Kelly
seemed to have it all. A loving mother of three and a public-relations executive
in Manhattan, she had a handsome and charming partner who was a successful entrepreneur.
They jetted off for vacations in the Caribbean and dined in the finest restaurants.
But their relationship floundered in one intractable area.
"After
a while," Kelly says, "he just stopped wanting to have sex. He'd go
months without even touching me."
It's
a subject that's full of shame: low sex drive. When your partner has no interest
in sex despite your best efforts, it's easy to become perplexed. And without guidance,
partners may characterize the problem in ways that can destroy the relationship.
In
a society saturated with sexual imagery, it seems strange that some people have
no desire for sex. But it is a startlingly common problem. Millions of people
suffer from a condition known as hypoactive sexual desire (HSD) - about 25 percent
of all Americans, by one estimate, or a third of women and a fifth of men. Sex
researchers and therapists now recognize it as the most common sexual problem.
In
recent years, experts have turned their attention to the causes of HSD, and sex
therapists are working on strategies to treat it. Although there is a 50 percent
positive outcome in treatment, many of those who have HSD don't seek help. This
is usually because they don't realize it's a problem, other issues in the relationship
seem more important or they feel ashamed.
Many
couples in conflict may have an underlying problem with sexual desire. When desire
fades in one partner, other things start to fall apart.
How
little is too little?
For
Pam, happily married and in her forties, her once healthy sexual desire simply
disappeared about six months ago. "I don't know what has happened to my sexual
appetite," she says, "but it is like someone turned it off at the switch."
She and her husband still have sex, maybe once every few weeks, but she does it
out of obligation, not enthusiasm.
"I
used to enjoy sex," Pam says. "Now there's a vital part of me that's
missing."
Ordinary
people aren't in a constant state of sexual desire. Everyday occurrences - fatigue,
job stress, even the common cold - can drive away urges for lovemaking. Usually,
however, spending romantic time with a partner, having sexual thoughts or seeing
stimulating images can lead to arousal and the return of a healthy sex drive.
Yet
for some people, desire never returns - or was never there to begin with. Frequently,
even healthy sexual fantasies are virtually nonexistent in some people who suffer
from HSD.
Just
how little sex is too little? Sometimes, when a partner complains of not having
enough sex, his problem may actually be an unusually high sex drive. Experts agree
that there is no daily minimum requirement of sexual activity. In a British survey,
published in the Journal of Sex and Marital Therapy, 24 percent of couples reported
having no sex in the previous three months. And the classic study, Sex in America,
found that one-third of couples had sex just a few times a year. Although the
studies report frequency of sex, not desire, it's likely that one partner in these
couples has HSD.
One
tiny pill
Years
ago, another sexual problem - erectile dysfunction - received a sudden burst of
attention when a medical cure hit the shelves. Before Viagra came along, men with
physically based problems suffered impotence in silence, and without much hope.
Now many couples enjoy a renewed reservoir of passion.
Obviously,
any pill that relieves hypoactive sexual desire would be wildly popular. Unfortunately,
the causes of HSD seem to be complex and varied; some sufferers might be treated
with a simple pill, but most will likely need therapy - not chemistry.
One
common source of reduced desire is the use of antidepressants known as selective
serotonin reuptake inhibitors. SSRIs have been found to all but eliminate desire
in some patients. Antidepressants such as Prozac and Zoloft are among the most
widely prescribed drugs for treating depression. Yet one distressing side effect
is a drop in sex drive. Some studies indicate that as many as 50 percent of people
on SSRIs suffer from a markedly reduced sex drive.
Researchers
believe that SSRIs quash the libido by flooding the bloodstream with serotonin,
a chemical that signals satiety. "The more you bathe people in serotonin,
the less they need to be sexual," says Joseph Marzucco, MSPAC, a sex therapist
practicing in Portland, Oregon. "SSRIs can just devastate sexual desire."
Fortunately,
researchers are studying antidepressants that act through other channels. Bupropion
hydrochloride, which enhances the brain's production of the neurotransmitters
dopamine and norepinephrine, has received extra attention as a substitute for
SSRIs. Early studies suggest that it may actually increase sexual desire in test
subjects. A study reported last year in the Journal of Sex and Marital Therapy
found that nearly one-third of participants who took bupropion reported more desire,
arousal and fantasy.
It's
all in your head
Physiological
problems can also lead to a loss of sexual desire. Men with abnormal pituitary
glands can overproduce the hormone prolactin, which usually turns off the sex
drive. As reported in the International Journal of Impotence Research, tests of
a drug that blocks prolactin found it increased the libido in healthy males.
In
women, some experts believe that one cause of weak sexual desire is, ironically,
low testosterone levels. Normally associated with brawny, deep-voiced men, testosterone
is a hormone with a definite masculine identity. But women also make small amounts
of it in their ovaries, and it plays an important role in their sexual lives.
Without a healthy level of testosterone in the blood, some researchers believe,
women are unable to properly respond to sexual stimuli. Furthermore, there is
anecdotal evidence that testosterone supplements can restore the sex drive in
women.
Rosemary
Basson, M.D., of the Vancouver Hospital and Health Sciences Center in British
Columbia, however, cautions that too little is known about the role testosterone
plays in women. "We don't even know how much testosterone is normal,"
Basson says. "The tests designed for men can't pick up the levels found in
women."
In
one study suggesting that HSD is more psychological than physiological, Basson
and her colleagues tested the effects of Viagra on women who reported arousal
problems. Basson found that while the drug generally produced the physical signals
of sexual arousal, many women reported that they still didn't feel turned on.
Indeed,
many psychologists and sex therapists believe that most patients with HSD have
sound bodies and troubled relationships. The clinical experience of Weeks has
shown that two factors identified in a relationship can, over time, devastate
the sex drive: chronically suppressed anger toward the partner and a lack - or
loss - of control over the relationship. And once these issues threaten a healthy
sex drive, lack of intimacy can aggravate the problems further. Without help,
these issues can balloon until the relationship itself is seriously damaged. And,
consequently, HSD becomes further entrenched.
Lacking
the desire for desire
Although
HSD is one of the most difficult to address of all sexual problems, it can be
treated successfully. The key is to find a highly qualified sex and marital therapist
who has experience in dealing with it. Unfortunately, while HSD is the most common
problem that sex therapists see, millions of cases go untreated.
Some
people who lack desire are just too embarrassed to seek help, especially men.
Others are so focused on immediate concerns - such as a stressful job or a family
crisis?that they put off dealing with the loss of a healthy libido. Still others
have become so used to having no sex drive that they no longer miss it; they lack
the desire for desire. These people represent the most severe cases - the hardest
to treat.
Some
people who don't get treatment find ways to adjust. "Thank goodness my husband
is so patient and caring," Pam says. "He tries to spark interest, but
when it is not ignited he'll settle for cuddling and caressing."
Other
relationships can't survive the strain. After a year, Kelly and her boyfriend
broke up. "I couldn't convince him that it was a problem," she says,
"but it was."
Gerald
Weeks, Ph.D., A.B.S., is a professor of counseling at the University of Nevada
in Las Vegas and a board certified sex therapist of the American Board of Sexology.
Jeffrey Winters, formerly with Discover magazine, is a science writer based in
New York.
By:
Gerald Weeks Originally published by Psychology Today:October 2, 2002
