Key Insights in Women's Sexuality

The more I work with women in my practice, the more I recognize that the science of human sexuality is young. For most of the last century, we assumed that men and women approach sex in roughly the same way.

Crazy. But there it is: The science is young.

Older models (Masters & Johnson, Kaplan) theorized that sex for people happens in a few neat, linear stages, beginning with desire, proceeding next to arousal, then orgasm, and finally satisfaction.

But it doesn’t always work that way, particularly for women, and especially for women over 40.

More recent researchers who focus on women’s sexuality, confirm that really, women do not experience sex in this simple, linear way. We sometimes skip phases. Our reasons to have sex are many and often complex.

We can be perfectly satisfied with sex that does not include orgasm, and we can reach orgasm without desire. We are flexible that way.

I continue to refer women to work done by Rosemary Basson, MB, FRCP, of the University of British Columbia. Basson formalized a new model of female sexuality that is now widely accepted.

She offers two key insights. First: Female sexual desire is generally more responsive than spontaneous. That is, we are more likely to respond to sexual stimuli — thoughts, sights, smells, and sounds — than we are to spark an interest in sex out of thin air (Men, on the other hand, specialize in this).

Another key insight: Emotional intimacy matters to women. That doesn’t sound like a news flash, but in the realm of the biological sciences, it’s news, trust me.

Basson's model of sexuality

So Basson drew a new model – not a linear series of steps, but a circle that includes both sexual stimuli—the thoughts that trigger a woman to take an interest in sex, and emotional intimacy—the emotional payoffs of the experience that lead her to want to come back for more. I love Basson’s model and use it every day in my practice to help my patients understand how sex really works for us.

We need to understand that it’s okay and it’s normal that we don’t always start with desire. And as we enter menopause, and our hormone levels drop, spontaneous thoughts about sex and responsiveness to opportunities for sex diminish for most of us. That’s natural and normal too.

If you don’t like the situation, and you want to feel more sexual, more responsive, Basson’s model gives us the hint: We need to stimulate our minds. The more sexual stimuli we receive, the more sexual we feel.

So, this is worth thinking about today, a worthy discussion to have with your partner: What makes you feel sexy? A juicy romance novel? A James Bond movie? Erotic art? Pretty underpinnings? A romantic dinner?  Having your partner empty the dishwasher?  Spend some time thinking about that. Maybe make a list. And then provide for these things. Sexy is as sexy does.

What Turns Us On? It's Complicated.

In past posts we tried to identify books and movies that we thought were hot—the kind of stuff to turn on a more discriminating, mature woman. It wasn’t easy. In the normal course of things, women are simply not turned on by straight-up porn. And sometimes, even if a woman is physically aroused, she can be mentally repulsed.

Experts agree: the arousal/desire circuitry in a woman is complicated.

For men, it’s simple. A two-minute video clip, a sexy photo of a favorite star, a crotch shot, and he’s off to the races. “Give a guy an erection and he basically wants to use it,” writes sex counselor Dr. Ian Kerner, columnist for CNN. “In men, porn initiates the ‘sexual-circuit’ very quickly.”

Guys tend to view porn by themselves; their comments on online sites tend to be monosyllabic: “Hot!” Often, their porn consumption is unpremeditated—they might see a racy photo, and they search for more stimulation, basically to “get it on.” And virtually all men consume porn. In an effort to understand the impact of porn on men, a researcher from the University of Montreal looked for a sample of young men who had never viewed porn. According to Kerner, he couldn’t find any.

By contrast, the process for women, according to the co-authors of A Billion Wicked Thoughts: What the World's Largest Experiment Reveals About Human Desire, “are not explicit scenes of sexual activity but character-driven stories of romantic relationships.”

Neuroscientists Ogi Olgas and Sai Gaddam screened the enormous amount of data available on the Web to analyze who goes where and views what. Unsurprisingly, they found that only 1 in 50 subscribers to major porn sites were women. “In fact, the main billing company for porn sites flags female names as potential fraud, since so many of these charges result in an angry wife or mother demanding a refund for the misuse of her card,” writes Olgas.

The female version of porn, according to Olgas and Gaddam, are “fan fiction” sites that peddle racy romance novels. Literally millions of women across the globe visit these sites to read and discuss the stories. The most popular of these is FanFiction.net. Discussion boards and comments on the novels are often long and probing, examining character and plot—it’s very much a group experience. Women can also be turned on by sexual scenes outside their own orientation—women having sex, for example, whereas straight men tend to stick with the flavor they like.

The times may be a-changin’, however, as women find their own voice in this formerly men’s world. We wrote about the new, couples-oriented porn format on the Playboy channel. There are also porn sites for women, and even a Feminist Porn award. And women seem to be seeking them out for the same reasons men do—to “get in the mood,” for pleasure, to learn new tricks.

For a girlfriend guide to the world of erotica for women, check out sex therapist Violet Blue’s The Smart Girl’s Guide to PornYou could also check out the queen of literati porn, Rachel Kramer Bussel, for her popular anthologies of sexy writing as well as her own four-alarm work. Happy hunting!

New Friends, New Resources

A wonderful and unexpected benefit of starting MiddlesexMD has been meeting other women and men who are like-minded, who see the value in—have a passion for—supporting sexuality throughout our lives. As we’ve gone to conferences and association events, I’ve been able to talk to doctors, nurse practitioners, and therapists who are eager to spread the word and join forces.

I’ve talked before about how the mind is as important for women as the body; that’s what makes the Basson model of female sexual response so helpful for my conversations with patients. Our need to address the emotional as well as physical aspects of sexuality made one of our encounters especially fortuitous: We met Mary Jo Rapini, a Texas-based psychotherapist who specializes in intimacy, sex, and relationships.

