The role of sexual functioning in the sexual desire adjustment and psychosocial adaptation of women with hypoactive sexual desire.

ABSTRACT: The associations among sexual functioning and two categorical constraints, psychosocial adaptation and sexual desire adjustment, were examined in a sample of women (N = 66) with hypoactive sexual desire. The findings suggest that sexual functioning, especially sexual stress, contributes an independent source of variance above and beyond that contributed by demographic characteristics, physical characteristics, and relationship dynamic variables in predicting the women's desire adjustment and psychosocial functioning. High sexual compatibility and high sexual satisfaction contributed unique variance in predicting positive self-motivation in women with hypoactive sexual desire. Acquired type hypoactive sexual desire and sexual stress in the relationships contributed independently to depression in the study sample. Sexual stress also contributed unique variance to the women's self-esteem and the husband's perception of problem impact. Additionally, social class and body weight served as unique predictors of female subjects' self-esteem. The findings suggest that husband-wife relationships and female sexual functioning represent interrelated and independent subsystems within the marital relationship, and both subsystems may influence the sexual desire adjustment and psychosocial functioning of women with hypoactive sexual desire.

Key words: Orgasm Hypoactive sexual desire disorder Waist-hip ratio Psychoevolution Female sexuality Sexual compatibility Sexual dysfunction

INTRODUCTION

Hypoactive sexual desire disorder is the most common sexual dysfunction among couples seeking sex therapy (Davies, Katz, & Jackson, 1999; Donahey & Carroll, 1993; Hurlbert, Apt, & Hurlbert, 1995; MacPhee, Johnson, & Van Der Veer, 1995). Population studies suggest that 22% to 50% of women may experience sexual desire difficulties (Basson, 2001; Laumann, Paik, & Rosen, 1999) and low sexual desire has been the presenting concern in 44% to 49% of female clients in some clinical settings (Hurlbert, 1993; MacPhee et al., 1995).

Despite the growing body of literature linking the development and expression of hypoactive sexual desire (HSD) to a variety of sexual and psychosocial variables, sexual desire problems remain among the most complicated and widespread of the sexual concerns encountered by therapists and other health professionals (Hurlbert et al., 1995; Leiblum & Rosen, 1988).

One focus of the literature on women with low sexual desire has been the role of relationship dynamics and individual psychological adjustment in their experience of HSD. Although a nearly overwhelming number of factors have been associated with HSD in women, relationship function recurs as a prevalent element connected to low sexual desire (Leiblum & Rosen, 1988). This observation seems consistent with the popular notion that female sexuality is, in general, more likely to be holistic, emotional, and interpersonal when compared with the generally more compartmentalized male sexual dynamic (Apt, Hurlbert, Pierce, & White, 1996; Davies et al., 1999; Donahey & Carroll, 1993; Hurlbert & Apt, 1994; Hurlbert, Apt, & Rombough, 1996; Hurlbert & Whittaker, 1991). Although the literature also acknowledges the potential significance of individual sexual functioning variables in HSD in women (Hurlbert et al., 1995; MacPhee et al., 1995), there is little research on these factors in the manifestation of HSD. Research on the individual and dyadic differences in couples with and without HSD in the female partner indicate that a key distinction between the two groups occurs not in general relationship attributes, but in measures of sexuality (MacPhee et al., 1995; Trudel, Fortin, & Matte, 1997). Given these findings, we seek here to more fully explore the possible role of individual sexual variables in women experiencing HSD.

This study examined key sexual and psychosocial variables that past research has associated directly or indirectly with HSD, in an attempt to evaluate the role sexual functioning factors play, relative to relationship dynamics, in the experience of women with HSD. In order to both expand the scope of the study and to attempt to control for as many potential confounds as possible, the analysis also included several demographic variables and selected measures of female physicality. It was hypothesized that sexual functioning variables such as sexual excitability, sexual satisfaction, sexual stress, and sexual-esteem would be associated with key elements of the women's HSD experience, independent of relationship, physical, or demographic factors. Given the wide scope of variables to be measured, it was expected that some notable associations outside of the primary focus of this hypothesis would emerge. Such findings will be included when relevant to the treatment of women experiencing HSD.