Female Sexual Desire—Beyond Testosterone

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Sexual dysfunction is common among the US population with a prevalence that is greater for women than men (43% versus 31%) ( 1 ). In this setting, a low level of desire is associated with low levels of arousal and sexual excitement, leading to infrequent orgasms and reduced sexual satisfaction ( 2 ). During the past 10 years, Basson ( 3 ) and Basson et al. ( 4 ) have reconceptualized the female sexual response to account for the complexity of female sexual desire and arousal, which does not follow the linear model of discrete phases of sexual response first proposed by Masters and Johnson ( 5 ) and Kaplan ( 6 ). Instead, a circular intimacy-based sexual response cycle was proposed ( Fig. 1 ), with overlapping phases of variable order. As noted by Basson ( 2 ), women participate in sexual activity for diverse reasons, including a desire for emotional closeness, but sexual desire is an infrequent factor for women in established relationships.