The 24th World Congress of Sexual Health issued a "Declaration of Sexual Pleasure" on October 15, 2019. The purpose of this blog is to help to contextualize this declaration. Part of my interpretation of the context is that there has been a shift by professionals towards emphasizing sexual pleasure as an important component of sexual health, which is evident by this declaration at this time. That’s interesting because the emphasis in the past was more on sexual function, which is why Masters and Johnson’s model of human sexual response similarly emphasized functioning and gave rise to DSM diagnoses. With the growing emphasis on pleasure, it makes me curious about why. Is that where we “should” be going in terms of emphasis? Or is it just a part of the acceptance of “other” reasons to have sex, finally.
On one hand, pleasure is absolutely an important part of sexual health but why are we only now recognizing pleasure as central to sexual experience? Pleasure shouldn’t be a new concept when it comes to sex. It’s a built-in part of the human sexual experience for as long as sex has existed – after all, pleasure and reproduction have been paired by evolution to promote the survival of the species. Is the study of human sexuality that far behind the experience of individuals? Yes, it is. It took until the early 2000s for sexual health professionals to finally recognize that sexual distress was an important concept when diagnosing sexual disorders! Until then, you could have been diagnosed with a sexual disorder based solely on how your sexual responses (desire, arousal, action, orgasm, and refractory period) aligned with Masters and Johnson’s model. Even if your sexual responses did not cause you distress, it didn’t matter, sexual health professionals with influence had decided that there was still something wrong with you that indicated attempts to change. That ridiculousness should sufficiently demonstrate the degree to which sexual function was positioned as THE most important part of sex in the past.
So, on the other hand, might the emphasis on pleasure nowadays merely be a reflection of what society believes is most important about sex? Have we shifted from a belief that sex is about reproduction to a belief that sex is about pleasure? And does that also reflect our changing beliefs about how we make meaning out of our lives? Abrahamic religions have typically emphasized guidelines that reinforce the belief that sex is more about reproduction than hedonistic pleasure. Without these religious beliefs shaping as many individuals’ sexual beliefs, it appears that society has developed a more individualistic and egocentric view of sexuality (and an understanding of those factors would be crucial to understanding the reasons for that shift over the last few hundred years, which for the purposes of this blog, I am merely referencing the fact that less individuals turn to religion to answer the questions they have posed about life). I imagine that one’s opinion on whether this shift is positive or negative is dependent on one’s beliefs about religion. However, that’s not the topic I’m interested in for the purposes of this blog. I’m interested in thinking about the context in which this declaration of sexual pleasure was made. Sexual pleasure is pretty obviously an important element of sexuality when individuals are having sex because they want to feel good either through the pleasure gained by connecting to a partner(s) which may or may not include orgasm, or through the pleasure gained via the 5 senses which likely includes orgasm. But, I also regularly see clients who are primarily interested in the functionality of sex for reproduction. They want to have a baby so they are focused on what they believe is the function of their sexual encounter – male orgasm via penetration. And that’s not something that is just a given for all couples. Research has shown that couples who are sexually satisfied in their relationship do not meet their sexual goals in about 15% of their sexual encounters. That’s a number that couples need to know because it is very normal for even couples with happy sex lives to not always get the sex they want, and those couples still consider their sex lives to be happy.
My point is that what individuals consider important about sex is unique and cannot be assumed. We must be respectful of the differences that exist about what is important about sex because what is important is in the eye of the beholder. Sex for reproductive purposes is just as valid as sex for pleasure purposes. We may be witnessing a shift in society’s beliefs about what is important in sexuality, but maybe this shift merely reflects some increased acceptance and advocacy for sexual pleasure as a contrast to society’s previous emphasis on sexual function. Let’s listen to each other to understand what is important to all of us about sex, and put it all on an equally valid level. For now, this declaration celebrates sexual pleasure, so consider it as one of the reasons for your sexuality, but remember that there are many, many, many reasons to have sex and one person’s reasons are not better than others (unless we start talking about sexual offending, which I am not trying to discuss here).
The participants of the Congress of the World Association for Sexual Health in Mexico City declared that they:
Sexual pleasure is the physical and/or psychological satisfaction and enjoyment derived from shared or solitary erotic experiences, including thoughts, fantasies, dreams, emotions, and feelings.
Self-determination, consent, safety, privacy, confidence and the ability to communicate and negotiate sexual relations are key enabling factors for pleasure to contribute to sexual health and well-being. Sexual pleasure should be exercised within the context of sexual rights, particularly the rights to equality and non-discrimination, autonomy and bodily integrity, the right to the highest attainable standard of health and freedom of expression. The experiences of human sexual pleasure are diverse and sexual rights ensure that pleasure is a positive experience for all concerned and not obtained by violating other people’s human rights and well-being.
