Women diagnosed with hypoactive sexual desire disorder (HSDD) may continue to have sexually satisfying experiences despite experiencing persistently low sexual desire. A 2026 review of clinical-trial data found that women with HSDD reported an average of about 2.5 sexually satisfying events per month before treatment (Guptan & Simon, 2026).
The researchers used the term “mercy sex” to describe this apparently counterintuitive pattern. But the term requires an important qualification: the underlying clinical trials did not ask individual women why they engaged in each sexual encounter.
The study therefore establishes something narrower than the phrase “mercy sex” might imply. Women can experience clinically significant low sexual desire while continuing to engage in sexual activity, including activity they report as sexually satisfying. The data cannot establish whether those encounters occurred because of affection, relationship dynamics, responsive desire, a sense of obligation, a wish to please a partner, or another motivation (Guptan & Simon, 2026).
That distinction is important for patients, clinicians, and researchers because sexual desire, sexual activity, and sexual satisfaction are related but are not interchangeable measures.
It also connects the 2026 findings with a much older debate in sexual-medicine research: Does counting sexually satisfying events really tell researchers whether a treatment has improved a woman’s sexual desire?
Women with HSDD reported about 2.5 sexually satisfying events per month before treatment, but researchers could not determine why the sexual activity occurred.
Key Takeaways
- Researchers reviewed baseline data from previously published randomized, placebo-controlled HSDD clinical trials (Guptan & Simon, 2026).
- Women in the reviewed trials reported approximately 2.5 sexually satisfying events per month before treatment, despite having documented low or absent sexual desire (Guptan & Simon, 2026).
- The authors called this phenomenon “mercy sex,” but the underlying trial data did not directly establish why individual women had sex.
- The findings do not demonstrate that the encounters were unwanted, coerced, or performed exclusively for a partner.
- The 2.5-events-per-month figure should not be generalized to all women with HSDD.
- Earlier research had already questioned whether sexually satisfying events reliably reflect changes in desire and distress (Kingsberg & Althof, 2011).
- Later treatment research has assessed sexual events alongside desire, distress, and patients’ own perceptions of improvement, illustrating why HSDD outcomes cannot easily be reduced to a single number (Simon et al., 2022).
What Is Hypoactive Sexual Desire Disorder?
Hypoactive sexual desire disorder describes clinically significant problems with sexual desire that are associated with personal distress.
In their 2026 paper, Guptan and Simon describe HSDD using criteria referenced to the DSM-IV-TR, including a lack of sexual thoughts, desire, or receptivity that causes personal difficulty or distress (Guptan & Simon, 2026).
Diagnostic terminology surrounding problems with sexual interest has evolved over time. That context is worth remembering when interpreting older HSDD clinical trials and newer analyses based on those trials.
One point, however, is particularly relevant to the new research: having clinically significant low desire does not necessarily mean that a person has stopped engaging in sexual activity.
What Did the 2026 Study Find?
Guptan and Simon (2026) reviewed baseline data on sexually satisfying events from a representative convenience sample of published, peer-reviewed, prospective, randomized, placebo-controlled trials involving heterosexual women with HSDD.
The clinical trials included research evaluating HSDD treatments such as testosterone therapy, flibanserin, and bremelanotide.
This was not a new clinical trial. The researchers did not recruit a new group of women and follow their sexual behavior. Instead, they examined baseline information that had already been collected in previous HSDD trials.
The researchers assessed sexually satisfying events across differences in time, age, reproductive status, and geography (Guptan & Simon, 2026).
Across the trials they reviewed, women reported approximately 2.5 sexually satisfying events per month at baseline.
In other words, these women were entering clinical trials because of clinically documented problems with sexual desire, yet some sexual activity classified as satisfying was still occurring.
That observation raises an obvious question: Why?
The available data cannot answer it.
Why Did the Researchers Call It “Mercy Sex”?
Guptan and Simon (2026) introduced “mercy sex” as their term for sexual activity occurring among women with documented HSDD despite low or absent desire. The authors also offered hypothetical biopsychosocial explanations for the behavior.
