Sigmund Freud famously said there was one question he could never answer in his research. The question? “What does a woman want?”
It turns out that modern science continues to have difficulty answering this same question. Female sexuality remains a relatively new and unstudied field.
During the Roman era, when Galen was a philosopher and physician, there was a great deal of interest in studying the female orgasm because it was believed to be necessary for procreation. When the era of Enlightenment science discovered the ovum, or egg, and its key role in reproduction, the female libido became less a necessity, and often was seen as a threat and inconvenience to the patriarchy, particularly amplified by Victorian sensibility. Daniel Bergner, in his groundbreaking book What Do Women Want: Adventures in the Science of Female Desire, writes that by the era of the first World War, an advice manual informed men that “the number of women who are not satisfied with one mate is exceedingly small,” highlighting the fact that even in the middle of the last century, women’s desire was seen by the popular culture as either unimportant or non-existent. Alfred Kinsey did famously study female sexual behavior, but it is important to note that his funding was largely revoked shortly after he published Sexual Behavior in the Human Female. Kinsey’s research didn’t look too closely at women’s desire, and it wasn’t until the 1970s that the question finally was taken seriously. The AIDS epidemic all but put a stop to research until it resumed again in the 1990s.
Daniel Bergner’s 2013 book, What Do Women Want: Adventures in the Science of Female Desire, which reviews the available science on female sexuality and desire, made headlines when it was published in 2013, shocking many, raising many more questions, provoking discussion, and even opening up new avenues in the exploration of how therapists and doctors handle female sexual dysfunction and lack of desire.
Many of the issues that arise in discussions about female desire stem from the fact that male desire and sexuality has been more heavily studied, while female desire and sexuality not so much. This has led many doctors and scientists to frame female sexuality on the models set forth for male sexuality, creating more confusion than clarity.
For example, it is important to distinguish between sexual desire and sexual functioning. Though both sexual desire and sexual functioning are important, for most women sexual desire and sexual functioning are often two different things, as we will learn later in this article. Women can experience physiological arousal, but not desire, while in men, these tend to progress linearly (that is, men experience desire, then erection). Healthline clarifies the difference nicely: “desire usually refers to emotionally wanting to have sex, while arousal refers to the physiological changes in your body that happen when you are sexually excited.”
There are studied differences in female and male sexuality and desire. Some of the differences are measurable and physiological, as we will see in the work of Meredith Chivers. Some of the other measured differences may stem from sociocultural factors—cultural factors, limitations placed on female sexuality, social cues, and different standards for men and women.
What has changed in the field since 2013 when Bergner published his groundbreaking book? What do we know now that we didn’t know then? Are we any closer to finding the “female Viagra”? How different is female desire from male desire? Let’s take a closer look at the differences, starting with the obvious.
Biological Differences in Male and Female Sexual Response
The main source of male sexual pleasure is the penis. When a man is aroused, his arousal is visually detectable, by virtue of the erect penis. When women are aroused, the signs are subtler. Lubrication and blood flow to the clitoris increases. The source of female pleasure is the clitoris, but nerves all along the vagina, cervix, and urethra can also be a source of pleasure. About half of women claim to have a G-spot, but research suggests that the G-spot may be more cultural construct than physical entity. Daniel Bergner writes about a study of identical twins (whose bodies are genetically and physically identical). When asked about their G-spots, identical twins often differed in their responses. While the G-spot, as a “spot,” may not exist, it does appear that the vagina has various nerves throughout that can trigger orgasm, and there are even various nervous pathways that carry genital signals to the brain. (Four nervous pathways, to be exact: two in the spinal cord, one in the hypogastric tract, and the vagus nerve). These physiological differences between men and women mean that women are more likely to orgasm when they engage in a variety of sexual acts, while men are more likely to orgasm to penetrative sex. According to the Kinsey Institute, women orgasm most often when vaginal and oral sex are included. Also interesting is that as women age, they become more likely to have an orgasm, while as men age, they are less likely to orgasm.
Women may also be more physiologically adapted to have multiple orgasms. According to the Journal of Sex Research, when genital temperature was taken after men and women masturbated in the lab, more women than men continued to experience sexual arousal and desire after orgasm. Daniel Bergner’s fascinating look into the world of female sex research indicates that in both primates and humans, females may be more primed to prolong sex, and to have multiple sexual encounters, and even multiple partners.
