More serious causes of low sexual desire include clinical levels of anxiety or depression, or relationship problems. One of the most common symptoms of depression is low sexual desire or lack of interest in sex, and anxiety is the most common cause of low sexual desire. Sometimes a person needs a little help in the form of the temporary use of antianxiety or antidepressant medication. Similarly, if you are having major problems in your relationship, your level of sexual desire is going to be affected. If you are angry at your partner because of dishonesty, abuse, adultery, or any number of other serious problems, it is usually really difficult to feel desire for that person. In cases like this, marriage counseling, family therapy, or some other form of relationship counseling is the treatment of choice rather than sex therapy. The low sexual desire in this case is a direct result of other problems in the relationship rather than a sexual problem as such.
Finally, much more serious causes of low sexual desire include reactions to past events such as sexual trauma. I have seen many cases in which a woman suffered rape or incest in her early life and as a result was unable to experience sexual desire as an adult. Often the past abuse was repressed, and the woman wasn’t even really aware of what sexual desire felt like. This experience isn’t unique to women, but it is more common in women. Since these sorts of causes of low sexual desire are lifelong and are pretty much built into someone’s personality, I believe the only solution is intensive individual therapy. Sadly, many people with these issues have experienced the problems for so long that they really don’t want to seek treatment.
This scheme for viewing low sexual desire served me well in the 1990s. It helped me decide which couples would benefit from psychological treatment and which should be referred to relationship therapists or medical doctors. In the past few years, however, a lot of information has come to light about other causes for low sexual desire, especially in women. I’ll list these in terms of causes of low sexual desire that are common to women, causes of low sexual desire that are common to men, and causes of low sexual desire that are common to both men and women. These lists come from different sources, including everything from scientific studies to anecdotal reports. There is obviously some overlap between male and female issues, but I’ve sorted them according to the things people most commonly report.
Causes of Low Sexual Desire in Women
Women experience a number of hormonal events throughout their lives that can cause low sexual desire. Most of them are temporary. They include childbirth, breastfeeding, the use of oral contraceptives, and menopause. All of these can cause low testosterone. Body-image issues can also cause low sexual desire. The most common of these is feeling fat. Related to this is lack of exercise, which can cause low levels of dopamine, a brain chemical that is highly related to being able to experience feelings of pleasure. Some women experience low sexual desire when they feel that their partner focuses sexually on a certain part of their body that they’re uncomfortable with.
Women are very susceptible to being influenced by their partner’s personality or mental state. Women have reported feeling low sexual desire because their partner is controlling and tells them what to do. Other issues include experiencing their partner as jealous or possessive, being patronized or talked down to, feeling that their partner doesn’t love them, feeling that their partner lacks commitment to the relationship, or feeling that their partner is moody and withdrawn and doesn’t want to communicate. Other issues reported by women include their male partner’s habit of telling unfunny sexual jokes, his being prejudiced (especially homophobic), or his making promises he doesn’t keep (such as promises of financial commitment).
Some women admit that they consciously sabotage a situation that could turn sexual. They purposely wait until their partner is too tired to have sex, or they wear something unappealing to bed. Other women report that having a television on in the bedroom turns them off to sex.
Of course, a woman’s sexual history has a huge effect on her desire for sex. Having a bad first experience of sex can set the stage for a lifetime of low sexual desire. A history of any form of sexual coercion (including molestation, incest, or rape) can shut down a woman’s sexuality. Women also have more fears and anxieties about sex in general than men have. Sex has the potential to be more dangerous for a woman than for a man. Women worry about being sexually abused and they worry about getting pregnant. It’s easier for a woman to catch a sexually transmitted disease from an infected man than vice versa.
Lack of understanding of the male sex drive can also be a problem. Sometimes women are turned off because their partner wants sex so much more than they do. Other women are turned off because their partners learned to have sex from watching porno movies. They resent that their partner’s idea of sex is focused only on the genitals instead of on full-body sensual contact. Other women are freaked out if they find out their partner has paraphilic interests—that is, an interest in what most people would consider unusual sexual activity. Maybe they discover a hidden collection of erotic materials that they find disgusting.
Causes of Low Sexual Desire in Men
For men, some of the biggest causes of low sexual desire include low testosterone, stress, anxiety, and depression. Work setbacks, such as job loss, also disproportionately affect men. The existence of other sexual problems, like premature ejaculation and erection problems, can also cause low sexual desire in men.
In the past, an unacknowledged homosexual orientation was often a cause of low heterosexual desire in men. This is less common than it used to be, now that same-sex behavior is no longer illegal and a homosexual orientation is no longer considered a mental disorder.
