There’s a new article out that addresses hypoactive sexual desire disorder (HSDD) and the DSM-V: Women Who Want to Want.

There have been comments already about the article’s odd non-mention of asexuality and the strange mantra that Lori Brotto tells her patients to repeat (“my body is alive and sexual”) whether they believe it or not. There’s concern about the possibility of pushing people too strongly to be sexual, and I share those concerns.

Somewhat related, I was also amused at the article’s mention of something that (via my close associations with transitioning people and the trans community) is already well-known to me: the placebo effect of taking hormones. You start taking hormones, and suddenly every zit is a sign that it’s working. You get comments like, “My skin feels softer already!” and “I think my hair is growing slower!” from people who started taking hormones only a few days ago. Which is of course nonsense. Those things do happen, sure, but not THAT fast! Of course people are going to think T is giving them zits when they’re not even on it!

Brotto’s mantra seems to me to be working with that same effect. And maybe for some people it can be useful… but for others, it might seem like something that is working for a while, but then end in disappointment when they realize that there is not really all that much of a difference, and their problem is still there. And is it really a good idea to continue to conflate the concept of life with sexuality? Because even if we use the broadest possible definition of “sexual,” there are plenty of living things which are not sexual in any sense of the word. It’s stupid, of course, to say “my body is alive” if the state of aliveness is actually what is being referred to, because that’s bleeding obvious! So of course I think she should change that word. But it’s also possible to be vigorous and effervescent, if that’s what’s meant by “alive,” without being sexual at all. I realize it is aimed at helping patients harness a certain “sexual energy” or whatever, but I still think it’s an ill-conceived and inappropriate metaphor all around. Do we really need any more of a push in the direction of “nonsexual = dead”?

Really, though, I wasn’t all that bothered by or interested in that part of it. I was too distracted by the ideas presented by Basson to pay much attention to Brotto:

A different manifestation of desire — not initial hunger—– appears about two-thirds of the way around Basson’s circle. There, in the diagrams she began publishing in obstetrics and sexuality journals 10 years ago, come the words “responsive/triggered desire.” For Basson, this is necessary to satisfaction. But it comes after arousal starts. So a typical successful experience might proceed something like this: first a decision, rather than a drive, to have sex; next, as Basson puts it, a “willingness to be receptive”; then, say, the sensations of a partner’s touch; next, the awareness of being aroused; then the “responsive desire” along with increasingly intense arousal; and at last the range of physical and emotional payoffs that sex can provide and that offer positive reinforcement leading back to the top of the diagram, to the reasons for setting off on the circle to begin with.

I have sometimes wondered if I might consider myself sexual if I had been presented with a different model of sexuality than the one that society adopts. And under this model, I might be considered so.

This describes pretty much exactly the way that I myself navigate sexual activity. It was never about desire to begin with; it has always been a conscious decision to go ahead with it, for me. Of course, it isn’t true that I decide I’m going to have sex before I find myself in the middle of foreplay every time. But it is true that I made the decision to have sex with my partner, and gave her my implicit consent to initiate if she wants to, told her that it is generally okay for her to touch me in ways meant to arouse me, and I’ll stop her if I don’t want her to do it right then. Almost always, I end up aroused and able to enthusiastically consent. Of course, it helps that C is good at reading my signals (which are subtle and probably difficult for most people to read), and that she knows what I will respond to. She doesn’t push beyond my limits, is careful to stop whenever I say it’s getting painful, and also checks in with me whenever my facial expression is so ambivalent that she is not sure how I am doing. Over time, we’ve built up a safety net that allows me to be receptive to her as a general rule. And because that safety net is in place, I’m able to relax and follow my body’s cues to experience this sort of arousal-desire that Basson is talking about.

And so I think she is onto something, here. Society’s model of sexuality really is very attraction-focused, but the truth of it is that attraction often has very little if anything to do with enjoyable sex. Lots of people, probably women more so than men, find it pretty easy to have sex with people they are not attracted to. Of course there are people who say that they can’t imagine having a sexual relationship with someone they don’t find sexually attractive, but a lot of them settle anyway. Sometimes it takes a bottle of alcohol and a sense of desperation to get them to do so, but other times? I know a guy who met a girl a while back that he kept saying he wasn’t attracted to because according to him she is a “hambeast,” and now they’ve been together for six months or so, and live together as well. And I wonder how many married couples there are who don’t find each other sexually attractive anymore, but are still perfectly able to enjoy having sex with one another? Maybe some of them stop having sex for that very reason, but I suspect a lot of them keep on going at it–a little less like bunny rabbits, maybe, but still!

However, as much value as I see in Basson’s approach as described here, I don’t think it covers everything. There’s still the idea of lust–a concept I feel greatly removed from. I don’t really get it. At all. I never find guys hot in a “check the oil” sort of way. Or girls, for that matter. The attraction part of it is just missing for me, and even if it is an overblown cultural ideal more often than it is a reality, I still feel pretty alienated when I’m the only one in the room who doesn’t get it, which happens pretty frequently.

So I call myself asexual. And although my moniker hints at me being in the gray area between sexual and asexual, and I guess since I find sex enjoyable then according to some people I would be considered sexual, I’m really not feeling particularly “gray” lately. I don’t think that having sexual desire pretty much only when it is sparked by physical arousal is very strong evidence of being sexually attracted to people, and that missing attraction is (for me) what asexuality is all about. That’s the only definition that makes sense to me, and during the years that I have identified as asexual, despite my frequent reevaluations and openness to new experiences, my own asexuality has only become increasingly clear to me.