When sexual desire is painfully absent

Nearly half of all American adults still say they are having problems or are unhappy with their relationships and sex lives. Nearly one out of five women finds her sex life a source of distress.

by Dr. David Roth — 

There are still some problems that people just do not talk about. In the days before TV ads for Viagra, many men lived in silent shame over not being able to get and sustain an erection. And many of their partners painfully, if compassionately, conspired in keeping their secret. Many times they never mentioned it to one another.

Although erectile dysfunction (ED) medications have helped many people, nearly half of all American adults still say they are having problems or are unhappy with their relationships and sex lives. Nearly one out of five women finds her sex life a source of distress. The lesson seems to be, that for all those it has helped, the little blue pill fails to address many, if not most sexual problems people face.

One of the most common sexual problems among both men and women is low sexual desire, and one of the biggest challenges relationships face today is “desire asymmetry” — when partners do not share the same level of interest in sex.

But like ED in the years before Viagra, you rarely find people talking about these problems. Most individuals and couples still suffer in silence, or their frustration leads to conflict that remains hidden behind closed doors. If anger and frustration build up, partners often drift apart emotionally and isolate themselves or seek sexual satisfaction elsewhere. Very often, one of the partners walks away.

A question patients typically ask a doctor or sex therapist is, “How much sex is normal?” or “How often do people typically have sex?” In an effort to find out whether their or their partner’s expectations are too low or too high, people come searching for a statistical norm, hoping to answer the question, “Am I expecting too much?” or “Is my partner offering me too little?” Answering these questions commonly results in pointing a finger: Either I am wrong or my partner is wrong. Whatever the answer, someone is to blame. But rarely is it quite so simple.

The fact is that there is no “normal” when it comes to how often we should have sex.

How often we desire sex, and how often we actually have it, varies widely. While the average for Americans in committed relationships is somewhere between two and three times a week, some have sex daily or almost daily, and many do so once a week or less. In some countries it is more frequent, in others less so. And there are many couples, even those in their 30s, who once had sex but no longer do and still report being happy together, although this is not very common.

What we call low sexual desire or “lack of libido” is not something that can be objectively measured. It is not really about how often a person has sex but how the seeming infrequency causes frustration between partners or affects a person’s overall satisfaction with life.

When two people have different levels of desire and cannot seem to reconcile the difference happily, the stress it causes can and usually does lead to further problems in their relationship. Blame, anger, shame, feelings of isolation and low self-esteem are common results.

Couples who have a lot in common may not share the same level of desire for sex. At the start, this may be overshadowed by the excitement of sharing other common interests. Other couples find that new relationship energy can raise sexual desire to a fever pitch for both partners, but in every long-term relationship this dynamic evolves. What may start out as an intense, shared erotic passion becomes something quite different in a matter of weeks, months or a few years, and this happens differently for each of us.

Among younger couples especially, lifestyle changes can have a direct and immediate impact. Overwork, the presence of children or aging parents in the home, and financial stresses are just a few of the factors that can affect desire in one or both partners. As we age, there is almost always a gradual decrease in how often we have sex. This does not mean, however, that the desire for sex disappears or that there will necessarily be a problem as things change. All lifestyles change over time and through the life cycle, and with this, intimacy becomes redefined.

Often changes in the desire for sex are affected by changes in hormones. This is especially true of women leading up to menopause — when they often desire more sex than their male partners — or through it, when the libido can play tricks, be a roller coaster ride and even disappear.

At any stage of life, poor body image can be the culprit, as can depression. Some antidepressant medications have the effect of dampening or even seemingly killing libido. Illness also can play a key role both in how much sex we have (or, in certain cases, can safely have) and our level of sexual desire.

The physical, psychological, emotional, interpersonal and social factors that affect sexual desire are complex. Sexual desire (and what we think of as desirability) touches each of us deeply. It affects us at our very core, where we find meaning and purpose. This is the deep spiritual part of the self, where it is most important to integrate who we are. This is also why, generally speaking, self-help resources do not prove very useful.

Trying to untangle the many strands of ourselves by ourselves can be dizzying and, in almost all cases, proves frustrating. While people find that they are not able to resolve most desire-related problems on their own, knowing that “I am not alone” can be a source of great comfort, possibly vanquishing shame if not fixing the problem. For some, in time, certain desire asymmetry problems can resolve themselves, but this is not true for most.

Most people suffering from desire-related problems rarely get the help they need. This is usually because they are too ashamed to talk about it, fear they cannot afford the cost of professional help or don’t know where to find a qualified clinician.

Finding capable help is a major problem. Not many medical schools offer new doctors training in the area of sexual dysfunction, and very few (including gynecologists, urologists and psychiatrists) receive any post-graduate training in human sexuality. Very few marriage and family counselors and therapists are trained to deal with specific sexual issues, let alone this complex one. And even many clinically trained sex therapists lack skill in this area because of the complexity of the problems and the wide range of the various causes.

Those who do seek help often give up trying after several frustrating, unfruitful attempts to find someone who can help. This is unfortunate because individuals and couples need not suffer alone; there is hope for this very troubling problem. For those who are serious about overcoming low sexual desire or desire asymmetry, finding the right, compassionate and capable clinician — usually someone who works with other specialists, as needed — is key.

A sex therapist could help

If you …

  • Are not satisfied with your level of sex and intimacy
  • Feel a disinterest in sex or deterioration of your sex life
  • Cannot “perform” as you would like or have in the past

If you are suffering the pain of …

  • Conflict in your sex life/relationship
  • Difficulties following a sexual betrayal or infidelity
  • A relationship break-up
  • The sickness or death of a spouse or intimate companion

If your or your partner’s personal history includes …

  • Sexual abuse or trauma
  • Body image problems
  • Rejection or emotional abandonment
  • Closeness or intimacy problems

If a partner’s sexual ability has been affected by …

  • Illness or disease
  • Traumatic physical injury or an accident
  • The effects of aging
  • Changing life circumstances

If you or your partner …

  • Have feelings of sexual shame
  • Engage in compulsive or addictive sexual behavior

If you or your partner think about, desire or engage in sexual activities that are …

  • Potentially dangerous
  • Unsettling to you or your partner
  • At odds with your or your partner’s beliefs, faith or conscience

If you and your partner have …

  • Different levels of desire, or if one of you has lost interest in sex •
  • Different ideas about what you should or should not do sexually


David Roth, Ph.D., is a medical school-trained sex and relationship therapist, certified clinical chaplain and former graduate school professor of spirituality in practice at The Center for Relationships and Sexuality. 480-773-3784 or www.relationshipsandsexuality.com.

Reprinted from AzNetNews, Volume 28, Number  4, Aug/Sept 2009.

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