What Do Women Want

asson’s colleague at the University of British Columbia, Lori Brotto, served on the DSM ’s sexuality committee. It was a group of thirteen, and, with the manual about to be fully revised for the first time since the early nineties, she was in charge of the work on female desire. She had high cheekbones, a face that was all angles, hair cut fashionably close to her jaw. About women with the condition the current DSM called “hypoactive sexual desire disorder” or HSDD, she told me, “Sometimes I wonder whether it isn’t so much about libido as it is about boredom.” For her, monogamy was less hovering angel than grim reaper.
    A psychologist whose sexuality research ran from hormones to acupuncture, Brotto treated women for HSDD in solo therapy and group sessions. “And unless you’re talking about lifelong HSDD, which is rare, the impact of relationship duration is something that comes up constantly.” In middle-aged women, she said, directing me to an Australian study that tracked hundreds of subjects from their forties onward, through menopause, hormones probably weren’t as much of a problem as the length of time a woman had been with the same partner. (The Australian psychiatrist Lorraine Dennerstein, who had conducted that research, was more emphatic: “The sexual feelings of a new relationship can easily override hormonal factors.”)
    Yet Brotto, who was in her mid-thirties, who had been married for eight years, who was pregnant with a third child when we first met at a psychiatric conference, didn’t mean to cast an all-encompassing pall on the ideal of long and loyal relationships. She was speaking about one aspect, about sex. And since monogamy simply was the prevailing standard—not only within the culture but within her profession—for success as a couple, and since it had a scarcely questioned status within the thinking of her committee, she was writing Basson’s ideas into the DSM . They were ideas Brotto used with her patients, most of them long attached to one lover. She taught the circle, taught “desire follows arousal,” taught these concepts as a way to begin to address disinterest in sex.
    Seven years? Two? Less? More? Long attachment was impossible to define, turning points impossible to predict. But if Brotto could help her patients to become more responsive to the touches of their partners, if she could help them to feel more physically aroused, then even if they started out, in any given encounter, indifferent to their partners’ overtures, they might reach a state of desire. To this end, she employed a little tub of raisins, passed around at her group meetings: six women sitting at a pair of pushed-together beige tables in a small windowless conference room. She asked each patient to take exactly one. “Notice the topography of your raisin,” she instructed in steady cadences, her Canadian accent abbreviating some of her vowels. “The valleys and peaks, the highlights and dark crevasses.”
    Her career, her path to the raisin exercise and to her rarified spot on the DSM committee, had been mapped out by chance. As a first-year undergraduate, she knew only that she wanted to do research, no matter what the discipline. She hadn’t thought about studying sex at all. “I grew up in a strict, Italian Catholic, don’t-talk-about-sex environment.” Even now, a silver cross hung from the rearview mirror of her car. She had knocked haphazardly on professors’ office doors, hoping for anyone who would have her as an assistant. No one would; she was too young. But at last a professor invited her to help with his study of antidepressants and their effect on male rat libidos, so, for the next few years, she clutched a stopwatch and tallied copulations. Then, as she headed toward a doctorate, she steered away from animal research and toward clinical work, “because,” she said, “the rat room smelled.”
    During her advanced training she did a stint with borderline personality patients. The condition mangles self-image to the point of horror: self-perception grows hideous. People are driven to cut or burn themselves; they ache to replace infinite despair with finite pain. Brotto’s supervisor had developed a treatment that borrowed from the Buddhist technique of mindfulness. The idea was that keen awareness of immediate and infinitesimal experience, down to the level of breath or the heart’s beating, might help to hold patients within the present and reduce their feelings