Recently, researchers conducted a national survey which concluded that low sexual desire is one of the top two reasons that people seek assistance for sexual concerns. Research concluded that 33% of women reported that they lacked sexual interest and the number of men presenting in therapy for problems with desire is on the rise (Laumann, 1994).
Defining Low Desire
Low sexual desire is not the same as having problems becoming aroused or difficulty with orgasm. In fact, even with low desire, most individuals are able to get turned on after sex is initiated and experience an orgasm. Low sexual desire is not the same as being fearful of sex or being disgusted at the thought of sex. With low sexual desire, you don’t find sex scary or bad, you just are not interested in participating in the process. You don’t seek out sex, fantasize about it and wouldn’t miss it if it was gone from your life completely (Foley, Kope & Sugrue, 2002).
Diagnosing Low Desire; Understanding Clinical Options
The DSM IV outlines the Sexual Response Cycle, which is important to understand in order to educate clients about sexual dysfunction. The sexual response cycle consists of four phases. Desire is phase one, which normally consists of sexual fantasies and subsequent desire feelings to want to participate in sex or foreplay.
Arousal/Excitement is phase two, which consists of physiological changes. The major change in males is vasocongestion, resulting in an erection. The major change for females is the vagina and vulva become moist and the clitoris enlarges. Orgasm is phase three, which is the peak of sexual response. During orgasm, there is a release of sexual tension with rhythmic contractions of the reproductive organs.
Finally, Resolution is phase four, which consists of the muscular relaxation. In males, resolution represent the time that an erection is physiologically unable to be obtained. This period of time is around 20 minutes on average, with an increase appropriately due to age. Women do not experience a resolution period (APA, 2000).
In order for sex to be pleasurable and to work properly, the sexual response cycle needs to be a seamless process, with all four stages functioning both well and properly. Although some individuals can experience successful sex without a stage being functional, most people find that when a sexual dysfunction is present in any of the 4 stages of the human sexual response cycle, problems with functional sex can present in the relationship.
In relation to diagnosis of a desire disorder, several options are available in the DSM IV. The first option is Hypoactive Sexual Desire Disorder, 302.71. This diagnosis is characterized by the deficiency or absence of desire for sexual activity. If sexual dysfunction is a general problem in more than one stage of the Sexual Response Cycle, a diagnosis of Sexual Dysfunction, NOS, 302.70, may be appropriate. If arousal is the problem, specifically for the female, a diagnosis of Female Sexual Arousal Disorder, 302.72, may be applicable (APA, 2000).
Assessment of Low Sexual Desire
Assessment and treatment of low sexual desire is becoming an option both individuals and couples are excited about. No couple wants to struggle with low desire, and low desire can affect the couple’s relationship in many areas including their level of intimacy and quality of the friendship. What happens in the bedroom can be a reflection of what happens outside the bedroom. If couples aren’t being intimate, a sexless marriage could ruin their relationship.
Assessment and treatment options are important for clinicians to be educated about. Ruling out a medical problem when an individual or a couple present with a low desire complaint is rule one. If something biological is happening, trying to fix the problem using psychotherapy won’t be of much help. Asking questions regarding the quality of their health, the date of their last physical examination by a physician and the results of that medical exam are important pieces of information that can aid in locating the source of the problem.
Certain hormonal imbalances in both men and women can contribute to low sexual desire. Thyroid functioning, both over and under functioning, can contribute to low desire, along with menopause, depression, stroke, some cancers, Parkinson’s disease and hepatitis. Prescription medications can also contribute to low desire and can include birth control pills, blood pressure medications, tranquilizers, mood medications including anti-depressants, bipolar medications and some ulcer medicines (Foley, Kope & Sugrue, 2002).
If a client presents with low desire and has not seen a physician within the last calendar year, a referral for a physical and blood work is a smart first step. By ruling out medical problems, locating the source of the problem will become clearer and treatment options can then be presented.
Treatment Options for Low Sexual Desire
Options for treating low desire are becoming more available and widespread for clients. Often treatment is a two step process if a biological problem is present, utilizing drugs or hormones to balance ones biology, and then using couples therapy to help the couple to discuss the impact of low desire on the relationship and to help develop a roadmap of their wants for the future of their courtship.
The number one treatment now available for both men and women is testosterone therapy. When testosterone levels are abnormal in women or men, a drop in desire can be the result. Administered by crème, pill, patch or drops, this therapy has helped countless individuals begin to feel some fire for sex in their relationship. This therapy is often prescribed by ones doctor, including OB-GYN’s, Urologists and Family Practice Doctor’s and Nurses (Foley, Kope & Sugrue, 2002).
Wellbutrin is also been proven to be effective in treating depression without sexual side effects. Recent studies also suggest that using Wellbutrin in non-depressed clients proved to be beneficial for the treatment of low sexual desire.
Non-prescription herbal options include Ginkgo biloba, Ginseng, DHEA, Dong-Quai and L-Arginine. Ask your doctor, naturopath or pharmacist about recommended dosages in the treatment of low desire with herbs.
Finally, fatigue, trauma, competing priorities, lack of attraction and relationship problems can all point to low sexual desire. Utilizing a couple’s therapist to help in diagnosing and treating low desire is a smart move that could benefit both you and your relationship with your partner.
Lastly, it is important to separate desire problems from relationship problems. Utilizing a therapist that is knowledgeable in the areas of relationship counseling as well as sex therapy can help properly diagnosis and treat the problem of low sexual desire.
American Psychological Association (2000). Diagnosis and Statistical Manual of Mental Disorders. Washington , D.C. , American Psychological Association.
Foley, Kope & Sugrue (2002). Sex Matters for Women . New York , Guilford Press Publications.
Laumann (1994 ). The Social Organization of Sexuality. Chicago, University of Chicago Press.
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