What Works to Increase Women’s Sexual Desire?
With the FDA workshop on Patient-Focused Drug Development Public Meeting and Scientific workshop on Female Sexual Dysfunction, much will be made in the media of the fact that there are not currently any FDA approved pharmaceutical treatments for low sexual desire in women.
This is true. There isn’t one.
What’s also true — but will probably not be mentioned in most of the press coverage — is that there ARE effective, nonpharmaceutical treatments.
Precisely why these non-pharma treatments will not get lots of coverage is something of a mystery to me. I don’t understand how public relations, publicists, press releases, the media, and marketing campaigns work. I’ve learned a little bit about them in the last six month, as I’ve prepared for the release of my own book, but I’m still a novice.
However:
Here are five things that I can tell you for sure about women’s experience of low desire and about effective treatments:
1. Women are struggling around issues of sexual desire.
I don’t know how many women — it’s somewhere between about 6% and 43% (for a review, see this [PDF])— and I’m not here today to argue about statistics, definitions, and what it means to be “dysfunctional.” The important thing is that women are suffering in ways that impact their overall quality of life, their relationships, their sense of self. As one woman I spoke with put it:
“I feel broken. I feel inadequate.”
And they deserve to have some kind of effective treatment.
Fortunately…
2. Effective treatments exist!
A growing body of research shows that a wide variety of (nonpharmaceutical) interventions can be effective in treating low sexual desire in women, including group mindfulness-based therapy, mindfulness-based cognitive behavioral therapy, sensorimotor therapy, “Sexual health model” education, and bibliotherapy (reading books).
Again, I don’t know why you don’t read big New York Times and Washington Post articles about the exciting new research on these treatments (all of the links above are to the original research), and I’m only guessing when I suggest it might be because sex therapists and educators can’t afford PR firms and publicists, but now you know: effective treatment exists! Please tell everyone you know!
(PS: Dear New York Times and Washington Post, effective treatments exist! Please write articles about them!)
3. The first-line-of-defense treatment is:
Specifically, education around the idea of “responsive” desire, rather than “spontaneous” desire.
Spontaneous desire is that out-of-the-blue desire that most of us have been taught to expect. You’re walking down the street, you have a sexy thought, and whammo! desire! “I would like some sex,” you think. “How can I get me some sex?”
Responsive desire, on the other hand, begins when the context has already gotten explicitly sexy. Your partner starts kissin’ on ya and you go, “Oh right! Sex! That’s a good idea!”
And both styles are normal. They’re just different. If spontaneous desire is, first and foremost, wanting, then responsive desire is, first and foremost, enjoying.
Understanding how responsive desire works, and learning to work with it, is central to a lot of people’s healing from low desire.
I recently asked other sex educators and therapists what books they recommended for couples struggling with low desire. Here are three that rose to the top of the list:
When Your Sex Drives Don’t Match Up by Sandra Pertot
Reclaiming Your Sexual Self by Kathryn Hall
The Sex Starved Marriage by Michele Weiner-Davis (who also has a TEDx talk)
4. (This is the bad news.) If what you’re looking for is spontaneous, out-of-the-blue desire, the nonpharmaceutical interventions will not give you that.
What education, mindfulness, CBT, etc, give you is greater pleasure, more openness, and skills to create context that really make the most of responsive desire. They may sometimes lead to spontaneous desire, but that’s not even their goal. Their goal is to support you in learning to enjoy sex.
Alas, our culture teaches us is that spontaneous desire isn’t just fun, it’s the only “normal” kind of desire. (Which it isn’t.) So a lot of people resist the idea of embracing responsive desire and instead seek out any intervention that can give them desire for sex without their having to invest any effort in creating pleasure for themselves.
5. No pharmaceutical will give you spontaneous desire either — at least, not safely.
Because there aren’t any drugs, qed.
Good thing you know that spontaneous desire isn’t the only normal, healthy way to experience desire, right?
So what do we do with these five things?
I’m going to offer an imperfect analogy here, comparing sexual orientation with desire style. I don’t in any way intend to imply that desire style is “innate” or a “trait.” It’s not. It’s a response to stimuli, and since stimuli change all the time, desire changes all the time too. The majority of people will experience both spontaneous and responsive desire at various times in their life, as their relationships, their stress levels, their bodies, and their lives change. I only want to show you a strategy for thinking critically about the idea of there being “one true kind of desire.”
Here is my imperfect analogy:
Until 1972, “homosexuality” was a clinical diagnosis in the bible of the American Psychiatric Association, the Diagnostic and Statistical Manual (DSM). That is: it was a “disease.”
Now, in the twenty-first century, homosexuality is viewed as a normal variation on human sexual orientation, as normal and healthy as being heterosexual. People only “suffer” from homosexuality when they are oppressed , stigmatized, and discriminated against on the basis on their sexual orientation.
What if we think of responsive desire in the same way? Not an illness at all, but a normal and healthy variation on human sexual desire.
Do we really need a pill for it?
Or do we just need to create space in our culture for a wider variety of normal experiences?
Do we, each of us, just need to consider the possibility that nearly everything we’ve ever been taught about how sexual desire, arousal, and pleasure work… is wrong?
So no. There is no “pink pill.”
There may never be one.
But what we might get instead is a revolution in the way we understand what it means to be a sexual human in the modern world.
Emily Nagoski is the author of Come as You Are: the surprising new science that will transform your sex life (2015). She’s been a sex educator for 19 years.
