Deakin Research Online This is the published version: Goldhammer, Denisa L. and McCabe, Marita P. 2011, A qualitative exploration of the meaning and experience of sexual desire among partnered women, Canadian journal of human sexuality, vol. 20, no. 1-2, pp. 19-29. Available from Deakin Research Online: http://hdl.handle.net/10536/DRO/DU:30036733 Reproduced with the kind permissions of the copyright owner. Copyright : 2011, Sex Information and Education Council of Canada

The Canadian Journai of Human Sexuality, Vol. 20 (1-2) 2011 19

A qualitative exploration of the meaning and experience of sexualdesire among partnered women

Denisa L. Goldhammer^ and Marita P. McCabe^

' School of Psychology, Deakin University Melbourne, Australia

Abstract: This qualitative study expiored the meaning and experience of sexuai desire for women.Data were gathered through semi-structured interviews with 40 partnered heterosexuai women aged20 to 61 years drawn from the gênerai population. Thematic analysis of the interview transcriptsIndicated that the participants understood and experienced their sexuai desire primariiy withinthe context of their partner relationships and most frequentiy reported responsive rather thanautonomous experiences of sexuai desire. The impiications of the study findings are discussedin reiation to the definition, classification, and treatment of sexual desire disorders in women.

Acknowledgements: Weextendoursinceregratitudetoail the women whosocandidiysharedtheirperceptionsand experiences during the interviews conducted forthis research, No confiict of inte rest exists for either author.

Introduction

The diagnostic criteria for Hypoactive Sexual DesireDisorder (HSDD) outlined in the Diagnostic andStatistical Manual of Mental Disorders (DSM;American Psychiatric Association, 2000) havegenerated a great deal of discussion and controversy(Basson et al., 2000; Brotto, 2010; Kaschak &Tiefer, 2002; Segraves, Balón, & Clayton, 2007).The discourse on this topic reflects both a lackof consensus concerning what constitutes femalesexual dysfunction (FSD) and the more specificdifficulties involved in conceptualizing women'ssexual desire as a construct (Meana, 2010). Notableinconsistencies exist ¡n how the term "sexual desire"has been defined, operationalized, and measuredacross studies and numerous synonyms have beenused interchangeably in the research on this construct.

In order to better conceptualize sexual desire, itis important to understand how women actuallyexperience this construct (Wood, Koch, & Mansfield,2006). Women's own sexual experiences andperceptions with respect to sexual desire have beenrelatively absent within the literature, although ahandful of recent studies have explored women'ssexual experiences using qualitative methodologies.

Such studies have focused on understanding sexualdesire experiences in adolescent girls/young women(Tolman, 2002; Tolman & Szalacha, 1999; Ussher,2005), the perceived causes of distressing reducedsexual desire (Traeen, 2008), the causal attributionsthat women make with respect to their loss of sexualdesire (Sims, 2008), postmenopausal women's sexualdesire experiences (Wood, Mansfield, & Koch, 2007),and differences in how middle-aged women with andwithout sexual ai'ousal difficulties describe sexualdesire (Brotto, Heiman, & Tolman, 2009). The lattertwo studies drew on the desire experiences of women,but with specific reference to peri- and/or post-menopausal women; there has been little researchon the meaning and experience of desire in a moregeneral sample of women. The present study soughtto fill this gap by exploring how broader sample ofpartnered heterosexual women conceptualized theirsexual desire.

BackgroundOur understanding of what constitutes sexual desirefor women, the factors we identify as influences onwomen's experience of desire, and our perceptions ofwhere sexual desire fits in a woman's sexual response,all have implications for how we conceptualize desireand classify and manage sexual desire difficulties.

