Is Low Sexual Desire a Misnomer?

Is Low Sexual Desire a Misnomer?

One of the major reasons that individuals in committed relationships seek the services of sex therapists is to address their self-diagnosed problem of low sexual desire. These low desire individuals typically arrive at my office with their high desire spouse or partner in agreement about one basic fact—that the low desire partner is the one with the problem. Many sex experts attempt to bypass this issue in which only one person is seen as “owning” the problem by reframing it as a “desire discrepancy” problem, one about which both partners can then claim ownership.

However, regardless of which label we attach to their problem, all couples seem to be in agreement that the problem is one of “desire” and that one or both partners have lost interest in sex. The other common denominator in virtually all of these couples is their perception of their initial joint sexual history. These low desire couples fall into one of two categories with a fairly consistent scenario for each.

First are the couples who describe a time, earlier in their relationship, when sex was satisfying, passionate, and frequent. Now, they inform me, they rarely if ever engage in sexually intimate contact. The second scenario is exemplified by those couples who describe their earliest sexual encounters with one another as having been filled with awkwardness and anxiety, but who early on in spite of some amount of avoidance were nevertheless able to muddle through—at least for a while. This second group also report that because of a lack of desire on one or both partners’ parts, they too, only rarely if ever, engage in sexually intimate contact.

By the time these two types of couples find their way to my office, virtually all sexual contact has either ceased or has become perfunctory and unsatisfying. They will often use the same phrase when describing their feelings about their spouse. “He or she feels more like a brother or sister to me than like a husband or wife.” But what is most relevant to the topic under discussion here is that both kinds of couples—those who once had a sex life they characterize as “passionate” as well as those who portray their sexual relationship, even at the beginning, as having been problematic—now describe themselves as having lost virtually all desire for sex.

It is important to notice that although both kinds of couples are being sexual only very infrequently, they describe their concern as one of sexual desire rather than a problem of sexual frequency. That is, these individuals do not see their infrequent sexual behavior as the primary problem requiring attention but instead see the their infrequent sex as but a symptom of another more serious problem, mainly one of low sexual desire.

However, it is my observation that these individuals’ self-diagnosis of low sexual desire is rarely an accurate description of the actual problem. Yes, it is true that these couples are rarely connecting with one another in sexual ways, but not having sex together is not necessarily the same as not desiring sex. For example, an employee may not speak up to a boss who he feels is treating him unfairly, but that does not mean the employee doesn’t desire to do so. In brief, avoidance is not the same as lack of desire. In addition, the majority (but not all) of those individuals presenting with complaints of low sexual desire, are typically masturbating at the same rate and frequency as they had been before their desire for sex with their partner had diminished and report in private meetings with me little change in their desire for solitary sexual gratification.

And accordingly, as I have written elsewhere in professional psychology journals, what is more often likely to be the case with many “low desire” individuals is not that they don’t desire sexual contact with their partners, but rather, for reasons that get addressed and resolved in our therapy sessions and which are beyond the scope of this essay, they are simply avoiding sexual contact. After all, how many of us would seek out an interaction that we suspect will likely end in failure, embarrassment, or disappointment? I, for one, would not be looking forward to taking batting practice from Nolan Ryan.

Once the problem of low sexual desire is redefined as one of sexual avoidance, then the problem changes from one of trying to discover the reasons someone is longer interested in sex to uncovering the reasons why in spite of someone’s continuing interest in sex, he or she is nonetheless continuing to avoid all partner-related sexual contact.

It might be worth noting here, that most individuals are usually more comfortable attributing their infrequent sexual behavior to a loss of desire and are likely to balk at the notion that their real problem might be sexual avoidance. My hypothesis is that people are more comfortable with a diagnosis that minimizes personal responsibility for a problem. According to this reasoning, “low desire,” for some individuals, implies an issue that may have a biological as opposed to a psychological cause and is therefore somewhat of our control. Thus, if my problem can be construed by me as “out there” in the physical realm over which I have little if any control, as opposed to “right here” in the psychological arena, over which I might have somewhat more control, my tendency would be to adopt the “out there” explanation for my behavior. Reframing low sexual desire as intentional sexual avoidance in some way forces the individual to acknowledge that he or she might have of a choice in the matter. (This same reasoning comes into play when I treat men with erectile dysfunction who appear disappointed to learn that there is no biological or physiological reason for their problem. These men were hoping they could blame their dysfunction on something outside of their own control.)

I wish to make clear at this point that my purpose in reframing the patient-diagnosed problem of low sexual desire as being a problem of low sexual frequency, which inevitably leads to conscious sexual avoidance, is not presented for the purpose of placing blame on anyone, but to clarify how we might go about treating the problem. When the problem is avoidance, the solution almost always requires that we address and stop running from those behaviors we have been avoiding. When the problem is desire, the solution is much less obvious.

I suspect that those of you who have read this far into the essay would feel somewhat cheated if you didn’t get at least a bit of a taste for how I might go about treating an individual complaining of what he or she themselves describe as low sexual desire. What I have discovered in working with such individuals is that they are often unable to either identify of to implement those conditions that would likely lead them to find sex a relaxing or enjoyable experience. Sex for these individuals has become so fraught with worry and embarrassment that they often can’t maintain the equanimity required to discover what those conditions are that might allow them to enjoy sexual intimacy with their partner.

What is also apparent, at least for certain of my patients, is that although they do know what conditions they might enjoy, they lack the courage to ask for their implementation. Thus I see among some of my patients, men who know exactly what would make for an enjoyable and relaxing erotic experience. More than one man has shared with me his wish that his partner would touch his soft penis in tender, gentle way. These men know that such touching would relax them and would likely lead to a level of arousal necessary to produce an erection. However, these men believe they should begin the sexual encounter in an already aroused state and therefore would feel embarrassed if they do not begin the encounter in possession of an already “rock hard” erection.

It’s not hard to understand why these men avoid initiating a sexual encounter. They don’t want to fail and have what they believe to be their sexual “inadequacy” discovered. These men then explain this avoidance to their partner (as well as to themselves) as being due to a loss of libido or desire rather than to the perfectly understandable fact that their conditions for good sex are not being met.

I see exactly the same phenomenon at work with many of the women I treat. Some women know that they would enjoy and would find highly arousing the experience of receiving a foot massage prior to beginning more genitally focused love play. But they don’t ask for that foot rub. “He’d probably be bored if he did that for me,” they say. Other women tell me that they wish their partner would spend more time giving them oral pleasure rather than having their partner be the one who is expecting to receive oral stimulation. When I ask why they don’t ask for what they want these women reply with some variation on, “I couldn’t ask for that. I’d be so humiliated if he told me he didn’t enjoy the taste or smell of my genitals.” And again, because they don’t ask for and therefore do not get their conditions for good sex met, they deceive themselves into believing that they have lost desire. What these women (and men) need is not more desire, but more courage to ask for what they actually want.