The word hypothetical is important.
The researchers were not reporting that women had been interviewed after individual encounters and said, for example, “I had sex because I felt sorry for my partner.”
The underlying data measured sexually satisfying events. They were not specifically collected to establish the motivation behind every encounter.
For that reason, the term “mercy sex” should not be treated as a proven psychological explanation for the approximately 2.5 monthly events.
What the evidence supports is simpler:
Women with clinically significant low sexual desire can continue to engage in sexual activity.
Why a particular woman participated in a particular encounter is a separate question that this analysis could not answer.
Why Might Someone Have Sex When Desire Is Low?
Sexual behavior does not necessarily follow a simple pattern in which spontaneous desire must always come first.
A person could potentially engage in sexual activity for many reasons, including affection, intimacy, closeness, relationship considerations, interest that develops in response to sexual activity, or a desire to please a partner.
But those possibilities should not be confused with findings from the 2026 study.
Guptan and Simon (2026) did not have participant-level information that allowed them to determine the motivation behind each sexually satisfying event.
The same limitation works in both directions.
The study does not establish that the women were having sex primarily for their partners. It also does not establish that the reported encounters were unwanted, pressured, or coerced.
Those conclusions would go beyond the evidence.
Sexual Desire, Sexual Activity, and Sexual Satisfaction Are Different
The study becomes easier to understand when three related concepts are separated.
Sexual desire concerns interest in or desire for sexual activity.
Sexual activity concerns whether sexual behavior occurs.
Sexual satisfaction concerns how a sexual experience is evaluated.
These concepts can be related without being identical.
This is particularly important because Guptan and Simon (2026) analyzed sexually satisfying events, commonly abbreviated as SSEs. They were not simply counting every sexual encounter.
The baseline data therefore indicate that women who met criteria for HSDD could nevertheless report events classified as sexually satisfying.
That does not mean the study established that women began each encounter without desire and subsequently became satisfied. The available data cannot reconstruct what an individual participant felt before, during, and after each event.
Instead, the finding demonstrates a broader point: the existence of satisfying sexual activity does not necessarily mean that clinically significant problems with sexual desire are absent.
Earlier Research Had Already Questioned Sexually Satisfying Events as a Measure
The concern raised by the 2026 study did not begin in 2026.
More than a decade earlier, Kingsberg and Althof (2011) examined the use of sexually satisfying events as an outcome measure in clinical trials of female sexual dysfunction.
Their review considered nine placebo-controlled randomized HSDD trials: seven evaluating transdermal testosterone and two evaluating flibanserin (Kingsberg & Althof, 2011).
The researchers compared changes in sexually satisfying events with changes in sexual desire and distress.
The results were not consistently aligned.
In four of the nine trials, changes in sexually satisfying events were generally in agreement with changes in desire and distress. In the other five trials, changes in sexually satisfying events did not consistently correspond with changes in desire and/or distress (Kingsberg & Althof, 2011).
That finding matters because it challenges a seemingly intuitive assumption: if a treatment increases the number of satisfying sexual encounters, sexual desire must necessarily have improved to the same extent.
The evidence suggested that the relationship was more complicated.
Kingsberg and Althof (2011) concluded that the literature did not uniformly support using diary-recorded sexually satisfying events as the primary endpoint in HSDD trials. They argued that patient-reported outcomes may be better suited to capturing the multidimensional and subjective nature of female sexual dysfunction.
How Does the 2026 Study Compare With the 2011 Research?
The two papers approached the same measurement problem from different directions.
Kingsberg and Althof (2011) asked whether changes in sexually satisfying events during clinical trials corresponded with changes in desire and distress.
Guptan and Simon (2026) focused on what was happening before treatment began: women with documented low or absent desire were nevertheless reporting about 2.5 sexually satisfying events per month.
The studies therefore should not be treated as replications of one another.
But together they raise a consistent methodological concern.
If satisfying sexual events can occur when desire is clinically low, and changes in satisfying events do not always track changes in desire or distress, then the frequency of sexually satisfying events cannot automatically be treated as a stand-alone measure of sexual desire.