Causes of Low Sexual Desire in Both Men and Women
The following are some other causes people have cited for low sexual desire in both men and women. I’ve listed them in order from what I consider least serious to most serious.
• Boredom
• Lack of knowledge about sex
• Overwork
• Laziness
• Difficulty finding a partner
• Fear of sexually transmitted diseases
• Lack of opportunity to have sex
• Relationship problems
• Crowding in the house
• The presence of young children in the house
• Taking drugs like Prozac (the SSRIs, or selective serotonin reuptake inhibitors)
• Fear of intimacy or commitment
• Lack of interest or involvement in any area of life
• Feelings of intimacy and attachment as the primary focus of the relationship, to the exclusion of sexual feelings
• Traditional religion that produces guilt about sex by teaching that sex is wrong
• Unhappiness
• Conflict, power struggles, and criticism in the relationship
• Poor health
• Avoidance of sex due to phobias
• Addiction issues
• Lack of trust between partners, especially due to unfaithfulness
• Being asexual
• Grieving or serious personal loss
It’s quite a list, isn’t it? And it goes on. Isn’t it amazing how many things that don’t seem like they would have anything to do with sex can have such a profound effect on your sex life? With everything that can go wrong, it’s remarkable that anyone wants to have sex at all. The good news is that because so many disparate things can affect your sex life, there are an infinite number of possible solutions to your desire problems, many of which I’ll discuss in Chapter 28. Low sexual desire presents a huge number of opportunities for sexual healing on many different levels.
Differences Between Men’s and Women’s Sexual Desire
To add even more confusion to the issue, in general, men and women tend to differ somewhat in the many components of sexual desire. Some of these differences may seem like clichés, but most have been supported by research. I include these potential areas of difference here so you
can see if any of them strike a chord with you, and thus can help you pinpoint specific areas of sexual desire with which you might have a problem.
The biggest difference is that men’s sexual desire appears to be controlled by nature and women’s by culture. A woman’s sexual desire is more influenced by context, situation, and environment than a man’s is. A man’s main motivation for having sex is horniness or sexual release; a woman’s main motivation for having sex is feeling that she is in love or feeling that she is emotionally connected to her partner. For women, romantic love and sexual desire appear to be the same for all intents and purposes. Sex for women is more about intimacy, or the emotional part of an encounter. It’s a cliché, but both my work with clients and surveys I’ve taken in my classroom support this. (Remember that we’re talking in generalities here; these statements may not be true for all women or for all men all the time.)
For women, sexual desire is more likely to have a particular object (a person). When a woman thinks about whether she desires sex, she thinks about whether she desires sex with a particular person. In the 1970s, with the advent of the women’s liberation movement, many women made the mistake of trying to define their level of sexual desire using male criteria: testosterone, a feeling of horniness, or itching in the genitals. In fact, however, women may need to be in love first in order to feel sexual desire. A woman’s sense of sexual desire may be a desire to seduce or be penetrated rather than a desire to have intercourse as such. This is the distinction between what’s called proceptive sexual desire and receptive sexual desire. Proceptive desire is the urge to seek out and initiate sexual activity. It is probably more common in men and seems to be caused by testosterone. Receptive sexual desire is the capacity to become aroused upon encountering certain sexual stimuli. What happens is that a woman becomes aroused, and that causes her to have more desire, rather than vice versa. This pattern is probably more common among women because it’s associated with estrogen.
Men often aren’t aware of or won’t admit to what could be causing them to go through a bout of low sexual desire. Women are the opposite—they’ll obsess about what could be causing low desire to the point that they might ignore an attractive potential partner.
A large component of sexual desire seems to be the ability to fantasize. Men and women differ somewhat in their fantasy lives—why they fantasize and what they fantasize about. While the most common fantasy for both men and women is having sexual intercourse with someone they are in love with, women are more likely to fantasize about sexual encounters with past and present partners. Men are more likely to fantasize about genital contact with partners they don’t know.
Surveys show that women seem to understand sexual desire better than men do. Women seem to have a better grasp that there’s something psychological involved. In surveys, many men admit that they don’t have a clue about whether their partner desires them sexually or why. Women have more potential turn-offs than men and are more susceptible to them. Because women’s sexual desire is heavily influenced by culture, women have more ways in which their level of sexual desire could potentially be manipulated. Women define desire in terms of the pursuit of interpersonal goals. Men are more likely to define desire in terms of purely sexual goals, like pleasure. Women’s sexual desire is heavily influenced by whether they feel their intellectual and spiritual needs are being fulfilled. And although women’s sexual desire is more determined by cultural factors, they undergo more lifetime hormonal events (like childbearing and menopause) that have the potential to affect their sexual desire.
