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In an effort to attain a perceived level of ‘normal,’ women often grapple with feeling abnormal, and even broken, when it comes to their sexual desire.

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Women's sexuality is evaluated, judged, scrutinized and criticized regularly, with everyone peddling an opinion about what women are expected to feel, enjoy and participate in when it comes to sex. Women's sexual desire has received the most attention, particularly after the approval of Viagra for men in 1999 in Canada, and this interest was amplified following the approval of the female sexual-desire pill, flibanserin, by the U.S. Food and Drug Administration in 2015 (flibanserin is under review right now by Health Canada). Over the past 18 years, doctors, researchers, the public and women themselves have asked: Is my level of sexual desire normal?

Indeed, among the diverse types of sexual concerns that women have expressed in large national surveys of women across ages and reproductive stages, low sexual desire is certainly the most common, and can wreak havoc on a woman's sense of self and well-being. And considerable effort has been invested in finding creative and efficient ways of increasing women's lost libido. Despite considerable excitement about flibanserin, systematic reviews of the science show it only improves women's reports of "sexually satisfying events" by about one in every two months, compared with a placebo. In an effort to attain a perceived level of "normal," women often grapple with feeling utterly abnormal, and even broken, when it comes to their sexual desire.

But on the other end of the desire continuum, women are also often scrutinized if they are perceived to have too high a level of sexual desire. Indeed, women were labelled as "nymphomaniac" as early as the 1700s if they initiated sex with a man or were found to have a penchant for self-stimulation (masturbation). Kim Cattrall's character, Samantha, in the famous HBO series Sex and the City, was praised by some as a symbol of women's sexual agency and condemned by others for being promiscuous and equating sex with power. On the other hand, the nymphomania diagnosis was rarely given to men who displayed the same sexual proclivities. In reality, the sexual practices that were historically labelled as deviant (that is, those that violate social norms) among "nymphomaniac" women are known today to be entirely within the range of normal and even healthy. Yet, there remains a tendency by society and health-care providers to label women with too low, or too high, sexual desire as being abnormal. This tendency to pathologize is partly because of our field's lack of objective markers for what constitutes "normal" versus "abnormal" sexual behaviour.

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There is very little research carried out on women with high sexual desire, in contrast to the category of "hypersexuality," which is defined by sex researchers and experts in psychiatric diagnoses as recurrent and intense sexual fantasies, urges and behaviours, which elicit clinically significant distress for the individual. One recent large study of Croatian women published in the Journal of Sex Research in September, 2016, found women with high sexual desire reported being more sexually satisfied and having better overall sexual function than control women with more moderate levels of desire, and also compared with women with distressingly high levels of desire that might characterize hypersexuality. Importantly, women with high sexual desire differed systematically from women labelled as hypersexual on a number of domains, including their having less negative behavioural consequences. The authors concluded that women with high sexual desire should not be treated or considered to have a problem. In other words, high sexual desire in women is entirely within the spectrum of normal.

How do you know if your desire is too high, too low or just right?

1. Do you use sex as a way to cope with negative mood?

2. Do you have a sense of lack of control around your own sexuality?

3. Do you engage in sex despite harmful consequences?

4. Do you experience distress and shame associated with your sexual behaviours?

If you answered yes to most or all of these items, you may be experiencing hypersexuality and you might consider speaking with a sexual-health expert about these issues if they create distress or significant bother in your life.

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On the other hand, if you have an abundant level of sexual desire and frequently fantasize or have erotic thoughts, but these are welcome, pleasurable and do not create distress for you (or your relationship), then your desire is probably completely normal. As long as your interests and activities are consensual, you should not be made to believe these signify a problem, an abnormality or a dysfunction.

Lori Brotto, a registered psychologist, is a professor of gynecology at the University of British Columbia and executive director of the Women's Health Research Institute of BC. You can follow her on Twitter @DrLoriBrotto.

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