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Our expectations around sexual expression and satisfaction have never been greater. Medications promising to restore sexual functioning, menopause treatments, movies like Hysteria, The Sessions and Hope Springs, and books like 50 Shades of Grey are all contributing to changing our views on sexuality and raising our hopes and expectations. There is also a greater selection than ever before of information available on the internet and easily purchased adult toys. Sexual expression is the accepted framework of the day.

Yet, within this sexually free era, we also have a significant rate of sexual dysfunction and in particular prevalence of low libido and low sexual arousal.

There are many causes of low libido and low sexual arousal and the driving factor may not be one single cause but many. We endeavour here to mention some of the more Commonly known factors.


Historical influences

To the surprise of many, historical influences play an important role in the way our sexual views are formed. We are, to some degree in any case, a product of the attitudes of our parents and their parents. The impact may be noticeable in some instances and in others may be subtler yet still present.

In 1902, Dr William H. Walling, prominent medical practitioner and author wrote in his book Sexology¹:

“We have but to glance around us at the dwarfed, miserable, sickly specimens of female humanity. The [female] love of dress... fraught with the greatest dangers. The statistics of prostitution abundantly prove the correctness of this assertion. Young women of America, if you knew how lightly you are estimated by those who so earnestly and passionately seek your favors, you would certainly deny them, if the effort cost your lives”.

“The latest modern invention, which we fear will plague the inventors, is the proposition that women are entitled to the same “privileges” as men in conducting political affairs and in all offices of honor and emolument now monopolized by the “sterner sex”. This heresy has been christened by the seductive cognomen of “Women’s Rights”. Set in motion by a singular class of advocates, it would almost seem to have become epidemic. As though dissatisfied with the irksome lullaby and the wearisome routine of household duties... She will become rapidly unsexed and degraded from her present exalted position to the level of man, without his advantages; she will cease to be the gentle mother and become the Amazonian brawler. Undoubtedly the special destiny of woman is to be wife and mother”.

Dr Walling, as many of his colleagues at the time, believed that physical ailments could be caused by the practice of masturbation. In his text about female masturbation, he writes:

“Very little girls are often thus borne along, by a kind of instinct, to commit masturbation. All physicians admit that it is very difficult – almost impossible, in fact – to ascertain the origin of many of the diseases of unmarried women which they are called upon to treat, and if the cause be perpetually in operation, they will prescribe with fruitless results. The broken health, the prostration, the great debility, the remarkable derangements of the gastric and uterine functions, too often have this origin, and when the cause is investigated the subject alleges great exertions, intense trouble, unhappiness etc., but is silent as to the real cause which perhaps, after all, she does not herself associate with her maladies”.

Even in the 1960s women were often still not considered to be individual sexual beings in their own right. Simone de Beauvoir (1961)⁴ writes:

“Humanity is male and man defines woman not in herself but as relative to him: she is not regarded as an autonomous being... she is simply what man decrees; thus she is called ‘the sex’, by which is meant that she appears essentially to the male as a sexual being. For him she is sex – absolute sex... She is defined and differentiated with reference to man and not he with reference to her; she is incidental, the inessential as opposed to the essential. He is the Subject, he is Absolute – she is the Other”.

We now of course find the above tenets difficult to comprehend and find it unfathomable that seemingly educated people wrote these types of epitomes. None-the-less, these were the popular beliefs of the time. These are what our Grandparents based their views on sexuality on and passed these on to their children.


The Definition

The DSM-5 (diagnostic manual) outlines³⁴ the term: Female Sexual Interest / Arousal Disorder

Criteria:  Lack of, or significantly reduced, sexual interest / arousal, must meet at least three of the following: 
Absent / reduced:

  1. Interest in sexual activity

  2. Sexual / erotic thoughts or fantasies

  3. Sexual excitement / pleasure during sexual activity in approx. 75%-100% of sexual encounters (in identified situational contexts, or if the condition is generalised, in all contexts)

  4. Sexual interest / arousal in response to any internal or external sexual / erotic cues

  5. Genital or non-genital sensations during sexual activity approx. 75%-100% of sexual encounters (in identified situational contexts, or if the condition is generalised, in all contexts)

  6. Initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate


The symptoms have persisted for a minimum of approximately six months and cause the individual significant distress. In addition, that the dysfunction is not better explained by other conditions.


