How do men and women define sexual desire and sexual arousal?

Abstract

The purpose of this study was to understand how men and women define sexual desire and

sexual arousal and how they distinguish between the two. We conducted 32 semi-structured

interviews with individuals in South East England, using a purposive sampling strategy to

maximise the variation in experience of sexual function across the group. We identified three

criteria that participants used to define and distinguish between desire and arousal: the

sequence in which they occurred; whether the mind or the body (or both) were engaged; and

the extent to which feelings of desire or arousal were responsive (in response to person or

stimulus) and motivational (orientated towards a goal). Most participants attempted to

distinguish between desire and arousal when prompted, but often with difficulty. Participants

commonly felt that desire preceded arousal; some felt that desire was ‘mind’ and arousal

‘body’; and many felt that both desire and arousal were responsive and motivational.

However, we identified numerous times when these distinctions were reversed or the

differences between terms were blurred. Our results support recent proposals to merge the

two diagnostic categories of Female Sexual Arousal Disorder and Hyposexual Desire

Disorder into a single diagnostic category.

Introduction

Sexual desire and sexual arousal are widely acknowledged as complex constructs and the

relationship between them as intricate (Ågmo, 2011; Janssen, 2011; Meana, 2010); despite

their ubiquity, there is little consensus on how best to define them (Janssen, 2011).
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An understanding of patient and research participant accounts of sexual desire and

arousal is important because of the reliance on self-report in diagnosing and measuring sexual

dysfunction. Patient accounts of other types of dysfunction often differ significantly from

scientific or professional definitions and theories (Furnham, 1988) and this appears true of

sexual dysfunction (see Bancroft et al., 2003; King et al., 2007).

Although there is now a small qualitative literature on women’s (and, to a lesser

extent, men’s) sexual experiences, little work has been done on how men and women

understand the terms “sexual desire” and “sexual arousal.” In this paper we briefly outline

prominent expert definitions of desire and arousal in relation to sexual response. We then

present data from a qualitative study designed to address the following research questions:

How do men and women define sexual desire and sexual arousal? Do they make a distinction

between the two? In exploring participant accounts of sexual desire and arousal we seek to

contribute to a conundrum currently troubling experts: are these two concepts distinct or are

they different facets of the same construct? (Binik et al, 2010). By exploring the accounts of

men as well as women, we will also address the current paucity of research into men’s

understanding of desire and arousal (Brotto, 2010b).

Expert definitions

Sexual desire has been broadly described as “the sum of the forces that lean us toward

and push us away from sexual behavior” Levine (2003, p. 285). Regan and Berscheid (1999)

proposed that sexual desire is “a psychological state subjectively experienced by the

individual as an awareness that he or she wants or wishes to attain a (presumably pleasurable)

sexual goal that is currently unattainable” (p. 15).

Most expert definitions of sexual arousal are similarly broad, incorporating a number

of different components of arousal beyond genital response. For example, Bancroft (2005)

conceptualized sexual arousal as “a state motivated towards the experience of sexual pleasure

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and possibly orgasm” (p. 411). He proposed that arousal included a range of physical and

mental processes, including information processing of relevant stimuli, arousal in a general

sense, incentive motivation, and genital response. Bancroft’s definition incorporates ideas of

both mind and body, as well as the idea of motivation towards a goal. Janssen (2011) defined

sexual arousal as “an emotional/motivational state that can be triggered by internal and

external stimuli and that can be inferred from central (including verbal), peripheral (including

genital), and behavioral (including action tendencies and motor preparation) responses.” (p.

708). Ågmo (2011) recently suggested that the term “sexual arousal” should be abandoned, or

restricted in its use to refer only to genital arousal, arguing that “subjective sexual arousal” is

a vague and unhelpful concept.

In a recent conceptual review of sexual arousal in men, Janssen (2011) concluded that

sexual desire has traditionally been described as a motivational state, and sexual arousal

mainly as an emotional state (“an embodied affective state”), but that there is increasing

evidence of “considerable overlap” between the two.

