The women I see in my office express a yearning for a deep connection and a big love affair, for a mate that treasures them more than anyone else. They want this passion and excitement in their everyday lives. Preferably they want to have this with their current husband, or partner. They do not want to change husbands to get this, though they may if it seems impossible otherwise.

At the same time that they express this yearning for a deeper and more exciting connection, they speak very highly of their mate. Nine out of ten women who come to my office give high marks to their partners. They deeply love and respect the male or female partner in their lives. They comment on his/her patience, understanding, and willingness to try anything. They talk about kindness and support and goodness. They are attracted to their mate.

And then we come to SEX, the reason she made the appointment in the first place. She says, “Is there something wrong with me, or wrong with my hormones, that I am not interested anymore? Is there a reason I am not into it? Can I change anything? Do I have to accept this as my new normal? Can I get back to the way it used to feel?” Or if she has never been turned on, “Can I ever feel what I hear is possible? It is not him, it is me. I am just not that into it.”

Low desire is the number one complaint women have worldwide. Four out of ten women say they have low libido, and one of those four is distressed about it.

One way to talk about women’s sexual desire is to break it down and talk about the different types of desire. Spontaneous desire is the name we give to desire when a woman herself wants sex. She is interested, she is on the prowl, she is excited. She is not responding to her partner’s advances; instead she is the one initiating the contact, making that first wink. There is also receptive or responsive desire. This is when a woman responds with interest to her partner’s or husband’s approaches. Sex is not her idea. The idea is originating with her partner. He or she does the thing that gets her interested, whispers the personal sweet thighs into her ear, or draws her a bath and lights candles.

Spontaneous desire in women can happen for a variety of reasons. One pattern that gets a lot of floor time in my office is cyclical or biological desire. This is the most common description I hear from women of what desire means to them. If you are still menstruating this occurs mid-cycle for a few days when hormones peak at ovulation time, about day 14 of your cycle. Some women also report an increase in desire right before their period begins or a day into their periods. At this point in your menstrual cycle, the PMS time, estrogen and progesterone are actually at their lowest levels. Testosterone is the only hormone left standing. It gets to dominate the action for a day or two, or longer. This type of desire is hormonally driven by the hormones that drive your menstrual cycles. This cycling drives the acne and irritability before your period too.

The cyclical spontaneous desire that can occur mid-cycle, and maybe at the end of the cycle, is not there after menopause. It is also not there when you block ovulation with hormonal birth control. As you can see women are not simple around sex, and in their beauty and complexity there are many places to look for desire. Occasionally low desire is caused by one thing, like an interfering medication. Sometimes it is hormones, vaginal dryness or sexual pain. Most often it is a variety of obstacles, physical and non-physical.

An important thing to remember: A woman does not have to have a surge of hormonal desire to make something interesting happen in the bedroom. She can create something interesting any day just because she can. 

Click here to read my blog post about women and sexual arousal.