What does healthy sexual function look like?

Let’s take a look at relevant models of sexual response first, and then we’ll look at the stages within those models.

What are the stages of healthy sexual response?

You’re probably familiar with the linear model of sexual response, which begins with desire, follows with arousal, and terminates with orgasm:

Kaplan’s linear model of sexual response. From page 164 of Our Sexuality (11th ed.) by Crooks and Baur.

However, the linear model of sexual response has been criticized for being based on a small subset of women (who could orgasm from vaginal intercourse while being observed in a laboratory setting) and failing to reflect women’s real sexual experiences. That is to say, women are more likely to agree with this model when they are in newer relationships, making this model less representative of women in long-term relationships. There are two other models that may be more relevant: Basson’s circular model (below) and Perelman’s Dual Control model (further below).

Basson’s circular model of sexual response. From page 51 of “A biopsychosocial approach to women’s sexual function and dysfunction at midlife: A narrative review” in Maturitas.

Basson’s circular model of sexual response looks a bit complicated, but the important takeaways are:

  1. Desire isn’t the only motivation for engaging in sexual activity. Women may have sex to express love to their partners, share physical pleasure, experience emotional closeness, make their partners happy, or increase their own well-being.
  2. Desire can come before arousal or after sexual arousal. This means that you may not have any sexual desire until after sexual stimulation begins or after your genitals are physically aroused. This is called responsive desire and it is totally normal, especially in long-term relationships! However, to any partners reading this, please take note: this does not give you permission to tell your partner that she will desire the sex once it gets going. Consent requires that a person is either seeking out or receptive to sexual stimuli.
  3. Orgasm is not necessarily a requirement for sexual satisfaction. It may be a requirement for your sexual satisfaction (and you should advocate for your orgasm if it is!), or it may not. You should not feel obligated to have an orgasm, and you certainly should not feel guilty if you do not have one.
  4. If you are in a long-term relationship or you have a sexual dysfunction, you are more likely to agree with Basson’s model of sexual response than the traditional linear model.

The other relevant model of sexual response is the Sexual Tipping Point or Dual Control model (see diagram below). This model is neither linear nor circular—it’s actually a balance scale! Our sexual response is controlled by a balance between excitatory and inhibitory influences unique to each of us. These influences can be biological, psychological, social, cultural, and behavioural. Some of these factors enhance (excite) sexual response, and some of these factors inhibit it. The sum of these factors determines the strength of your sexual response. Low excitation (e.g., insufficient stimulation) or high inhibition (e.g., limited privacy) are relevant to female sexual dysfunction (FSD). Some people have used a driving analogy to explain it: high inhibition is like sticky or sensitive brakes (it doesn’t take much to turn them off) while low excitation is like having an insensitive gas pedal (it takes a lot to get them turned on).

Adaptation of the Dual Control model. From page 27 of “Central nervous system anatomy and neurochemistry” by Pfaus and Jones in Textbook of female sexual function and dysfunction: Diagnosis and treatment (2018), edited by Kim, Goldstein, Clayton, Kingsberg, and Goldstein.

For example, several strong inhibitors and only one weak excitor will produce overall inhibition of sexual response. (Note that, in this model, “inhibition” does not mean “shyness” or “frigidity”—it means “restricted.”) The chart below shows some examples of inhibitors and excitors. Keep in mind that these are possible factors, not definitive factors—you may experience some of these factors without noticing any impact on your sexual function.