Expert models of sexual response

Where attempts have been made to establish the chronological order of the two terms,

desire has generally been held to precede arousal. Kaplan (1979) and Lief (1977), for

example, both positioned sexual desire as the first stage of Masters and Johnson’s Human

Sexual Response Cycle, before sexual arousal. Kaplan (1979), for instance, defined sexual

desire as “a sensation that moved the individual to seek out, or become receptive to, sexual

experiences” (p. 10). These traditional models have characterised sexual response as

essentially a linear progression from sexual desire to sexual arousal, orgasm, and ultimately

resolution.

Although this linear model has received much criticism, particular with regard to its

relevance for women (Levin, 2008; Mitchell & Graham, 2008; Tiefer, 1991), it nevertheless

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forms the basis of the current Diagnostic and Statistical Manual classification of discrete

desire, arousal, and orgasm disorders (DSM-IV; American Psychiatric Association [APA],

2000). More recent models of sexual response have not conceptualised sexual desire and

arousal as discrete “stages.” Basson (2000, 2001) proposed instead a circular model of sexual

response, in which sexual neutrality is the starting point, and desire is primarily responsive

(for instance, to cues from a partner or other stimulus) rather than spontaneous. A second

model - the Incentive Motivation model (Laan & Both, 2008; Laan & Everaerd, 1995; Laan

& Janssen, 2007) – argues that desire actually reflects early stages of arousal in response to a

sexually relevant stimulus, and this model has received considerable empirical support

(Toates, 2009). These models see arousal and desire as closely interlinked, and allow that the

experience of sexual desire may follow rather than precede sexual excitement (Laan & Both,

2008).

Reviewing the evidence for linear vs. circular models of female sexual desire and

arousal, Hayes (2011) concluded that although there was better support for linear models of

sexual response than for circular models, there was also growing evidence that “responsive

desire” (desire in response to a sexual stimulus) is a feature of many women’s sexual

experiences. To our knowledge, there have been no comparable studies involving men.

Much of the existing literature has involved “fitting” expert models to participant

experiences (e.g., Giles & McCabe, 2009; Sand & Fisher, 2007). In this study we took a more

inductive approach, allowing participants to define and describe their experiences of desire

and arousal without reference to any expert models. The data presented here come from a

larger qualitative study whose overall aim was to explore the meaning of sexual (dys)function

for individuals with and without sexual problems.

Method
Sampling strategy

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We used a purposive sampling strategy that sought to maximize variation in

experience of sexual function by recruiting individuals from three groups, each with a

different likelihood of experiencing sexual difficulties. Our sampling strategy was designed

to capture roughly equal numbers of those with and without significant problems; as Table

one shows, this aim was achieved. The first group consisted of those who had sought

professional help for their difficulties. The group comprised consecutive patients attending an

NHS sexual problems clinic in London (n=6)), who were introduced to the first author by the

doctor, following their appointment. Those expressing interest were given a recruitment pack

and interviews were arranged with those who chose to take part. The second group comprised

individuals who, because of underlying health conditions (diabetes, depression and HIV),

were likely to be experiencing some difficulties but not necessarily to have sought help for

them or to have self-identified as having problems (sub-clinical). On behalf of the authors,

staff at a London general practice (GP) practice selected names randomly from their diabetes

and depression clinic lists, and invited these patients to participate by letter (n=13). This

group also included three HIV-positive participants, recruited via a staff member from an

HIV charity in a regional town. The third group served as a proxy to the general population,

with some individuals experiencing difficulties and others not. These individuals were

recruited in person by the first author from the waiting room of the same GP practice (n=10).

The waiting room was small, such that during a series of recruitment sessions, every

unaccompanied individual was approached. Non-English speakers and those under age 18

were excluded. All those taking part were given time to consider their decision and were

reassured that they could change their mind at any point. Written informed consent was

obtained prior to each interview. Although we expected, and were prepared for, some

participants to feel upset when relating their experiences, this only happened once. In this

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case, and in several others, the experience of relating personal stories appeared therapeutic

for the participant.