That is arguably the most useful context for understanding the newer study.
Why This Matters for HSDD Drug Trials
Sexually satisfying events have historically been used as an endpoint in clinical trials evaluating HSDD treatments.
The logic is understandable. If a treatment successfully improves sexual desire, an increase in satisfying sexual experiences might be expected.
But consider a hypothetical participant who reports two satisfying sexual events per month before treatment and three after treatment.
The increase is objectively countable.
By itself, however, it cannot tell researchers whether her underlying desire meaningfully increased, whether distress about low desire decreased, why the additional sexual encounter occurred, or whether she personally considers her condition substantially improved.
Guptan and Simon (2026) argue that baseline sexual activity may consequently affect estimates of therapeutic efficacy, clinical-trial sample-size calculations, and interpretations of what constitutes a clinically meaningful treatment response.
This does not make sexually satisfying events useless.
Rather, it suggests that event frequency should be interpreted alongside other measures that capture different aspects of the patient’s experience.
Later HSDD Research Has Looked Beyond Event Counts
A 2022 analysis of flibanserin clinical trials provides a useful example of a broader approach to evaluating treatment response.
Simon et al. (2022) analyzed data from three pivotal trials involving premenopausal women and separate trial data involving postmenopausal women. Researchers assessed clinically meaningful benefit using the Patient Global Impression of Improvement (PGI-I) alongside key outcomes involving sexually satisfying events, sexual desire, and distress associated with decreased sexual desire.
Among premenopausal participants, 49.8% of women receiving flibanserin reported clinically meaningful benefit on the PGI-I compared with 33.6% receiving placebo. Among postmenopausal participants, the corresponding figures were 40.5% and 28.7% (Simon et al., 2022).
The study was evaluating treatment efficacy rather than investigating why women with HSDD engage in sexual activity, so it does not directly confirm the 2026 “mercy sex” hypothesis.
Its relevance is methodological.
Simon et al. (2022) assessed treatment response across several dimensions rather than relying exclusively on the number of sexually satisfying events. The researchers specifically noted that patient-reported assessments such as the PGI-I capture the patient’s perspective and may help assess the overall clinical meaningfulness of treatment.
The paper also identified the use of sexually satisfying events as a limitation because the endpoint is indirectly related to HSDD (Simon et al., 2022).
Taken together, the 2011, 2022, and 2026 papers illustrate an evolution toward asking not only “Did the number of sexual events change?” but also “Did desire, distress, and the patient’s own experience meaningfully improve?”
Does Having Sex 2.5 Times a Month Mean HSDD Is Not Severe?
No.
Sexual frequency alone cannot establish whether someone has clinically significant problems with sexual desire.
The women represented in the 2026 analysis had documented HSDD while nevertheless reporting some sexually satisfying activity (Guptan & Simon, 2026).
That is precisely why the finding is noteworthy.
A person can engage in sexual activity while still experiencing low desire and distress related to that low desire.
The number of times someone has sex therefore should not, by itself, be used to dismiss concerns about sexual desire.
Does the Study Show That Women Were Having Unwanted Sex?
No.
The data do not establish that conclusion.
They also cannot establish the motivation behind every encounter.
Because the researchers analyzed previously collected trial data rather than interviewing participants about individual sexual experiences, they could not determine whether an encounter reflected affection, intimacy, responsive interest, relationship considerations, perceived obligation, or another motivation (Guptan & Simon, 2026).
There is likewise no basis in these data for assuming that the reported sexually satisfying events represented coercion.
The scientifically defensible conclusion is that motivation was not directly established.
Does the Study Prove That Women With HSDD Typically Have Sex 2.5 Times Per Month?
No.
This is an important limitation.
The approximately 2.5-events-per-month figure describes women represented in the clinical trials reviewed by Guptan and Simon (2026). It is not a population estimate for every woman with HSDD.
The researchers used a representative convenience sample of previously published clinical trials rather than conducting a new population-based study.
People who qualify for and participate in clinical trials may differ in important ways from the broader population of people experiencing low sexual desire.