Correspondence concerning this artide shouid be sent to Professor Marita McCabe, School of Psychology, DeakinUniversity, 221 Burwood iHighway, Burwood, 3125, Melbourne, Victoria, Australia, E-mail: marita.mccabe@deakin,edu.au

20 The Canadian Journal of Human Sexuality, Vol. 20 (1-2) 2011

TheDSM-lV-TR (American Psychiatric Association,2000) conceptualizes sexual dysfunction as arisingfrom an impairment or disturbance in one of the stagesof sexual response first identified by Masters andJohnson (1966) and later refined by Kaplan (1977).This model assumes a fixed, linear pattern of stages(desire, arousal, and orgasm) across time and context.Empirical evidence suggests that this model maynot be the most appropriate conceptualization for allwomen (e.g. Giles & McCabe, 2009; Sand & Fisher,2007). Basson's (2000) circular model distinguishesbetween spontaneous (untriggered) experiencesof sexual desire and responsive experiences (i.e.receptive experiences occurring in response tosexual stimuli). Although there is currently limitedempirical evidence to support this circular model,it does depathologize women who may not reportspontaneous sexual desire experiences.

Thepresentstudyusedaqualitative(phenomenological)research methodology to identify and explore themeanings and conceptualizations of sexual desirethat women draw from their lived experiences. Thisapproach expressly avoids imposing the researchers'own conceptualizations of this construct on studyparticipants. We drew women from the generalpopulation who self-defined as heterosexual and wereinvolved in a committed relationship. We defineda committed relationship, as did West (2008), as arelationship equal to or greater than three months inlength. In addition to asking about the meanings thatwomen attached to sexual desire, we also investigatedthe factors they perceived to be influences on theirexperiences of sexual desire within the contextof a committed relationship. We had two broadhypotheses.

Hypothesis 1: Women will indicate that theyexperience sexual desire in a wide variety of ways,including physiological, emotional, cognitive, and/or interpersonal experiences.

Hypothesis 2: Women will report both spontaneoussexual desire, hypothesized to emerge as anuntriggered (spontaneous) experience, and responsivesexual desire, hypothesized to occur in response tostimuli perceived by the women to be sexual.

Methods

ParticipantsParticipant recruitment was primarily achievedutilizing online advertisement via a number ofwomen's health web sites, psychological health andresearch organization sites, and women's onlinediscussion forums. Eligible participants werewomen aged over 18 who self-identified as beingheterosexual and were involved in a committedrelationship of at least three months duration.Participants were recruited independent of sexualfunctioning and menopausal status so that we couldexplore the meaning and experience of sexual desirein an unrestricted participant sample. Reports ofsexual functioning were not obtained, as the studywas intended to explore women's experience of theconstruct of sexual desire in a broad sense, and notto examine the differences in experiences of sexualdesire according to the different groups in whichwomen might be placed (e.g. , pre- versus post-menopausal, functional versus dysfunctional, etc.).Future studies may use intentional sampling to obtaina sufficient number of women in such groups to allowdifferences to be detennined but this was not thepurpose of the current study.

The gold standard for how many participants toinclude in a phenomenological study is that datacollection and sampling continue until thematicsaturation is reached, i.e., until no new themes emergefrom participants' narratives (Kvale, 1996). Dataanalysis was therefore an ongoing process that endedwith a final sample size of 40 women.

Interview scheduleQuestions and probes in an interview schedule(Table 1) were used to flexibly guide conversation.The questions were developed through a review ofthe current literature on sexual desire in women thatalso included research on women's sexual functionand dysfunction. The schedule covered a numberof thematic areas chosen to probe participants'understanding of sexual desire as a phenomenonand to clarify the way in which they experiencedsexual desire and the factors they associated withthis experience.

The Canadian Journai of Human Sexuaiity, Vol. 20 (1-2) 2011 21

Table I Interview seiiedule

Prior to the interview, women were reminded that the terms sexual activity and sex encompassed all manner of sexual behaviours(e.g. giving/receiving oral stimulation, touching of genitals), and were not limited to penile-vaginal intercourse.

Question 1 : What is the meaning of sexual desire to you?Probes: Please explain what the term sexual desire means to you.

When 1 say sexual desire what do you understand by that?

Question 2: What words or phrases come to mind that are synonymous with sexual desire for you?