The issue can be categorised as either lifelong or acquired at some point during the lifespan and can be generalised meaning it occurs in all situations, or situational meaning it only occurs in certain situations or with particular partners.


The low libido or low arousal may cause mild, moderate or severe distress for the individual.



Population studies suggest that between 22% and 50% of women may experience sexual desire problems at some point in the lifespan⁹. The reason for this wide variance in statistic is that obtaining accurate data on female sexual functioning is difficult for two primary reasons.


Firstly, the low libido or arousal may largely go underreported for numerous reasons including that the woman may not see the condition as an issue.  Secondly, it may be partly due to assumptions of male-female sexual equivalency. Meaning that, the male standards of arousal and performance are the same standards for women as well¹². Women may not only compare themselves to the male standard but may also compare themselves to standards portrayed in movies and books¹³.

Pornography and Hollywood movies such as 9 ½ Weeks may provide women and couples with a healthy erotic experience but may also paint pictures of women as being excessively erotic and sexually insatiable. If women are to normalise these images and make these a benchmark for comparison, there will be a significant gap between what is sexually reasonable and what they believe their sexual performance should be.


The Boston Area Community Health Survey of 3205 women reported that, among women in relationships, a history of physical, sexual or emotional abuse approximately doubled the chances of developing a female sexual dysfunction¹⁷.

Less traumatic, negative sexual experiences may also have long-lasting effects on developing and maintaining sexual desire and arousal issues. Many people may learn early, that a sexual experience can have negative outcomes and this is likely to develop into a core belief that remains with the person¹⁶. Individuals who have experienced unwanted sexual events are likely to develop a disconnection between psychological and physiological facets¹⁹˒²⁰, which may have been a protective mechanism to deal with the event²¹. Research indicates that women tend to relate past negative sexual events to personal incompetence. If these negative events are repeated women tend to form negative schemas about sex, which is more likely to create sexual dysfunction²². Conversely a history of past rewarding experiences is considered to correlate with the development of positive sexual schemas and healthy sexual functioning¹⁸.

Belief systems

The terms erotophobia and erotophilia were first used in the 1970s and 1980s and describe a linear continuum with erotophobia (a fear of sex or negative attitudes towards sex) on one end, and erotophilia (positive attitudes about sex) at the other end.  Byrne & Schulte (1990)²³ demonstrated that either of these beliefs may be developed in childhood from family-of-origin influences, religious tenets or other social impacts. In adulthood these past negative sexual messages or events then influence current sexuality.

Our belief system, whether we believe sexual encounters to be positive or negative, can be based on real experiences, opinions of others including the family-of-origin or perceptions we have formulated over time. They impact on the way be view and engage in sex. The can be challenged and changed over time is we can begin to view them as an unhelpful. 


Different cultures provide variance on how sexual functioning and low sexual desire are defined⁷. A potential difficulty arises when women find themselves in a position where they may need to challenge their culturally held beliefs and this is likely to be difficult for many women²⁶. We are now facing a world of high migration across nations, arranged and inter-racial marriages and greater multiculturalism in our day to day living, and these interactions are likely to cause confusion for many individuals.



Studies consistently evidence that sexual problems, regardless of the severity, do not always cause distress²⁸˒³⁰˒³¹˒³²˒³³. When the classification of distress is included prevalence rates of sexual dysfunction are lower³³, meaning that not all women feel distress about their lack of sex drive. With the absence of distress, the issue should not be considered as a sexual dysfunction per se.

However, some research studies do evidence that many women find their lack of interest in sex distressing and impactful on the relationship. It is for the relationship itself or the partner that many women see therapy, not necessarily for themselves or their own interests.


In Conclusion

The entire list of potential causes for low libido (low sex drive/desire) or low arousal exceed the scope of this article. From evolution we have learnt that sexuality is designed to be fragile – we must not be procreating when the individual or the clan is not operating at optimum levels.

Many women could positively view sexuality as almost a warning beacon; an indication of when other things aren’t at equal Librium. It is up to each individual how they view their own situation: not an issue at all, an issue for themselves, partner or the relationship etc. Once this has been defined a course of action can then be established.



¹ Walling W. H. (1904). Sexology. London, UK: Bibiolife, LLC.