We examined each participant account closely and categorized them subjectively

according to their reported experience of sexual difficulties (see Table 1). Individuals who

did not describe any significant frustration or difficulty were categorized as “functional;”

those who expressed minor frustrations and/or difficulties but no significant concern about

these experiences were categorized as “dissatisfied;” and those who described significant

problem(s), some level of distress and had also either sought or considered professional help

were categorized as “problematic.”

[Table 1 about here]

Data Collection

Interviews lasting between 45 minutes and two hours were carried out by the first author

(30) and second author (2) and were audio-taped (with permission). Interviews were held in a

private room in the clinics from which participants were recruited, except if the participant

requested an interview at home (2) or by phone (1), because of poor health. The interview

was guided by a topic guide that sought to draw out an individual’s priorities for a functional

sex life, and included the following questions:

• What do you understand by the term sexual desire (wish for sex/sexual drive/libido)?

• What do you understand by the term sexual arousal (readiness for sex)?

• Is arousal different from desire? In what way?

Analysis

The interviews were transcribed verbatim by an audio-typist. The first author listened

to all the tapes and checked the transcripts as part of the familiarization process. The data

were then indexed and charted according to broad themes (Ritchie & Lewis, 2003).

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Following principles of grounded theory analysis (Charmaz, 2006), the first and second

authors then undertook intensive open coding of excerpts of transcripts that had been charted

under the themes of sexual desire and sexual arousal. We generated a set of provisional codes

that conceptually labeled the ways in which participants talked about desire and arousal.

Through discussion, and with the aid of a mind map (diagrammatic representation of linkages

between codes) we began to develop categories (made up of interlinked codes), each of

which described a key criterion that participants used to distinguish between desire and

arousal (whether explicitly or implicitly). We then used these categories to selectively code

the data. The analysis developed iteratively; clarifications and refinements to categories

continued into the writing stage, through discussion between analysts, feedback on successive

drafts and by returning regularly to the transcripts.

Ethical approval

Ethical approval for the study was obtained from Camden and Islington Local

Research Ethics Committee and the London School of Hygiene and Tropical Medicine Ethics

Committee. Governance approval was obtained from Camden and Islington Primary Care

Trust and Camden and Islington Mental Health and Social Care Trust.

Results

Difficulty making a distinction between sexual desire and sexual arousal

Participants were asked what they understood by the terms sexual desire and arousal,

and some spontaneously proffered a distinction between the two. Most attempted to do so

when prompted, but with often with difficulty (“I find that a very difficult question to

answer”; man aged 78).

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Man aged 39: [Pause]… linguistically you could just as well say one is totally
interchangeable for the other, but if I had to make a distinction in English language I
would probably separate them [out as follows….].

For these participants, difficulty in distinguishing between concepts stemmed from

the view that they were intertwined, and the difference was “very subtle; it’s a matter of

degree really” (woman aged 54).

I: I’m interested a little bit in the relationship between these two – arousal and desire.

How do you see the relationship between those two?

Woman aged 47: I would see them as very closely linked. I’m not sure if you can
unpick them.

Temporal sequence

Desire before arousal

Amongst those participants who referred to a time dimension to distinguish between desire

and arousal, many saw desire as occurring before arousal. For some, the sequence – desire

first, arousal after – was clear. A sense of chronology was conveyed by terms such as

“preceding” or “coming before” in the case of desire, or as “following” or “coming after” in

the case of arousal.

P (participant): I think the arousal comes after the desire. The desire is there first
and then if the touching goes on any longer…
I (Interviewer): So you experience desire first and then that can lead to…?
P…arousal.
I: A sort of second stage.
P: I think so yes. I might not have thought too clearly about it, but I think so.
[Woman aged 64]

Woman aged 51: Well I suppose desire is a little twinge that would be followed up
by something … If you saw a bloke and you thought “oh”… and you want to get to

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know them..., or there would be something physically that you wanted to see more of
... you get the little bit of interest and then you build on that to see if there’s anything
to stoke it up with.

For some participants, desire was seen not only as a precursor but as a prerequisite to arousal.