Question 3: Do you ever experience sexual desire? How frequently? Please explain the nature ofthat experience.Probes: How do you know when you are experiencing sexual desire?

What are the feelings, thoughts, sensations, etc. when you experience sexual desire? When you experience sexualdesire, what would you like to have happen (e.g., to be touched by a partner, to take part in sexual activity, etc.)?

Question 4: Sexual desire may occur when we are alone, with our partners, or even in the presence of others. Could you pleasedescribe/explain when (and how) you experience sexual desire?

Probes: Do you experience sexual desire only when in the presence of your partner or also when you are by yourself?Do you feel that your sexual desire is usually triggered by something?

Question 5: How often do you desire to engage in paitnered sexual activity of any kind?Probes: How often do you actually engage in sexual activity'? {If there is a discrepancy between desired amount and actual

engagement, ask: Why the discrepancy?^

Question 6: How often do you masturbate? What do you feel drives this behaviour?

Question 7: When your partner approaches you for sex, how do you generally respond?Probes: What factors influence your response towards him? What are your main motivations/reasons for engaging in

sexual activity with your partner?

Question 8: When you are experiencing sexual desire, do you also experience sexual arousal?Probes: Do you differentiate between sexual desire and sexual arousal? What are the signs of your sexual arousal?

When do you experience se.xual arousal in relation to sexual desire?Is it always the same pattern, or does it depend on the context/situation?

Question 9: While experiencing sexual desire, do you ever have fantasies with sexual content or sexual thoughts?

Question 10: Do you find that certain situations or places increase your level of sexual desire? Examples?Probes: What about situations or places that decrease your level of sexual desire?

Question 11: How long could you comfortably go without engaging in sexual activity of some kind?Probes: What sort of feelings do you have if you do not engage in sexual activity for a while? Do you ever teel distressed/

other negative emotions?

Question 12: Any other comments?

ProcedureSemi-structured interviews were conducted by thefirst author via telephone, and followed a guidedconversation style (Kvale, 1996). Predeterminedquestions were used to elicit physiological, emotional,cognitive, and interpersonal factors that may be pai1of, or accompany, the experience of sexual desire forwomen. To ensure that the meaning the participantwas attempting to convey had been understood

correctly, the interviewer periodically summarizedeach participant's narrative so that the participantcould make corrections and/or clarifications as needed.

Interviews lasted between 17 and 86 minutes, with anaverage duration of 32 minutes. All interviews wereaudio-taped and transcribed in full as part of the dataanalysis process. Repeated close readings of thesetranscripts identified key themes related to women's

22 The Canadian Journal of Human Sexuality, Vol. 20 (1-2) 2011

experiences of sexual desire within the context ofa committed heterosexual relationship. Interviewswere conducted until no more themes emerged inthe ongoing analytic process, which occurred after40 completed interviews.

Data AnalysisInterpretative phenomenological analysis, whichinvolves a close analysis of the experiences of anindividual and aims to offer insight into how theindividual makes sense of a given phenomenonwithin their personal context, was used to analyzedata. The NVivo (v7; QSR International, 2008)qualitative research computer software programassisted with data management, and provided astructured framework within which to amalgamateemerging themes. Since the analytical process iscomplicated by the researcher's own views, theresearchers monitored and recorded personal thoughtsand reactions to the data throughout the analysis asrecommended by Tolman and Szalacha (1999).

Individual transcripts were read several times by eachauthor, such that familiarization with the participant's"voice" was achieved. Upon a further reading, theauthors independently identified and compiled alist of themes and sub-themes emerging fi"om eachtranscript. The specific qualities and intensity thatthe participants ascribed to the experience of sexualdesire were identified first. Factors associatedwith and or influencing this experience were thendocumented in a second pass.

Thematically similar material was grouped togetherin nodes within NVivo (v7). This yielded a list ofthethemes that predominated in participant narrativesacross transcripts. Additional emerging themes wereadded to this list as more interviews were conducted.These lists were then discussed between the authorstoward the goal of agreement with respect to themajor emergent themes and sub-themes. Since theconvention for qualitative data analysis is to achieveas high a rate of agreement as is possible through aprocess of dialogic exchange (Smith & Osbom,2003),the inter-rater reliability of these assessments wasnot calculated.

