The absence or loss of sexual desire can be observed in a number of pathological conditions. These include schizophrenia, temporal lobe epilepsy, head injuries, tumors, cerebral vascular diseases, substance abuse (drugs, alcohol, etc.), depressive disorders. In particular, in patients with depression, a decrease in libido is observed in 70% of cases. Endocrine disorders: in men, primary (associated with pathological changes in the testes) and secondary (caused by the pathology of the pituitary and hypothalamus) hypogonadism, prolactin-secreting pituitary tumors, castration; in women, there is a pathology of the adrenal glands, ovaries, congenital and acquired (for example, in menopause) hypothalamic-pituitary failure. Side effects of a number of drugs: neuroleptics, tranquilizers from the group of benzodiazepines, tricyclic antidepressants, antihypertensive drugs (clofelin, reserpine, etc.). Loss of sexual desire sometimes develops as a result of other sexual disorders. For example, a man who has long suffered from erectile dysfunction, against which his interest in sex has gradually faded away, may find that stopping sexual contact attempts helps him to avoid the unpleasant effects of sexual failures, anxiety fears and fears, new painful blows to self-esteem. In these cases, alibidemia is secondary (neurotic) in nature and serves as a kind of protection against spiritual upheavals and humiliation of male vanity. A similar protective mechanism is observed in women with prolonged sexual dissatisfaction, accompanied by anorgasmia. In such cases, the extinction of libido until alibidemia is explained by the absence of positive reinforcement during sexual intercourse.
Considering the psychodynamics of frigidity, X. Kaplan (1987) notes that a woman has an unconscious conflict that prevents her from experiencing the pleasure of contact with a man. As a rule, this form of disorder is not associated with a single conflict, but appears as a syndrome. The manifestations of this disorder include fears or guilt feelings associated with sexual experiences, hostility towards men in general or a particular man, fear of being rejected if she allows herself to “internally relax”; concern about the “proper” performance of their sexual activities, a sense of shame about the manifestations of eroticism, etc. The specific protection mechanisms characteristic of frigid women actually do not allow them to show their sexual response. Women either avoid receiving adequate stimulation from the man, or, in the event that she does not prevent her partner from initiating her, she develops a mechanism of perceptual protection that prevents the enjoyment of this excitement. She, in a literal sense, does not allow herself to experience any erotic sensations. She unknowingly forbids herself any sexual response and does not allow herself to indulge in sexual experiences.
According to K. Stifter (1999), the absence of sexual desire may be an unconscious expression of problems in relationships or intrapersonal tensions. There are many unconscious reasons to force another person to repent of something with the help of a denial of sex, which we ourselves often do not guess. For example, such a reason could be a disappointment in the spouse that he or she is not the “prince” or “princess” they were considered to be. Also, partners who are entangled in the struggle for power do not “want” to feel any lust for their “counterparty”. They do not want just because the partner “wants” it. Another motive is the conflict of intimacy and distance. It exists where the relationship does not clearly define how each partner can consider that degree of mental intimacy and dependence is permissible, without fear of losing its autonomy, and how much independence everyone is willing to develop to the extent that both of them do not have the impression that they are no longer a couple.
Other psychological factors of libido suppression: trauma of sexual abuse; low self-esteem associated with the belief in their sexual unattractiveness (true or imaginary); painful personal reactions to criticism of a partner or parting with him; unconscious (repressed) homosexual impulses that inhibit heterosexual attraction; prolonged sexual abstinence (for any reason); a gradual decrease in sexual desire among people who are completely absorbed in their career or business.
Women with a lack of sexual desire show an inability or low ability to sexual arousal in intimate situations, and if sexual intercourse takes place, then frictions do not give voluptuous sensations due to low sensitivity of the genitals and orgasm is usually not achieved. Thus, alibidemia in most cases includes anorgasmia. Sometimes, frigid women may experience arousal and orgasm as a result of effective sexual stimulation, although this happens rarely and in the absence of any initiative for closeness on their part.
Weakening or loss of sexual desire is the most common sign of a decaying sexual connection. In these cases, sexual “inhibition” is not generalized, and, manifesting itself only with a certain sexual partner, may not find itself in other intimate situations. Such selective disorder of sexual desire, caused by a partner’s lack of erotic attractiveness, indifference or negative attitude towards him, is a consequence of pronounced family-sexual disharmony, and therefore requires clarification in the diagnosis indicating the situational (selective) nature of dysfunction.
Examination of patients with complaints of lack of sexual desire is usually performed on an outpatient basis. Includes standard sex examination. When collecting sexological history, special attention should be paid to psychosexual development, the presence of deviations of sexual desire (bisexual, homosexual, etc.), sexual debut and subsequent experience of intimate contact, the patient’s ideas about sexual norm and psychophysiology of sexual life, the nature of interpersonal and sexual relationships with constant sexual partner / spouse or finding out the reasons for the lack thereof.
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