1. The possibility of having pleasurable and safe sexual experiences free of discrimination, coercion, and violence is a fundamental part of sexual health and well-being for all;
2. Access to sources of sexual pleasure is part of human experience and subjective well-being;
3. Sexual pleasure is a fundamental part of sexual rights as a matter of human rights;
4. Sexual pleasure includes the possibility of diverse sexual experiences;
5. Sexual pleasure shall be integrated into education, health promotion and service delivery, research and advocacy in all parts of the world;
6. The programmatic inclusion of sexual pleasure to meet individuals’ needs, aspirations, and realities ultimately contributes to global health and sustainable development and it should require comprehensive, immediate and sustainable action.
URGE all governments, international intergovernmental and non-governmental organizations, academic institutions, health and education authorities, the media, private sector actors, and society at large, and particularly, all member organizations of the World Association for Sexual Health to:
A. Promote sexual pleasure in law and policy as a fundamental part of sexual health and well-being, grounded in the principles of sexual rights as human rights, including self-determination, non-discrimination, privacy, bodily integrity, and equality;
B. Ensure that comprehensive sexuality education addresses sexual pleasure in an inclusive, evidence-informed and rights-based manner tailored to people’s diverse capacities and needs across the life span, in order to allow experiences of informed, self-determined, respectful, and safe sexual pleasure;
C. Guarantee that sexual pleasure is integral to sexual health care services provision, and that sexual health services are accessible, affordable, acceptable, and free from stigma, discrimination, and prosecution;
D. Enhance the development of rights-based, evidence-informed knowledge of the benefits of sexual pleasure as part of well-being, including rights-based funding resources, research methodologies, and dissemination of knowledge to address the role of sexual pleasure in individual and public health;
E. Reaffirm the global, national, community, interpersonal, and individual commitments to recognition of the diversity in sexual pleasure experiences respecting human rights of all people and supported by consistent, evidence-informed policy and practices, interpersonal behavior, and collective action.
I’m going to invest some time in blogging each week so I hope you will enjoy the new format and the content to follow.
Intended audience: More towards professionals but also those interested in translating couples research into practical action
Reference: McNulty, J. K., Maxwell, J. A., Meltzer, A. L., & Baumeister, R. F. (2019). Sex‑Differentiated Changes in Sexual Desire Predict Marital Dissatisfaction. Archives of Sexual Behavior, 48, 2473–2489.
Problem identified by authors: Since couples regularly come to see me because of sexual desire differences, I’m regularly trying to better understand how couples can best manage this issue. This article that I’m discussing today appears to partly address this problem that heterosexual couples often experience. It causes people to question whether they can stay together, whether the seeming incompatibility in sex drives is tolerable or stifling, and whether they can compartmentalize this problem and just grin and bear it while they try to raise their kids. What are the factors that drive sexual desire issues with heterosexual couples? And what does that mean for a couple’s relationship satisfaction?
Context and previous research: I’ve always remembered a story that my PSCYO 105 prof told the class about how the Coolidge Effect got its name. Turns out that US president Calvin Coolidge and his wife were visiting a chicken farm and Mrs. Coolidge remarked that the rooster must have remarkable sexual stamina to reproduce so often, as there was only one rooster for the entire farm. Mr. Coolidge responded by saying, “I’d like to remind Mrs. Coolidge that the rooster’s remarkable stamina was owed in large part to the fact that the rooster had a variety of partners and was not stuck with the same partner, which would result in Mrs. Coolidge’s dissatisfaction.” Or something like that, I’m paraphrasing from my memory. But it was an important contextualization, albeit during a time of misogyny and patriarchal repression of female sexuality. Regardless of its origins or the politics of it, the Coolidge Effect suggests that novelty is more important to sexual desire for men than women. It may be interesting to further understand the possibility of how the Coolidge Effect merely represented an adherence to gender roles.
That’s the second contextual factor I’d like to speak to before we get into examining what the article found. Is it really biology that drives the differences between genders? (apologies for not using a non-binary research study, I will try to include articles that are more inclusive). Could testosterone explain the changes in sexual desire over time? Research has indicated that men’s testosterone levels decline over time after full maturity but women’s testosterone levels also drop after menopause. Could the cultural expectations of our society be the larger influence? Meaning that if men and women are expected to behave in certain ways, they will conform unconsciously to fit in. And we already know how problematic gender roles have been for sex positivity and freedom of expression. How many people do you know where it is the man who wants more sex and how many people do you know where it is the woman who wants more sex? My clients are about 50-50 when they come to see me. Have you ever asked anyone else? Or do you assume that you know what must be happening in their sexual dynamic? Does that make you feel shameful? Even though you don’t really know?
