Low sex drive

Sexual desire (or libido) is similar in many ways to an appetite for food.

When we are feeling happy, healthy and carefree, we tend to enjoy food more and consequently eat more. If we are tired, stressed and anxious we lose our taste for food, and may even lose weight as a result.

For both men and women, the feelings of relaxation and well-being are important to the ability to enjoy sex, and so life events (marriage, house moves, new baby, new job, etc.) can dampen sexual desire.

Most people recover their stride once the ‘crisis’ is past. If they are unable to, it may be that more serious problems, perhaps with the relationship itself, need to be resolved.

Less common are those who have rarely or never been sexually aroused, who never masturbate or fantasise about sex, and who seem disinterested in engaging in a sexual relationship. They may be perfectly comfortable with them­selves, or seek help because they feel that they are ‘different’ from the rest of the population.

Low sex drive may be global, that is, the person is unable to feel aroused in all situations and with all partners, or it may be a problem only with a certain partner or in certain situations. Whatever the case, as with many other sex prob­lems, low sex drive can be the result of physical illness, drugs or psychological conflict.

Sex therapists estimate that about 40 per cent of people who seek their help come because they are worried about having a low sex drive. However, individual sex drive varies so much that it is not always easy to say what is ‘low’ and what is ‘normal’.

In men, sexual activity peaks in the late teens, when they are intensely interested in sex, and thereafter slowly declines, so that in adulthood and middle age they are able to go for longer and longer periods without release, and not experience frustration. They can, however, become highly sexually active again when attracted and excited by a partner.

Women experience a more gradual rise in interest in sex, which peaks in their thirties. It appears that their sex drives are more fragile and easily dampened, compared with those of men, although they have the capacity to have more orgasms.

A young man who shows little or no interest in sex and rarely mas­turbates and a 39-year-old woman who cannot be aroused by herself or any partner are therefore different from the normal experience, and can be said to have low sex drives.

CAUSES OF LOW SEX DRIVE

Physical causes

• ‘Normal’:

Just as we accept some people have large appetites for food or drink, it is clear from sex surveys that libido varies hugely in the general population. All surveys report on men and women who reach orgasm several times a day on a regular basis, and also those who go for long periods without seeking sexual release.

• Hormonal:

A sudden change in libido, with no other obvious fac­tors, may rarely indicate disease of the hypothalamus, pituitary gland or the testicles. Otherwise, in men, the level of the male hormone testosterone decreases with in­creasing age, and some men may find their libido tailing off earlier than others. Women, whose sex drives are more fragile, may also notice fluctuations during their monthly cycles, and experience large changes with major hormonal events, that is, pregnancy, after childbirth, menopause. Women taking hormonal therapy of any sort, including the oral contra­ceptive pill, may also find their libido affected.

• General health:

Not surprisingly, serious illness or chronic health problems can sap libido, partly due to stress but also perhaps due to specific biochemical causes. Loss of sex drive may also be a feature of postviral fatigue.

• Drugs:

Many drugs can lower libido. Among these are drugs used to treat schizophrenia or psychotic states, morphine-based pain killers, beta blockers for hypertension and hormone therapy as mentioned above. Men who take oestrogens or cyproterone acetate will find their libido diminished.

• Mood changes:

Sexual appetite can be the first thing to go in de­pression – before loss of appetite for food, or inability to sleep. Conversely, people who are manic and hyperactive have greatly in­creased sex drives. The fragility of an individual’s sex drive to fluc­tuations in mood varies, so it may appear that relatively small events can still have a large impact for some people.

Psychological causes

It is important to differentiate be­tween the loss of sexual interest in one’s partner, through tensions within that relationship, and the loss of sexual desire itself. It may be easier to complain of a low sex drive than to admit that one partner has simply ‘gone off’ the other, or that for some reason sex with that partner creates too much anxiety. In such cases, the desire itself may be intact, but suppressed – or the person may find release through masturbation or other partners.

Other reasons why a person may lack sexual desire can be complex and very individual, and need to be explored carefully. For some people, sex is too closely related to fear and anxiety or guilt and shame, to the point that they are unable to be­come aroused. Others may find their own sexual fantasies alarming – perhaps if they involve homo­sexuality or violence or unusual practices – and are therefore fearful of their sexual identities.

Some people find that they are only able to feel sexually aroused in situations that are ‘safe’ to them, i.e. with strangers, prostitutes, etc., and the possibility of a committed relationship with a compatible partner represents too much ‘dan­ger’. They may have found the partner of their dreams, and des­perately want a committed re­lationship, but are at a loss to explain why they cannot be sexually aroused by them.

TREATMENT AND OUTCOME

As the causes of low sex drive are so varied and can be so complex, the length of treatment required and how successful it is also vary a great deal. Clearly someone with a well-defined problem which can be resolved quickly will do better than someone whose situation is more complex.

In some cases, relationship counselling is more appropriate for couples who have normal individual sex drives but who are having prob­lems relating to each other sexually. Otherwise, psychosexual therapists may see a person on his or her own or a couple together. They may use a variety of treatment methods, but the main objective is to help the person or couple gain insight into why they have gone off sex. This may be combined with simple, non­threatening sexual exercises (see pages 36–9) or erotic tasks to  carry out at home, and the feelings around these tasks are explored.

Soon after Viagra hit the headlines as a cure for erectile dysfunction in men, news reports suggested it was also a wonder drug for women who had problems with sexual arousal and orgasm. Viagra for women is marketed as a cream (called Viacreme) on the internet. Although Viagra may increase genital blood flow in women the same way it does in men, clinicians have cautioned that sexual arousal for women (and probably men) has more to do with psychological and emotional factors than blood flow changes. Some women with specific problems with physical arousal may find it helpful, but many others may not.

As some of the psychological issues relating to low sex drive can be highly complicated, therapy for some cases needs to be lengthy and intense before any improvement is seen. Although many people can be helped, a few will remain difficult to treat.

KEY POINTS

• It may be normal to have a low sex drive

• Low sex drive must be differentiated from relationship difficulties

• Some psychological causes are deeply complex

• The outcome depends on the cause and whether it can be resolved