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Women experiencing a chronic lack of sexual desire still routinely engage in sexual activity with their partners, a behavior researchers have quantified as happening about two and a half times per month. These baseline events, often motivated by relationship obligations rather than personal arousal, could alter how medical treatments for low sexual desire are evaluated. The findings were published in the Journal of Sex & Marital Therapy.
Hypoactive sexual desire disorder is a condition where a person persistently lacks sexual thoughts or desire, leading to personal distress. Clinical trials for treatments often measure success by tracking an increase in sexually satisfying events. A sexually satisfying event is defined as any sexual activity, from intercourse to manual stimulation, that a participant considers fulfilling.
In 2015, the Food and Drug Administration approved the first drug for premenopausal women with this condition. During the evaluation process, the agency required pharmaceutical companies to measure success using criteria similar to those used for male erectile dysfunction. This meant focusing heavily on the frequency of sexual events. The disorder is fundamentally a cognitive dysfunction related to a lack of mental desire, whereas erectile dysfunction is often tied to vascular or anatomical issues. Using event frequency to measure a psychological lack of desire created a mismatch in the data.
Nikita Guptan and James A. Simon, researchers at IntimMedicine Specialists in Washington, D.C., noticed a pattern in these trials. Women diagnosed with a complete lack of sexual desire were still logging multiple sexual events before receiving any medication. Guptan and Simon sought to quantify this baseline activity, which they termed mercy sex.
The researchers define this behavior as consensual participation in sexual acts not for personal arousal, but to fulfill a perceived obligation. By examining these baseline numbers, the authors aimed to understand the prevalence of this behavior and explore the social and psychological reasons behind it.
The researchers analyzed baseline data from multiple randomized, placebo-controlled trials spanning nearly a decade. These trials tested three different medical treatments for low sexual desire. The researchers first looked at four clinical trials evaluating a testosterone patch, which included a large sample of 2,204 naturally and surgically menopausal women.
In these testosterone studies, the baseline frequency of sexual events remained highly consistent. Across the different trial groups, the women reported an average of 2.5 to 2.9 sexually satisfying events per 28 days. This rate showed very little variation regardless of whether the women were naturally menopausal, surgically menopausal, or taking hormone therapies.
Next, Guptan and Simon evaluated data from clinical trials testing flibanserin, an oral medication approved for low sexual desire. They reviewed four trials conducted in the United States, comprising a large sample of 3,413 women. The baseline data for these trials showed a similar pattern, with women reporting between 2.0 and 3.0 sexually satisfying events every 28 days.
The researchers noted that older participants tended to report slightly lower frequencies. A trial focusing on naturally menopausal women with an average age of 55 reported the lowest baseline frequency at 2.0 events. Trials focusing on younger, premenopausal women with an average age of 36 reported frequencies closer to 3.0 events per month.
The researchers also examined an unpublished flibanserin trial conducted across 13 European countries, which included 915 participants. The European data averaged 2.41 baseline events per month, closely mirroring the United States findings. The rates varied widely between individual countries, ranging from 4.19 events per month in the Czech Republic to 1.12 in Italy.
Finally, the authors analyzed two trials evaluating bremelanotide, an injectable medication for low sexual desire. These two trials included over 1,200 women. The baseline frequencies in these studies were notably lower, averaging about 1.2 events per month. The researchers attribute this lower number to the specific design of the bremelanotide trials, which included a four-week observation period where participants took a placebo before the actual baseline measurements were finalized.
Guptan and Simon suggest a biopsychosocial framework to explain why women with low desire consistently engage in sexual activity. From an evolutionary perspective, women may participate in sex to maintain stability and prevent their partners from seeking intimacy elsewhere.
According to sexual selection research, males and females often have different reproductive strategies. Short-term mating strategies might benefit males seeking multiple partners, but they can disadvantage females who historically required stability and resource sharing to raise offspring.
The authors hypothesize that women may have learned to keep their male partners monogamous by fulfilling their faster-paced reproductive desires. In modern contexts, this translates to engaging in obligatory sex as a defense mechanism to preserve a long-term relationship. One qualitative study cited by the authors featured a patient who reported forcing herself to have sex to prevent her husband from satisfying his needs with someone else.
The authors suggest that women might also use sex as a tool to fulfill a psychological need for emotional closeness, even if the physical desire is absent. The authors reference Rosemary Basson’s circular model of sexual response, a psychological framework suggesting that female sexual arousal is highly nuanced and often driven by a need for emotional connection rather than spontaneous physical hunger.
Because men are socially conditioned to associate physical sex with emotional closeness, women may engage in sex simply to maintain that emotional bond. They learn to accept the physical act as a replacement for pure emotional intimacy, complying with their partner’s expectations to avoid conflict or emotional distance.
Social and religious conditioning can play a role in setting expectations for marital duties as well. The authors noted that countries with historically strict religious frameworks regarding marital obligations, such as Catholic teachings on conjugal debt, often showed varying rates of this behavior. Italy, for instance, had the lowest reported rate, which the authors speculate might relate to cultural shifts following the 1968 decriminalization of female adultery.
The analyzed data relies on samples limited to heterosexual women in monogamous relationships. The proposed explanations regarding partner dynamics and evolutionary pressures do not reflect the experiences of women in non-heterosexual relationships or those without regular partners.
The use of the term “satisfying” in these clinical trials is highly subjective. A participant might log an event as satisfying because it fostered emotional intimacy or resolved a relationship conflict, rather than providing physical gratification.
Future researchers designing clinical trials for sexual dysfunction will need to differentiate between an increase in actual sexual desire and an increase in obligatory sexual events. If clinical success is measured purely by the frequency of sexual activity, a drug’s true effect on internal desire could be misjudged.
The study, “Quantification of “Mercy Sex” in Heterosexual Women,” was authored by Nikita Guptan and James A. Simon.