Desire vs. Arousal: What’s the Difference?

By: Dr. Alyssa Dweck, Bonafide Medical Advisor

Seems like a simple enough question on the surface, right? Not so fast….   

Desire is that incredibly intense feeling of “wanting to want.” This might also be referred to as, libido, sexual drive or feeling “in the mood.” Muscles tense, heart rate increases, skin may get flushed and the mind gets busy with sexual thoughts.

Arousal entails the unmistakable physical signs of the sexual response. The clitoris becomes super sensitive, the vagina lubricates copiously, and the genitals swell and become noticeably engorged with blood.

In fact, theories about the sexual response in women have been contemplated and debated for years; specifically, which, if any, comes first, desire or arousal?

One theory, proposed by Masters and Johnson in the 1960s, states that it’s linear. In other words, they proposed four distinct steps during the female sexual response that appeared to occur in a clear and sequential pathway. The four phases included, excitement (desire, libido, drive), plateau (arousal), orgasm and resolution. This model suggests that each step occurs in this exact order, linearly, during the female sex response during solo and/or partnered sex.

In contrast, in 2001, Basson proposed a nonlinear, more circular female sexual response model in which these steps were more loosely intertwined, overlapping and could occur in different sequences. This model incorporates the importance of emotional intimacy, sexual stimuli, and relationship satisfaction. Basson suggested, in contrast to the linear model, that women have many reasons for engaging in sexual activity, other than desire alone.

Sex, desire and arousal… can be complicated for women, and unlike for men, is probably more like a complex mission control panel than a simple light switch. 

Why? The most important sex organ for women may very well be the brain, where a delicate balance of hormones and neurotransmitters are at play.  For example, there are hormone receptors for estrogen, progesterone and testosterone in the brain, which most definitely influence one’s sexual drive and experience. Add to that, a collection of neurotransmitter chemicals that work within the nervous system and send specific signals to organs, vessels, muscles and other nerves with every activity. When it comes to sex, dopamine, oxytocin and norepinephrine are excitatory or “pro-sexual” neurotransmitters. Serotonin, in contrast, is inhibitory and thus more of a bedroom “buzz kill.” This delicate balance of hormones and neurotransmitters influences the female sexual response on a physiological level.

Many external factors have tremendous impact on the female sexual response.  For example, one’s partner status and relationship health are hugely influential. If one has anger, resentment or just plain isn’t attracted to a partner, response may be muted and dulled. Chronic medical conditions, various medications and physical discomforts may also play a role. How one feels about herself as a sexual being, aka “sexual self-esteem,” is also quite important. I often see women in my practice who are admittedly unhappy with their weight or muscle tone, and feel less sexy and thus less sexual. Finally, stress and the busy mind play a big role in a woman’s sexual experience; this is proving to be even more dramatic during the COVID-19 pandemic.

So now to the question at hand…  What’s the difference between desire and arousal? In some instances, desire comes first (you see a scene from Fifty Shades of Grey) and results in arousal (you get hot and bothered physically). For others, both happen simultaneously without a distinct boundary. Perhaps in the end, it’s all really just a matter of semantics. Either way, it feels great!

Alyssa Dweck, MS, MD, FACOG, Bonafide Medical Advisor, is a practicing gynecologist in Westchester County, New York. She provides care to women of all ages and has delivered thousands of babies. A graduate of Barnard College, she has a Master’s Degree in Human Nutrition from Columbia University and her Medical Degree from Hahnemann University School of Medicine in Philadelphia, now named Drexel University. Dr. Dweck currently practices in Mount Kisco, NY and admits to Northern Westchester Hospital in Mount Kisco, NY. She has been voted “Top Doctor” in New York Magazine and in Westchester Magazine and has authored three books to date: “The Complete A to Z for your V,” “The Sexual Spark,” and “V is for Vagina.”