Chapter 9
“YOU NEVER WANT TO.” “YOU’RE INSATIABLE.”
THE GREAT STRUGGLE OVER DESIRE DIFFERENCES AND LIBIDO
LOSS
When couples first fall in love, they often can’t keep
their hands off each other. But, over time--typically six
months to a year or two, feelings of sexual urgency
subside, and so does sexual frequency. This happens for
several reasons:
* The end of unrealistic fantasies. “Initially people have
fantasy-based pictures of each other,” explains Advisory
Board member Marty Klein, Ph.D. “But as time passes, you
reveal who you really are, and you see who the other person
really is. The fantasies fade, and you’re left with
reality. Now, that reality might be good enough for a long
and basically happy relationship. But it’s still reality,
warts and all. Fantasies generally heat up libido. Reality
has a way of cooling it.”
* The intrusion of the mundane. When couples first connect,
they give each other their undivided attention. It’s
flattering--and a turn-on--to have another person be so
wrapped up in you. But over time, other priorities demand
attention: jobs, family, friends, mowing the lawn, picking
up the dry cleaning. These inevitable distractions and many
others, often prove sexually distracting as well.
* Less time budgeted for fun with each other. Initially,
there’s no need to make dates to have fun or sex because
that’s all you do. But over time, as the banalities of
daily living compete with fun and sex time, fun becomes
less of a focus and sex becomes less frequent. “People
start taking their relationships for granted,” Advisory
Board member Louanne Weston, Ph.D., explains. “There’s less
courting, less special time together. Combine that with
kids, careers, and how you’re going to afford a new roof,
and sex often takes a back seat.”
Whatever the reason(s), after a while, in almost all
longterm relationships, the sexual heat cools and frequency
declines. Sex becomes less like the Fourth of July, and
more like Thanksgiving. When both people are in synch on
this change, then reduced sexual frequency does not become
a sore point. But typically, couples fall out of synch on
desired sexual frequency. One person wants sex more often
than the other. When that happens conflict is
inevitable--and often acrimonious. “Desire differences,”
says Advisory Board member Dennis Sugrue, Ph.D., “have
become one of the leading reasons why couples consult sex
therapists. Many couples have a hard time negotiating their
sexual frequency, and dealing with the emotional issues
desires differences raise.”
When desire differences cause chronic conflict, both lovers
lose their sense of humor, and a grim chill may descend
over the sexual side of the relationship. Good will erodes
and sexual quality deteriorates, and often extends to
nonsexual aspects of the relationship, finding expression
in irritability, bickering, and loss of generosity with
each other.
The one who wants more sex typically feels rejected,
unloved, confused, angry, unattractive, and deceived: “You
used to want sex five times a week. If I’d known you’d
eventually only want it twice a month, I’m not sure I would
have stuck around. But now we’re married and have kids and
a mortgage. I love you, and to me, love means sex. I feel
you don’t love me. I also feel that you tricked me. Now I
feel stuck.”
Meanwhile, the one who wants less sex typically feels
guilty, unloved, confused, and resentful of being besieged
by seemingly constant sexual demands: “This is what happens
in longterm relationships. Over time, sex becomes less of a
priority. If I’d known you were such a sex fiend, I’m not
sure I would have stuck around. I love you, but there are
big differences between love and sex. I feel you don’t love
me, you just want sex, sex, and more sex. But now we have
kids and a mortgage. You’re insatiable. I feel stuck.”
As good will erodes, sex becomes increasingly more
difficult to discuss. Couples often slip into two modes:
bickering or silence. “Over time,” Advisory Board member
Linda Alperstein, M.S.W., L.C.S.W., explains, “desire
differences often becomes festering sores that make both
people feel miserable and estranged.”
Quite often the higher-desire partner decides to stop
initiating to see how long it takes for the lower-desire
partner to ask for sex. “It’s often a long wait that just
makes the higher-desire person angrier,” Sugrue says.
