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Sexual Desire Disorders Sexual desire is generally considered to be the first stage in the sexual response cycle, characterized by sexual fantasy or desire for sexual activity. Desire, also referred to as libido, may seem like a purely psychological phenomenon, but it may also be influenced by physiological changes due to medications or hormonal fluctuations. Disorders of Sexual Desire Hypoactive sexual desire disorder is defined as a deficiency or absence of sexual fantasies or desire for sexual activity, causing distress or personal difficulty (DSM-IV, American Psychological Association). It may be generalized to all partners and all sexual activities, or it may be more situational. It is often associated with other sexual problems (such as inhibited orgasm, lack of lubrication, etc.), although some individuals with low sexual desire are perfectly capable of becoming sexually aroused and having orgasms. Low sexual desire can be caused by physical and psychological factors and often results from a combination of both. High levels of stress, interpersonal problems, body image concerns, anxiety, and depression can impact sexual desire. Physical factors that can decrease desire include aging, certain types of drugs, pain, neurological conditions, and hormonal irregularities. Lack of sexual desire is the most common sexual complaint in women. It has been estimated that approximately 33% of women experience a lack of sexual interest or desire at some point in their lives. Interestingly, the percentage of women experiencing low sexual desire wavers back and forth across a range of ages from 18 to 59: low sexual desire affects about 32% of 18- to 24-year olds, but only 29.5% of 30- to 34-year olds. The largest percentage of women with low sexual desire, however, is in the 35-39 age group (37.6%). This percentage steadily declines in women between the ages of 40 and 54, and then increases sharply once again. (Reference: Laumann, EO, Gagnon JH, Michael RT, Michaels S. The Social Organization of Sexuality. Chicago: The University of Chicago Press, 1994.) It is difficult to say how much sexual desire is normal. In general, a clinician must take into account many factors, such as relationship characteristics and cultural context, when making a diagnosis of hypoactive sexual desire disorder. It is also necessary at times to assess the partner's level of sexual desire to rule out an excessive desire for sex on the part of the other person. That two partners have very different levels of sexual desire, however, does not necessarily mean that either of them have a psychological disorder. Sexual aversion disorder is a more severe interruption of sexual desire. Individuals with sexual aversion disorder actively avoid sexual activity and express fear, anxiety, or disgust when approached sexually, ultimately causing distress or interpersonal difficulty. Individuals with severe sexual aversion disorder may even experience panic attacks in sexual situations. This may occur in conjunction with other psychological problems, such as posttraumatic stress disorder. Treatments to Enhance Sexual Desire in Women Given the complexity and individuality of this problem, it is clear that one treatment will not work for all. Complete information about the nature of the sexual desire decrease is necessary to plan effective treatment. For instance, sexual desire problems that stem from boredom, conflict, or distrust in the sexual relationship are not likely to be remedied with medical treatment; psychotherapy focusing on the couple may be most helpful. On the other hand, hormonal disturbances due to illness, menopause, or surgical removal of the ovaries may affect sexual desire; these problems may be addressed with hormonal treatments prescribed by a physician. Because testosterone appears to influence sexual desire in both men and women, several clinical studies are evaluating the effectiveness of testosterone as a treatment for low sexual desire. It is important to note, however, that testosterone may only be effective in women who have abnormally low levels of testosterone and is not intended for casual use. (Many women with low sexual desire have normal levels of testosterone.) Because testosterone therapy is associated with several health risks, including potential liver damage and increased risk of heart disease, it should only be used under the supervision of a licensed physician. When speaking to a health provider about sexual desire difficulties, it is important to be honest and thorough in describing the nature of the problem. Be wary of "quick fixes" and "one size fits all" treatments, as well as over-the-counter supplements that promise to restore sexual vitality. In reality, treatment for sexual desire disorders requires time, commitment, and openness to different therapeutic options. |
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