One man (aged 56), for example, referred to sexual desire as the “physical and psychological

requirement/need to experience sexual satisfaction” and so for him desire was a condition

without which, sine qua non, arousal could not occur. This sense is echoed in descriptions of

desire as “potential” (man aged 56) and “opportunity” (man aged 78). For some, however,

sexual desire was a necessary, but not always a sufficient - condition for arousal. The not

infrequent use of the conditional tense “ I would like to... ,” in the context of desire,

indicated that sexual arousal was seen as not only in the future, but as conditional on other

favourable conditions occurring before arousal could take place:

Man aged 65:“...the attraction that you’re seeing ... That comes first and after that
there has to be something else… to continue your desire. It doesn’t happen – it could
be cut off immediately”.

By contrast, arousal was seen as more proximate to sexual activity, and contingent on sexual

activity occurring. Where desire was expectant or hopeful, arousal was in the moment, and

contiguous with sexual activity.

Woman aged 42: Desire would be wanting to have sex, and arousal or being turned
on is the act of being with somebody where sex is imminent and they were doing… if
I was attracted to them and they were doing the things that would make me feel I
wanted to have sex.
Man aged 56: [Pause]. Sexual desire is physically thinking “I would like to have
sex”. Sexual arousal is actually when sex has begun to take place – your changed,
altered state.

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Woman aged 23... for me, it’s more the there and then… yes – there and then, being

aroused. (Emphasis added)

Arousal before desire

A smaller number of participants saw the order as reversed; arousal preceded, and in one case

at least, was a prerequisite to desire: “You get a total sense of desire for a person because

you’re totally aroused” (man aged 55; emphasis added). A woman aged 47 described the

reciprocal relationship between the two, desire increasing with heightened arousal and vice

versa:

I: Some people argue that they happen sequentially, so you desire sex and then you
become aroused. Would you agree with that or would you think they can happen in
all sorts of order?
P: I think I might say I desire sex because I am aroused. I might become more
aroused.
I: So for you there isn’t a particular order necessarily?
P: … I think maybe there is, to the extent that desire can probably proceed from quite
a low level of arousal. If there was absolutely no arousal I don’t think the desire
would be there… and as the desire sets in you become more aroused.
[Woman aged 47]

Temporal sequence - blurred distinction

By no means all participants, however, saw the temporal order of desire and arousal

so unequivocally. For some, the two conditions were seen as occurring simultaneously and,

at least in terms of sequence, were therefore indistinguishable. For others, there was no clear

pattern:

I: Do you think these happen in sequence – the sexual arousal and desire – or does
one happen before the other, or might they happen at the same time, or does it
change?

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P: I think it can change. I think it can happen… [pause]. It comes in different ways I
think.
I: There’s not necessarily an order to it?
P: No, no.
[Man aged 33]

Factors influencing temporal sequence

A key factor determining whether desire was seen as preceding or following arousal appeared

to be the nature of the relationship. One man, whose sexual script emphasised the erotic (see

Mitchell et al., 2011), described the sequencing of desire and arousal in the context of the

social distance between the self and the object of desire. He saw arousal as subsumed by

desire when the person is less familiar:

Man aged 55: Arousal on that scale is not there with someone that you just don’t
know, because that’s instantaneous. The arousal’s gone in desire, it doesn’t come into
it – that is just pure sexual desire.
By contrast, this man felt that with a familiar partner, a gradual build up of arousal leads to

desire, rather than the reverse:

P: “... you know the person – you feel more at ease with them and I’d include
foreplay but not a sexual foreplay. It’s the evening – making the dinner, sitting down
just touching the person, and sitting there just talking to them. You’re looking at
them and maybe you just touch them, so you’re just slowly, slowly building up to it.
I: Would [desire and arousal] happen at the same time or one before the other, or in
different circumstances?
P: I think the arousal could go on through the evening, and then maybe you just walk
into the bedroom and she might just drop whatever and be stood there – stocking and
suspenders. For my age that was the normal, and that is how I picture most women –
to be like that. Then you get total sexual desire for the person because you’re totally
aroused.
I: So, in a way, arousal comes first and then the desire?