A frequent casualty of a persistent desire difference is
nonsexual affection: holding hands, friendly hugs during
the day, cuddling while watching TV, and kissing each other
goodnight. The one who wants sex more typically initiates
such affection, and interprets any positive response as a
chance for sex. As a result, the one who wants sex less,
shrinks from nonsexual affection for fear of engendering
conflict that reciprocation might be misinterpreted as
interest in sex. The one who wants it more complains,
“You’re cold as ice.” Meanwhile, the one who wants it less
complains, “Can’t you experience affection without
immediately assuming it’s sexual?”
As resentments deepen, what began as one problem, a desire
difference, becomes two problems: the desire discrepancy
and the emotional pain the situation has caused.
“SEX FIENDS” VS. “NYMPHOS:” WHO WANTS SEX MORE?
In some couples, the man wants sex more. In others, the
woman has the greater libido. Culturally, however, men are
assumed to be eager for sex while women are assumed to be
more demure. When the man wants greater sexual frequency,
the couple may experience considerable distress, but they
have a problem that feels culturally expected and,
therefore, “normal.” However, when the woman is the one
eager for more frequent sex, the pain inherent in a
persistent desire difference become compounded by the fact
that both people are likely to view the situation as
culturally unexpected, “abnormal,” and therefore, even more
distressing.
While it’s more common for the man to be the one interested
in more frequent lovemaking, the woman finds herself in
that position surprisingly often. An informal survey of
this book’s Advisory Board and other sex therapists
suggests that the man is the more libidinous partner in 60
to 70 percent of couples, while the woman has more libido
in 30 to 40 percent. “I’ve seen plenty of cases where the
woman wants sex more than the man,” Weston says. “That’s
hard for many couples. That’s when terms like ‘nympho’ get
thrown around. The man accuses the woman of being one, and
the woman wonders if she’s somehow abnormal. Of course,
name-calling makes things worse.”
WHO CONTROLS THE SEX? WHAT DO YOU REALLY WANT?
When sex therapists work with couples dealing with desire
differences, they often ask, “In your relationship, who
controls the sex?” Invariably, the man and woman both point
at each other--and are astonished to learn that their other
half thinks they wield the sexual power, because they feel
utterly powerless. The one who wants more sex feel
powerless because the less sexually inclined partner can
shut sex down by uttering that one awful word, “no.”
Meanwhile, the one who wants less sex feels powerless
because constant badgering wears down that person’s
resistance, resulting in grudging sex when the lower-libido
partner is not in the mood. An important step in resolving
a desire difference is for both lovers to realize that they
have more power than think they have, the power to drive
the other crazy.
Therapists typically ask the partner with more libido:
“What do you really want? Sex? Or other things?” “I want
sex,” that person typically replies. True enough. “But
typically,” Klein explains, “that person also wants more
nonsexual affection, which has faded away because of
acrimony over the desire difference, and more attention in
general, which has faded or disappeared because of the
couple’s mutual resentments. Those things are possible
without sex.”
Therapists typically ask the partner with less libido:
“What do you really want? How often do you want sex? Is
there anything else you want?” “I have no idea how much sex
I want,” that person typically replies, “because I never
get the chance to experience my own libido. I’m either
fending off sexual advances or giving into them. It’s never
about what I want, only what my spouse wants.” True enough.
“But typically,” Klein says, “that person also wants the
same things the other partner wants--more nonsexual
affection and more attention in general--and doesn’t get
them for the same reasons, erosion of good will.”
The realization that sexual desire differences often mask
nonsexual issues gives couples some room to negotiate. “The
higher-desire person might say, ‘I’m willing to have less
sex if you pay more attention to me out of bed,’” Klein
explains. “And the lower-desire person might say, ‘I’m
willing to have more sex if you make me feel more special
out of bed, less like a sex object.’”
WORKING OUT DESIRE DIFFERENCES
There is no magic formula for dealing with desire
differences. But here are some guidelines that often help:
* It may be biological.
