Sexual and Relationship Therapy Is responsive sexual desire for ...

This article was downloaded by: [b-on: Biblioteca do conhecimento online ISPA]On: 02 November 2013, At: 04:47Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UKSexual and Relationship TherapyPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/csmt20Is responsive sexual desire forpartnered sex problematic among men?Insights from a two-country studyAleksandar Štulhofer a , Ana Alexandra Carvalheira b & BenteTræen ca Sexology Unit, Department of Sociology , University of Zagreb ,Zagreb , Croatiab Institute of Applied Psychology, University of Lisbon , Lisbon ,Portugalc Department of Psychology , University of Oslo , Oslo , NorwayPublished online: 21 Dec 2012.To cite this article: Aleksandar Štulhofer , Ana Alexandra Carvalheira & Bente Træen (2013) Isresponsive sexual desire for partnered sex problematic among men? Insights from a two-countrystudy, Sexual and Relationship Therapy, 28:3, 246-258, DOI: 10.1080/14681994.2012.756137To link to this article: http://dx.doi.org/10.1080/14681994.2012.756137PLEASE SCROLL DOWN FOR ARTICLETaylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

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Sexual and Relationship Therapy, 2013Vol. 28, No. 3, 246–258, http://dx.doi.org/10.1080/14681994.201 2.756137Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013Is responsive sexual desire for partnered sex problematic among men?Insights from a two-country studyAleksandar Sˇ tulhofer a *, Ana Alexandra Carvalheira b and Bente Træen ca Sexology Unit, Department of Sociology, University of Zagreb, Zagreb, Croatia; b Institute ofApplied Psychology, University of Lisbon, Lisbon, Portugal; c Department of Psychology,University of Oslo, Oslo, Norway(Received 21 May 2012; final version received 3 December 2012)In contrast to the body of research focusing on female sexual desire, there hasbeen very little research into patterns of male sexual desire. This study addressesthis deficiency in the literature by providing empirical answers to the followingthree questions: (1) is there a pattern of responsive sexual desire – defined as beingpredominantly receptive to a partner’s initiation of sexual activity withoutinitially desiring it – among men? (2) Is this pattern associated with lower levels ofsexual health than a more spontaneous pattern of male desire? (3) Are existingclinical observations regarding possible causes of reduced interest in partnered sexuseful for understanding the more responsive men’s sexual desire? A large onlinesurvey about men’s sexual interest was conducted in 2011 among 2215 Norwegianand Portuguese men aged 18–75 years (the average age in the sample was 36.5years). Sociodemographic, health-related, sociosexual and relationship-relatedinformation was collected. Three distinct patterns of male sexual desire wereobserved: decreased (23.6%), responsive (2.5%) and spontaneous (73.9%) desirepatterns. Men in the more responsive and spontaneous desire groups significantlydiffered from participants in the decreased desire group, as they reportedsignificantly higher levels of sexual interest, sexual satisfaction and frequency ofsexual intercourse and were less likely to have experienced sexual healthdifficulties in the past 12 months. Interestingly, participants with more responsiveand spontaneous desire patterns were indistinguishable in terms of a number ofsociodemographic, health-related, sociosexual and relationship-related variables.The sole predictor of the responsive sexual desire pattern was proneness torelationship-related sexual boredom. Clinical observations about the roles ofnegative emotions, relationship strain and specific sexual arousal patterns(homoerotic, autoerotic and/or paraphilic) in the etiology of hypoactive sexualdesire did not seem relevant for men with responsive desire.Keywords: sexual desire; men; sexual health; responsive desire patternIntroductionIn a series of influential papers, Basson (2000, 2001, 2002) proposed a new model ofhuman sexual response based primarily on her understanding of and evidenceregarding female sexuality. Unlike the standard sexual response model (developed byMasters and Johnson and appended by Kaplan), which is linear and starts with a*Corresponding author. Email: astulhof@ffzg.hrÓ 2013College of Sexual and Relationship Therapists