The sexual response cycle is often broken down into four phases for both men and women, and traditionally, the cycle was believed to follow this strict order: desire (wanting sex), excitement (lubrication for women, erect penis, and increased blood flow to the genitals for both sexes), orgasm, and resolution.
However, recent studies indicate that for women, the cycle may not follow that order. AARP recently reported on several studies where many women felt “erotically neutral” at the start of sex, with desire following the actual lovemaking process. Ana Carvalheira, a Portuguese sex researcher surveyed 3,687 women and found that sex came before desire for 2 out of 1 of the women surveyed. For some women, the excitement phase may come before desire. For these women, foreplay, massage, and touching before sex may be particularly important. Psychology Today differentiates between “responsive vs. spontaneous desire.” Responsive desire occurs when women experience arousal before desire. Spontaneous desire is the desire that arises that leads to a craving for sex. Men often report spontaneous desire.
While some link this “inverted” response cycle to a woman’s need to feel physically and emotionally safe before sex, some of the research in Daniel Bergner’s book contradicts this, suggesting that women may be more likely to experience spontaneous desire at the start of the new relationship and may be drawn more to strangers rather than to familiar partners. In long-term relationships many women report experiencing responsive desire (explaining the waning of desire many women report when they are in long-term relationships). These women may need sexual stimulation in order to trigger desire. The linear progression for sex that describes male desire may not apply to women. Women may not initiate sex, but if sex is planned in a relationship, desire can often follow, along with pleasure and orgasm.
Sexual Dysfunction and the Female Viagra
For women, the physiological sign of arousal is lubrication and increased blood flow to the vagina and clitoris. For men, the physiological sign of arousal is an erect penis. A man can be aroused and not be able to maintain an erection. This is where Viagra can improve blood flow to the penis in men suffering from erectile dysfunction. When it comes to male sexual dysfunction, you basically have two potential areas of concern: erectile dysfunction (for a variety of physical reasons) and failure to maintain an erection due to psychological reasons. (Men can also experience difficulty having an orgasm, but the most commonly reported issue is erectile dysfunction.)
Female sexual dysfunction is a little different—and a lot more complicated than sexual dysfunction as it is commonly experienced in men. The Indian Journal of Psychiatry breaks down female sexual dysfunction into five areas: disorders of sexual desire (hypoactive sexual desire), disorders of arousal, orgasmic disorder, sexual pain, and vaginismus (constriction of the vagina that makes penetration difficult or impossible to achieve). 20% of women may suffer from hypoactive sexual desire disorder. 35% of women report difficulty maintaining sexual excitement. Anywhere from 5 to 10% of women have difficulty having an orgasm. Sexual pain and vaginismus disorders are variously defined, but anywhere between 4% to 55% of the female population might experience sexual pain or vaginismus. As many as 40% of women on a whole may experience some kind of sexual dysfunction, a major issue, given that this is close to half of women. According to Focus: The Journal of Lifelong Learning in Psychiatry, hypoactive sexual desire disorder is the most common form of sexual dysfunction reported among women. Management of these conditions varies from therapy, couple’s counseling, cognitive behavioral therapy, sexual fantasy training, mindfulness training, and medication.
Medication is an area where there has been both rapid development of new drugs, but at the same time, for many women, not sufficient development at all. When women say they are looking for a female Viagra, what they often are asking is for a pill to be developed that will increase their desire. Until recently, such a drug did not exist. However, a few drugs are now available on the market that hold promise, though they don’t offer the same reliability as Viagra and they come with some serious risks of side effects. Viagra doesn’t increase desire in men, it merely helps men with the plumbing, in the same way lubricants and hormonal therapy can help a woman suffering from lubrication issues. The search for female Viagra is really the search for a female aphrodisiac. Daniel Bergner argues that the media and marketing executives may have increased the hype surrounding the search for the female Viagra, creating expectations that some wanted to temper: “…a set of clinicians had taken up a campaign, waged mostly within the psychiatric profession but also through the media, to make sure that the industry didn’t manage to persuade huge numbers of women that they should feel more drive, that they needed a drug soon to be discovered.”