Male folklore is filled with resentment over women’s
transformation from hot lovers into ice maidens: She fucked
me to the altar, many men complain, but since we’ve been
married, we hardly do it at all. “No matter who the
higher-desire lover is,” Sugrue observes, “that person
often accuses the other of conscious bait-and-switch
tactics--lots sex until the relationship becomes committed,
and then turning off the sexual faucet.” However,
diminished desire is often not conscious. In one study,
Sugrue explains, researchers tracked blood levels of
serotonin, a neurotransmitter crucial to mood, in three
types of people: a group who had just fallen in love, a
group with obsessive-compulsive disorder (OCD), and in
controls. The serotonin levels in the new lovers were
almost as high as those of the people with OCD, and both
were much higher than the controls’. Over time, the levels
in many of the new lovers declined and became closer to the
controls’. “Falling in love is like an obsession,” Sugrue
explains. “You’re totally focused on the other person. That
serves an evolutionary purpose. It keeps people together
long enough to reproduce. But then serotonin levels return
to baseline. When I explain that the lower-desire person’s
change is often biological and not a conscious
bait-and-switch, it often helps the higher-desire partner
let go of some resentment.”
* Count your blessings.
So you want sex twice a week, and your lover would be
perfectly happy with twice a month. That’s a drag, but at
least your partner wants sex sometimes. Many people don’t
want it at all--perhaps one-quarter of women and 10 percent
of men. (See “Libido Loss” later in this Chapter.) In cases
of desire differences, sex itself if not the issue, just
frequency. But in cases of libido loss, sex becomes the
issue, and “not tonight” becomes “never.” “Desire
differences are hard,” Klein says, “but libido loss is
harder.”
* Be flexible.
Some people enjoy sex late at night when their lovers are
too tired for it. Others are preoccupied by work, school,
or family commitments. Some like sex under warm quilts,
while others prefer it on the sofa with no coverings at
all. “Over time,” Sugrue explains, “little differences can
add up to a big desire difference. Talk about when you have
sex, where, and how. The higher-desire partner should make
every effort to accommodate the lower-desire partner’s
preferences.”
* Find a friend on the opposite side of a desire
difference.
It’s safe to assume that if friends have been coupled up
for more than a year or two, they, too, probably struggle
with desire differences. Ask how they cope. If possible,
try to find a same-sex friend who is on the opposite side
of the argument from you. Explore how that person feels. A
same-sex friend who shares your partner’s view of your
desire difference may be able to help you appreciate that
side better than your other half has been able to.
* Experience your power.
You feel that your partner controls the sex in your
relationship, and by extension, controls you. But that’s
not the case. You have more power than you think. It
doesn’t matter whether you’re the one who wants sex more or
less. You have the power to make your other half think you
have all the sexual power in your relationship. You have
the power to turn sex into a subject that makes your
partner feel miserable. And you have the power that comes
from nursing a grudge, the power to destroy good will by
obsessing about your complaints.
A desire difference is like an ancient walled city under
siege. The besieging forces have not broken through, but
their presence and their demand to surrender places
tremendous pressure on every aspect of the city’s life.
That’s not victory, but it is power. Meanwhile, the
defending forces have not repelled the attackers, but their
resistance keeps the besieging army pinned down. That’s not
victory either, but it is power.
* Explore underlying psychological issues.
If the lower-desire partner has issues with self-esteem,
body image, or a history of sexual trauma, or if the
higher-desire partner seems completely preoccupied with
sex, or if either partner is dissatisfied with other
aspects of the relationship, work to resolve these issues,
or seek professional counseling.
* You can’t change your lover’s libido.
In couples with desire differences, each person hopes the
other will somehow “come around” to their position on the
libido spectrum. Unfortunately, neither partner has the
power to make that happen--and as the desire difference
festers and good will erodes, instead of showing any
willingness to change, both people are more likely to dig
in their heels. Libido and sexual receptiveness can change.
But any real change must come from within. It can’t come
from a lover’s cajoling. Pressure to “see the light” is
most likely to cement intransigence. “Often,” Weston says,
“I find that the man has orchestrated the sex for years,
and it hasn’t been that great for the woman, so eventually,
she gets tired of it and starts fighting sex, or loses her
libido. Partly this is her fault, for not communicating the
kind of sex she wants. And partly it’s his fault for not
appreciating the kind of sex women usually like. Either
way, it’s important to get inside your lover’s eroticism,
learn what turns the person on, and then do your best to
provide it.”
