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The absence or loss of sexual desire part 1

Loss of sexual desire is a major problem, and not secondary to other sexual difficulties, such as lack of erection or dyspareunia. Lack of sexual desire does not exclude sexual satisfaction or arousal, but makes sexual activity less likely.

Diagnostic criteria:
1) the lack or loss of sexual desire is expressed in the reduction of sexual fantasies, the search for sexual stimuli, thoughts about the sexual side of life, accompanied by a subjectively pleasant emotional tinge;
2) interest in the implementation of sexual activity with partners or masturbation without them appears less frequently than could be expected, taking into account age, situation and the previously familiar level.

Included (refer to this category):
– frigidity (alibidemia);
– reduced sexual desire;
– hypoactive sexual desire.

H. Kaplan (1987) defines this condition as repressed sexual desire. W. Masters and W. Johnson (1986) call it “inhibited sexual desire” (YSD) and identify two main signs of loss of sexual desire:
1) low degree of sexual activity;
2) the absence of the subject’s desire to show this activity.

And the desire includes sexual fantasies, manifestations of attention to erotic stimuli and materials, the ability to notice attractive potential partners, mental and physical discomfort (sexual abstinence) in case of a forced rejection of sex.

According to W. Masters and B. Johnson (1983), lack of desire is one of the frequent complaints about the treatment of married couples, and this is more common for women (up to 35%) than for men (up to 15%). They believe that lack of interest in sexuality should be classified as YSD only when it turns out to be a source of personal problems or leads to disorder in relationships. Some people, for reasons of subjective order, voluntarily reject sex, choosing celibacy (for example, Catholic clergy), which ultimately leads to the complete suppression of their sexual desire. This non-pathological lifestyle has been called normal asexuality, and there are no signs of sexual dysfunction.

However, often enough reduced sexual desire can be a serious problem in marriage. Thus, the discrepancy in the levels of sexual desire in the two partners is one of the most common complaints that come to sex therapists (J. Beck, 1995).

X. Kaplan (1987) refers to the manifestations of the absence or loss of sexual desire hidden forms of avoiding intimate contact; the emergence of negative ideas blocking sexual reactions and experiences; anxiety associated with a sense of inferiority of their own sexual activities; rejection of adequate physical and / or psychological stimulation during sexual activities; suppression of erotic fantasies.

There are a number of biological (organic) disorders, accompanied by a decrease or absence of sexual desire. In men, this is most often associated with hormonal deficiency, which is manifested by a pronounced decrease in the level of testosterone, or rather of its active metabolite – 5a-dehydrotestosterone in the blood.

The causes of androgen deficiency include primary (associated with pathological changes in the testes) and secondary (due to the pathology of the pituitary and hypothalamus) hypogonadism; prolactin-secreting pituitary tumors, which are detected in more than 10% of men with a loss of sexual desire, etc.

Hormonal (estrogenic) deficiency in women with gross ovarian dysfunction or their removal often leads to loss of the erotic component of sexual desire (a positive reaction to erotic stimuli, including superficial caress), and adrenal pathology, which causes a decrease in the level of androgens, may be accompanied by a complete lack of interest in sexual act (reduced sexual component of libido). Other biological causes that often lead to a decrease in sexual desire in people of both sexes include toxic effects (substance abuse, especially drug abuse); side effects of certain drugs (for example, neuroleptics or a number of tranquilizers, antihypertensive drugs such as clophelin or reserpine, etc.); metabolic disorders in the presence of signs of hepatic, renal or respiratory failure; temporal epilepsy.

Mental disorders, primarily accompanied by depressive affect, often contribute to the suppression of sexual desire. According to U. Masters and V. Johnson (1979), in patients with depression, a decrease in libido is observed in 70% of cases, and in 33% there are various kinds of disorders during sexual intercourse.

The main diagnostic value for the attribution of cases of reduction or loss of sexual desire to this category is the identification of psychological mechanisms in patients that inhibit sexual desire, in the absence of obvious biological causes of the disorder.

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