Results

Participant characteristicsThe 40 women in the study sample ranged from20-61 years of age (mean = 36.7; SD = 1 I.I). Allwere in heterosexual relationships that ranged induration from 0.25 to 40 years (mean = 8.8; SD=10.2). Women's ages were significantly correlatedwith relationship length (r = .65,p < .05), indicatingthat older women tended to be involved in longerrelationships. Overall 16 were married and 24 wereunmarried but in partnered relationships. Half of thewomen had no children and the other half rangedfrom 1-4 children. Countries of residence wereAustralia (35), United States (3), New Zealand (1)and Germany (1).

Themes and influencesThe analysis identified five themes that reflected thevarious meanings and experiences of sexual desirethat emerged from the interview data. Those themeswere (1) desire as an idiosyncratic experience, (2)difficulties differentiating between sexual desireand sexual arousal, (3) sexual desire and initiationof sexual activity, (4) sexual desire is not generallya motivator for engagement in sexual activity, and(5) spontaneous and responsive experiences ofsexual desire. The factors tliat women perceived asinfluencing their experiences of sexual desire fellinto three categories: personal factors, interpersonalfactors, and lifestyle factors.

Theme 1: Desire as an idiosyncraticexperienceParticipants used a great variety of terms to reflectwhat they meant by sexual desire and how thisexperience manifests itself (Table 2). Some synonymsfor sexual desire describe a physical aspect of theexperience (e.g., awakening, libido), others refer toa cognitive process (e.g., fantasies, imagination),some reflect an emotional experience (e.g., affection,love), and others are interpersonal descriptions (e.g.closeness, caring for partner).

A number of women described their experiences ofsexual desire as physical sensations. These sensationsincluded a tingling in the genital region, vaginallubrication, a feeling of their bodies becoming alive,and an ache for physical satisfaction or sexual release.

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Table 2 Participants' synonyms for sexual desire

Affection; Anticipation; Awakening; Body image; Caring for partner; Closeness; Enjoyment; Erotic; Excitement; Fantasies; Fun;Heat; Horny; Imagination; "In the mood"; Libido; Love; Lust; Mojo; Passion; Physical intimacy; Physicality; Randy; Sensuality;Sex drive; Sexual arousal; Sexual attraction; Sexual chemistry; Sexual connection; Sexual emotions/feelings; Sexual excitement/energy; Sexual frame of mind; Sexual longing/inclination/ urge; Sexual need; Sexual pleasure/satisfaction; Sexual stimulation;Sexual tension; Sexual thoughts; Sexual want; Sexual yearning; Sexy; "Turned on."

One 53-year-old woman who had been with herpartner for a little over a year said: "It's an intensething you're feeling. Physical sensations. Your bodycan be on fire."

Most participants did not perceive that sexualthoughts/fantasies constituted a part of their sexualdesire experiences, reporting that they did not engagein sexual thoughts/fantasies, or if they did so, it wasto serve the purpose of increasing their sexual arousaland facilitating orgasm. However, some womendescribed sexual desire as a cognitive process thatinvolved being in a sexual frame of mind, havingsexual thoughts or fantasies, recalling past sexualencounters, anticipating a future sexual interaction,and recognizing a conscious want or need for sexualactivity (most often penetrative intercourse):

Sexual desire is the thinking about your [sexual]wants and needs. I think it's certainly morein the mind and your thoughts than what youphysically want, (age 21, partnered 2-3 years)

Several participants described their experience ofsexual desire as an emotional experience, akin toother emotions such as anger, sadness, joy, etc.