Yet, the search for a female Viagra shouldn’t just be chalked up to marketing and the media. Hypoactive sexual desire, or low sexual desire, is so prevalent, and distressing to so many women, that the FDA has made female sexual dysfunction one of 20 diseases deemed in need of “high priority and focused attention” for the FDA. There are two main medications on the market that have been called the “female Viagra,” though it is important to reiterate and make clear that the mechanisms these drugs address involve complex psychological and physiological responses, while Viagra merely handles the physiological and mechanical action of supporting an erection.
The two main drugs on the market to address hypoactive sexual desire are flibanserin (Addyi) and bremelanotide (Vyleesi). Flibanserin targets brain chemistry. According to Harvard Health, it is believed to work by increasing the release of dopamine and decreasing the release of serotonin. Dopamine is the hormone believed to be responsible for sexual drive, but too much dopamine, unregulated by serotonin, results in unfocused sexual drive. Serotonin is known as the inhibitory hormone. It stops the sex drive, but it is believed to be needed in small quantities to balance dopamine in order for desire to occur. When serotonin and dopamine are in balance, desire can focus on an object and attain it. For women who have experienced decrease in desire after taking birth control or depression medications (SSRIs), flibanserin may be able to help rebalance brain chemistry. But there are downsides. Flibanserin, unlike Viagra, must be taken every day. The improvements women report in desire are modest, at best. And it can have some serious side effects that include low blood pressure, nausea, and fainting. Bremelanotide, works better, but it carries a higher risk of nausea as a side effect and must be administered by injection 45 minutes before a woman wants sexual intercourse to begin. Bremelanotide is more effective in increasing desire, but according to the FDA, we don’t know how it works, and patients are not advised to take more than 8 doses a month. Bremelanotide was only recently approved for use by the FDA (it was approved June 2019).
Given bremelanotide’s known effectiveness, it is odd that it hasn’t gotten more media time.
When Daniel Bergner wrote What Women Want, bremelanotide had not yet been approved by the FDA. In fact, when the developers of the drug sought approval, there were concerns that the “drug would be too effective for the FDA.” There was fear of “sexual mayhem.” There was even concern among some researchers whether the “chemical’s impact would be “selective,” that Bremelanotide-sniffing wives and daughters wouldn’t want to “go off and do the football team.” There was literally concern about turning women into “nymphomaniacs.” Bergner notes: “There’s a bias, a bias against—a fear of creating a sexually aggressive woman. There’s this idea of societal breakdown.” Or is it just that the side effects are so serious (you might experience desire, but you also might experience nausea), and the method of delivery so intensive (it needs to be injected into the abdomen), that doctors and patients are both a little wary of taking it? Either way, women suffering from hypoactive sexual drive may want to speak to their doctors about medical options.
Because of the limited number of medications and their many side effects, many women turn to natural or herbal remedies to increase desire. According to Focus: The Journal of Lifelong Learning in Psychiatry, ArginMax, a supplement containing L-arginine, ginseng, ginkgo, damiana, multivitamins, and minerals was found to provide improvement in sexual satisfaction in a randomized controlled clinical trial. In the study, women reported improvement in sexual desire, vaginal lubrication, and increased frequency of sexual intercourse and orgasm, as well as clitoral sensation. No side effects were reported when taking ArginMax. In another study, both premenopausal women and postmenopausal women experienced statistically significant improvements in their sex lives after taking ArginMax. The Journal of Lifelong Learning in Psychiatry also noted that studies of L-arginine have shown that in combination with other herbs and remedies, it can have a positive effect vaginal response during sex. Korean red ginseng was found to also benefit sexual functioning in post-menopausal women. There is some preliminary research that indicates that maca may also have benefits, especially among women taking SSRIs. Women who are thinking of taking herbal remedies to improve sex drive should talk to their doctors, because some herbal remedies can interact with medications or be risky for women with certain health conditions.
Does Aging and Menopause Have an Effect on Female Desire?
Menopause can cause hormonal levels to drop, which can lead to dryness, tightness, and pain during sex. Lubricants and hormone replacement therapy can help. Does menopause lead to lower desire? According to Healthline, some women do report a decrease in desire, but Daniel Bergner reports on a fascinating Australian study that found that while menopause could have an effect on libido, a new relationship could override these hormonal factors. This raises interesting questions about female desire in the context of long-term relationships, and we’ll explore that next.
Do Men Have Stronger Sex Drives Than Women?
