Let's Talk Sex

Written By Dr Vicki Windholz

Life is complicated. Sex is complicated. Sex is profoundly influenced by everything that’s happening in our lives, and sex reciprocally influences what is happening in our lives. They are not separable.
Many of the ideas that we develop about sexuality and our bodies begin with familial and socio-cultural beliefs, and the sex education we receive at school. Most of us went into puberty education classes only to learn boys have erections and ejaculations, and girls have periods and unwanted pregnancy. Subsequent conversations were usually framed in terms of risk and danger. 

The concept of pleasure, and balancing responsibility and joy, was not mentioned. The skills and tools it takes to talk about sex and pleasure with a partner, to advocate for your own pleasure, to accept a ‘no’ and get enthusiastic consent, and have meaningful intimacy were not acknowledged.

Myths and Misconceptions About Sex

Many aspects of sex are shrouded in myths and misconceptions, and even those of us who consider ourselves educated about our own bodies continue to believe some of them. For example, sexual desire was originally believed to be a spontaneous biological drive, akin to thirst and hunger.

The standard narrative of sexual desire is that it just appears. You’re doing the dishes, an attractive person appears on the tv, or you have a positive sexual thought, and suddenly you are thinking “I want to have sex.” This is spontaneous desire. 

Research over the last couple of decades has shown sexual desire is context dependent. It feels more spontaneous for some, and more responsive for others, because even though we are made of the same core biological substrates, the different, highly individual organisation of our biology results in different experiences.

What Influences Sexual Desire?

Sexual desire is a product of an interaction between biology (hormonal), thoughts that generate the wish to behave sexually, and emotions that drive our motivation that results in a willingness to behave sexually. 

This psychological dimension is very much influenced by our attitudes about sex (e.g. “a real man is always ready to have sex”; “it is dangerous to have sex if you are sick”) and the quality and satisfaction of the relationship. 

Once you understand the bio-psycho-sociocultural construct of sexual desire it is easier to understand the fluctuations of sexual desire experienced over a day, a week, a month, a year and a lifetime. It is never “just” culture, or “just” biology or “just” anything. It is always the interaction of all the variables.

When Sexual Desire Is Low 

Distress often arises because the spontaneous sexual desire style is so privileged in our culture, so valued, that it’s easy to feel disempowered if that’s not your primary style. 

Understanding that sex is an incentive motivation system—that responsive desire is normal and healthy—is important. It helps us understand why sex is about ‘thriving’ and not just ‘surviving’. It explains why physical and psychological stress deprioritizes sex for most people, and reduces sexual pleasure for everyone. It also explains how our developmental history, our psychosexual history and our current physical and mental health directly influence our experienced sexual desire. 

People sometimes feel more comfortable with the idea that their sexual desire has everything to do with their chemistry and nothing to do with their life. This false belief disconnects individuals from the potential to change their attitude to their present context, or to modify the context itself.

Sexual Desire In Long Term Relationships 

When it comes to sexual desire in long term monogamous relationships there are two different contextual approaches. 
One approach, described by Esther Perel, conceptualises desire as ‘wanting.’ It focuses on the contradiction at the core of modern relationships: the antithetical pull between the familiar versus the novel, the stable versus the mysterious. We want love, which is about security and safety and stability, but we also want passion, which is about adventure and risk and novelty. Love is ‘having’. Desire is ‘wanting’. And you can only want what you don’t already have. 
By way of contrast, John Gottman, in The Science of Trust, says that the sexual desire problems are due to a lack of deepening intimacy and not the result of a lack of distance and mystery. From this point of view, intimate conversation, affection, and friendship are central to the erotic life of a long-term relationship.
For Perel, desire is eagerness, wanting and seeking. For Gottman, desire has more to do with enjoying, savouring and allowing.  The goal of both approaches is to facilitate and sustain curiosity. 
Perel suggests we sustain curiosity about our partner as viewed from a distance. Gottman suggests we sustain curiosity about the very nature of pleasure in the context of commitment. Both are clear that passion doesn’t happen automatically in a long-term, monogamous relationship. They are also both clear that passion does happen—as long as the couple takes deliberate control of the context. And every couple’s needs for context are unique.

When A Couple’s Sexual Desire Doesn’t Match Up

A mismatch in sexual desire is a very common relationship sexual dysfunction. It’s not the differential itself that causes the issue - it’s how the couple manages it. 
Problematic dynamics emerge when one person’s level of desire is believed to be “better” than the other person’s. This often results in an unsuccessful bid to eradicate the mismatch in sexual desire style, rather than learning to manage it constructively. 
For example, one person may have a spontaneous desire style and their partner a responsive desire style. In this scenario the person with the spontaneous desire style may feel rejected and undesirable because they do almost all the initiating. Their partner with the responsive style of sexual desire may be feeling pushed and pressured, which results in a further lowering of their sexual desire. Rather than preference one sexual desire style over the other, the aim is to see sexuality and desire as an intimate interactive process.

Creating A ‘New Sexual Normal’

Sexual intimacy is a way of feeling loved, showing love, and experiencing pleasure. It is a part of living, and it is a part of dying. 
In my clinical practice I see individuals or couples experiencing sexual distress. I explore their sexual distress in the context of their sexual identity, their sexual function and their sexual relationship (actual or desired). We usually experience these three domains as a narrative, a story: it is a story we tell ourselves, a story we tell our partners and a story we tell others. When it comes to sexual desire and ageing and illness, society expresses a story of decline, and we subconsciously incorporate this into our personally held view. 
I work with people to change the narrative they tell themselves: I encourage them to reframe their narrative from one of powerlessness, decline and distress, to a narrative of explore, experiment and create a ‘new sexual normal’. 
Dr Vicki Windholz is a psychosexual medicine specialist, holding public appointments at Monash Health & the Royal Women’s Hospital, and consulting privately at Women’s and Men’s Health Physiotherapy Camberwell Rooms, 549 Burke Rd Camberwell. 
Basson, R. “Biopsychosocial Models of Women’s Sexual Response: Applications to Management of ‘Desire Disorders.’ “ Sexual and Relationship Therapy, no 1 (2003)
Bitzer, Giraldi, and Pfaus “Sexual Desire and Hypoactive Sexual Desire in Women” Journal of Sexual Medicine 10, no.1 (2013): 36-49.
Gottman, John M. The Science of Trust: Emotional Attunement for Couples. New York: W. W. Norton, 2011
Heiman, J and and Pfaff, D “Sexual arousal and Related Concepts” Hormones and Behaviour 59, no 5(2011)
King, R “Where Did My Libido Go?”: Ebury Australia (2010)
Metz, M and McCarthy, B: “The ‘Good-Enough Sex’ Model for Couple Sexual Satisfaction.” Sexual and Relationship Therapy 22, no 3 (2007): 351-62.
Nagoski, E. “Come as You Are: the surprising new science that will transform your sex life.”: Simon & Schuster 2015
Perel, E “Mating in Captivity: Unlocking Erotic Intelligence.” New York: Harper 2006
Perel, E “The secret to Desire in a Long-Term Relationship.” TED video, February 2013.


August 2019