1 suppose I perceive [sexual desire] as beingan overwhelming passion, something thatis not necessarily controllable or somethingthat you think about. It's something veryemotional. I perceive it as...an emotionalprocess, (age 29, partnered 2 years)

The majority of women described sexual desire asan interpersonal reaction. That is, their descriptionsof the sexual desire experience specifically madereference to a partner, either as a trigger for theexperience itself (through physical proximity orpartner-related sexual thoughts), or as a force directedtowards a partner.

What I think of as sexual desire is actuallypertaining to an object ofthat desire...Isee it as pertaining to a person. So I seesexual desire as my sexual desire towardsmy partner or toward someone else...l seeit as quite person-centered and relationshipbased, (age 38, partnered 4-5 years)

A preponderance of participants described sexualdesire as a complex interplay of these aforementionedelements.

I think that [sexual desire] can bea combination of everything. I think itcould be a physical thing; wanting to bepleasured physically and sexually. Butit could also be another thing deeper;that you want to be close to someone. Soemotionally you might want to be intimate.So I guess it's got both physical andemotional parts, (age 23, partnered 2 years)

Theme 2: Difficulties differentiating betweensexual desire and sexual arousalIt was evident from participants' narratives that theygenerally found it difficult to differentiate betweenexperiences of sexual desire and sexual arousal. Anumber of women reported that the experience ofsexual desire co-occurred with sexual arousal.

It's very easy to interchange desire andarousal, because they are so interlinkedI guess, (age 38, partnered 4-5 years)

Theme 3: Sexual desire and Initiation ofsexual activityParticipants reported that the experience of sexualdesire would manifest in a variety of behaviours,dependent on context. Notably, women reported thatexperiencing sexual desire may lead them to initiatesexual activity with a partner, given appropriate

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circumstances (e.g. opportunity, privacy). However,sexual initiation was not always reported to be drivenby an experience of sexual desire, but rather it wasoften motivated by a sense of obligation, a wish toplease the partner, or a perception that sexual activityis expected of the woman.

If 1 initiate sex, it is because I have aconscious thought that we haven't hadsex for a few days; not because I feel[sexual] desire, (age 44, partnered 5 years).

Numerous participants described that experiencingsexual desire was pleasurable in and of itself;therefore, they were equally as content to enjoy thisexperience in private as they were to act on it with apartner. Some women indicated that they experiencedsexual desire when on their own more often than not.

[I'd generally experience sexual desirewhen] 1 might have a few moments spareor I'll be at home and I'll have a fewhours off and I'm a little bit relaxed.Whereas often when I'm with my partnerit's at the end of the day...so your mind iselsewhere, (age 39, partnered 5.5 years)

Very few women reported that experiencing sexualdesire led to sdf-stimulation (i.e. masturbation).The majority reported a preference for engagingin partnered sexual activity or none at all, althoughexperiencing sexual desire under circumstances wheresexual wants could not be fulfilled by a partner mayoccasionally have led a woman to self-stimulation.One woman noted: "It's like masturbation and sexwith a partner satisfy different part of sexual desire",(age 37, married 13 years)

The women who did report engaging in self-stimulation viewed this activity in almost non-sexual terms in that masturbation was frequentlyconceptualized as a tension-releasing exercise or anaid for sleep.

Sometimes I masturbate as a sleepingtablet before I go to bed. If I can't sleep,I'll masturbate. Sometimes I'll do it ifI'm bored even, (age 42, partnered 1 year)

Theme 4: Sexual Desire is Not Generally aMotivator for Engagement in Sexual ActivityIn general, sexual desire was not cited as the mainmotivator for engaging in either partnered sexualactivity or self-stimulation. Instead, an array of othermotivators was described by women, the majority ofthese being personal or interpersonal incentives. Themost commonly cited motives are presented in Table3. The most frequently reported benefits includedincreasing the connection and bond between partners,experiencing pleasure and a sense of general well-being, feeling good about yourself, and feeling morerelaxed both witliin yourself and with your partner.

