Sexual Desire Disorder
Sexual desire disorder is a psychiatric condition marked by a lack of desire for sexual activity over a prolonged period. In the DSM-5, sexual desire disorder has been broken down into two separate conditions: female sexual interest-arousal disorder and male hypoactive sexual desire disorder. Both of these refer to a low level of sexual interest resulting in a failure to initiate or respond to sexual intimacy. This can include an absence of sexual thoughts or fantasies, reduced or absent pleasure during sexual activity, and absent or reduced interest in internal or external erotic cues. Neither of these conditions can be diagnosed if the main problem is a "desire discrepancy" in which one partner desires more sexual activity than the other; rather, the conditions are diagnosed when symptoms have been present for a minimum of six months and cause clinically significant distress for the individual.
Female sexual interest-arousal disorder and male hypoactive sexual desire disorder can both be diagnosed as generalized, meaning they may be a general attitude toward any potential partner or situation. These conditions can also be diagnosed as being situational, meaning symptoms are only present with certain types of stimulation, situations, or partners. Female sexual interest-arousal disorder was known as sexual arousal disorder in previous versions of the DSM, although this diagnosis has been replaced by gender-specific conditions in the DSM-5.
Symptoms for female sexual interest-arousal disorder include the following:
- Absent or reduced interest in sexual activity
- Absent or reduced sexual thoughts or fantasies
- Reduced or no initiation of sexual activity
- Absent or reduced sexual excitement or pleasure during most sexual activity
- Absent or reduced sexual interest or arousal in response to internal or external cues, such as a partner's attempts to initiate sexual activity
- Absent or reduced genital or nonessential sensations during sexual activity
To meet the criteria for female sexual interest-arousal disorder, the symptoms must be present for at least six months and cause significant distress to the individual.
Symptoms for male hypoactive sexual desire disorder include the following:
- Reduced or absent sexual thoughts or fantasies
- Reduced or absent desire for sexual activity
Similar to female sexual interest-arousal disorder, the symptoms must also be present for at least six months and cause significant distress to the individual.
Both of these conditions can be diagnosed as a lifelong problem or an acquired problem that emerges after a period of normal sexual activity.
What is the prevalence of sexual desire disorder?
The prevalence of female sexual interest-arousal disorder is unknown, although some older women report less distress about experiencing low sexual desire than younger women. In men, it is estimated that 6 percent of younger males (ages 18-24) and 41 percent of older males (ages 66-74) have some problems with sexual desire. Only 1.8 percent of men ages 16-44, however, experience persistent problems lasting more than six months.
Changes in sexual desire are natural and may come and go depending on personal events or partner-related issues. When the lack of interest in sexual activity lasts longer than six months and causes distress, however, the criteria for a sexual desire disorder may be met.
Some risk factors for developing a sexual desire disorder include:
- Negative attitudes about sexuality
- Relationship difficulties (poor communication, abuse)
- Partner sexual functioning
- Childhood stressors
- Medical conditions (diabetes mellitus, thyroid dysfunction)
- Endocrine disorders (hyperprolactinemia)
- Erectile dysfunction
- History of emotional or physical abuse
- Other psychiatric diagnosis (depression, anxiety)
- Medication side effects
- Stressors (job loss, bereavement)
- Alcohol use
Treatment for a sexual desire disorder may include psychotherapy and medication. In 2015, the FDA approved a medication called Addyi (flibanserin) to treat acquired, generalized hypoactive sexual desire disorder in premenopausal women. The medication has faced controversy, and research is underway to evaluate its efficacy.
Treatment must be individualized—some couples will need relationship or marital therapy prior to focusing directly on enhancing sexual activity. Of course, many couples may need to focus on the sexual relationship itself, and through education, they can expand the variety and time devoted to sexual activity.
When problems with sexual arousal or performance are factors, these sexual dysfunctions will need to be addressed.
One helpful way to prevent issues with sexual desire is setting aside time for nonsexual intimacy. Couples who reserve time for one-on-one conversations are more likely to experience sexual desire. Also, reserving time before exhaustion sets in will encourage closeness and sexual desire. Couples might mentally separate sex and affection so that neither one is afraid to be affectionate daily.
Low sexual desire may be a barometer of the emotional health of the relationship. In the case of a loving relationship, low sexual desire may cause a partner to repeatedly feel hurt and rejected, leading to eventual feelings of resentment and emotional distance.
Sex is something that, for most couples, either bonds their relationship or creates a wedge that gradually drives them apart. When one partner is significantly less interested in sex than their companion, professional help is recommended before the relationship becomes strained.
How can couples address a mismatch in sexual desire?
A relative lack of sexual desire on the part of one individual is a common problem for couples. While the person with less desire may feel the brunt of responsibility, both partners can work together. It may mean seeing a couple's therapist and discussing overall intimacy in the relationship. The couple may be asked to think about more time for foreplay and simple affection. Taking action and not letting problems linger is advised.
How can couples encourage more closeness?
Reading books or taking courses in couples communication may also encourage feelings of closeness. For some couples, even reading novels or viewing movies with romantic or sexual content may also serve to encourage sexual desire.