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Understanding a Woman’s Lack of Sexual Desire
by Stanley
Ducharme, Ph.D.
In sexual medicine clinics across the country, the most prevalent female sexual concern is typically that of low sexual interest. Although issues related to sexual pain or lack of orgasm can certainly cause stress for a woman or her relationship, it is the lack of sexual desire of women that challenges most professionals working in this field. Even today, little is understood about this condition.
 A lack of sexual interest can happen to any woman. It occurs to women both with and without a spinal cord injury (SCI). In general, a lack of interest is not related to a neurological issue and can therefore occur to women with any level of spinal cord injury. Women who are care providers for a person with a disability are also very prone to the condition because of lack of sleep, chronic pain, fatigue and difficulties shifting roles between care provider and lover.
 Although pharmaceutical companies have completely revamped our understanding of men’s sexual difficulties, they have been far less successful in tackling the sexual issues of women. Although early studies on Viagra with women who have a spinal cord injury were encouraging, it is now fairly common knowledge that there probably will never be the female equivalent of Viagra. Pharmaceutical companies have now generally abandoned this research on Viagra for women with or without disabilities.
Simply encouraging a greater supply of blood flow to the genitals, as Viagra does for men, does not accomplish the same feat for a woman. Her sexual response is thought to be far too complex. It addition to the physiological factors related to blood flow and hormones, her comfort in the relationship, past sexual history, emotional frame of mind and feelings of safety and trust all contribute to her sexual responsiveness. For women with SCI, positive or negative feelings regarding her body after injury can also play a role in her enjoyment of sexual activity.
Just how common is this sexual condition of low sexual desire for women? Current studies suggest that about at least 30% of young and middle age women go through extended periods of feeling dim sexual desire- or of feeling no wish for sex whatsoever. As women get older and go through peri-menopause or menopause itself, this number increases dramatically. Studies suggest that over 40% of women in this age group have low sexual desire. As for women with SCI, there have never been studies to examine the prevalence of this sexual condition. Clinical experience however indicates that it is extremely common.
These women with low desire are the women who would rather get a good night’s sleep than have an intimate encounter. These are the women who often state, that it would be fine for them if they never had sexual relations again. Often, when they are sexually active, it is because of feelings of guilt, a sense of obligation, or for the sake of keeping peace in a relationship. Their enjoyment of the sexual act is, for the most part, non-existent.
 Although many women may say that it is fine not to have sex for months at a time, in reality their lack of libido isn’t fine at all. They long for those cravings, those desires and the emotional connection that comes with a passionate sexual experience. Many women miss that inner fire of sexual desire that makes them feel alive. Some sex therapists have estimated that approximately 15 to 20% of women feel extremely distressed over their absence of desire. Yet, these women often are unsure where to turn. All too often, their doctors simply shrug their shoulders and have nothing to offer. Rehabilitation doctors often have little experience helping a woman with SCI regain her sexual interest. Other women are placed on hormone replacement therapies and see little or no change over long periods of time.
It was the famous sex therapists Masters and Johnson who back in the 1960s first began to investigate sexual difficulties such as low sexual desire. They developed a treatment plan that removed all pressures from the couple and gradually encouraged people to focus on the feelings and sensations of sexual pleasure. With this technique of sensate focus exercises, Masters and Johnson believed that people needed to turn off their minds and stop thinking during the sexual experience.
 Some of today’s sex therapists often use a more cognitive approach. They encourage the woman to tell herself over and over again, like a mantra, that she is a very sexual woman, capable of a high level of desire and responsiveness. Current sex therapists try to harness the power of positive thought into affirmations of sexual potential and vigor. In psychology terms, such an approach is often described as “mindfulness” and is a form of Buddhist therapy aimed at raising awareness in the body. Mindfulness encourages awareness down to the level breathing and beatings of the heart.
Armed with such an approach, sex therapists send women home with the assignments such as to observe their bodies in the shower and to repeat over and over “My body is alive and sexual,” no matter if they believe it. These women are taught that new research shows that the belief doesn’t matter. The feelings of being a sexual person will ultimately follow these repeated declarations. If a woman continually is aware of her body, her sensual qualities and sensations, she can ultimately learn to recognize and enjoy these feelings.
To look at this approach from another perspective, a woman who sees herself as sexually “dead” will ultimately behave in such a manner. This is often the case for women with a disability. After the disability, the woman tends to avoid relationships and perceives herself as unattractive. She will unknowingly learn to ignore or push aside any possible sensual feelings. It is easy to become oblivious to the body’s excitement or sexual messages. Concerns about children, work, medical complications or appearance, for example, can easily distract a woman from any erotic feelings. Over an extended period of time, these erotic feelings become increasingly diminished and serve no purpose for the woman. In time, the erotic feelings disappear.
Most women wait for an indication of sexual desire before engaging in sexual activity. Unfortunately, if her erotic sensations have been ignored for long periods of time, sexual desire will never occur. The newer approach suggests that desire comes later. In this model if a woman can be attuned to her erotic feelings and her sexual potential, the sexual desire will follow at a later time. The sexual encounter starts with the decision to be sexual and receptive, followed by the pleasurable sensations of being touched. Ultimately, the pleasure of being touched may lead to feelings of arousal and to the desire to be responsive. Even when the women is unable to perceive the sensations of being touched, she can often feel aroused by the experience, her partner’s excitement or from the emotional closeness.
In spite of the work being done by sex therapists, many people still question whether sexual desire is driven by factors inside the person or external to the person. For example, why is sexual desire often so strong at the beginning of a relationship? Why does it diminish so often in long term relationships? Why is it stronger at different times in the woman’s menstrual cycle? The reality seems to indicate that sex drive for a woman is not simply an internal force such as hunger or thirst. Sex drive for a woman seems to be something that is not automatic but something that needs to be nurtured, enjoyed and built upon. Often, it is a reflection of what is going on in her life.
In conclusion, the jury is still out on what constitutes a woman’s sexual desire. Sex researchers tend to either think of desire as something that can be controlled by hormone treatments or something that is determined by how a woman feels about herself. The truth may lie somewhere in the middle. In the meantime, for women who want to feel sexual once again, there is hope that researchers are beginning to better understand the complexities and mysteries of the feminine sexual response.
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