* You have three choices.
A desire difference creates three stark choices: You can
break up. You can live in misery (with the more libidinous
partner possibly seeking sex elsewhere). Or you can
negotiate a mutually workable compromise. Which will it be?
If you don’t want to break up, or live in misery, you have
only one choice, compromise.
* Negotiate your desire difference as you would any
difference of opinion.
What happens when you both have strong feelings on opposite
sides of a nonsexual issue? One covets a sports car, while
the other insists on a minivan. One is dying attend a
certain concert, but it’s on the night of a major event in
the other’s family. Here again, if you want to live
comfortably with the other person, what choice do you have
but to compromise?
To work out a desire difference, you use the same
negotiation skills involved in resolving any difference of
opinion. Ideally, you state your own feelings as clearly as
possible. You listen to the other person’s feelings
respectfully. You work to separate your love for the person
from your disagreement with the person’s opinion. You avoid
name-calling and other signs of contempt. You try to
maintain a sense of humor. And with any luck, somehow you
thrash out a solution you can both live with comfortably.
* Half a loaf is better than none.
“Compromise doesn’t produce happiness,” Klein explains. “It
reduces everyone’s unhappiness.” If one person wants sex
two or three times a week, while the other would be happy
with once or twice a month, a reasonable compromise might
be once every week or 10 days. Agreeing to, say, weekly sex
means that neither of you gets what you truly want. It also
acknowledges that you’ll probably never get what you really
want. But by compromising, you show flexibility and good
faith, and a willingness to invest in the happiness and
longevity of your relationship. “Ideally,” Weston says,
“you look for a solution that’s a win-win, where both
people get what they need, even if they don’t get
everything they want.”
No frequency you negotiate is set in stone. You might agree
to weekly sex as an experiment for, say, four to six
months, and then agree to re-evaluate. Compromise frequency
should also be flexible. Weekly lovemaking doesn’t mean sex
absolutely once every seven days. People get sick.
Obligations arise. Adjustments become necessary. Both of
you should do your best to be kind and understanding.
Of course, it’s no fun to compromise. But if you don’t want
to break up, and you don’t want misery (and possibly
affairs), then compromise is the only alternative--and the
sooner you negotiate a compromise frequency, the better off
you are. “Try to remember,” Weston advises, “that in
longterm relationships, desire differences are inevitable.
If the relationship is going to survive, both people have
to adjust. I often ask couples: ‘What’s your bottom line?
What do you really need to make your sexual relationship
work?’ When people feel that their personal bottom lines
are understood and respected, they can usually compromise
on the other stuff without feeling ripped off.”
* Schedule sex dates.
One of the most maddening aspects of a desire difference is
the daily battles it engenders. It feels like you’re
constantly arguing about sex. The partner who wants more
continually asks, begs, pleads, and grovels: “Tonight?”
“Tonight?” “Tonight?” Meanwhile, the one who wants less
continually fends off advances, “No,” “I have a headache.”
“I’m not in the mood.” Or the worst response, “Maybe.”
“Maybe” is worst because it’s ambiguous, and maddening for
the more libidinous partner: “Well, what’ll it be? Sex? Or
no sex?” It invites that person to become even more
plaintive and relentless, which makes the less sexually
inclined partner feel even more pressured. “Maybe”
invariably makes both people feel miserable.
The daily battles cease when you get out your calendars and
schedule sex. “Many people think the ‘best sex’ is
spontaneous,” Sugrue says. “That may be true in new
relationships. But in established relationships, the best
sex is scheduled.” Scheduling means you both know exactly
when you’ll be making love. That’s usually a tremendous
relief for both partners. Evenings become calmer,
conversations less strained, resentments less stinging.
Sexual uncertainty--and the anger that accompanies it--get
replaced by sexual certainty and, over time, usually by
grudging acceptance of the compromise solution. “Scheduling
sex is good for both people,” Alperstein explains. “The one
who wants more knows there will be sex on a certain date
and can look forward to it. The one who wants less knows
sex will happen only on certain days, and gets a break from
fending off advances, which helps that person get psyched
up for sex dates.”