InhibitorsExcitors
Physical problems (e.g., low free testosterone)
Negative psychological, social, or cultural factors (e.g., belief that women’s sexual role is for men’s fulfillment)
Stress (e.g., giant to-do list)
Being touched in ways that you do not like to be touched
Relationship problems (e.g., resentment, lack of trust) Performance anxiety (e.g., worries about lubrication, orgasm)
Worrying about consequences (e.g., pregnancy, STIs)
Body image issues
Mental health issues (e.g., depression, anxiety)
Medications with sexual side effects (e.g., antidepressants)
Orgasm (i.e., desire, arousal, and orgasm ability generally dissipate after orgasm)
Physical health
Being in love with your partner
New relationship energy (“NRE”)
Seeing something sexy (e.g., a romantic movie, pornography).
Thinking about sexy things (e.g., fantasizing, reading erotica)
Genital stimulation
Being touched in the way you prefer to be touched
Doing new sexy things (e.g., outdoor sex, role playing)
Seeing your partner in an attractive way (e.g., in clothes you really like, doing something they are good at)
Medications (e.g., FSD medications)
Feeling confident in your body
Watching your partner be a good parent
Massage

Sexual excitors and inhibitors

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Next, we move on to the stages of sexual response. In Basson’s circular model, willingness is the first stage, and it means either seeking out or being receptive to sexual stimuli. You may be initially interested in sexual activity for reasons other than desire, such as expressing love, sharing in physical pleasure, increasing your well-being, or pleasing your partner. This willingness is related to sexual consent, which is the freely given agreement to sexual activity. Willingness is openness to sexual activity, while consent is agreement activity, and they are foundational to healthy sexuality. Whether or not you initially have sexual desire, sexual activity should not begin unless you (and your partner) are willing and consenting. If you’re confused, don’t worry—you’ll understand the importance of willingness more when we look at desire (specifically, responsive sexual desire). You can learn more about consent from Dr. Lindsey Doe, Planned Parenthood, RAINN, or Sex and U.

Note: While some women have experienced arousal and orgasm during rape and sexual assault, this is because the body was designed to respond this way to sexual stimulation and not because they secretly desired rape. Consent is crucial to sexual health and healthy sexual functioning, even in consensual non-consent (“rape roleplay”).

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What does healthy sexual desire look like?

Sexual desire can be described in many ways, leading to difficulty distinguishing between normal and abnormal sexual desire. Many people (and the DSM-5!) think of desire and arousal as the same thing, but they are distinct processes that do not always occur together. Sexual desire is simply an “anticipatory motivational state” and may be a desire for the rewards of sexual activity (e.g., physical pleasure, emotional intimacy, partner satisfaction). However, if these rewards decrease, then sexual desire may also decrease. Many women have concerns about low sexual desire, but these concerns are actually quite common the longer women’s sexual relationships last. What you need to know is the difference between spontaneous desire and responsive desire.

Spontaneous desire is pretty self-explanatory—it occurs spontaneously. Most people think of desire this way, expecting desire to precede arousal. In the beginning stages of sexual relationships (and in teens and young adults), spontaneous desire is common.

Have you ever consented to sex that you weren’t interested in at the time, but you got interested after the sex got going? Maybe you ended up having really good sex at the end. This is called responsive sexual desire. Responsive desire occurs after a woman has started seeking out (or is receptive to) sexual stimuli (e.g., sexual images or touch) or after a woman’s body is sexually aroused. This type of desire is more common in long-term relationships. If this is the only type of desire you experience, nothing is wrong with you. However, Lori Brotto’s book might be of help if you wish to cultivate more desire.

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What does healthy sexual arousal look like?

Healthy arousal occurs after paying attention to erotic cues (e.g., sexual images, your partner’s naked body) or sexual stimulation. There are actually two types of arousal: subjective and genital. Subjective sexual arousal refers to mental engagement and focus on sexual stimuli while genital arousal refers to the body’s physical changes in response to sexual stimulation. These two types of arousal do not necessarily occur at the same time. Genital arousal in females involves genital swelling, vaginal lubrication, and clitoral engorgement (like a little erection), though females are not necessarily always subjectively aware of their body’s physiological arousal. You may not notice your genital arousal because most of the engorgement happens to structures inside your body (covered in internal genital anatomy).

Arousal should dissipate if you stop paying attention to erotic cues, if you stop sexual stimulation, or if you orgasm. (If arousal does not go away, you may want to check out the information on PGAD/GPD in When should I seek help? and self-help resources.)

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What does healthy orgasm look like?

