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4.8: Building Upon Classical Thought on Biological Sexual Response

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    Masters and Johnson’s four-phase model of sexual response became the foundation for understanding human sexual response. As the first scientific description of the physiology of sexual response, it would become the basis for defining sexual health and also in the treatment of sexual problems (Nagoski, 2015 p 50). People who were unable to orgasm (anorgasmic) can learn to have orgasms, those with premature ejaculation can learn to control orgasm, those with vaginismus (vaginal spasms) can learn to relax those muscles. But there’s also a group of people who don’t respond to therapy informed by the four-phase model.

    In 1977 psychotherapist Helen Singer Kaplan published Hypoactive Sexual Desire in an effort to build upon this model and address a missing piece in the previous work done by Masters and Johnson, desire.  Reviewing treatment failures among patients, she found that the clients with the least successful outcomes were those who lacked interest in sex. Kaplan realized something important was entirely missing from the four-phase model, desire (Kaplan, 1977 p. 3). The biological model put forth by Masters and Johnson removed how our brain connects us to the body and the reason it may not have come into play in the studies done in a lab might make sense. 

    It seems like a glaring oversight in retrospect, but of course it was missing, people who come to a laboratory to masturbate for science don’t have to want sex before they begin; they just have to get aroused for the purpose of the experiment.  Kaplan took the four-phase model out of the laboratory and adapted it to the lived experience of her clients. Her “triphasic” model of the sexual response cycle begins with desire, which she conceptualized as “interest in” or “appetite for” sex, much like hunger or thirst. The second phase is arousal, which combines excitement and plateau into one phase, and the third phase is orgasm (Nagoski 2015, p. 50).

    Kaplan’s model of sexual response has served as the foundation for diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual. Low desire and desire discrepancy between partners are the most common reasons people seek sex therapy.  Some also seek help for “hypersexuality,” where they feel their desire and behaviors are out of their control (Nagoski, 2015 p.51). This begs the question, how much desire is too little or too much? Circling back to the beginning of this chapter, the answer is there is not a right amount of desire, everybody is different. Understanding your individual sexual temperament can be useful in caring for your overall wellness. If there is something that concerns you about your level of desire, it is always good to talk with a sexual health educator. 

    The box below provides a way to understand your individual sexual temperament, and how certain stimuli can either excite or inhibit your sexual appetite. Because we are all different, our desires are as well. Bottom line, there is no “right” way to be sexual. It is time to let go of feeling the need to be a certain way, look a certain way, want sex in a certain way and focus on what you really want. 

    Sidebar 4.6: The Dual Control of Sexual Response Temperament Gauge and Adapted Quiz 

    Sara Paules describes the dual control of sexual response that is referenced by Emily Nagoski in her 2015 groundbreaking text that we have referred to throughout this chapter, Come As You Are. Nagoski asserts that we all develop these systems based on our lived experiences and we all vary. It can be broken into two parts that can be compared to a car:

    1. Sexual Excitation System (SES). The system that responds to any sexually relevant stimuli in the environment-something we see, smell, remember etc. It is the accelerator.
    2. Sexual Inhibition System (SIS). The system that responds to any sexually inhibiting stimuli-like your parent being in the next room. It is the brakes.

    This system can be further broken down into two different SIS systems:

    1. Responds to fear of performance failure (erectile dysfunction, premature ejaculation, etc.)
    2. Responds to fear of performance consequences (STI transmission, unwanted pregnancy, social consequences).

     Sexual arousal can be understood as two equally important processes:

    1. Having gradually increasing stimulation for the SES
    2. Removing anything that the SIS might respond to, whether it be physical or emotional

    Sara Paules, MA, LPC from the  Mindful Soul Center in Austin, TX has an adapted sexual temperament quiz based on the work of Emily Nagoski and other sex researcher studying sexual temperament. You can take the quiz here. These types of assessments are meant to inform, not judge your personal temperament. People vary in their responses and there is not a normal temperament type (Nagoski, 2015, Paules, n.d.).

    This page titled 4.8: Building Upon Classical Thought on Biological Sexual Response is shared under a CC BY 4.0 license and was authored, remixed, and/or curated by Susan Rahman with Nathan Bowman, Dahmitra Jackson, Anna Lushtak, Remi Newman, & Prateek Sunder.