What Do Women Want

of limitless torment.
    While she was working with this supervisor, Brotto was also trying to help gynecological cancer patients with their sexual problems after surgery. The women who talked about lost libido, she thought, described their disconnection and sadness during sex in a way that was similar to the language borderline personality patients used to depict their entire lives. She wondered if mindfulness could help draw these women away from detachment and connect them to sensation.
    She did some experimenting on herself. She didn’t see herself as lacking in desire, but she did like to view herself sometimes as “an n of one,” a single test subject for her ideas. Along with mindfulness, the treatment her supervisor had devised for borderline personality used cognitive therapy, with its stress on transforming patterns of thought, on reversing habits of damning self-assessment. And one day in yoga class, Brotto tried the combination.
    As she arranged her body in her usual yoga poses, she attempted “a cognitive reframe. I said to myself over and over, like a mantra, that I was a highly sexual woman, a highly responsive woman. Not that I wasn’t a sexual person, but now I was very consciously telling myself these things, taking on this persona. And there was the mindfulness. That’s a part of yoga anyway; you’re deeply aware of what your body is doing. You’re aware of your breathing, your heartbeat. But that day there was a deliberate intent not only to listen to my body even more than I would normally in yoga but also to interpret the signs from my body as signs of my sexual identity. So my breathing was not just breathing through the pose; it was breathing because I was highly sexual.”
    Sensation and self-image became linked. She was in a tricky position, bent over and balanced on one foot and one inverted hand, when she had a profound moment. It wasn’t that anything she was trying mentally was in itself so stunningly new. The power of positive thought was a cliché. And the acute concentration on the sensory harkened back to a style of sex therapy practiced by Masters and Johnson decades earlier. Yet by melding the two, something revelatory happened. Suddenly her straining muscles and racing heart were affirmations “of my sexual vigor, my arousability.” She finished class and walked out onto the street and bicycled home with an exhilarating sense of her own body, her potency.
    Brotto took what she learned treating borderline personality—the raisins came from that training—and what she discovered in yoga class, and tested it first with her gynecological cancer patients, then with a range of women who rued their weak desire. These days she sent her groups home to repeat over and over and over, “My body is alive and sexual,” no matter if they believed it. And she guided them in the conference room, “Lift the raisin to your lips. . . . Notice that your mouth has begun to salivate. . . . Place the raisin in your mouth, without chewing it. Close your eyes and just notice how it feels. . . . Notice where the tongue is, notice saliva building up in your mouth. . . . Feel your teeth biting through the surface. Notice the trajectory of the flavor as it bursts forth, the flood of saliva, how the flavor changes from your body’s chemistry. Notice the clenching of your jaw when chewing, the sensation of the raisin passing down the throat as it is swallowed. Notice the aftertaste and even the echo of the aftertaste.”
    Her results, published in the leading journals of sex research, showed her patients reporting stronger libidos and stronger relationships, though she was quick to note the caveats: that desire isn’t easy to measure; that people are prone to claim improvement on questionnaires given by those who treat them; that just about any method that gets someone to think of sex can increase her interest in having it. And Brotto wasn’t maintaining that she could grant her patients what they actually wished for. She had quoted to me from their files: “I want to have sex where I feel like I’m craving it.” She sighed. She couldn’t provide that, not without a semimiracle or someone new in the patient’s bed.
    I asked her about an irony within her DSM work: that while disorders were supposed to be abnormal, HSDD seemed to be a normal abnormality, a condition that was largely not psychiatric but created by our most common domestic arrangement. This was confirmed by all the