⁴ de Beauvoir, S. (1961). The Second Sex. New York, USA: Bantam Books.

⁷ McCabe, M.P. & Goldhammer, D.L. (2013). Prevalence of women’s sexual desire problems: What criteria do we use? Archives of Sexual Behavior, 42, 1073-1078.

⁹ MacPhee, D.C., Johnson, S.M., & Van Der Veer, M.M.C. (1995). Low sexual desire in women: The effects of marital therapy. Journal of Sex & Marital Therapy (21), 159-182.

¹² Elton, C. (2010). Learning to lust. Psychology Today, 3, 70-79.

¹³ Avis, N.E., Zhao, Z., Jahannes., C.B., Ory, M., Brockwell, S. & Greendale G.A. (2005). Correlates of sexual functioning among multi-ethic middle-aged women: Results from the Study of Women’s Health Across the Nation (SWAN). Menopause,      12 (4), 385-398.

¹⁶ Barlow, G. H. & Durand, V. M. (2009). Abnormal psychology: An integrative approach (5th ed.). Belmont, USA: Wadsworth.

¹⁷ Lutfey, K. E., Link, C. L., Litman, H. J., Rosen, R. C., & McKinlay, J. B. (2008). An examination of the association of abuse (physical, sexual, or emotional) and female sexual dysfunction: Results from the Boston area community health survey. Fertility and Sterility, 90, 957–964.

¹⁸ Basson, R. (2006). Sexual desire and arousal disorders in women. The New England Journal of Medicine, 354 (14), 1497-1506.

¹⁹ Kinzl, J. F., Traweger, C., & Biebl, W. (1995). Sexual dysfunctions: Relationship to childhood sexual abuse and early family experiences in a nonclinical sample. Child Abuse and Neglect, 19, 785–792.

²⁰ Rellini, A. (2008). Review of the empirical evidence for a theoretical model to understand the sexual problems of women with a history of CSA. Journal of Sexual Medicine, 5, 31–46.

²¹ Boysan, M., Goldsmith, R. E., Cavus¸, H., Kayri, M., & Keskin, S. (2009). Relations among anxiety, depression, and dissociative symptoms: The influence of abuse subtype. Journal of Trauma & Dissociation, 10, 83–101.

²² Nobre, P.J. & Pinto-Gouveia, J. (2008). Cognitions, emotions, and sexual response: Analysis of the relationship among automatic thoughts, emotional responses, and sexual arousal. Archives of Sexual Behavior, 37, 652–661.

²³ Byrne, D. & Schulte, L. (1990). Personality dispositions as mediators of sexual response. Annual Review of Sex Research, 1, 93- 117.

²⁶ Robinson, B., Munns, R.A., Weber-Main, A.M., Lowe, M.A. & Raymond, N.C.  (2011). Application of the sexual health model in the long-term treatment of hypoactive sexual desire and female orgasmic disorder. Archives of Sexual Behavior, 40, 469-478.

²⁸ Witting, K., Santtila, P., Varjonen, M., Jern, P., Johansson, A., von der Pahlen, B. & Sandnabba, K., (2008). Female sexual dysfunction, sexual distress and compatibility with partner. Journal of Sexual Medicine (5), 2587-2599.

³⁰ Bancroft, J., Loftus, J. & Long, J.S (2003). Distress about sex: a national survey of women in heterosexual relationships. Archives of Sexual Behavior, 32, 193-208.

³¹ Oberg, K., Fugl-Meyer, A.R. & Fugl-Meyer, K.S. (2004). On categorization and quantification of women's sexual dysfunctions: an epidemiological approach. International Journal of Impotence Research, 16, 261-269.

³² King, M., Holt, V. & Nazareth, I. (2007). Women's views of their sexual difficulties: agreement and disagreement with clinical diagnoses. Archives of Sexual Behavior, 36, 281-288.

³³ Hayes, R.D., Dennerstein, L., Bennett, C.M., Sidat, M., Gurrin, L.C. & Fairley, C.K. (2008). Risk factors for female sexual dysfunction in the general population: exploring factors associated with low sexual function and sexual distress. Journal of Sexual Medicine, 5, 1681-1693.            

³⁴ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.), (DSM-5). Washington, USA: American Psychiatric Publishing.

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