Inhibited Sexual Desire

Inhibited sexual desire (ISD) is a medical condition with only one symptom: low sexual desire. A person with ISD seldom, if ever, engages in sexual activities. He or she does not initiate or respond to a partner’s sexual overtures. This condition is also called hypoactive sexual desire disorder, sexual aversion, or sexual apathy.

ISD is one of the most common problems couples face today.

ISD can be seen as either a primary or a secondary condition. For treatment purposes, this is an important distinction.

Primary: The person with ISD has never had sexual desire.

Secondary: The person with ISD began a relationship with normal sexual desire, but later became disinterested.

ISD can also be understood as a relationship issue, which helps to guide medical or psychological treatment. This includes:

Situational: The person with ISD has sexual desire for others, but not for his or her partner.

General: The person with ISD has no sexual desire for anyone.

There is no true normal range for sexual desire because it naturally fluctuates throughout life.

Major life changes can affect our sexual desire. These include:

• pregnancy
• partner changes (marriage or divorce)
• menopause
• work and life imbalance

People seek help when ISD puts stress on their relationships. However, the problem is not always a case of ISD. One partner may have an overactive sexual desire. When this happens, it can:

• erode affection
• cause neglect of the nonsexual relationship
• cause the other partner to lose sexual interest

ISD is often an intimacy issue. Common relationship factors that can reduce sexual desire include:

• conflicts
• toxic communications
• controlling attitudes
• contempt or criticism
• defensiveness
• breach of trust (infidelity)
• lack of emotional connection
• spending too little time alone

People who are most at risk of developing ISD have experienced trauma (incest, rape, or sexual abuse), or were taught negative attitudes about sex by their families while growing up.

There are many medical and psychological factors that can also hamper sexual desire, including:

• painful intercourse
• erectile dysfunction (impotence)
• delayed ejaculation (inability to ejaculate during intercourse)
• negative thinking patterns (fear of intimacy, anger, dependency, or feelings of rejection)
• pregnancy and breast feeding
• mental health problems (depression, anxiety, low self esteem)
• stress
• use/overuse of alcohol and street drugs
• chronic illness
• pain and fatigue
• side effects of medicines (especially antidepressants and anti-seizure drugs)
• hormonal changes
• low testosterone (in both women and men)
• menopause

Nonsexual Diseases

Certain diseases can affect libido (sexual desire). The most common of these are:

• high blood pressure
• cancer
• coronary heart disease
• neurological issues
• diabetes
• arthritis

Sexual Dysfunction

Women who have had breast or vaginal surgery may experience sexual dysfunction, poor body image, and inhibited sexual desire.

Erectile dysfunction (ED) is a man’s inability to achieve an erection. This can cause ISD in the man, who may feel he is a failure sexually. Perceived failure in both men and women (failure to orgasm, for example) can cause the individual experiencing the dysfunction to have ISD.

Erectile dysfunction is not caused by aging. It can be a sign of medical problems, including:

• diabetes
• heart disease
• clogged blood vessels

In the majority of ISD cases, medical conditions are less important than each partner’s attitude about sexual intimacy.

You may be diagnosed with ISD if you experience low sexual desire and it causes you distress personally or in your relationship.

Your doctor can look for causes of ISD and recommend strategies that may help. After questioning you about your medical history, the doctor may prescribe some or all of the following tests:

• blood tests to check for diabetes, high cholesterol, thyroid problems, or low testosterone
• pelvic exam to check for physical changes, such as vaginal dryness, painful areas, or thinning of the vaginal walls
• blood pressure check
• tests for heart disease
• prostate gland examination

After treating any medical conditions, your doctor may recommend evaluation by a sex therapist or psychiatrist, either individually or as a couple.

Psychological and sexual counseling are the primary treatments for ISD. Many couples first need marriage counseling to improve their nonsexual relationship before addressing the sexual component directly.

Communication training is one option that teaches couples how to:

• show affection and empathy
• respect each other’s feelings and perspectives
• resolve differences
• express anger in positive ways

Sexual counseling will help couples learn how to:

• devote time and energy to sexual activities
• find interesting ways to sexually approach their partner
• decline sexual invitations tactfully

Some people may need individual counseling if their ISD stems from sexual trauma or sexual negativity learned as a child.

Male problems, such as impotence or delayed ejaculation, can be treated in private counseling or with drug therapy. Drugs such as Viagra can help with ED. But it is important to keep in mind that these drugs only permit erections; they do not cause them.

A woman’s sex drive is greatly influenced by the hormones testosterone and estrogen. Small doses of estrogen delivered via a vaginal cream or a skin patch can increase blood flow to the vagina. However, long-term estrogen therapy has increased risks of breast cancer and heart disease. Female testosterone therapy may also help, but it is not yet approved by the Food and Drug Administration for treatment of female sexual dysfunction.

Testosterone side effects include:

• mood and personality changes
• acne
• excessive body hair

Certain lifestyle changes can have a positive effect on sexual desire while also improving overall health.

• Set aside time for intimacy: If one or both partners’ schedules are very busy, it can help to put dates on your calendar to make intimacy a priority in your relationship.
• Exercise: Working out can elevate your mood, improve libido, increase stamina, and create a more positive self-image.
• Communicate: Talking openly and honestly fosters a closer emotional connection. It may also help to tell your partner your sexual likes and dislikes.
• Manage stress: Learning better ways to manage financial pressures, work stress, and the hassles of daily life can help you to relax.

ISD is often successfully treated through couples’ therapy. However, treatment can be more challenging for men—both in counseling and drug therapy.

Counseling can be a lengthy process, but it can enhance a couple’s attitude towards each other and improve their general outlook on life.