Women Who Want to Want
By DANIEL BERGNER
At her group therapy sessions for women despairing of low sexual desire, Lori Brotto likes to pass around a plastic tub of raisins. The women, usually six to a group, sit around two pushed-together beige tables in a fluorescently lighted conference room at the British Columbia Center for Sexual Medicine in Vancouver. A little pottedtree is jammed randomly in one corner. Ragged holes scar one wall where a painting used to hang. The décor doesn’t speak of sensuality. That is the job of the raisin.
Brotto asks each woman to take a single raisin from the small tub. A slender, elegant 34-year-old psychologist, a mother of two with a third child on the way, she began her career studying the libidos of rats. She is now one of theworld’s leading specialists in what is known as hypoactive sexual desire disorder in women. She is in charge of defining the condition’s criteria for the next Diagnostic and Statistical Manual of Mental Disorders, commonly called the D.S.M, which the American Psychiatric Association is preparing to publish in 2012 or 2013. The book is the bible of psychiatric diseases, from autism to sleepwalking,relied on by researchers and clinicians throughout the United States and Canada. Studies suggest that around 30 percent of young and middle-aged women go through extended periods of feeling dim desire — or of feeling no wish for sex whatsoever. “Black raisins,” Brotto said, laughing at her own arbitrary preference as she described her methods. “I don’t like brown raisins or green raisins or cookedraisins.”
She handed me the script she has developed for the exercise. We sat, in August, in her orderly, compact office, with a reproduction of “The Kiss,” by Gustav Klimt, mounted above her desk. She wore a blue paisley skirt and a cream-colored blouse; her short dark hair was cut stylishly and angled close to her jaw. The couple in the painting, with the woman either bending sublimely in theman’s emphatic embrace or wincing away from his lips, floated over Brotto’s copy of the current D.S.M., which lay open to the disorder that has become her obsession.
“I’d like you to start by examining your raisin,” the script reads. “Study its shape, its contours, its folds. Touch the raisin with a finger. Look into the valleys and peaks, the highlights and dark crevasses. Lift the raisin to yourlips.”
MORE THAN BY any other sexual problem — the elusiveness of orgasm, say, or pain during sex — women feel plagued by low desire. The problems often overlap, but above all the others that can thwart an erotic life, the remoteness of lust is what impels women to seek treatment. And as Brotto discusses the disorder, she is not talking about something physical. She regularly wires the genitalsof her patients to a photoplethysmograph to measure whether the women respond with surges of vaginal blood flow while they watch a pornographic video. Almost always, they do.
Brotto is dealing in the domain of the mind, or in the mind’s relationship to the body, not in a problem with the body itself. Beneath Klimt’s couple, she opened yellow case folders and described the desolation andbewilderment recorded in her notes. She spoke about a woman in her 40s who, years ago, had sex with her husband as often as seven times in a day but who now, more than a decade into a marriage with this still-handsome man, cringes at the very same gesture, the very same touch to her back, that once electrified her. Two or three months might go by now without their having sex. “It’s fine for me not to havesex at all,” Brotto quoted the wife, and commented, “I hear that from a lot of women.” And yet, at the same time, the lack of libido isn’t fine at all. “What exactly is turning me off?” Brotto read the wife’s plaintive question.
Brotto talked as well about another woman in early middle age, who had no period of lust to look back on, whose sexual indifference had prevailed throughout her long —...