38,000,000 American adults do not want to have sex, according to a survey finding that 20% of married couples have sex less than 10 times a year. Such complaints are the Number 1 problem brought to sex therapists. Inhibited sexual desire is an extremely complex problem with multiple causes and a wide spectrum of solutions. Medical, psychological, and relationship factors must be explored in order to understand and improve problems of sexual desire.

People vary considerably in sexual drive. A person satisfied with sex once or twice a week may view a partner who desires sex at least once a day as “a sex maniac” although each of their sexual appetites is considered to be well within the norm. A psychiatric diagnosis of hypoactive sexual desire is applicable only if there is a loss of sexual urges, sexual fantasies, and/or a persistent lack of sexual activity not accounted for by a medical condition or side effects of medications. Hypoactive sexual desire is twice as prevalent in women as in men.

The sexual cycle begins with desire. Desire is in the mind. For men, desire may be stimulated by visual cues, whereas for women desire is often associated with romantic words and actions. Desire is followed by arousal, excitement, and orgasm. The earlier in the sexual cycle a problem exists, the more complex and the longer it takes to remedy. For example, premature ejaculation in males, which occurs at the end of the sexual cycle, can be successfully treated in approximately 95% of men seeking help. Desire problems, which are at the onset of the sexual cycle, are therefore the most complicated to treat and require a multi-dimensional analysis. The sooner the issue of low desire is addressed, the easer it will be to restore a pleasurable sexual relationship.


Loss Of Initial Passion

During the initial stages of infatuation and love, chemical changes in the brain (PEA) create an intense level of sexual desire and passion. Everything is on fire. Chemistry provides sexual arousal without any need to communicate sexual preferences or create sexual desire. Sexual problems related to early childhood abuse, negative attitudes, sexual inhibitions, or a low libido which may be overpowered by early passion often re-surface when the fire simmers down.

Conflict And Resentment

Over the years, underlying resentment or open hostility can quench sexual desire. Although one person may feel relieved after a verbal battle, the other harbors psychic wounds which accumulate and create a sense of numbness and lack of sexual desire.

Lack Of Emotional Intimacy

Sexual desire usually represents a more romantic, interpersonal experience for women than for men. Women need to feel emotionally connected before sexual intimacy, whereas men tend to feel more emotionally connected after sex. In a classic Mars/Venus situation, a non-verbal male fails to connect by sharing affection, thoughts, and feelings before bedtime and is subsequently rejected sexually by a female partner whose sexual desire has evaporated along with the disappearance of verbal and affectional intimacy.

Splitting Sex And Affection

Couples in egalitarian, communicative, and comfortable relationships may experience little sexual passion and infrequent lovemaking — particularly when they perceive their relationship as more platonic than erotic or romantic. Since distance, novelty, mystery, danger and power differences inflame sexual passion, familiarity and security can suppress or extinguish passion. Furthermore, individuals who tend to separate sex and love may experience inhibited sexual desire in their committed relationship while they are sexually excited by someone whom they would never consider as an appropriate life partner.

Lack Of Attraction

Obvious reasons for sexual avoidance is lack of physical attractiveness because of poor personal hygiene, body weight, and failure to dress in a manner which one’s partner prefers. Unfortunately, some individuals are in relationships where they have never felt “sexual chemistry” for their partner; they don’t enjoy looking at their partner, touching them, or kissing them. There are DNA components which are part of the chemistry between two people which may simply be lacking. An unfortunate trick of nature is that we tend to be most attracted to persons whose DNA is most opposite to us. Therefore, we may be attracted to someone who appears very exotic and different but would be a very poor choice because of incompatible backgrounds and interests.

Sexual Problems

If the sexual relationship has not been sensitive and satisfying, sexual desire will diminish over time. A woman who is not orgasmic, or a man who experiences premature ejaculation or erectile problems may avoid sex because they anticipate that the sex will not be pleasurable. Constant fights over sexual frequency because of differences in sexual drive may eventually lead to a cessation of sexual intimacy if sexual requests are experienced as inconsiderate pressure or as an exploitative demand.

Individual Psychological Problems

Sexual desire is often impacted by work stress, grief, fatigue, anxiety, or depression. Individuals with a childhood history of sexual, emotional, or physical abuse, or those raised in homes where sex was regarded as something bad may regard sexual intimacy as intimidating or aversive.


Antidepressant Medications

Antidepressants such as Prozac, Zoloft, Effexor, Paxil, and Luvox may affect difficulty achieving orgasm (60%) and cause loss of sexual desire in approximately 30% of men and women.. Patients should discuss sexual side effects with their prescribing physicians.

Hormone Deficiencies

Estrogen is produced from male hormones (androgens) including testosterone. Desire is triggered in the brain by testosterone. Lower levels of testosterone with the onset of menopause can decrease in libido and sexual response. Medications which reduce testosterone levels are birth control pills and anti-hypertensives. Low sexual desire after chemotherapy is often associated with a decrease in testosterone. Symptoms of low testosterone are dry skin and hair, loss of pubic hair, shrinking of genital tissues, and loss of muscle tone. Testosterone deficiencies in men and women can be detected by having a physician check your testosterone levels in a simple blood test.


  1. Rule out medical conditions and possible side effects of medications.
  2. Explore childhood messages about sex.
  3. Work on healing from emotional, physical, and sexual abuse.
  4. Improve marital communication.

Develop conflict resolution skills. Discuss marital issues assertively with respect and consideration for each other. Talk to each other openly about your wishes, hopes, and dreams. Communicate your sexual feelings and desires. Share your turn-ons and turn-offs.

5. Focus on sensuality and romance.

Have a moratorium on sexual intercourse. Decrease the pressure for orgasms. Create warmth and comfort in touching each other – especially outside the bedroom. Go dancing. Give each other back rubs, facial and foot massages before attempting whole body massages. Take showers and hot tubs together.

6. Don’t make desire a prerequisite for sexual intimacy.

Desire does not necessarily have to precede arousal. If you allow yourself to be open to being sexually stimulated by your partner, desire can follow your arousal.

7. Understand and work on individual, medical, and relationship issues that contributed to the problem.

Consider individual and couples therapy. Remember that problems with sexual desire don’t occur overnight, so healing and recovery will take time.

This column appeared on oxygen.com, part of Oxygen Media. All rights reserved

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