This article describes the ways in which arousal and sexual urges in women and men reflect  in the links between brain responses and genital changes. Boys are more sexually motivated from puberty on, whereas girls tend to seek emotional connections as a precursor to sexual contact. Although feelings and thoughts are important for both sexes, women are not always psychologically aroused by genital vasocongestion, while the opposite tends to pertain to men. Lack of subjective arousal commonly leads to loss of sexual interest in women: negative emotions in the current relationship are often involved. For men, the causes of sexual withdrawal are more variable, and childhood family dynamics are a frequent, but unconscious, factor. The role of the neuropeptides oxytocin and vasopressin, synthesised from oestrogen and testosterone respectively, is described as a biological underpinning for some observed Oxytocin is released at orgasm by both women and men and promotes sexual pleasure and emotional bonding. Vasopressin, secreted during the male arousal phase, is linked to men’s drive for sexual expression. This peptide may have the opposite effect on women and impair arousal and motivation due to the link between vasopressin release and aggression. Psychological treatment needs to explore the meaning of lack of sexual motivation for each person, and to address individual and couple issues. An integrated psychosexual model combining behavioural and psychodynamic approaches can alter feelings and relational patterns, and facilitate the return of sexual desire between partners in a committed relationship.

Introduction

Male sexuality has been the focus of much popular and scientific interest since oral medication for the erectile response was first introduced. When used as part of a planned therapeutic approach, pharmacological interventions can clearly be beneficial for a range of erectile problems. But from the perspective of a clinical psychologist working with individual people and couples who are distressed by issues of sexual motivation, it is also clear that sexual behaviour between people is far more complex than neurophysiology and endocrinology, for men as well as for women. In particular, the loss of desire, or motivation, for sexual contact with a partner in an on-going relationship is a common presenting complaint, and remains one of the most difficult to treat.

For effective clinical practice the ability to respond sexually must be differentiated from the motivation to be sexual with a specific partner. Sexual interactions occur in social and interpersonal settings that are mediated by emotions and cognitions: what we feel and think (consciously and unconsciously) about a partner before and during love-making will influence psychophysiological mechanisms and alter our perception of sexual experiences. Arousal and desire are interwoven in different ways for women and men, neurochemically and psychologically, as will be elaborated later in this article. My aim here is to show that a notion of sexuality occurring in an emotional context between people, constructed in the social environment, and also dependant on biological underpinnings, can inform theoretical models and thereby guide our treatment of sexual motivation issues.

How do our feelings and thoughts (brain responses) interact, via bodily (genital) changes, to lead to sexual expression? Although complex connections are poorly understood in humans, there is a wealth of literature on attachment patterns and sexual bonding in other mammals, which deserves consideration. As humans we are, of course, able to reflect on sensations, to consciously experience feelings, and to make choices. At the same time our sexual urges emanate from primitive subcortical areas of the emotional limbic brain, which are hormonally regulated and very similar to that of other mammals. Panksepp [1] has described how neuropeptides released from the pituitary gland, which are manufactured from gonadal hormones, are essential for erotic mood states, and suggests that cross-species comparisons can be made, albeit with caution.

In contrast with the subcortical systems that govern sexual urges, and can be investigated by way of animal models, the evolutionarily modern neocortex (unique to humans) has been shown by Damasio [2] to be the structure where conscious reasoning, planning and mindfulness take place. Damasio [3] has also argued that the neural patterns that constitute feelings are based on the brain’s perception of emotions (visceral states), and this occurs through a process of dynamically updated evaluations of bodily states including the musculoskeletal system, the viscera and the internal chemical milieu. Conscious decision-making about sexual behaviour will therefore interact with current bodily states, personal history and the social context, to varying degrees at different stages of the life course, within a biopsychosocial model [4].

Recent neuroscientific evidence adds weight therefore, to the need to integrate psychology with biology, for a broader appreciation of human sexual responsiveness. To what extent do men and women differ in the links between feelings (neocortical activity), genital responses and sexual urges, and how can an understanding of these inform clinical practice ? Similarities and differences between men and women which link psychological concepts or arousal and motivation with the neuroendocrine systems that underpin sexual feelings and behaviours will be discussed.

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Section snippets

Loss of sexual desire: disease entity or psychological phenomenon

Since the concept of problems with sexual desire was first described by Kaplan [5], low or absent motivation to be sexual has become a well recognised and common presenting issue. Generally it occurs in the context of a committed relationship, when one partner becomes reluctant or refuses to engage in sexual contact. The rejected partner often feels hurt and confused and may withdraw emotionally or become attacking, so that the difficulty is further compounded by disharmony. The partner who has 

Motivation for sexual activity over the life course

That women and men tend to differ in their motivation for sexual activity, particularly in the context of a long-term relationship, is a well-observed phenomenon. Incompatible need for sexual contact can occur despite partners experiencing similar levels at the start of a new relationship. More frequently it is a change in the female partner’s desire for sex that causes conflict and tension, and leads the couple to seek treatment. For example, 40% of the female referrals at a London sexual

Difference in arousal stimuli for men and women

Whereas the human sexual response cycle was originally conceptualised as consisting of three phases – desire, followed by arousal, leading to orgasm [5] – recent advances in understanding the complexity of sexual responding has highlighted the centrality of arousal in organising sexual behaviour. For men, the erectile response generally leads to subjective feelings of arousal. By contrast a series of studies have shown that women’s subjective experiences of arousal are not automatically linked

Neuropeptides, feelings and sexual behaviour

Central to current thinking on the links between gender differences in sexual behaviour, brain chemistry, and feeling states are the neuromodulators vasopressin and oxytocin. These peptide hormones, which are synthesised in the hypothalamus and released into the bloodstream during sexual activity, are found exclusively in mammals. They cannot pass the blood- brain barrier if taken orally. Men and women secrete vasopressin and oxytocin, (manufactured from testosterone and oestrogen,

Sexual responses, aggression and vasopressin

What do we know about the effect on women’s sexual feelings when vasopressin is secreted? The female brain has fewer vasopressin neurons than the male brain, but as with men, vasopressin is linked with aggression, social memories and focused attention. Despite the lack of direct evidence from laboratory studies, I have proposed that the central release of vasopressin may have the opposite effect on women’s sexual urges and could actively impair arousal mechanisms [27]. Support for this

Sexual responses, emotional bonds and oxytocin

Although both men and women release oxytocin during arousal, sufficient oxytocin levels seem particularly important for women’s awareness of arousal mechanisms. If oxytocin receptors are blocked in the ventromedial hypothalamus of female rats, (the brain area assocoated with many emotional and motivational processes), males who approach them for copulation will be rejected or attacked [30]. When male rats palpate the flanks of females, oxytocin secretion is stimulated and erotic states are

Loss of sexual interest and negative emotions

Of particular relevance is the interaction between oxytocin and the neurochemistry of romantic attraction. Passionate feelings and obsessive thinking about the love object, which often occurs when partners first meet, have been identified as a neurotransmitter balance in which dopamine (DA) and noradrenaline (NA) are elevated and serotonin is decreased [32]. As DA and NA can regulate the release of neuropeptides in the central nervous system [25] strong romantic attraction at the start of a

Concluding comments

Within the framework outlined here, sexual withdrawal is viewed as an adaptive mechanism that protects from perceived threat or harm. A review of the psychological conditions that facilitate or impede sexual activity between people points to the centrality of negative emotions for women’s lack of sexual arousal and desire. Less is known about the predictors of men’s lack of motivation, but clinical evidence suggests that damaging developmental experiences (e.g. a boy’s inability to cope with