Sexual and Relationship Therapy 247Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013spark-like occurrence of sexual interest (desire), this cyclical model was advocated asa more accurate representation of the sexual response of women in long-termrelationships (Basson, 2001, 2002; Hayes, 2011). One of the core ideas embedded inthe model – which has since substantially influenced both research and clinicalpractice – was that responsive female sexual desire (i.e., being sexually receptiverather than ‘‘spontaneous’’) is not pathological. In other words, a woman’s sexualneutrality at the onset of a sexual encounter is not an obstacle for satisfactory sexualexperience and, hence, it need not be viewed as problematic. Because desire mayfollow arousal that was triggered by external erotic stimuli, a lack of morespontaneous desire caused by internal erotic dynamics such as sexual thoughts is nota sign of inhibited sexual interest (Basson, 2002; Carvalheira, Brotto, & Leal, 2010;Goldhammer & McCabe, 2011).Although Basson (2000) explicitly linked her model (primarily) to women’ssexual experiences, the question about the utility of the concept of responsive desirefor understanding male sexual response seems relevant, especially given theindications that male patterns of sexual desire and arousal may be more complex(particularly as men age) than is usually acknowledged (Bancroft, 2009; Jenssen,McBride, Yarber, Hill, & Butler, 2008). The fact that the cyclical model has recentlybeen challenged – as a couple of studies suggested that it may be more descriptive ofwomen with sexual concerns and deficits in desire than of those with no sexualdifficulties (Giles & McCabe, 2009; Sand & Fisher, 2007) – does not negate the abovereasoning.What do we know about more responsive, or receptive (Meuleman & vanLankveld, 2005), sexual desire (MRD) among men? There is little empirical evidenceon male sexual desire in general (Brotto, 2010; DeRogatis et al., 2012; McCarthy &McDonald, 2009). To the best of our knowledge, there has been no attempt to studythe prevalence and/or characteristics of the predominantly responsive pattern ofsexual desire among men. However, a couple of studies analyzed consenting,unwanted sexual experiences among male college students. In a three-country study,Sprecher, Hatfield, Cortese, Potapovc and Levitskaya (1994) found that 30–35% ofmale students from one Russian, two Japanese and five American universitiesreported having sex without really wanting it. In the other study, which used a sexdiary method, 21 of the 80 surveyed men (26.3%) claimed one or more episodes ofunwanted sexual activity (O’Sullivan & Rice Allgeier, 1998). A host of reasons weregiven by participants to explain their consent to unwanted sex, including relationship-supportingand intimacy-promoting reasons. Notably, a majority of malestudents (52.3%) reported no negative outcomes related to engaging in unwanted sex(O’Sullivan & Rice Allgeier, 1998). Comparably, approximately one quarter of men(26%) in a random community sample of cohabiting/married Norwegian couplesacknowledged the experience of ‘‘obligatory sex’’ (Træen & Skogerbø, 2009), whichwas defined as having sex ‘‘even though you don’t feel any desire, just to satisfy yourpartner’’. Among men, correlates of obligatory sex were partner communicationabout sexual needs and sharing sexual fantasies.Although documenting the prevalence of unwanted sex among young adult men,these studies provide little information about the existence of a specific pattern ofsexual desire. Are there men who can be characterized as having MRD? If so, doesthe pattern substantially differ from hypoactive desire disorder (HSSD)? One way totest this hypothesis would be to explore whether men with MRD display some ormost of the characteristics associated with HSSD. Anecdotal evidence from sex

