Biopsychosocial models of women's sexual response: applications to management of ‘desire disorders’

Abstract

The complexities of women's sexual response preclude useful management strategies which are modelled only on the traditional human sex response cycle beginning with sexual desire rather than other motivations. Both biological and psychological parameters affecting women's sexual motivation and arousability can be depicted in alternative models. These reflect that motivations to begin a sexual experience, although varied, are most often intimacy-based in women. The key role of subjective sexual arousal, which often precedes and then accompanies sexual desire, is clarified. A positive outcome emotionally and physically is necessary to achieve the original goal of enhancing emotional closeness, sense of being attracted and attractive, committed, loved—together with the goal (accessed en route) of sexual satisfaction. Innate, spontaneous desire may only occasionally augment the intimacy-based motivation. Thus therapy for ‘desire disorders’ may more profitably focus on the woman's problematic motivation, inadequate sexual stimuli and context, diminished arousability and/or unsatisfactory outcome to an experience. A model of subjective sexual arousal reflects the ongoing affective and cognitive modulation and variable input from physical genital congestion. Awareness of the poor correlation between genital vasocongestion and the subjective experience allows subtyping of arousal problems in order to facilitate their management.