Orgasm is the sensation of intense pleasure after adequate sexual stimulation. Different people require and prefer different kinds of stimulation for orgasm to occur. Most females require direct or indirect clitoral stimulation. Some experience multiple orgasms while others can’t, don’t want to, or haven’t been properly stimulated to experience them. Some are sexually satisfied without orgasm, though most women prefer to have an orgasm.

With enough of the right stimulation (usually direct or indirect clitoral stimulation), you should be able to reach orgasm. Masturbation is the easiest way to orgasm, though you may still need to practice. Cunnilingus (oral sex on a vulva) is the easiest way to orgasm with a partner.

If you cannot orgasm from vaginal intercourse alone, but you can orgasm with masturbation, nothing is wrong. The clitoris is not usually stimulated very well with just vaginal intercourse. You just need to find a way to translate your masturbation knowledge to vaginal intercourse—either by pursuing partnered orgasm in different ways (e.g., mutual masturbation, cunnilingus) or by adding clitoral stimulation to intercourse.

If you feel like you’re taking too long to orgasm, consider these ideas:

  • Men are praised for how long they last before orgasm.
  • Most women do not orgasm from intercourse alone.
  • Women that can orgasm from intercourse alone have better or faster orgasms if clitoral stimulation is added.
  • Orgasm problems are often caused by social and cultural factors, not by biological or psychological factors.

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Is sexual pain ever normal?

Partnered sex (e.g., intercourse, cunnilingus) and masturbation should not ever hurt. If it does hurt, one of two things is probably happening:

  • Someone is doing something that they should not be doing (e.g., trying to penetrate a vagina that is either not ready or wet enough, thrusting too hard/deep), or
  • Something is physically wrong and needs attention (e.g., your pelvic floor muscles are tight, infection/dermatitis, vulvodynia).

No matter how good your sex education was, it’s unlikely that you will ever learn this: you need to pull back your clitoral hood and clean the glans under it (with water or with a gentle cleanser—not soap!). Every female develops some smegma on the vulva, and smegma can also develop under the clitoral hood. If this smegma is not washed away (with water only!), it can cause the clitoral hood and the clitoral glans to stick together, resulting in clitoral adhesions, which can (but do not always) cause pain. To check if you have clitoral adhesions, try pulling back the foreskin of your clitoris. You should be able to pull it back to reveal the glans (the head), which is about the size of a pea (though it varies between women) and looks like a tiny penis head. Check out HealthLine for more information on clitoral adhesions.

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Is sex supposed to feel good?

Sexual stimulation from yourself or from another person (by whom you wish to be touched) should produce pleasure. Some stimulation may not feel good, such as deep thrusting, fast rubbing, or high vibrations—or you may not be aroused enough to enjoy these yet. Avoid anything that doesn’t feel good and experiment to find the stimulation that feels best. This may involve giving feedback to your partner about their techniques.

Sexual satisfaction is considered a sexual right by the World Health Organization. It’s unclear whether orgasm is necessary for sexual satisfaction, but you can decide that for yourself—if you want an orgasm, you should get an orgasm, and if you do not want one or do not care if you have one, you can still be sexually satisfied.

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What if I’m not sexually attracted to anyone?

Asexuality is a sexual orientation describing people who do not experience sexual attraction to other people. It is different from celibacy, which is the choice not to act on sexual impulses, and it is different from low sexual desire (though a person can be asexual and have low desire). About one percent of the population is asexual.

A number of groups of girls and women are incorrectly assumed to be asexual, including older women, women who have cancer, mammies, children, mothers, women with disabilities, people with mental illnesses, women during the Victorian era, and even lesbians. These women can be asexual, but should not be assumed to be asexual (or heterosexual—we just shouldn’t assume).

Most asexual women are single and most asexual people have not had intercourse, though some asexual people engage in sexual activity for their partners’ benefits. While fewer asexual women masturbate than sexual women, many asexual women do masturbate. If any of this describes you, don’t worry—nothing is wrong with you. To learn more about asexuality, check out The Asexual Visibility & Education Network.

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