Low Sexual Desire

Low Desire (Hypoactive Sexual Desire Disorder [HSDD])

Prevalence

Among men aged 18-59 in the general population, about a fifth report a lack of interest in sex. But it's an age related thing - 26% of men aged 70 and over have HSDD.

As men age, there's a gradual decrease in sexual desire - it's natural.

Men's interest in sex declines gradually beyond the age of 60 leaving about 25% of men who want regular sexual activity into their eighties.

Decreased desire is a problem when it drops off suddenly, less so when it fades gradually - which helps older couples adjust to a decline in sexual desire and genital sexual activity.

However, for some individuals and couples, let's remember that sexual activity continues to be a major part of individual and relationship well-being.

And for men especially, the decrease of libido ma be associated with shame.

Etiology of Low Desire

In most instances, low sexual desire in a man can be caused by a combination of four factors:

  1. Reduced testosterone
  2. Side-effects of SSRI's and other drugs
  3. Chronic illness of some kind
  4. Psychosexual issues such as losing sexual interest in a partner or sexual boredom.

Diagnostic Criteria for Hypoactive Sexual Desire Disorder

  1. persistent deficiency or absence of sexual fantasies and desire.
  2. Distress or interpersonal difficulties caused by the above
  3. The presence of low desire is not due exclusively to the physiological impact of drug abuse, a medication or a general medical condition.

The origins of low desire can be complex and you have to be aware that adverse testosterone levels may not be the cause of low desire in men - a lot of guys with low desire have total and free testosterone levels well within the normal range.

For the man who reports little or no interest in sex the first step is to find out if the issue is caused by low desire or low arousal. For example, a man who says that he has no interest in sex may mean he is having difficulty getting an erection ! Suitable questions to elicit the truth include the following:

Questions - Low Desire and Erectile Dysfunction

Despite your lack of interest, can you still get an erection?

Compared to your past, how would you rate your interest in sex?

If you can get an erection, do you think that you would be interested in having sex?

Medications Associated with Low Desire

Antihypertensive Antiarrhythmic Antineoplastic Anticonvulsant Antidepressant

Treating Low Desire

The effective treatment of low desire among men is all about identifying the cause of the problem and providing appropriate treatment.

For example, androgen supplementation in cases of low desire and normal range testosterone levels will not increase a man's sexual desire.

And even if a primary factor is identified, low sexual desire will in many cases be multifactorial.

For example, a man's declining androgen levels may cause low desire but the problem was made worse by the decreased sense of masculinity, and increased tension with his partner resulting from lack of sexual interest.

This can cause stress (e.g., depression) and so androgen supplementation needs to be supported by brief psychosexual counseling.

This may involve helping him to understand the various factors involved in his low desire; set new expectations for his future sexual life; and show him how to speak clearly and openly with his partner about their sexual relationship.

Addressing Low Desire Associated with Reduced Androgen

Low sexual desire associated with low testosterone levels may be linked to erectile dysfunction, fatigue, lethargy, mood swings, loss of motivation, and reduced physical vitality.

Laboratory tests to determine testosterone levels may indicate a need for androgen supplementation, which can increase sexual desire among men with low serum testosterone levels.

There are risks, however - which means careful screening for any contraindications such as liver or renal disease which may lead to the development of gynecomastia.

Addressing Low Desire Associated with Medication Side Effects

A number of medications cause low hormone and desire levels - one can substitute a different but equivalent medication that has less of an impact on a patient's level of desire, especially where antidepressants are concerned.... 38% to 50% of men report impairments in sexual desire on SSRIs.

And it is important to note that many patients with antidepressant-associated low desire will also have erectile dysfunction .

Addressing Low Desire Associated with Chronic Illness

Low desire and other sexual dysfunctions caused by chronic illness have both physical and psychological aspects, so the doctor needs to differentiate between the physiological and psychological factors at play.

For example, the illness itself, and medical treatments for it will in many cases have a direct impact on sexual function.

Thus, in some cases, medical intervention can help to alleviate the problem. In cases of musculoskeletal disease, for example, positional changes for sexual intercourse might make a difference, as may less demanding sexual practices.

The doctor should aim to help the patient maintain, restore and adjust sexuality.

Addressing Low Desire Associated with Psychosexual Issues

Low desire associated with psychosexual issues can have a complex etiology including abuse in childhood - and often problems in a couple relationship.

Here counseling may be brief and solution focused, emphasizing current couple behaviors and practical suggestions, many of which can revolve around enhanced couple communication.

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