In the 1970s psychiatrist Helen Singer Kaplan of the Human Sexuality Program at Weill Medical College of Cornell University added a critical element to this cycle—desire—based on her experience as a sex therapist. In her three-stage model, desire precedes sexual excitation, which is then followed by orgasm. Because desire is mainly psychological, Kaplan emphasized the importance of the mind in the sexual experience and the destructive forces of anxiety, defensiveness and failure of communication.

In the late 1980s gynecologist Rosemary Basson of the University of British Columbia proposed a more circular sexual cycle, which, despite the term, had been described as a largely linear progression in previous work. Basson suggested that desire might both lead to genital stimulation and be invigorated by it. Countering the idea that orgasm is the pinnacle of the experience, she placed it as a mere spot on the circle, asserting that a person could feel sexually satisfied at any of the stages leading up to an orgasm, which thus does not have to be the ultimate goal of sexual activity.

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