The Role of Sexual Functioning in the Sexual Desire Adjustment and Psychosocial Adaptation of Women with Hypoactive Sexual Desire

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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.

LITERATURE REVIEW AND RATIONALE

Despite the conceptual independence of individual sexual functioning and relationship dynamics, research indicates that elements of the two areas are entangled in a web of interdependence (Apt, Hurlbert, Pierce, et al., 1996; Hurlbert & Apt, 1994, Hurlbert, Apt, & Rabehl, 1993; Hurlbert et al., 1996; McCabe, 1999). Such interactions pose a challenge to researchers seeking to go beyond universal measures to assess the impact of variables subsumed within these overlapping paradigms (McCabe, 1999). This type of approach is important in relation to the broad concept of sexual functioning, an area in which researchers need meaningful assessment measures sensitive to their analytical needs (Meston & Derogatis, 2002; Rosen at al., 2000). For example, with respect to the specific dimensions of sexual functioning in the context of women with HSD, a factor such as frequency of sexual activity may not be particularly useful due to potential confounds (Davies et al., 1999; Hurlbert & Apt, 1994; Hurlbert, Apt, Hurlbert, & Pierce, 2000; Hurlbert & Whittaker, 1991; Regan, 2000). In contrast, other elements such as sexual satisfaction seem to be critically relevant in assessing sexual functioning (Rosen at al., 2000). With this cautionary note in mind, the present study chose specific variables of sexual functioning consistent with those used in established instruments (Meston & Derogatis, 2002) with some modifications to meet the specific needs of this research.

Similarly, with respect to relationship dynamics, this study employed common relationship measures that are often associated with disorders of sexual desire from both a research and treatment perspective (Basson, 2001; Davies et al., 1999; Hurlbert et al., 2000; Leiblum & Rosen, 1988; McCabe, 1997).

Given the complexity of HSD, testing for the possible effects of individual variables related to sexual functioning should include steps to prevent extraneous variables from corrupting the analysis. As noted above, this study evaluated the link between women's experience and relationship dynamics, but it also assessed the effects of demographic and physical factors in order to account for potential confounds and to test for additional noteworthy associations.

Since the research literature presents diverse findings, of varying significance, on the connection between sexual and demographic variables in women (Hurlbert, 1991; Kingsberg, 2002; Laumann et al., 1999; Rosen, Taylor, Leiblum, & Bachmann, 1993), our analysis included several demographic factors that may be associated with women's experience of HSD.

Given the societal emphasis on physical attractiveness, especially in women, it seems likely that individuals would have a conscious, and potentially unconscious, sensitivity to the role that physical characteristics play in their lives, especially when it comes to sex. In light of these potential implications, the present study assessed two relatively objective measures of physical attractiveness (body weight, waist-hip ratio) in an attempt to further test for the relative independence of variables associated with sexual functioning in the experience of HSD. Body shape, to a great extent, depends upon the body's distribution of fat, and waist-hip ratio (WHR) serves as a reliable measurement of this resulting body shape. When asked to judge attractiveness and sexual desirability, both U.S. men and women chose women with lower WHR over the women with identical weight but higher WHR (Singh, 1993). Such preference for lower WHR has been noted across ethnic groups including African-American (Singh, 1994) and non-Western societies, such as Indonesia (Singh & Luis, 1994). The inclusion of such measures in the study made it possible to assess their influence on women with HSD and their partners.

In summary, this study sought to examine the associations between relationship dynamics, sexual function, demographics, and physical characteristics as they relate to women's experience of HSD. Our goal is to better understand and assess how the woman is adjusting to HSD. In many instances, this also involves her partner's adjustment. In the interest of clarity, the eight dependent variables used in this assessment are categorized under two constructs: sexual desire adjustment (assessed on scales for sexual desire; sexual fantasy; relationship impact) and psychosocial adaptation (assessed on scales for self-esteem, sexual assertiveness, self-motivation, depression). The central intent of these descriptive categories is to make the sizable body of data easier for the reader to navigate and understand.

HSD does not merely involve some objective deficiency of desire measured against a universal standard of desire. It also involves the perceived failure to meet levels of desire set by perceived societal norms and expectations (Basson, 2001; Donahey & Carroll, 1993). Given that levels of desire can differ even within a population diagnosed with inhibited desire, the present study sought to measure the sexual desire of the female subjects, if for no other reason than to explore what factors may be affecting sexual desire in this group of women. The same rationale applies to the inclusion of a woman's disposition towards sexual fantasy, which is a consideration found in the diagnostic criteria for HSD and in clinical research (Nutter & Condron, 1983). Thus, this study examined the woman's level of sexual desire and disposition towards sexual fantasy …