Many studies and papers are quick to report that men have higher sex drives than women, but a closer look reveals potential issues in this research. While Current Directions in Psychological Science notes that men report masturbating more than women do as a signal that men may have stronger sex drives than women, studies indicate that cultural prohibitions on female sexuality may be partially to blame for this disparity. Daniel Bergner writes about a study performed by Terri Fisher, where women and men were asked about their use of porn and masturbation and given three options for presenting their response: to hand their response to a college student who would see them responding, to provide a response where they were promised their answer would be kept anonymous, and finally, they were put in a scenario where they were asked to respond while hooked up to a fake lie detector test. Men replied the same in each condition. Many women told the college student they didn’t masturbate, more admitted to masturbating when they were promised their responses were kept anonymous, and women hooked up to the fake lie detector test responded similarly to the men. (The Kinsey Institute notes that more than 50% of women between the ages of 18 and 49 reported masturbating in the last 90 days.)
Another piece of evidence used by Current Directions in Psychological Science to support the claim that men have stronger sex drives than women is the fact that in lesbian couples, the lesbians report having less sex than the men. But this could also be due to the fact that gay male couples tend to be more open to “open relationships,” and monogamy has been reported as a factor in decreased sexual appetite. Approximately 20% of women report having low sex drive, but men may be no better off. Ana Carvalheira (the same researcher who found that many women were sexually unmotivated at the start of sex, but later became motivated), found that low desire affected anywhere between 13 and 28 percent of men.
Emily Esfahani Smith, writing for the Atlantic, notes two studies that may support men having stronger sexual appetites than women. She writes about a 1995 study that found that 62% of male clergy had been sexually active since taking their vows, while only 49% of female clergy had been sexually active (though the disparities here could also perhaps be attributed to the different status that female and males hold in the church). She wrote about another study where attractive research assistants approached men and women on a college campus, asking “Would you like to go to bed with me tonight?” The researchers found that three-quarters of the men who were asked said yes, while zero of the women agreed. Though again, these differences could be due to cultural norms, higher selectivity among women, and less to do with women’s sexual appetites.
A study published in Personality and Social Psychology Review asked men and women to report how many spontaneous thoughts about sex they had, frequency and variety of sexual fantasy, desired frequency of intercourse, frequency of masturbation, likeliness of sexual encounters, and willingness to forego sex. The researchers found that men reported more instances of sexual encounters and thoughts than women. Again, sociocultural pressure could be playing a role in the responses provided. It seems that based on reports, men may have stronger sex drives than women, but other factors could be confounding these results.
Researcher Pamela Regan asked men and women to report the number of times they desired sex a week. In the journal of Social Behavior and Personality, she writes that men on average desired sex 37 times a week, while women desired sex only 9 times per week. Again, sociocultural factors can always be playing a role in these responses, but the research seems to suggest, time and again, that men have stronger sex drives than women, and that they want sex more than women.
The biggest difference between the male and female sex drive may have less to do with differences in strength of libido, but in sexual plasticity. Straight men tend to remain straight their whole lives, and gay men gay, while women are more sexually flexible. Lesbians are more willing to sleep with men than gay men are willing to sleep with women.
And this brings us to the fascinating work of Meredith Chivers, whose research on female sexual desire and physical response proved groundbreaking. In the lab, men always physically responded to the stimuli they reported as finding attractive. When women were connected to a plethysmograph, a sensor placed inside the vagina to measure blood flow, Chivers found that physiologically women were responding to all kinds of sexual imagery, though they only reported being attracted to some of the imagery. Women’s self-reported feelings of arousal barely matched the response being measured by the plethysmograph. Chivers found that the women physically responded to all types of sexual imagery, including images of women having sex with women (for straight and gay women), men having sex with men (for straight and gay women), erect penises, and even bonobo sex. Women also responded more strongly to situations in which strangers were described, rather than familiar partners, which upends many theories that women are drawn to safety in relationships. However, when women were shown images of an erect penis, a flaccid penis, a half-concealed vagina, and a full-on “crotch shot,” women responded more categorically—that is, straight women responded physiologically to the erect penis, and lesbian women to the vagina. The research raises more questions than it answers. But it suggests that women’s physiological desire for sex may, in fact, be similar in strength to that of men, but that sociocultural factors, or other factors may be at play in reducing its expression. In fact, according to Letita Anne Peplau, women’s sexual behaviors and beliefs were found to be more readily shaped by cultural and environmental factors than were men’s sexual behaviors and beliefs. Women were also found to be more variable than men in how much sex they want over time. Peplau found that women in relationships may have regular sex, but then may have no sex or masturbation without a partner. Men without partners may still engage in regular masturbation.