As a psychotherapist, Mary Jo can help us to round out the resources we offer you—so we’re thrilled that she’s offered her expertise to MiddlesexMD! Mary Jo has a private practice, but also publishes and speaks in a variety of places; you’ll learn more over the next several months. Plus we’ll interview her from time to time on topics of particular interest to us as midlife women.

To give you an idea of what’s in store, here is an excerpt from Mary Jo’s recent post, “Women Need Time to Get Their Sexy On,” in YourTango (read the whole article online):

“Body image is so highly correlated with women’s sexuality that in a recent study reported in the Journal of Sex Research, Dr. Patricia Barthalow Koch PhD discovered that body image was one of the top reasons women don’t want to have sex. Men may have difficulty understanding this because many of them tell their wives every day how beautiful she looks only to realize their wife still doesn’t want to have sex. The husbands may not understand that although their intentions are good, their wife doesn’t derive her body image by what he says. It may help and reassure his wife, but more helpful is if she believes that she is beautiful and desirable. In other words, if she beats herself up, or is critical in regards to her looks when she compares herself to others no matter what her husband tells her, it falls on deaf ears.”

Yes! Precisely. I hear evidence of this same issue. And remember our discussions of erotica? How it’s different for us than for men? Mary Jo goes on to talk about the same issues:

“Women need different stimuli to turn them on than men. We don’t get excited when we see a naked man. In fact, most women prefer a man with shorts on to a man in the buff…. Your sex text may not do it for us, but if we catch a glance at your jaw while you are drinking from a water fountain in the right lighting, we may feel a sexual impulse. Women don’t talk to you about this, because we know you won’t understand. Women are also somewhat reticent about telling you what turns them on, because it is so different than what turns men on, or what media believes should turn them on.”

You can see why I’m glad to have Mary Jo’s perspective and expertise with us for our exploration. Watch the blog and our Facebook page for more results of our work together. We can’t wait!

Q: Any suggestions for overcoming lack of desire and pain during sex?

The first thing I try to do with women who have both of these issues is to make sex comfortable. It is pretty hard to be interested in intercourse when you know it is going to lead to pain.

You might consider vaginal estrogen--estrogen that is 'localized' rather than 'systemic' and is delivered only to the vagina. This would require a prescription product. Or you need to commit to using a vaginal moisturizer consistently; this reintroduces moisture to the vagina on an ongoing basis.

Once sex is comfortable, then approach the issue of desire, which admittedly, is difficult. Yours might be a situation in which to consider using testosterone or buproprion, an antidepressant that can have the side effect of increasing desire. Engaging mindfulness and choosing sex is important to the sexual relationship. I review Basson’s research with patients, and remind them that desire does not play as big a role in women’s sexuality at this stage of life, so being intentional and choosing to engage is often necessary.

Find a provider you trust to talk through some of these issues and begin to explore options.

Why We Love Rosemary

Rosemary Basson's model of female sexual response

The science of human sexuality is young. For most of the last century, we assumed that men and women approach sex in roughly the same way.

I know: Crazy. But as I said, the science is young.

Older models (Masters & Johnson, Kaplan) theorized that sex for people happens in a few neat, linear stages, beginning with  desire, proceeding next to arousal, then orgasm, and finally satisfaction.

But it doesn’t always work that way, particularly for women, and especially for women over 40.

More recent researchers who focus on women’s sexuality, confirm that really, women do not experience sex in this simple, linear way. We sometimes skip phases. Our reasons to have sex are many and often complex.

We can be perfectly satisfied with sex that does not include orgasm, and we can reach orgasm without desire. We are flexible that way.

Enter Rosemary Basson, MB, FRCP, of the University of British Columbia. Basson formalized a new model of female sexuality that is now widely accepted.

She offers two key insights. First: Female sexual desire is generally more responsive than spontaneous. That is, we are more likely to respond to sexual stimuli — thoughts, sights, smells, and sounds — than we are to spark an interest in sex out of thin air (Men, on the other hand, specialize in this).

Another key insight: emotional intimacy matters to women. I know, that doesn’t sound like a news flash, but in the realm of the biological sciences, it’s news, trust me.

So Basson drew a new model – not a linear series of steps, but a circle that includes both sexual stimuli — the thoughts that trigger a woman to take an interest in sex, and emotional intimacy — the emotional payoffs of the experience that lead her to want to come back for more.

I love Basson’s model and use it every day in my practice to help my patients understand how sex really works for us.

We need to understand that it’s okay and it’s normal that we don’t always start with desire.  And as we enter menopause, and our hormone levels drop, spontaneous thoughts about sex, and responsiveness to opportunities for sex diminish for most of us. That’s natural and normal too.

If you don’t like the situation, and you want to feel more sexual, more responsive, Basson’s model gives us the hint: We need to stimulate our minds. The more sexual stimuli we receive, the more sexual we feel.

So, this is worth thinking about today, a worthy discussion to have with your partner: What makes you feel sexy? A juicy romance novel? A James Bond movie? Erotic art? Pretty underpinnings? A romantic dinner?  Having your partner empty the dishwasher?  Spend some time thinking about that. Maybe make a list. And then provide for these things. Sexy is as sexy does, friends.

And, hey, if you’d like to help a sister find some sexual motivation, use the comment field below to share. What sights, sounds, scents, scenes help you get in the mood?

Here's more:

Theories of Female Sexual Response

Sex:Desire, Chicken:Egg

Why Women Have Sex