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The most common phase of the sexual cycle to have a problem is usually the drive or desire phase. So we call that decreased sexual desire, decreased sexual drive or decreased libido. And it has to do with a reduction in wanting to have sex or a desire to have sex. And in my gynecology office, the vast majority of female sexual dysfunction is related to this lack of drive or lack of sexual desire. Now sexual drive is thought to be the biological or physical or physiologic need or hunger to have sex. And we now know that sexual desire incorporates not just the biological drive, but also a woman’s cognition or what she’s thinking. Is she mentally prepared? Is she mentally feeling safe? Is she mentally and emotionally connected to her partner and a woman’s motivation? So does she feel like she wants to, is she motivated to have sex or be close to her partner?
And we know that a woman can, for example, have a really strong sexual drive. So all her hormones and her physical need is there, but she’s not feeling overly connected to her partner, or there’s been a recent fight or marital discord, or she’s not feeling safe. And that would mean there’s a reduction in either the cognition or the motivation. And therefore, even though she has a strong drive, she doesn’t have a desire and she doesn’t really want to have sex. And conversely, there can be women who are very low, say low in hormones, maybe post-menopausal women or there’s a hormone imbalance and the drive is not there, but the motivation is there. In other words, she really wants to be close to her partner. She feels protected and loving and vulnerable and wanting to have that sexual experience. So she’s motivated. So even though the drive is not strong, the motivation carries through and she has ongoing sexual desire. So again, desire is a bit more complicated in that it includes not just the biology, but also the connection, motivation and how the woman is feeling about herself and the sexual experience.