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P: Yes – in a long-term relationship. The desire is the erection; the arousal is

making sure everything’s alright beforehand; you might not have an erection but that
you know that something’s going on chemically inside yourself. (Emphasis added)
[man aged 55]

Mind/body engagement

Desire as mind, arousal as body

Participants frequently defined desire and arousal in terms of what was happening both in the

mind and body. Where participants distinguished between the two, desire tended to be

associated with the mind (thinking about or wanting sex) and arousal with body (physical

signs and sensations). However, the distinction was often not clear-cut:

Woman aged 34: Desire I suppose is, not always, but it’s more of a mental process
and arousal is more of a physical thing. It’s not a strict demarcation but it’s
[something like that].

The “thinking” words that participants associated with desire often signified motivation and

aspiration (“wanting”, “fancy”, “liking”). In contrast, arousal was associated with an

embodied “altered state”; an “awakening of the senses” (man aged 56); and “a state of

perpetual readiness for sex” (woman aged 51). Several participants described being “turned

on,” a term that suggests a “switch” or a move to a new physical state. In contrast to desire,

arousal was associated with a set of distinct physical signs, of which the most salient were an

erection (for a man), and lubrication (for a woman):

Woman aged 27: For a man it’s getting an erection. For a woman it’s getting
lubricated. For both it’s… I don’t know, it’s everything else that happens –
quickened heart beat, and that kind of thing.

The woman quoted below describes both a change of state as well as distinct physical signs:

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Woman aged 54: I suppose you feel some sort of inner tingling or whatever, if you
want to be very exact about it – you do. Your lips start to swell a little bit and all
these changes, but I think it’s a general openness in your whole stance…...

This woman expressed frustration at being asked to describe signs of arousal as she assumed

there was a normative set with which the interviewer would be familiar. She was surprised to

learn that the signs varied from one person to another. For some men, the erection became

the definitive sign, without which it was not possible to “achieve” arousal:

P: Oh well, of course in a man [the sign of arousal is] primarily erection isn’t it,
which of course I can’t do.
I: Would you say that you’re no longer able to feel sexually aroused then?
P: Not properly.
[man aged 78]

Desire as body; arousal as mind

At times this distinction was reversed: desire was associated with body and action, and

arousal with mind and thinking. Desire was described by one man as “related to the loins […]

you can look at a woman and you maybe get a tingling around there…” (man aged 55).

Desire was associated with an altered embodied state: “something that wells up in you and

one gets into a heightened state” (woman aged 64). And the converse, a loss of desire, was

described by one man as “the loss of a physical drive, so it’s your body telling you that you

want to have sex” (man aged 39, emphasis added).

On the other hand, arousal was described as an altered state of mind: “a slight loss of

rational thinking, inability to concentrate on other things…” (man aged 39), or as an

aspiration, originating in the mind:

I: […] how do you know if you’re feeling sexually aroused?

P: Something happens in you so you feel that “God, actually I wouldn’t mind some
of that”.
I: So it’s a thought – it’s a thinking thing?

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P: Yes it’s always in the mind isn’t it? It starts from the mind doesn’t it? I think it
starts in the mind.
[man aged 65]

Mind-body - blurred distinction

The accounts showed that the distinction between mind and body was not always easily made

For instance, terms such as “urge” and “impulse” were often used in association with sexual

desire and an urge might originate from the mind or the body or both together. Arousal was

also sometimes described as of both mind and body: “[you know you’re aroused because] the

whole body is telling you – your mind, everything.” (woman aged 38). And when asked to

describe the signs of arousal, some definitions included both mind (aspirations/motivations)

as well as bodily signs:

I: What are the signs of that physical arousal?

P: Quickening heart rates, am…pure excitement, in some cases erectile function, a
draw towards another person – a real sort of want of that person ….
[man aged 48]

The view that both mind and body are simultaneously engaged is nicely illustrated by this

woman:

Woman aged 47: Sexual desire is physically thinking “I would like to have sex”

Motivational/emotional states

This final criterion relates to the extent to which desire and arousal are motivated

towards a goal, and the extent to which they are felt spontaneously or arise in response to

cues. These criteria were used, not so much to distinguish between the terms but to define

each one. Indeed, desire and arousal were usually both viewed as responsive and

motivational, and the distinctions between them on this criterion were particularly blurred.