Sexual and Relationship Therapy 249MeasuresDownloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013Patterns of sexual desireThe participants who reported a decrease in sexual interest in the past six months(‘‘Did you notice a decrease in your sexual interest [i.e., sexual thoughts and fantasies,motivation to have sex, being receptive to have sex, etc.] during the past 6 months?’’)were considered men with decreased sexual desire. Men who did not report thedecrease in sexual interest, but who stated that in the same timeframe they ‘‘often oralways engaged in sexual activity without initially wanting it (‘‘How often in the past6 months did you engage in sexual activity just because your partner wanted it, that iswithout really desiring sex?), were categorized as men with MRD. All otherparticipants – that is, men without reduced sexual interest who stated that they onlyinfrequently (from ‘‘never’’ to ‘‘sometimes’’) had sex solely because their partnerwanted it – were considered men with more spontaneous pattern of sexual desire.Current level of sexual desireCurrent level of sexual desire was assessed by two moderately strongly correlateditems (r S ¼ .63, p 5 .001): ‘‘How would you rate the degree of your current sexualinterest?’’ and ‘‘How would you rate your current desire for sexual activity?’’ Bothindicators used the same 5-point scale, ranging from 1 ¼ very high to 5 ¼ very lowor non-existent, to anchor answers. The two items were summed and reversed so thathigher scores denoted more sexual desire.Sexual difficultiesSexual difficulties were measured by six yes/no questions from the National Surveyof Sexual Attitudes and Lifestyles (Mercer et al., 2003) asking about inability toreach orgasm, reaching orgasm too quickly, pain during sexual intercourse, lack ofinterest in sex, unpleasurable sex, feeling anxious about performing sexually andtrouble achieving or maintaining erection. Those who had no such experienceslasting at least 2 months in the past 12 months were instructed to check the option ‘‘Ihave experienced none of these difficulties’’.Frequency of sexual intercourseFrequency of sexual intercourse in the past three months was reported using a sixpointscale (1 ¼ never, 2 ¼ once, 3 ¼ two or three times, 4 ¼ once a week,5 ¼ several times a week, 6 ¼ daily or more often). A similar scale (ranging from1 ¼ never to 7 ¼ daily) was used to anchor answers regarding the frequency ofmasturbation in the past six months.Sexual satisfactionSexual satisfaction was measured using a short version (k ¼ 12) of the recentlyvalidated New Scale of Sexual Satisfaction (Sˇ tulhofer, Busˇ ko, & Brouillard, 2011).Participants were asked to rate their satisfaction with the quality of their orgasmsduring the past six months, the pleasure they provide to their partner, the partner’ssexual creativity, the frequency of sexual activity and so on. The scale had high

250A. Sˇtulhofer et al.internal consistency in both subsamples (Cronbach’s a ¼ .92 and .93). Higher scoresindicated more sexual satisfaction.Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013Sociodemographic characteristicsSociodemographic characteristics were assessed by asking participants how oftenthey attend religious services (an eight-point scale for anchoring answers wasrecoded into 1 ¼ never, 2 ¼ up to several times a year, 3 ¼ once a month or morefrequently), what is the highest level of formal schooling they completed (theindicator was dichotomized into 0 ¼ secondary or less and 1 ¼ college education),how they would compare their total household income in the past year to thenational average (a five-point scale, ranging from 1 ¼ substantially below averageincome to 5 ¼ substantially above average income, was used), how many years havethey been in the current relationship and whether they have children.Health-related characteristicsHealth-related characteristics included Body Mass Index (participants were askedabout their height and weight), general health status (participants were askedwhether they had any of 13 listed health problems, which included heart disease,diabetes, high blood pressure, chronic pain and so on [the additive indicator wasdichotomized into 0 ¼ healthy and 1 ¼ one or more illnesses reported]), job-relatedstress (‘‘In the past 12 months did you have any stressful experience on the job?’’)and the SCL_ANX4 and SCL-DEP6 scales measuring anxiety (four items) anddepression (six items), respectively (Søgaard, 2009). The two composite indicatorshad acceptable internal consistency in this study (Cronbach’s a were .74 and .83) andwere combined due to their strong interrelatedness (r ¼ .73, p 5 .001). Higherscores denoted higher levels of anxiety and depression.Relationship-related characteristicsRelationship-related characteristics were measured using the Emotional IntimacyScale (Sinclair & Dowdy, 2005: Cronbach’s a for the scale was .90 in this study –higher scores indicate stronger relationship intimacy) and the seven-item BodyAppearance Evaluation dimension from the Multidimensional Body-Self RelationsQuestionnaire (Cash & Labarge, 1996; Cash & Szymanski, 1995; Cronbach’s a ¼.91 – higher scores reflected a more positive body image). Men were also asked abouthow sexually attractive (from 1 ¼ very attractive to 5 ¼ very unattractive) theyfound their current partner/spouse.Sexuality-related characteristicsSexuality-related characteristics were the number of sexual partners in the past fiveyears and the gender of sexual partners during the same period. A shortened, fouritemversion of Sexual Boredom Scale (Watt & Ewing, 1996) was used to assessproneness to sexual satiation in a relationship. The scale had acceptable reliability inthis study (Cronbach’s a ¼ .85) but needed to be categorized into quartiles becauseof extreme skewness. Placement into a higher quartile denotes more sexual boredom.Frequency of pornography use in the past 12 months was measured on an 8-point

Sexual and Relationship Therapy 251scale ranging from 1 ¼ never to 8 ¼ daily or more often. Problematic use ofpornography in the past year was a composite indicator including the following threeitems: (1) ‘‘I feel that my use of pornography negatively affects my sex life’’, (2) ‘‘Ifeel that I have became dependent on pornography, i.e., that I could not control myuse of pornography anymore’’ and (3) ‘‘pornography caused problems in myrelationship’’. A four-point scale, ranging from 1 ¼ not at all to 4 ¼ a great deal,was used. Because of their limited range and skewness, summed scores weredichotomized into 0 ¼ median value (of three) and 1 ¼ above median value.Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013ResultsMost surveyed men had attended college or a higher level of education (63.1%),followed by those who completed secondary education (35.6%). Over two-thirds ofthe men were employed full-time (72.7%), while 9.0% reported being unemployed.Although the majority of participants stated that their household incomes in the pastyear were above average (49.4%), less than a fifth of surveyed men (18.8%) reportedbelow-average incomes. Over one-third of participants (37.2%) were married, 20.0%were cohabitating, 28.7% were in a relationship but not living together with theirpartner and 14.13% stated that they were single at the time of the survey. Theparticipants’ median length of relationship/marriage was seven years (M ¼ 8.5,SD ¼ 5.60), with one-fourth of participants (25.2%) reporting a relationship ormarriage of 15 years or longer. Almost half of the surveyed men had children(48.3%). Regarding religiosity, 50.1% of participants reported that they never attendreligious services. Only 10.2% of surveyed men attended religious ceremonies moreoften than several times a year.Considering socioeconomic and sociocultural differences between the EuropeanNorth (Norway) and South (Portugal), a number of predictable differences in thesociodemographic characteristics of the two subsamples were observed. More Norwegianmen (77.7%) than Portuguese men (71.4%) were employed full-time (w 2 [4] ¼ 11.25,p 5 .05) and reported living in a cohabitating relationship (23.9 and 19.0%, respectively,w 2 [3] ¼ 24.07, p 5 .001). In addition, a substantially higher proportion of Norwegianparticipants, compared to participants in the Portuguese sample, stated that they neverattend religious services (68.7 