Masters and Johnson are famous for researching the sexual response cycle, the body’s reaction to sexual stimuli.  What is amazing about the sexual response cycle is that most people, regardless of race or religion or country they live in, respond to sexual stimuli and go through four phases: Excitement/Arousal, Plateau, Orgasm and Resolution.  The stimuli vary depending on the culture or society , but the response is typically the same: men will start to get erections, women will begin to lubricate.  What makes a man have an erection in Zimbabwe may be different for a man in America, but the reaction is the same…erection.

This model has been critiqued and modified, and new models have been proposed.  One aspect that is missing from the original response cycle is sexual desire.  Desire is referenced as a state that typically occurs before excitement or arousal.  But in essence, if someone or something does not stimulate this desire, often, the response we expect may not exist. 

Rosemary Basson explains desire and women like this:   women start in a place of neutrality and can move into desire – or not – depending on the stimuli available to her.  If the stimuli do their job, a woman feels desire which will produce a response or reaction in the body.

What about people who may be able feel excitement or arousal without desire?  Is that possible? 

This is something I see with some of our patients with low desire. It tends to be very confusing to the patient and particularly to her partner.  These patients experience low desire and are not very interested in have sex with a partner , but the partner keeps initiating sex and the patient thinks: “well, it has been 2 months since we did anything sexual so I should give in.” 

When I ask a patient if her body was able to “respond” once she began sexual activity,  some patients reply, “Yes, I do get turned on and even orgasm at times; and then I think to myself, ‘why do you keep saying no, this isn’t bad and feels good’ until the next time comes around again.”  One woman equated it with going to the gym.  “You really don’t want to go to the gym, then you’re there and feel, wow, this is great for me and my body, on the way out of the gym you think this isn’t so bad, why did I make it so difficult, I should do this more, until the next time rolls around again and you don’t want to go.” 

This situation is very confusing for partners because, if their partner seems satisfied at the conclusion of lovemaking, having been adequately lubricated and perhaps experiencing an orgasm,  it is not clear why they wouldn’t want to have sex more often.  

If we begin to separate desire and response into two different phases, we observe how some women can respond to sexual stimuli, even if they do not arrive at the experience with a high level of desire.  Conversely, we treat women who feel desire, but their desire does not follow with the appropriate physiological response such as lubrication and orgasm.

As a clinician, it is important to look at these two aspects of lovemaking and examine how desire and response interact on a patient by patient basis.  The diagnosis and treatment may vary depending upon what we learn.