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Desire and arousal as responsive and motivational

Participants frequently talked about desire and arousal as responsive (a response to a person

or stimulus) and motivational (orientated towards a goal). Desire was often described as a

response to a cue, such as an invitation from an intimate partner:

Woman aged 64: I think sexual desire is all to do with having a loving partner who
wants to touch you and when that person touches you, you experience sexual desire.

Equally, desire could be triggered in response to a stranger whose attributes or behaviour are

attractive: “there can be a desire just with the movement of her bottom, the way she walks, or

the way she smiles…” (man aged 55). The stranger here does not necessarily intend to trigger

this desire, and although the felt desire may be motivational, it may be accompanied by an

acceptance that these feelings will not translate into action.

Desire was often defined in motivational terms (“wanting to have sex”; man aged 56).

The motivation might be orientated towards the physical rewards of sex (“a keenness to have

sex with penetration”; man aged 60); or might pertain to a relational goal (“there is this desire

to disappear into each other which I think is very important”; man aged 61). Arousal was also

described as a response. Again the trigger might come from a partner or from some subtle

attribute of a stranger (“something she’s wearing or the way she sits, the way she is playing

or her smile”; man aged 65).

Like desire, arousal was expressed as a motivational state, orientated towards a

physical goal (“getting to the point where they feel like they want to have sex”; man aged

60); or a relational goal (“a real sort of want of that person”; man aged 48). But the

motivation was often expressed with more urgency: “It’s an urgency of wanting to go to bed

with the person – either make love or have sex with them” (man aged 55).

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Comparisons between the two terms sometimes depicted arousal as a response to a

partner or someone known well and desire as an instant and fleeting response to a stranger or

stimulus (such as an image). There was a sense in which arousal required more than just an

image; there needed to be “something to continue your desire” (man aged 65). As one woman

put it:

P: You see I wouldn’t think pictures of someone like Lucian Freud… they’re sexy but
they wouldn’t make me feel sexy. Sometimes I think you can see someone and you
can think “Cor blimey!” – just a glance or… a type of person.
I: Would that be desire or arousal?
P: That would be desire I think.
I: So when would the arousal…? What would need to be there for arousal to
happen?
P: Well I think you’d have to know that person a bit deeper.
[Woman aged 51]

This association of arousal with someone known well was, however, by no means

universal. On several occasions, a sexual response to erotic images in magazines or scenes in

films was described in terms of arousal:

Woman aged 51: Have you ever seen that film ‘Don’t Look Now’? […]. There’s an
immensely erotic scene. That aroused me.

Desire as not motivational and not responsive

Desire was also talked about as an emotional state or an ongoing appetite that was

neither goal oriented (motivational) nor responsive. When talking about desire in this way,

participants used terms such as need, drive and urges.

Several participants talked about sexual desire in terms of a libido or drive, an

ongoing appetite, need or sense: “It’s like the sixth sense to me. You’ve got your natural five

senses and you’ve also got this other need within your body, and it doesn’t do any good to try

and suppress that need totally” (man aged 48). On several occasions, sexual desire was

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expressed as “one of the constituents of the partnership” (man aged 61), or as an attraction

towards another that could grow, stay steady or wane (“I lost my desire for him”; female aged

35). And finally, it was described as an affective state - a mood or feeling of comfort:

Woman aged 54: [the] problem with sex was [my] level of desire – how much you actually
felt in the mood for sex and sexuality, or felt comfortable with being a sexual being yourself.

Several participants differentiated desire from arousal using the criteria of motivation

and responsiveness. Three of these participants described arousal as motivational and

responsive and desire as neither. One man contrasted his view of desire as an appetite with

his view of arousal, which he saw as of the moment and relating to a specific encounter:

Man aged 39: I think if I could make a distinction, it would be the drive is the long
term… The arousal is the short-term case-by-case based situation you are in, on any
given night, and trying to build up these feelings. [ Pause]…

Another woman viewed arousal as a response to a person, but desire as an emotional state

that could arise in the absence of a partner:

Woman aged 46: When I’m with somebody and they kiss and cuddle you, then you
get sexually aroused, but you can desire sex without that. You can be on your own
and feel desire.