versus 45.5%, w 2 [2] ¼ 58.71, p 5 .001).Three patterns of male sexual desireOver one-fifth of the surveyed men reported experiencing reduced sexual desire in thepast six months (n ¼ 523, 23.6%). The proportion was significantly larger (w 2 [2] ¼27.53, p 5 .001) in the Norwegian subsample (32.6%) than in the Portuguesesubsample (21.4%). Of the men who did not experience reduced desire, only 56(2.5% of the total sample – 3.4% of the Norwegian subsample and 2.3% of thePortuguese subsample) reported MRD. As expected, those with neither decreasednor responsive sexual desire, that is, men with spontaneous desire pattern,constituted the majority of participants (n ¼ 1636, 73.9%).Are men with MRD distinguishable from men with self-reported decreased desire?To assess how different the three groups of men were (particularly the participantswho reported decreased sexual desire and those who reported MRD in the past six

252A. Sˇtulhofer et al.Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013months), a number of univariate ANOVAs were conducted. As shown in Table 1,the groups scored significantly differently on three of the four indicators: currentlevel of sexual desire/interest (F ¼ 311.53, p 5 .001), frequency of sexual intercoursein the past three months (F ¼ 40.43, p 5 .001), and sexual satisfaction (F ¼ 140.0,p 5 .001). In all three cases, the reduced desire group differed significantly(p 5 .001) from the two other groups of men.The above findings did not seem to reflect country-specific differences in the threedomains, as no consistent between-country patterns were found. While no significantdifferences were found in current levels of sexual desire and interest, Portuguese menreported a significantly higher frequency of sex than did Norwegian participants(t[650] ¼ 4.17, p 5 .001), which may have been related to their higher sexualsatisfaction (t[611] ¼ 4.49, p 5 .001) or to a somewhat lower average age andshorter relationship duration (t[536.3] ¼74.30, p 5 .001). 1 Interestingly, Norwegianparticipants had a significantly higher frequency of masturbation (t[2207] ¼76.0, p 5 .001).Finally, there was a statistically significant difference in the proportion ofparticipants who reported that they experienced no sexual difficulties (other than‘‘lacking interest in sex’’) in the past 12 months among the three desire patterngroups (w 2 [2] ¼ 120.09, p 5 .001). Only 34.1% of participants in the reduced desiregroup reported having no sexual difficulties, in comparison to 64% in the morespontaneous desire group and 61.2% in the MRD group. The difference between themore spontaneous and MRD groups was not significant (p 5 .08).What differentiates men with more spontaneous sexual desire from men with MRD?As men characterized with MRD differed significantly and consistently fromparticipants who reported a recent decrease in sexual desire but not from those in themore spontaneous desire group, univariate and multivariate logistic analyses werecarried out to explore potential predictors of the membership in the morespontaneous versus MRD groups. The choice of independent variables, such asnegative emotions (Brotto, 2010; Meuleman & van Lankveld, 2005), specific sexualarousal pattern (McCarthy & Ginsberg, 2008; McCarthy & McDonald, 2009) andrelationship-related issues (Bancroft, 2009; Schnarch, 1991), was guided by theTable 1. Desire/interest, frequency of sexual intercourse, frequency of masturbation andsexual satisfaction among three groups of men with different sexual desire pattern.Decreaseddesire group(n ¼ 523)More spontaneousdesire group(n ¼ 1636)More responsivedesire group(n ¼ 56) Welch a /F bM (SD) M (SD) M (SD) (p5)Sexual desire/interest 4.71 (1.67) 6.54 (1.36) 6.00 (1.83) 255.96 a,c (.001)Frequency of sexual 3.69 (1.11) 4.16 (1.07) 4.41 (1.04) 38.65 a,c (.001)intercourseFrequency of 5.18 (1.56) 5.16 (1.57) 5.11 (1.82) .04 b (.95)masturbationSexual satisfaction 37.56 (8.62) 45.0 (8.59) 42.89 (9.70) 140.0 b,d (.001)Notes: a Welch test for equality of means; b F-test; c Group 1 6¼ group 2, 3 (Tamhane’s post hoc test,p 5 .001); d group 1 6¼ group 2, 3 (Bonferroni post hoc test, p 5 .001).