Pleasure obviously would be one. Besides theway it feels, and the experienced closenessand things like that, 1 find that [sexual activity]makes you more relaxed. I notice if 1 haven'thad sex., .if there's a few days in between.. .1get more wound up easier and I just find it'sa way to relax, (age 29, partnered 7 years)

Theme 5: Spontaneous and ResponsiveExperiences of Sexual DesireSpontaneous experiences of sexual desire were notfrequently reported within participants' narratives.Nevertheless, some women reported experiences ofspontaneous sexual desire at times when they did notperceive any sexual stimuli within their environment.

It could be at a time when nothing sexual isgoing on; so 1 haven't seen anything sexual, Ihaven't read anything sexual.. .just sitting atmy desk at work, just feeling desire. So 1 guessit's something that just is spontaneous, andusually you can't anticipate where it's goingto happen. (23 years old, partnered 2 years)

Responsive experiences of sexual desire were moreevident within participants' narratives. That is, womenreported that a multitude of external/environmentalfactors had the ability to trigger experiences of sexualdesire, as well as to inhibit such experiences. Thesefactors included visual, auditory, and tactile media.However, women most often cited their partner asthe primary activator of a sexual desire experience.

It could be at...times when you're in thepresence of your partner, just cuddling

The Canadian Journai of Human Sexuality, Vol. 20 (1-2) 2011 25

Table 3 Participants' self-identified motivations to engage in self-stimulation or in partnered sexual activity

Self-Stimulation Partnered Sexual Activity

Due to lack of satisfaction with partnered sexual activity;easier and more convenient than partnered sexual activity;enhances arousal during partnered sexual activity;for relaxation or as a sleeping aid; out of opportunity orboredom; physical need; to achieve orgasm; when partner isnot available.

Achieve sexual satisfaction or fulfillment; acquiescenceto partner needs/wants/sexual initiations; conception;experiencing sexual arousal; experiencing sexual desire; feelobligated; fulfill a 'role'; increase connection with partner;increase self-esteem; long time between sexual encounterswith partner; love; mutual pleasure; sexual attractionto partner; share intimacy; to keep partner/maintain therelationship; way of expressing sexual self; way of learningabout partner.

or something, or it could be sparked bysomething like TV; if there's a sex scene on TV,that sometimes can provoke desire. Or if yousee something attractive—like if my partnercomes out of the shower in a towel—that cansometimes spark it. (age 23, partnered 2 years)

Categoricai factors influencing sexuaidesireThe factors that participants identified as influenceson their sexual desire fell into three categories:personal, interpersonal, and lifestyle

Personal factors infíuencing sexual desireThe most commonly cited factoi"s within thispersonal category were body-image and self-esteem.Negativity about these factors was associated withlow or absent sexual desire.

My body image...I find that how much Ifind other people attractive, like my partner,can be very dependent on how attractive Ifeel I am myself, or how [I perceive] theywould see me. (age 29, partnered 2 years).

A large proportion of women reported that their levelof sexual desire depended on their menstrual cyclestage. Although some inconsistencies were notedas to the phase that women identified as being mostinfluential, most reported that tliey experienced anincrease in sexual desire in the few days prior to theirmenstrual flow.

It [sexual desire] varies widely...in theweek preceding my period, wow, it goeshigh, but then the week after I'm prettyrock bottom, (age 43, partnered 4 years)

Contraceptive status, e.g., use of the pill or injection,was commonly cited by women as their explanationfor the dampening effect on their levels of sexualdesire; and they reported a resurgence of desire oncethey had stopped using these methods.

I think because I'm on the Pill, mynatural urges have been sort of...I guesssmothered, (age 29, partnered 3 years).

Interpersonal factors infíuencing sexual desireThe most frequent interpersonal factor reported tofacilitate sexual desire was the quality of a woman'srelationship with her partner, as assessed by theperceived quality of interpersonal communication,level of emotional connection and intimacy withthe partner, and the partner's level of considerationtowards her:

When we have poor communication or we'reboth emotionally disconnected or shut down,or one of us is, I can experience absolutely nodesire; I feel like I 'm the least sexual person inthe world. (38 years old, partnered 4.5 years)

Women generally agreed that engaging in partneredsexual activity was good for their relationship and ameans to increase interpersonal closeness. However,women also reported that such closeness had to pre-exist within the relationship for sexual activity to occur.

