Women With Very Low Sexual Desire Still Have Sex Several Times a Month, Study Finds

Women diagnosed with chronically low sexual desire may still engage in sexual activity with their partners several times a month, according to a new analysis of clinical trial data. Researchers argue that this pattern, which they describe as “mercy sex,” raises questions about how the effectiveness of treatments for low sexual desire is measured.

The study, published in the Journal of Sex & Marital Therapy, examined baseline data from trials involving women with hypoactive sexual desire disorder (HSDD), a condition characterized by persistently low sexual desire accompanied by personal distress. Despite their diagnosis, participants commonly reported sexually satisfying events before receiving active treatment.

Rethinking how treatment success is measured

Clinical trials of treatments for HSDD have often used the number of sexually satisfying events as one measure of effectiveness. Sexual encounters that participants considered satisfying could therefore contribute to treatment outcomes even when the encounter was not initiated because of spontaneous desire.

This distinction matters because sexual frequency and sexual desire are not necessarily equivalent. A person may choose to have sex for reasons including intimacy, affection or maintaining connection with a partner, even when spontaneous desire is low.

The researchers therefore questioned whether counting sexual events alone adequately captures meaningful improvement in HSDD.

Similar patterns across several clinical trials

Lead authors Nikita Guptan and James A. Simon of IntimMedicine Specialists in Washington, D.C., retrospectively analyzed baseline data from randomized, placebo-controlled trials conducted over nearly a decade. The trials investigated treatments including a testosterone patch, flibanserin and bremelanotide.

Four testosterone patch studies involving 2,204 naturally and surgically menopausal women showed relatively consistent baseline sexual activity. Participants reported an average of approximately 2.5 to 2.9 sexually satisfying events every 28 days before active treatment.

Four U.S. flibanserin trials involving 3,413 women showed a similar pattern, with approximately 2.0 to 3.0 sexually satisfying events per 28 days at baseline. Younger premenopausal participants generally reported somewhat higher frequencies than menopausal participants.

An unpublished flibanserin study involving 915 women across 13 European countries reported an average of 2.41 events per month. Country-level averages ranged from 4.19 in the Czech Republic to 1.12 in Italy.

Two bremelanotide trials involving more than 1,200 women recorded lower baseline frequencies of approximately 1.2 events per month. The authors suggested that differences in study design, including a four-week placebo observation period, may have contributed to the lower figure.

Why sex can occur without spontaneous desire

Guptan and Simon interpret the baseline sexual activity as potentially reflecting sex motivated by factors other than intrinsic desire. These could include maintaining intimacy, responding to a partner’s needs or preserving a relationship.

However, the term “mercy sex” represents the authors’ interpretation and should not be assumed to describe every sexual encounter recorded in these trials. The baseline data show that women with HSDD continued to have sex, but they do not establish the motivation behind each encounter.

The paper discusses evolutionary explanations for sex undertaken to maintain partner investment or reduce concerns about infidelity. Such explanations remain theoretical and should not be treated as evidence that women generally engage in unwanted sex for evolutionary reasons.

The authors also reference Rosemary Basson’s circular model of female sexual response, which emphasizes that sexual motivation does not always begin with spontaneous desire. For some women, willingness to engage in intimacy may precede arousal or desire, particularly within an established relationship.

This is importantly different from assuming that sex without initial spontaneous desire is necessarily unwanted or performed solely out of obligation.

Social and cultural factors may also matter

The authors discuss how cultural, social and religious expectations can influence attitudes toward sex within relationships. Historically, some religious traditions have framed marital sexual obligations through concepts such as “conjugal debt.”

The variation between countries in the European flibanserin data could be consistent with cultural differences, but the study cannot establish why those differences occurred. Factors including participant characteristics, reporting practices and other social influences could also contribute.

The authors discuss historical changes in Italy, including the decriminalization of female adultery in 1968, but any connection between such changes and the trial’s lower Italian baseline frequency remains speculative.

The analysis also focused on heterosexual women in monogamous relationships, limiting how broadly its conclusions can be applied to other sexual orientations and relationship structures.

Implications for future treatments

One of the study’s central arguments concerns what constitutes a “satisfying” sexual event. Satisfaction can potentially reflect physical pleasure, emotional closeness or other positive aspects of an encounter and does not necessarily indicate strong desire before sex began.

For this reason, changes in sexual-event frequency and changes in sexual desire should not automatically be treated as interchangeable outcomes.

The researchers argue that future HSDD trials could more clearly distinguish among spontaneous desire, responsive desire, physical arousal, emotional satisfaction and sex motivated partly by relationship considerations.

Such measures could provide a more detailed picture of whether a treatment changes sexual desire itself rather than simply changing the frequency of sexual activity.

At the same time, the retrospective analysis cannot determine how many of the baseline encounters were actually motivated by obligation, fear of infidelity or what the authors call mercy sex. The trials were not originally designed to measure those motivations directly.

The study, titled Quantification of Mercy Sex in Heterosexual Women, therefore raises an important measurement question rather than demonstrating that women with HSDD routinely have sex primarily out of duty. Its findings highlight why sexual frequency alone may not capture the complex relationship between desire, motivation and satisfaction.

Article prepared by Victoria Caldwell.