfere with sexual interest. Relational factors can also influence interest in sex: if the relationship is feeling rocky or unsafe, if there are built up feelings of anger or resentment, if the partner frequently criticizes or shames, poor communication, or frequent power struggles. Some women might also have low interest because of the messages they received about sex when they were growing up from their family, society, culture, or religion. For example, if you were always told sex is shameful or only to be done for purposes of procreation, this narrative will naturally shape how you view sex when you get older. Rather than fostering an interest in sex for its own right, you might have learned that sex is to be used only for the goal of having children, and so of course you have a disconnect with your own feelings of arousal and interest as you learned to ignore or disregard any feeling of interest or arousal you had while growing up
Difficulty or dissatisfaction with sexual interest and arousal can be a distressing or upsetting experience. However, there are resources to help address these issues, be they physiological or psychological. If you are concerned about your sexual interests or desire and are not sure where to start, reach out for help today.