The first weakness of the EPOR model is that it was derived from the study of a highly selected group of American men and women volunteers who could arouse themselves to orgasm in a laboratory, on demand, and allow themselves to be watched/filmed or measured for scientific and altruistic (or perhaps exhibitionistic) purposes. The second weakness was the lack of interobserver agreement about the changes observed and of confirmation of their sequential reliability. Robinson (21) examined the E phase and P phase, and concluded convincingly that the P phase was simply the final stage of the E phase. Helen Kaplan, (22) a New York sex therapist, proposed that before the E phase there should be a 'desire phase' (D phase). This proposal came from her work with women who professed to have no desire to be sexually aroused, even by their usual partners. She suggested that the desire must occur before sexual arousal can begin. Kaplan's subjects were attending a clinic and no studies were ever conducted with a control normal population (either women or men) to investigate whether this 'self-evident' fact was true. Despite this, the EPOR model gradually became replaced by the desire, excitation, orgasmic, and resolution phase ( DEOR) model. While this is the currently accepted model, the centrality of the desire phase in women remains uncertain ( Fig 1). In a survey of non-clinic sexually experienced women in Denmark, about a third reported that they never experienced spontaneous sexual desire(23) and in an American survey women reported periods of several months when they lacked interest in sex.(15) The other problem with the desire phase is its location in the sequential DEOR model. Sexual desire that appears to be spontaneous (but presumably must still be activated by a learned trigger) should obviously be placed at the beginning of the model ( Fig 1)(b)), but what of sexual desire created when the person is sexually aroused by another? Where do we place this sexual desire, at the early stages of the excitation phase ( Fig 1)(c))? Courtship behaviour, which begins the initiation of sexual activity, is also difficult to position in regard to the DEOR ( Fig 1)(d)).
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