Dysfunctions related to the sexual response cycle: Inhibited sexual desire

Features

  • Inhibited sexual desire (ISD) refers to a low level of sexual interest. Also known as Sexual aversion; Sexual apathy; Hypoactive sexual desire (HSD).
  • ISD can be primary, in which the person has never felt much sexual desire or interest.
  • Secondary, in which the person used to feel sexual desire, but no longer does.
  • Partner related, the person that experience ISD is interested in other people, but not in his or her partner.
  • General, the person with ISD isn't sexually interested in anyone, in the extreme form of sexual aversion, the person not only lacks sexual desire, but may find sex repulsive.
  • Sometimes, the sexual desire is not inhibited. The two partners have different sexual interest levels, even though both of their interest levels are within the normal range.
  • In some cases a partner can claim that his or her partner has ISD, when in fact they have overactive sexual desire and are very demanding sexually.

Epidemiology

Studies have found that complaints of low sexual desire increase with age, relationship duration, number of small children, relationship discord and symptoms of anxiety and depression. The problem of sexual aversion occasionally happens in men but is much more common in women. If the problem occurs after a period of normal sexual activity, the cause can be related to a partner (because of the situation or if there is something lacking in the relationship) or might be due to some trauma or to pain caused during intercourse.

Causes

It often occurs when one partner does not feel intimate or close to the other. Communication problems, lack of affection, power struggles and conflicts, and not having enough time alone together are common factors. ISD can also occur in people who've had a very strict upbringing concerning sex, negative attitudes toward sex, internalised homophobia or traumatic sexual experiences (such as rape, incest, or sexual abuse).

Illnesses and some medications can also contribute to ISD, especially when they cause fatigue, pain, or general feelings of malaise. A lack of certain hormones can sometimes be involved. Psychological conditions such as depression and excess stress can dampen sexual interest.

Commonly overlooked factors include insomnia or lack of sleep, which lead to fatigue. ISD can also be associated with other sexual problems, and sometimes can be caused by them. For example, a man who has erection problems (impotence) or delayed ejaculation can lose interest in sex because they associate it with failure or it does not feel good. People who were victims of childhood sexual abuse or rape, and those whose marriages or relationships lack emotional intimacy are especially at risk for ISD.

Treatment

Treatment must be targeted to the factors that may be lowering sexual interest. Often, there may be several such factors. Some couples will need relationship or marital therapy before focusing on enhancing sexual activity. Some couples will need to be taught how to resolve conflicts and work through differences in nonsexual areas.

Communication training helps couples learn how to talk to one another, show empathy, resolve differences with sensitivity and respect for each other's feelings, learn how to express anger in a positive way, reserve time for activities together, and show affection, in order to encourage sexual desire.

Many couples will also need to focus on their sexual relationship. Through education and couple's assignments, they learn to increase the time they devote to sexual activity. Some couples will also need to focus on how they can sexually approach their partner in more interesting and desirable ways, and how to more gently and tactfully decline a sexual invitation.

Most of the time, a medical exam and lab tests will not show a physical cause. However, testosterone is the hormone that creates sexual desire in both men and women. Testosterone levels may be checked, especially in men who have ISD. Blood for such tests should be drawn before 10:00 a.m., when male hormone levels are at their highest. Interviews with a sex therapy specialist are more likely to reveal possible causes.

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