Sexual and Relationship Therapy 253Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013literature on the correlates of male sexual desire disorders. Univariate logisticregression analysis controlled for a number of sociodemographic and sociosexualvariables, as well as for two general health indicators. Controlling for age,independent variables significantly associated with the outcome at the univariatelevel were entered in multivariate assessment. Due to a small number of participantsin the MRD group, the multivariate model was a priori limited to four independentvariables (including age).As presented in Table 2, only one indicator was significantly correlated with theoutcome at univariate level. Participants in the highest quartile of Sexual BoredomScale scores were over three times (OR ¼ 3.17, p 5 .01) more likely to exhibit theMRD pattern than those scoring in the lowest quartile. Controlling for participants’age did not affect this association. A non-significant result on Hosmer andTable 2. Correlates of the spontaneous versus responsive male sexual desire patterns(n ¼ 1692).OR (95% CI)AOR a (95% CI)Age 1.02 (.99–1.04) 1.02 (.99–1.04)ReligiosityNot religious (reference)Somewhat religiousVery religious11.50 (.85–2.64)1.28 (.51–3.18)College educated .81 (.47–1.39)Relative household income .96 (.75–1.24)Length of current relationship .98 (.93–1.04)Having children .92 (.54–1.57)Body Mass Index 1.01 (.94–1.08)Job-related stress 1.24 (.72–2.14)Health problems .84 (.48–1.48)Anxiety/depression 1.03 (.99–1.08)Body image 1.00 (.95–1.06)Sexual boredom1 st quartile (reference)2 nd quartile3 rd quartile4 th quartile11.27 (.58–2.77)1.80 (.81–3.00)3.17* (1.49–6.76)Relationship intimacy .98 (.91–1.05)Partner’s attractivenessVery attractive (reference)1Somewhat attractive1.27 (.70–2.31)Not attractive1.87 (.76–4.62)Number of sexual partners in the past five years1 (reference)2–45One or more male sexual partnersin the past five yearsPornography useSeveral times per year or less (reference)Monthly to once per weekSeveral times per week or more1.74 (.36–1.50)1.52 (.83–2.80)2.02 (.89–4.47)1.61 (.30–1.25).80 (.44–1.47)Problematic use of pornography 1.27 (.69–2.32)11.25 (.57–2.73)1.76 (.79–3.91)3.05* (1.43–6.51)Notes: a Odds ratios adjusted for the contribution of the other independent variable in the model;*p 5 .01.

254A. Sˇtulhofer et al.Lemeshow’s test (w 2 [8] ¼ 2.37, p 5 .97) suggested an acceptable fit of themultivariate logistic regression model with two independent variables.Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013DiscussionThis study explored the existence and characteristics of MRD. Using large-scaleconvenience samples of Norwegian and Portuguese men, we found that a smallminority (2–3%) of participants in both countries reported this pattern of sexualdesire, which was consistently and substantially different from the decreased sexualdesire pattern. Men with MRD exhibited substantially higher levels of self-reportedsexual interest, frequency of sexual intercourse and sexual satisfaction than men whoreported decreased desire. In addition, the two groups differed in the prevalence ofsexual difficulties experienced in the past 12 months. In comparison to men withMRD, participants with self-reported reduced desire were almost twice as likely toreport the presence of one or more sexual health difficulties.Unexpectedly, men with MRD were indistinguishable from participants withspontaneous sexual desire across a number of sociodemographic, health-related andsociosexual characteristics. The only significant difference between the two groups ofmen was their scores on the relationship-related sexual boredom scale: men withMRD scored significantly higher on this scale than participants with spontaneousdesire. As a similar frequency of dyadic sexual activity was observed among menwith MRD and those with more spontaneous sexual desire, men with MRD seem tohave been fully receptive to their partner’s initiative, to the extent that their levels ofsatisfaction with their sexual lives were similar to the ones reported by men with thepattern of spontaneous desire.The reasons for elevated sexual boredom scores among men with MRD wereimpossible to explore in this study since the questionnaire used did not contain therelevant indicators. It could be hypothesized, however, that men with MRD were notonly more prone to sexual boredom (for unknown reasons), but that they alsodisplayed a specific variant of sexual boredom – one that does not substantially affectsexual receptivity. This is likely to be more relevant for men with primary rather thansecondary MRD. Another related issue may be the learned and internalizederoticization of personal sexual passivity – paired with a preference for the partner’ssexual assertiveness and perceived control over sexual activity. Although wecollected no data that would support this