Research has demonstrated that child-birth and child-rearing still impact women more than men and stress appears to impact women’s sexual desire more than for men. Research also has demonstrated that women are twice as likely to be “responsive” in terms of sexual desire, rather than “spontaneous,” which is twice as likely for men. Again, it is unclear if this is due to biological differences or gender role expectations. So, it’s a real thing that women seem to more often bear the stress of child-rearing, and that this stress is likely to impact their sexual desire while men are less likely to undergo such changes.
Another contextual factor to think about is Helen Fisher’s research on the 3 stages of love that she identified by observing different brain processes in response to a relationship partner over time. At first, lust is the driver as our brains are stimulated by dopamine and adrenaline, evolution’s trick to try and get us to reproduce, accidentally or not. The dopamine-release habituates to that partner after between 6 and 18 months, and that’s when those relationships end. In order to continue, Fisher says that the brain must rely on the serotonin neurotransmitter to perpetuate the pair-bond. She calls this the love stage and it is also temporary, up to about 4 years into the relationship, long enough for evolution to get us to raise a child together to an age it can survive more independently. To stay together after year 4 requires attachment, yes that same thing I’ve talked about lots. Only with attachment do we stay together. And only when we can repair our attachment injuries can we tolerate the waves of being in a relationship for a long time. But wait, does this mean that we are predestined to shift from a sex-heavy courtship to a more secure and loving (which isn’t that sexy) long term bond? Maybe.
Some researchers pin the blame on women, saying that women use enhanced sexual desire and activity to attract a man, but as security increases over time, they have less reason to behave sexually to keep him. This narration makes it sound as if women have a plan to trap a man by giving them lots of sex as a way to ensnare him, which is followed quickly by a sexless and unsatisfying marriage. This stereotype is unfair and hurtful to women, just as is the stereotype that men are horn-dogs and don’t need to be courted into getting turned on too. Maybe there are some evolutionary or biological factors involved in female courtship, but those factors are conflated by women bearing more of the stress of child-rearing, so if male participation could unburden mothers and make it more equal, maybe women wouldn’t lose so much sexual desire after having a child. Do they also have to deal with the extra burden of household responsibilities too? Is that still a bit of an expectation from many men?
Research findings: “Results of this study demonstrated that women’s sexual desire declined more steeply over time than did men’s sexual desire, which did not decline on average. Further, childbirth accentuated this sex difference by partially, though not completely, accounting for declines in women’s sexual desire but not men’s. Finally, declines in women’s but not men’s sexual desire predicted declines in both partners’ marital satisfaction. These effects held controlling depressive symptoms and stress, including stress from parenthood. In sum, compared to their husbands, wives demonstrated lower levels of initial sexual desire that (1) declined more steeply over time, (2) were partially, but not completely, attributable to the birth of children, even after controlling stress, including stress associated with parenthood, as well as depressive symptoms, and (3) ultimately predicted changes in marital satisfaction for both members of the couple (though somewhat less reliably for husbands) and thus lower levels of marital satisfaction at the end of the of the study for both members of the couple… Changes in wives’ sexual desire predicted changes in both partners’ marital satisfaction, not because they predicted change in couples’ sexual frequency, but because they predicted changes in their sexual satisfaction. Our findings might reassure some couples that the emerging mismatch in marital sexual desire is normal and typical.”
Interesting results. I read it to say that women have lower sex drives than men generally (which could be biology or adherence to gender norms), and that women’s sexual desire goes down steeply over time while men’s sexual desire remains unchanged (even though testosterone levels go down over time). Some of the changes in sexual desire could be attributed to child rearing but not all (so maybe changes in testosterone or changes in gender norms due to increasing age whereby older adults are expected and considered to be less sexual than younger adults). And when women’s sexual desire levels went down, satisfaction in their relationship also went down for both partners. Interestingly, the dissatisfied couples appeared to have the same amount of sex as satisfied ones, but when women had less desire both partners experienced less sexual satisfaction. The lesson – women’s sexual desire matters in relationships. My take – how couples manage these sexual desire issues is what matters. Is this true – if men can satisfy and nurture their partner’s sexual desire throughout the years, both partners will be happy.
Remaining questions: Does testosterone have any impact? Or is it only when testosterone changes to outside the normal range that it becomes an issue? Why doesn’t men’s sexual desire drop more as they get older? Are women’s sexual desire levels supposed to drop because of evolution, biology, and reproductive success? Or is that a bunch of bullshit that has been fed to us in order to control our sexuality? I’ve met too many clients who experience a sexual awakening after a 20-year marriage ends to believe that we are hamstrung to outdated notions of heteronormativity, ageism, and an emphasis on the differences between men and women, as if in an attempt to reinforce an unconscious bias towards a binary understanding of gender. And those sexual awakenings are maintained well beyond what could be explained by the “lust phase” of relationships. Provide a context for your partner to be sexual, and not just based on what you think it should be, and it appears your relationship is more likely to stay strong throughout the years.
Let me know your thoughts.