Women may be primed to respond to sexuality in general, for evolutionary reasons. A paper published in the journal Psychological Science theorized that women’s responses to a variety of sexual stimuli may be “protective.” Women who have been raped reported experiencing lubrication, and physiological arousal, but the researchers theorize that this response may be evolutionarily beneficial, protecting the sexual organs from injury.
In Chivers research, women were more physically drawn to strangers over familiar partners. This raises questions about the impact that monogamy may be having on the female sex drive. According to the journal of Sexual and Relationship Therapy, both men and women are equally as likely to report lower sexual desire relative to their partner, indicating that low desire may not just be a “women’s problem.” Studies indicate that women may be less monogamous than previously thought. Women are often credited as being the “protectors” of monogamy. “Parental Investment Theory” is the idea that women are more monogamous than men because they have to invest more time and energy in pregnancy and child-rearing. But newer research shows that this theory may have more gaps and problems than previously thought. In rhesus monkeys, the monkeys often studied due to their physiological similarities to humans, females tend to have sex with many males and replace their cohort of male partners about every three years. Daniel Bergner spoke to Kim Wallen, who studied the sexual behavior of rhesus monkeys in captivity, and Wallen quickly began to wonder whether women may have similar sexual drives to the female rhesus, but because of social norms, fail to act on these drives. Wallen believes that monogamy is a “cultural cage” that distorts our picture of female libido.
Monogamy may put a damper on sex drive, but not necessarily on orgasm. According to the Journal of the American Medical Association, unmarried women were 112 times more likely to experience climax problems than married women.
Thanks to this research, more work is being done on how to nurture desire in long-term relationships. Researchers in this area generally agree that in order for eros to exist, there must be some distance between people. Marta Maena, a sex therapist, encourages couples to disentangle themselves. One example she provided was asking men and women to arrive separately at a bar or restaurant when going out for date night, providing each person the ability to see the partner alone, in a new context. Esther Perel, the famous relationship and sex therapist agrees in her book Mating in Captivity: Unlocking Erotic Intelligence writes “Eroticism requires separateness. In other words, eroticism thrives in the space between the self and the other…Excitement is interwoven with uncertainty, and with our willingness to embrace the unknown rather than to shield ourselves from it. But this very tension leaves us vulnerable. I caution my patients that there is no such thing as ‘safe sex.’”
What Do Women Want?
If the research on female sex drive is confounding and conflicted, the research on what women want is even more fraught. We can return to Chivers findings, which indicate that women may be more sexually flexible than men in what they are physiologically drawn to. But when you look at self-reports of attraction, things are still complicated. An interesting study published in the Journal of Personality and Social Psychology highlights this. In the lab, women who were asked to select ideal romantic partners chose men who appeared to have the greatest earning potential. But when the women were put with the same group of men in a speed dating situation, these stated differences didn’t apply. In another study published in the Journal of Psychology and Human Sexuality, men and women looked to more superficial cues when selecting a sex partner (men looked for sexual desirability while women looked at social status), while both men and women looked for personality compatibility when searching for long-term relationships.
Daniel Bergner’s research into female desire discovered that women’s fantasies were highly variable. Marta Meana is a researcher who believes that women may desire being desired. Other researchers have found that “fantasies of submission” and even violent sexual fantasies were more common than not. For many women, thrill and fear could cause erotic feelings to peak.
According to the American Association of Sexuality Educators, women may sometimes feel that there’s something wrong with them due to the cues they are receiving from the media about what is “normal.” Often women come to therapists for “low” desire, but what’s really at play is a difference of libidos between two people. And some women who claim to experience low or no desire, may be able to experience desire after arousal (after sex or sexual touching begins), supporting the theory that, for women, the sexual response cycle is not always linear.
What are the key takeaways about female desire? Ultimately, the answer is more uncertain than not—more research needs to be done. Biological and psychological differences between men and women indicate that women and men often differ in what they need to achieve orgasm, and often differ in the order of their sexual response cycles. While there are medications that can help with female sexual dysfunction, these medications have major side effects and may not always be effective in all cases. In some instances, herbal remedies may be just as effective. And when it comes to research on desire and sexual drive, we are clearly in the infancy of a field that warrants more study.