speculation, future assessments of maleMRD need to pay attention to the issue of sexual boredom and its dynamics, scopeand defining characteristics, as well as to a possible erotic preference for passivity.This study’s findings are informative when addressing the question of whetherMRD shares a similar etiology with hypoactive sexual desire disorder. Leaving asidephysical pathology, three major pathways to a chronic deficit of sexual interest havebeen suggested and described in the literature: (1) negative emotions, such asdepression, anxiety and anger (Brotto, 2010; Meuleman & van Lankveld, 2005), (2)relationship problems (Bancroft, 2009; Schnarch, 1991) and (3) a specific sexualarousal pattern that cannot be enacted in the present relationship (McCarthy &Ginsberg, 2008; McCarthy & McDonald, 2009). Although our study was notdesigned to directly test the above mechanisms, it enabled a partial assessment of theproposed pathways.No difference in depression and anxiety levels was observed between men withMRD and those with more spontaneous desire patterns (participants taking

Sexual and Relationship Therapy 255Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013antidepressants at the time of the survey were excluded from the analyses). Ourfindings indicate that apart from anger – which was not measured in the study –negative emotions are not defining characteristics of MRD. Similarly, the fact thatthe two groups of men did not differ in terms of reported levels of relationshipintimacy (cf. Table 2) suggests that relationship strain is an unlikely source of MRD.The third pathway (the variant sexual arousal pattern) entails at least threedistinct mechanisms responsible for decreased male desire in heterosexual relationships(McCarthy & Ginsberg, 2008); (1) homoerotic desire, (2) autoerotic preoccupation(i.e., masturbation is preferred to dyadic sexual activity) and (3) paraphilicinterest. All three mechanisms were assessed, although not robustly, in themultivariate regression model presented in Table 2. No evidence was found for therole of homoerotic desire in MRD. Men with MRD were equally but not more likelyto report having had same-sex partners in the past five years than were men withspontaneous sexual desire. In all, 16% of men with MRD and 14% of participantscharacterized with spontaneous desire pattern were not exclusively heterosexual(p 5 .27). Regarding autoerotic preoccupation, we found that the reportedfrequency of masturbation was not different among men with reduced desire,MRD and spontaneous desire – suggesting that MRD may not completely lackspontaneous desire. The finding corroborated the recent recommendation that‘‘masturbation frequency should not be considered to be a proxy for sexual desire inmen’’ (Brotto, 2010, p. 2023).Possible paraphilic interest was assessed only indirectly, through reportedfrequency of pornography use and related relationship and personal problems. Itwas assumed that men with paraphilic interest would be characterized by a higherfrequency of pornography use and/or an increased likelihood of problems resultingfrom the consumption of this specific sexually explicit material. These two measures,however, failed to distinguish between men with MRD and those with morespontaneous sexual desire.Several study limitations need to be mentioned and discussed in anticipation ofcriticism. The validity of the operationalization of MRD is the crucial point of thisstudy. Although our one-item indicator seems to have strong face validity, itsconstruct validity may be less straightforward. Although the MRD pattern has beenshown to significantly differ from the pattern of reduced sexual desire, this does notrule out the possibility that the participants categorized as men with MRD actuallyexhibited both a more responsive and a more spontaneous desire pattern. In otherwords, maybe they were simply more sexual: more proactive and more receptive. Inthat case, men with MRD would have necessarily reported more frequent sexualactivity than men with spontaneous desire. This, however, was not the case. In thiscontext, the idea that men with MRD differed from other men only by having anextraordinarily sexually proactive female partner cannot be excluded, but thepossibility does not seem very likely.This study collected no information to answer the question of whether theobserved MRD pattern was a primary (lifelong) or secondary (acquired) characteristic.The type of responsiveness observed in a minority of participants may havebeen only a temporary state (for example, a situational reaction to a set of specificlife circumstances) and not a more durable characteristic. Our assessment of thethree patters of sexual desire should be understood as time- and partner-specific. Itdoes not negate the possibility that men may experience different desire patterns atdifferent times or with different sexual partners.