Arousal as not motivational and not responsive

Arousal was talked about as not motivational and not responsive far less often than

desire. Occasionally, arousal was described as detached from a specific person or context. For

instance, it was described by two participants as integral to the relationship; and also as a

feeling of satisfaction with a partner (woman aged 23). For some men, the experience of a

waking erection contributed towards a view of arousal as not motivational and not

responsive:

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Man aged 52: I think if you’re aroused, or you get aroused, I think it’s a natural
thing, a thing that happens on its own. It needn’t necessarily be anything to do with
sex. You can be aroused when you wake up in the morning and you can be on your
own, it doesn’t necessarily mean that you want sex.

Discussion

We found that both men and women had difficulty making a distinction between

desire and arousal although they could usually do so after some thought. This is consistent

with the qualitative findings of Brotto et al. (2009), who reported that women had difficulty

distinguishing between desire and arousal, and achieved greater clarity in their definitions

after thoughtful reflection. Consistent with Janssen and colleagues (2008), we found that men

also struggled to disentangle the terms or gave definitions that differed from the expert view.

We identified three criteria that individuals used to define sexual desire and arousal or

make a distinction between the two: temporal sequence, mind/body engagement, and

motivation/responsiveness. Participants commonly felt that desire preceded arousal; some felt

that desire was ‘mind’ and arousal ‘body’; and many felt that both desire and arousal were

responsive and motivational. However, for each of the criteria, we identified numerous

instances of participants reversing distinctions or blurring differences between the two. The

overall picture was one of variable definitions and overlap between terms.

Several qualitative studies have supported the idea that women often do not

differentiate between sexual desire and arousal (Beck et al., 1991; Brotto et al., 2009;

Carvalheira et al., 2010; Ellison, 2000; Giles & McCabe, 2009; Graham et al., 2004;

Goldhammer & McCabe, 2011). One study found that women diagnosed with Female

Sexual Arousal Disorder (FSAD) were more likely to distinguish between desire and arousal

(Brotto et al. 2009), and women without a diagnosis were more likely to conflate the two

constructs. But a second study found the opposite: an overlap between sexual desire and

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arousal was more evident among women reporting lower levels of sexual functioning (Giles

& McCabe, 2009). We did not detect any clear differences in the way that these terms were

defined across the three groups of participants, according to experience of sexual function

problems (see Table one). It is not possible to say whether this lack of difference was due to

the small and purposive sample, or whether in fact, the experience of sexual difficulties does

not change the way that individuals define these terms. Further quantitative work would be

required to explore this in detail.

Consistent with previous studies (Giles & McCabe, 2009; Sand & Fisher, 2007), we

found that a linear model of sexual response – in which desire precedes arousal – was

endorsed by some, but not all participants. We also found some support for the idea of a

circular relationship between desire and arousal (desire feeding into arousal feeding into

desire, etc.). Several studies have indicated a lack of temporal pattern in women’s accounts.

In a focus group study involving women aged 18-84 years, women sometimes reported desire

as preceding arousal, at other times following it, and also sometimes perceived sexual arousal

without any experience of sexual interest/desire (Graham et al., 2004). These latter occasions

were often linked to physical triggers, such as ovulation. In an online survey of 3,000 women,

16% of respondents reported only engaging in sexual activity if they felt sexual desire at the

outset, but almost a third of women typically or always only recognized sexual desire after

they perceived that they were aroused (Carvalheira et al. 2010).

Although it is often assumed that the distinction between sexual desire and arousal is

more clear-cut in men than in women, there have been remarkably few studies on men’s

experiences of sexual desire (Kleinplatz, 2011). Apart from studies of hypogonadal men,

problems relating to desire in men have been also been under-researched (Brotto, 2010b;

Maurice, 2007). In one of the few qualitative studies focused on male experiences of sexual

desire and arousal (Janssen et al., 2008), men aged 18-70 years participating in focus group

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discussions did not consistently or easily distinguish between sexual desire and arousal. Men

also described genital arousal (i.e. an erection) as sometimes occurring independently of

(subjective) sexual arousal and, conversely, feelings of sexual excitement were reported in

situations where they did not have an erection. These findings challenge some of the

stereotypes regarding men’s sexuality (Kleinplatz, 2011) as being more “straightforward” and

genital-focused than women’s sexuality.