The analysis also concerned heterosexual women represented in the selected trials.
The accurate interpretation is:
Women in the HSDD clinical trials reviewed by the researchers reported approximately 2.5 sexually satisfying events per month at baseline.
It should not be converted into the broader claim that all women with HSDD typically have sex 2.5 times per month.
What Are the Main Limitations of the 2026 Study?
Several limitations determine how the findings should be interpreted.
First, this was a review of existing clinical-trial data, not a new trial or observational study designed specifically to investigate why women engage in sex when desire is low (Guptan & Simon, 2026).
Second, the researchers generated no new participant data.
Third, the underlying clinical-trial data did not directly establish the motivation behind individual sexually satisfying events.
Fourth, the 2.5-events-per-month estimate came from selected clinical trials rather than a population-based sample.
Fifth, the authors’ term “mercy sex” is an interpretation of the observed phenomenon. It should not be mistaken for a motivation individually reported by every woman whose data contributed to the analysis.
Finally, sexually satisfying events themselves represent only one dimension of sexual functioning. Previous research demonstrates why desire, distress, satisfaction, event frequency, and patients’ perceptions of improvement may not always move together (Kingsberg & Althof, 2011; Simon et al., 2022).
Conflicts of Interest and Funding
Financial disclosures provide important context when interpreting medical research, particularly research involving pharmaceutical treatments.
Guptan reported no potential conflicts of interest. Simon disclosed research support, consulting relationships, speaker’s bureau participation, and other financial relationships with multiple pharmaceutical and healthcare companies. He also reported being a stockholder in Sermonix Pharmaceuticals (Guptan & Simon, 2026).
The authors reported that the research received no specific grant from public, commercial, or nonprofit funding agencies. Editorial assistance with preparing the manuscript for journal submission was supported by Simon (Guptan & Simon, 2026).
These disclosures do not establish that the study’s conclusions are incorrect. They allow readers to evaluate the research with relevant information about potential competing interests.
What Does This Research Actually Tell Us?
The most useful takeaway from the 2026 study may not be the provocative phrase “mercy sex.”
It is the distinction between desiring sex, having sex, and experiencing sex as satisfying.
Women represented in the HSDD clinical trials reviewed by Guptan and Simon (2026) reported approximately 2.5 sexually satisfying events per month at baseline despite having documented problems with sexual desire.
The researchers could quantify those events, but the underlying data could not establish why each encounter occurred.
Earlier research provides important context. Kingsberg and Althof (2011) found that changes in sexually satisfying events did not consistently align with changes in desire and distress across HSDD trials. Later research has incorporated sexual events alongside desire, distress, and patient-reported perceptions of improvement when evaluating treatment benefit (Simon et al., 2022).
Together, these findings support a cautious conclusion:
Sexual-event frequency can provide useful information, but it does not tell the whole story of sexual desire.
For patients and partners, this means that how often someone has sex should not automatically be interpreted as a measure of how much sexual desire that person experiences.
For clinicians and researchers, it reinforces the importance of considering desire, distress, satisfaction, sexual activity, and the patient’s own perception of improvement as related but distinct outcomes.
And for anyone encountering the phrase “mercy sex” in connection with this research, one limitation should remain clear: the study documented sexual activity in women with low desire; it did not establish a universal reason why those women were having sex.
References
Guptan, N., & Simon, J. A. (2026). Quantification of “mercy sex” in heterosexual women. Journal of Sex & Marital Therapy, 52(5), 474–484. https://doi.org/10.1080/0092623X.2026.2651862
Kingsberg, S. A., & Althof, S. E. (2011). Satisfying sexual events as outcome measures in clinical trial of female sexual dysfunction. The Journal of Sexual Medicine, 8(12), 3262–3270. https://doi.org/10.1111/j.1743-6109.2011.02447.x
Simon, J. A., Clayton, A. H., Kim, N. N., & Patel, S. (2022). Clinically meaningful benefit in women with hypoactive sexual desire disorder treated with flibanserin. Sexual Medicine, 10(1), 100476. https://doi.org/10.1016/j.esxm.2021.100476