For me the most important and enjoyablepart of sexual activity with my partner is theintimacy. When I feel etnotionally close tohim, I desire sexual activity more. Conversely,I also desire sexual activity with him when Iwish to reconnect, (age 36, married 14 years)

26 The Canadian Journai of Human Sexuality, Vol. 20 (1-2) 2011

Lifestyie factors influencing sexuai desireThe most common lifestyle factor associated with adecrease or inhibition of sexual desire was fatigue.Women also identified day-to-day stress and (over)work, getting into a sexual "routine", and childrenas impediments to sexual desire.

1 don't want to sound like I resent mychildren, but I'm aware that my desire hasjust gone down the gurgler since havingchildren, because we're just so busy andwe're so tired. I put it down to that a lotof the time, (age 42, married 19 years)

Discussion

Previous research findings on women'sconceptualizations of sexual desire are reflected inmany of the aspects of desire described by women inthe present study. For example, Schiavi and Segraves( 1995) defined sexual desire as a construct involvingphysiologic, cognitive, and behavioral components;similar components were evident in the women'snarratives reported here. Consistent with Leiblumand Rosen (1988), our participants also indicatedthat an experience of sexual desire might or mightresult in overt sexual behaviour such as initiatingsexual activity with a partner. Similarly, Levine's(2002) conceptualization of sexual desire as thesum of the forces that incline us toward and awayfrom sexual behaviour fits with the wide range offactors (psychological, biological, and social) thatour participants cited as either positive or negativeinfluences on desire. Consistent with Stanislaw andRice (1988), this finding suggests that the womenin our study used a variety of indices to assess theirlevel of sexual desire.

While some women described their experiences ofsexual desire in physical terms, others used cognitive,emotional, or interpersonal descriptors. Womengenerally did not report that sexual thoughts andfantasies comprised an integral aspect of their sexualdesire experiences. This finding has implications fortlie current DSM criteria used to diagnose HSDD,one of which specifies ".. .persistently or recurrentlydeficient (or absent) sexual fantasies" (AmericanPsychiatric Association, 2000, p. 541). Specifically,there may be a case for reassessing the validity of

this criterion, when it appears that many women donot in fact engage in sexual fantasizing as part oftheir sexual desire experiences. Our findings in thisarea require further investigation to detennine theirgeneralizability.

Participants in the present study had difficultydifferentiating between sexual desire and sexualarousal. While most women were able to make thisdistinction when prompted, they used the termssexual desire and sexual arousal interchangeablyin their narratives. Similar difficulties in makingthis distinction have also been noted in focus groupresearch (Graham, Sanders, Milhausen, & McBride,2004) and in research on post-menopausal women(Wood et al., 2007). This suggests that some womenmay not experience sexual desire and arousal asdistinct phases within their sexual response asimplied by Kaplan's (1977) linear model. Indeed,women indicated that sexual desire did not alwaysprecede sexual arousal suggesting that desire andarousal may be aspects of the same experience. Thehigh concurrence of desire and arousal disordersis consistent vvith this notion (Hayes, Dennerstein,Bennett, & Fairiey, 2008; Segraves & Segraves,1991; West et al., 2008), as is the empirical datafrom other studies (Giles & McCabe, 2009; Sand &Fisher, 2007).

The foregoing findings suggest that cun-ent definitionsof sexual desire may require expansion in order tobe more inclusive of a range of subjective qualitiesthat women experience. There is a need to recognizethe diversity within women's sexual experiencesand to move away from the tendency to pathologizeand medicalize particular sexual response patterns(Leiblum, 2001; Tiefer, 1996). Ultimately, modelsof women's sexual functioning should reflect theheterogeneity of response patterns across individuals(Giles & McCabe, 2009; Sand & Fisher, 2007) andspecify the contexts in which particular models havethe most relevance. To the extent that age mightbe a factor, it is of interest that the themes aboutsexual desire that emerged in our present study ofyounger women are similar to those documented inthe narratives of mid-age women reported by Brottoet al. (2009).