256A. Sˇtulhofer et al.In addition, the study questionnaire contained no direct measures of the variantarousal pattern (cf. McCarthy & Ginsberg, 2008), which substantially hampered theexploration of the possible presence of paraphilic interests among men with MRD.Finally, as both samples were non-probabilistic, no population estimates of theprevalence of MRD were possible. If MRD proves to be uncommon, as suggested bythis study, low statistical power associated with only small proportions of participantshaving the trait of interest would remain a problem for future studies.Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013ConclusionThis study represents the first attempt to assess the existence and characteristics of amore responsive sexual desire pattern among Norwegian and Portuguese men. Thefindings indicated that a small minority of men reported sexual behavior indicativeof responsive desire. In addition to reporting similar levels of sexual satisfaction,sexual functioning, sexual intercourse and masturbation, participants characterizedby the responsive desire pattern were indistinguishable from men with a morespontaneous sexual desire on a number of sociodemographic, health-related,sociosexual and relationship-related variables. As previous clinical observationsabout the roles of depression, intimacy deficit or autoerotic or homoerotic arousalpatterns in the etiology of male hypoactive sexual desire did not seem relevant formen with responsive desire, this study offers some preliminary evidence for the nonpathologicalnature of responsive male sexual desire.Our findings revealed a diversity of sexual motivation among men (Janssen,McBride, Yarber, Hill, & Butler, 2008). Some men most often engage in partneredsex with sexual desire, while other seem to respond to their partner’s interest –without really desiring sexual contact. Clinicians should be aware of this diversityand of the existence of different pathways in the pursuit of men’s sexual satisfaction.Note1. In comparison to Portuguese men, Norwegian participants self-assessed a negative impactof the length of relationship on their sexual motivation as significantly more substantial(t[610.7] ¼ 74.59, p 5 .001).Notes on contributorsAleksandar Sˇ tulhofer is full professor of Sociology at the University of Zagreb andAffiliated Faculty of the Kinsey Institute for Research in Sex, Gender, andReproduction. He is a member of the International Academy of Sex Research andthe Scientific Committee of the European Federation of Sexology. Apart fromresearch and teaching, he is also active as a sex therapist.Ana Alexandra Carvalheira received her European PhD certificate in Psychologyfrom the University of Salamanca, Spain. She is a member of the InternationalAcademy of Sex Research and President of the Portuguese Society of ClinicalSexology. Psychotherapist registered with the Portuguese College of Psychologists,she has been engaged in clinical work in the field of sexology for sixteen years.Bente Træen is Professor of Health Psychology at the University of Oslo. She hasworked with the National Institute of Public Health and National Institute for

Downloaded by [b-on: Biblioteca do conhecimento online ISPA] at 04:47 02 November 2013258A. Sˇtulhofer et al.Sˇ tulhofer, A., Busˇ ko, V., & Brouillard, P. (2011). The New Sexual Satisfaction Scale and itsshort form. In T.D. Fisher, C.M. Davis, W.L. Yarber, & S.L. Davis (Eds.), Handbook ofsexuality-related measures (3rd ed., pp. 530–532). New York: Routledge.Træen, B., & Skogerbø, A. (2009). Sex as an obligation and interpersonal communicationamong Norwegian heterosexual couples. Scandinavian Journal of Psychology, 50, 221–229.Watt, J.D., & Ewing, J.E. (1996). Toward the development and validation of a measure ofsexual boredom. Journal of Sex Research, 33, 57–66.