x. Desire

Sexual desire (referred to in the past as ‘libido’ and today often referred to as ‘interest in sex’) is difficult to define and operationalize. This is evident from the convoluted description in classification systems such as the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) and ICD-10 (International Statistical Classification of Diseases and Related Health Problems). In DSM-IV and ICD- 10, reduced sexual desire is defined in terms of a persistent or repeated lack or absence of sexual fantasies and desire for sexual activity. The notable aspect of this definition is its quantitative approach; it refers to frequency, duration and/or intensity. It does not incorporate qualitative aspects such as the object, aim and evaluation of desire. In other words: desire for what? The definition also lacks the ‘measure’ for the quantitative components: too often, too much or too little with regard to what or whom? The operationalization of sexual desire appears to be based on an implicit norm. However if questioned, this norm is hard to give. Moreover, this quantitative approach reduces human sexuality to a ‘quantifiable activity’. It leaves little scope for humans as cultural-historical and above all intentional and evaluating beings. This is odd because sexual desire, particularly in women, involves much more of an evaluative aspect, a feeling or cognition, rather than a purely ‘physical event’. The evaluative character also means that sexual motivation is intended to fluctuate in different situations, depending on the context, and that a quantitative approach is not only too reductionist but is also of little practical use. In practice, this is resolved by moving away from the formal definition and mainly adopting the clinician’s view. In the Netherlands, clinicians mainly work with a type of bio-psycho-social model, which not only incorporates contextual aspects, but also allows for a distinction to be made between causal and conditional aspects. Everaerd et al. (2001) describe sexual desire in the causal sense as a response to a particular situation, intended to make sexual behaviors or interaction possible with oneself or another. This is not so much a personality trait as a process that takes place within the person but in interaction with his or hers environment. From a phenomenological point of view, one could state that the sexual respons is part of the condition humaine: people make use of their sexual capacity because they are predisposed to do so. Just like birds make use of their wings to fly. Obviously, they take circumstances into consideration when doing so. In other words, sexual interaction requires, in a conditional sense, a functioning sexual system on various levels:
According to this vision, which aligns with modern incentive-motivation theories, sexual desire is the result of an interplay between a sexual response system and stimuli (incentives) that activate the system, whereby both the sensitivity of the system and the meaning and intensity of the stimuli present in the mind or the environment play a role.
It follows from this view that sexual desire does not precede arousal, but is a consequence of or accompanies it. In this vision, sexual motivation is not seen as something that comes from within the person – in the sense of something that we can experience to various degrees – but as something that manifests itself if certain conditions are met. The conditions for activating a sexual process are threefold:

If one of these conditions is not met, or is not sufficiently met, the sexual process is not activated, or is ended. In this process, motivation ‘emerges’, as it were, and becomes stronger in proportion to how well the conditions are fulfilled.
Sexual activity is not always the consequence of a process in which sexual arousal and lust are involved. Men and women report a wide range of motives, such as experiencing physical pleasure, showing affection, satisfying the partner, relieving boredom or fulfilling a perceived obligation. Although the top ten motives are largely the same for men and women, physical motives (e.g. seeing an attractive body) are more important for men, while relational motives (e.g. showing love or expression of an unique intimate relationship) are more important for women. Particularly in long-term relationships, women seem to be receptive to sexual stimuli due to a need for intimacy, leading in turn to arousal and interest in sex. The reward value of the sexual interaction determines how receptive the woman will be to sexual stimuli in the future.