Measuring Sexual Desire
One of the difficulties in figuring out whether someone has a problem with low sexual desire is that we really don’t have a good way to measure sexual desire. Synonyms that have been used for sexual desire include sexual interest, lust, romantic love, passion, libido, and attraction. Sometimes sexual desire has been defined as sexual satisfaction or sexual arousal, even though these appear to be conceptual opposites of sexual desire. Plus, to me, there’s a lot of potential ground between “sexual interest” and “lust.”
Sexual desire has been measured by the calculation of vaginal or penile blood flow using special instruments. These are actually measures of arousal, not desire, but the assumption was that if you could get aroused, you must have desired sex, which is not necessarily true.
I’m aware of two questionnaires that measure sexual desire. However, they confuse sex drive (the physiological component) and sexual desire. They also confuse the frequency of sexual desire and sexual behavior. For example, common measures of sexual desire include the questions “How frequently do you want to have sexual intercourse?” and “How often do you think about sex or think about wanting sex?” My point here is that it’s no wonder if you are confused about whether you have an abnormally low level of sexual desire—even the experts have problems with the issue.
Asexuality
Related to the problem of low sexual desire is a concept called asexuality. A person is defined as asexual if he or she has never had sexual desire for anyone of either sex. I don’t think this is a great definition. There are many people with a strong sex drive who don’t want to have sex with other people; they only want to have sex with themselves or with inanimate objects.
The concept of asexuality has not been studied in depth. Here’s what we do know: It may affect 1 to 2 percent of the population. It’s related to gender—more women than men report being asexual. Other factors that appear to be related to asexuality are poor health, short stature, going through puberty at a later age, religiosity, and lower socioeconomic status.
Some people who seek out sex therapists for the treatment of low sexual desire may actually be asexual. The main difference that I can see between someone who has low sexual desire and someone who is asexual is that the typical person who sees a sex therapist for low sexual desire has felt desire in the past and knows what it feels like, so they know what they’re missing. The typical person who is asexual senses that they are not like other people, but they really don’t know what the fuss is all about. They generally are accepting of their status.
The Relationship of Low Sexual Desire to Other Sexual Problems
A final concern is that many people who seek sex therapy for low desire actually have other problems. A woman who has difficulty becoming aroused or having an orgasm may develop low sexual desire as a defense mechanism. So could a man who has premature ejaculation or erection problems. Women with vaginismus and sexual pain also often exhibit little or no desire for sex. We call this “low sexual desire secondary to other sexual dysfunctions.” That’s why, as a sex therapist, it’s important to recognize that people can have more than one sexual dysfunction. If I see a client who claims that he or she has low sexual desire, I can’t really take the client’s self-diagnosis at face value. It could very well be that some other dysfunction occurred first that has caused the client not to want sex. The following are two patient stories illustrating this fact:Ron
Ron, in his early sixties, stated that his main problem was low sexual desire. When I took his sex history, it was clear he’d had significant erection problems for many years. (This was well before Viagra was introduced and before erectile dysfunction was regularly discussed in the public forum.) I asked him, “If you knew that you could have a rock-hard erection whenever you wanted, and you knew that you could have sex with any woman you wanted, do you think you would want to have sex?” He looked at me like I had lost my mind and said, “Well, yes! Of course!”
Ron’s problem was clearly not low sexual desire. He clearly was still extremely interested in sex. In sex therapy we usually find that other sexual problems are masquerading as low sexual desire. That’s why it’s important to treat the first (primary) problem rather than low sexual desire, because often the low desire is not the more significant problem.
Mary Ann
Like Ron, Mary Ann came to see me with a complaint of low sexual desire. She was in her late thirt
ies. (I saw quite a few clients with this complaint in the 1980s, when the issue received a lot of press and many people were going to sex therapists with a self-diagnosis.) She complained that she used to feel sexual desire for her husband but didn’t feel it anymore. Her sex history seemed to indicate that she didn’t have any other sexual dysfunctions. However, her relationship with her husband was a mess. He had cheated on her, refused to work, and verbally abused her. And yet she was convinced there was something wrong with her because she didn’t want to have sex with him! (I would have said there was something wrong with her if she did want to have sex with him!) I asked her who her favorite male celebrity was. She said she really had a thing for Harrison Ford. (This was in the Indiana Jones era.) I asked her, “If Harrison Ford asked you out on a date, would you want to have sex with him?” Again, she looked at me like I had lost my mind and said, “Of course! I’d cut off my right arm to have sex with him!”
Sexual Healing Page 7