Further evidence for overlap between these constructs comes from studies that have

investigated the psychometric properties of self-report measures of sexual functioning among

clinical and non-clinical samples of women. These studies have documented significant

overlap between the sexual desire and arousal domains (Dennerstein & Lehert, 2004;

Graziottin et al., 2009; Leiblum et al., 2006; Taylor et al., 1994; Sidi et al., 2008). Brotto et

al. (2010) reviewed studies reporting correlations between the FSFI Desire and Arousal

domains; across six studies, correlations between .52 and .85 were observed. High

correlations between desire and arousal have also been reported in studies employing other

questionnaire measures, such as the Profile of Female Sexual Function (Leiblum et al., 2006).

In a study of Australian women that utilized the Personal Experiences Questionnaire

(Dennerstein et al., 1997), Dennerstein and Lehert (2004) found that items related to sexual

“responsiveness” could not be separated from the construct of sexual interest or desire.

Overall, our findings support the view that there is diversity in women’s and men’s

experiences of sexual response (Carvalheira et al., 2010; Janssen et al., 2008; Tiefer et al.,

2002) and that no one model fully captures this diversity. These findings are supported by a

range of studies suggesting that sexual desire and arousal are not discrete categories and are

not always experienced in a uniform, temporal sequence, as traditional linear models of

sexual response assumed.

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The methodological limitations of our study relate to qualitative approaches more

broadly. Qualitative methods are suited to exploring phenomena from the perspectives of

others. Semi-structured interviews provide rich and detailed descriptions but partly because

the data generated are cumbersome, the sample sizes are generally small. Our sampling was

purposive rather than probabilistic, with the aim of generating ideas and concepts that are

transferable to other contexts, rather than results that are statistically generalizable. A further

caveat is our focus on definitions rather than experience. An individual’s definition of sexual

desire and arousal may not accurately reflect how they experience the concepts (as

professionally defined). This may be particularly true where the terms are not often used in

everyday conversation. That said, participants often defined the terms by describing their

own experiences. And, for the purpose of achieving accuracy and reliability in clinical

diagnosis and research, an understanding of how individuals define these terms is important

in its own right.

So what can we conclude from these findings? Our results have implications for

clinical consultations. They imply that a shared meaning of desire and arousal between

professional and patient cannot be assumed. Lack of shared understanding may unwittingly

hamper the accuracy of history taking and diagnosis. This is most likely to be an issue during

brief consultations where time does not permit discussion of meanings. Our findings are also

important for epidemiological research, particularly because of the reliance on self-report to

measure sexual dysfunction. There is good evidence that bias arises where participants

misunderstand terms, or understand them differently to the meaning intended by researchers

(Catania, 1996; Tourangeau, 1996). Localized usage of terms may be particularly important

here. For instance, a term such as “turned on” which is often employed in questionnaires as a

vernacular term for arousal, may have a different meaning among U.S. and British English

speakers.

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Finally, these findings have implications for diagnostic classification of desire and arousal

disorders. We believe that the blurred distinction between these concepts among many lay

people provides further support to recent proposals to merge the two diagnostic categories of

Female Sexual Arousal Disorder and Hyposexual Desire Disorder into a new diagnostic

category (“Sexual Interest/Arousal Disorder”) for the upcoming revision of the DSM (DSM-

5) (Brotto, 2010a and b; Brotto et al., 2010; Graham, 2010). Because of the limited literature

on men’s sexual desire, the proposed DSM-5 criteria for diagnosing low desire in men are

largely preserved from the previous edition of the DSM (DSM-IV-TR; APA, 2000). We

found that men as well as women found difficulty distinguishing between desire and arousal.

We hope that in future, the literature on men’s desire will develop sufficiently to permit a full

re-appraisal of the diagnostic categories for men. Certainly, our data suggests that such an

appraisal is warranted.

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