The Canadian Journal of Human Sexuality, Vol. 20 (1-2) 2011 27

Many of our participants' narratives identified theexperience of responsive sexual desire as a resultof sexual initiations made by a partner. However,this aspect of responsive sexual desire is differentfrom Basson's (2000) model, in that many of theexperiences of responsive desire were to externalstimuli before the woman was actually engaged in asexual interaction. Experiencing sexual desire wasnot identified as the main motivator for engagingin partnered (or solitary) sexual activity, andspontaneous experiences of sexual desire were notfrequently mentioned within the women's accounts.As proposed by Avis et al. (2005), the standard ofspontaneous desire may be more reflective of malesexuality, and may not be experienced by all women.Women in this study frequently described sexualdesire as an interpersonal reaction, reinforcing thenotion that there exists a responsive element to thisexperience for women.

In exploring factors associated with sexual desire,women identified a broad array of perceivedinfluences, categorized as personal, interpersonal, andlifestyle characteristics. These categories are similarto the individual, interpersonal, and intergeneratiotialfactors described by McCabe (1991) as potentialinfluences on sexual desire. Intergenerationalcharacteristics were the only category of factors thatwere not readily identified by women in this study,perhaps due to the present as opposed to historicalfocus ofthe current investigation.

Within the category of personal factors, bodyconfidence and self-esteem were most commonlycited as influences on sexual desire. Body imageperception and dissatisfaction in women has beenproposed to be a mediating factor in the developmentof sexual dysfunction (McCabe & Giles, in press),and has only recently been considered within theliterature in this area. The perceived quality of awoman's relationship was reported to be a significantinfluence on sexual desire. This is consistent withprevious research that has described a positiveassociation between women's sexual desire andrelationship satisfaction (e.g. Brezsnyak & Whisman,2004; McCabe, 1999; Witting et al., 2008). Amonglifestyle factors, children, fatigue and day-to-daystress were the most commonly cited influences onsexual desire, reflecting similar findings by Gayler,

Conaglen, Hare, and Conaglen (1999), and Morokoffand Gillilland (1993).

Overall, our findings indicate that sexual desire is aholistic, emotional, and interpersonal experience forwomen, as suggested by Davies, Katz, and Jackson( 1999), and also that contextual factors are cruciallyimportant to their sexual desire and behaviour. Itis therefore noteworthy that contextual factors arenot incorporated in the DSM-IV-TR (AmericanPsychiatric Association, 2000) diagnostic criteriafor HSDD (Bancroft, Lofhis, & Long, 2003). Ourparticipants' narratives highlighted the need toinclude both contextual and systemic aspects intothe conceptualization and measurement of women'ssexual desire. This applies also to the classificationof sexual desire problems (Hartmann, Heiser, Ruffer-Hesse, and Kloth, 2002). A better understanding ofthe factors that influence sexual desire in women mayshed light on the etiology of sexual desire problems/disorders and advance treatment for such difficulties.Overall, the results of our study suggest that nosingle conceptualization adequately encompassesthe complexity ofthe experience that women label assexual desire. It follows that any measure of sexualdesire must incorporate and evaluate multiple aspectsof this construct.

Study limitationsA limitation ofthe current study is the small samplesize used, although data saturation with respect tothemes emerging from participants' narratives wasachieved. Furthermore, it must be noted that thefindings in the study pertain exclusively to partneredheterosexual women. It is important to repeat thisstudy with women involved in same-sex partnershipsand with women not in partnerships. The resultsof this investigation are not intended to provide adefinitive answer to the question of what sexualdesire is or how the experience manifests for womenwithin the general population. Rather, the findingsare intended to stimulate further examination of thisconstruct and move the research agenda towards amore comprehensive, multifaceted conceptualizationof sexual desire.

28 The Canadian Journal of Human Sexuality, Vol. 20 (1-2) 2011

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