* What if I’m not in the mood?
For people who want sex less frequently, the idea of
scheduling it raises a difficult question: “What if we have
a sex date, and I’m not in the mood?”
A pervasive myth holds that sex should “just happen” when
lovers are “in the mood.” It feels wonderful to fall
spontaneously into an eager lover’s arms, but after a
while, that usually stops happening. By the time people
have been together long enough for a desire difference to
become a festering sore, sex never “just happens” because
one person always seems to be in the mood while the other
rarely is.
What does it mean to be “in the mood”? When Masters and
Johnson first described the sexual response cycle in 1966,
they didn’t mention sexual desire. They assumed that
everyone had a “sex drive,” that it was a biological
imperative that fueled procreation. Now we know that
desire-lust-libido-sex-drive can’t be assumed. In 1979,
noted sex therapist Helen Singer Kaplan, M.D., was the
first to discuss desire as a distinct element of sexuality.
She observed that individual levels of desire varied
tremendously, and that “desire disorders”--differences in
preferred sexual frequency and lost libido--were problems
that needed to be addressed. Sex therapists have been
addressing them ever since. In fact, today, desire problems
are a leading reason why couples consult sex therapists.
In the classic formulation, sexual desire, i.e. “the mood,”
precedes sex. That’s true for many people. But not all.
Rosemary Basson, M.D., a professor in the departments of
psychiatry and obstetrics and gynecology at the University
of British Columbia in Vancouver, has discovered that many
women say they experience no particular desire for sex
before it begins. Instead, they feel sexually neutral, and
then warm up to sex gradually as they make love. Only when
they become highly aroused do these women become aware of
feeling desire. In other words, for some women, desire does
not precede sex. It is the result of sex. Basson’s research
has focused only on women. However, because men are the
lower-desire partner in about one-third of couples with
problematic desire differences, I believe it’s reasonable
to assume that many men experience desire the same way.
If these women (and presumably men) don’t experience a
“drive” for sex, why do they make love? For other reasons,
Basson contends: to please their lover, to feel close to
their lover, as an investment in the relationship, to
reassure themselves that they are sexually attractive, and
to share the experience of intimacy with their lover. In
other words, many women (and presumably men) get their
sexual motors running for reasons that are not strictly
sexual.
What about early in relationships when new lovers can’t
keep their hands off each other? Basson’s model still
holds. People who feel a classic sex drive revel in their
libido as they fall in love and enjoy hot-and-heavy sex.
Meanwhile, people who feel more interested in physical and
emotional closeness know that sex opens a door to those
elements of a relationship, so early in relationships, when
they feel hungry for closeness, they, too, are up for lots
of sex. But as the relationship develops, and the lovers
settle into life together, needs for physical and emotional
closeness become less intensely felt, and as a result,
people for whom those needs are primary feel less interest
in sex.
Basson’s observations basically support an old saying about
the sexual difference between men and women: “For men, sex
leads to intimacy. For women, intimacy leads to sex..”
Today, it’s clear that desire differences are not
gender-based. It would probably be more accurate to say:
For the partner who wants more sex, sex leads to intimacy.
For the one who wants it less, intimacy leads to sex.
It’s important for those who want more sex not to pressure
their lovers by saying, “If desire doesn’t precede sex for
you, then your desire doesn’t really matter. Just have sex
with me whenever I want, and you’ll get in the mood as we
make love.” This misconstrues Basson’s research. Imagine a
situation where your partner loves to socialize with
certain friends. You like them, sort of, and usually come
away from get-togethers having enjoyed yourself, but
they’re not entirely your cup of tea. How would you feel if
your partner said: “It doesn’t matter that you don’t really
care for them. Just play along and you’ll have a good time
by the end of the visit.” That may be true once a
month--but not twice a week. The key here is to negotiate a
compromise sexual frequency you both consider workable. Sex
should never feel coerced.
But in the context of resolving a desire difference, it’s
equally important for those who want less sex to let go of
the idea that they must feel “in the mood,” i.e. driven by
desire, before it’s okay to become sexual. “If you’re
feeling neutral about sex, and you have a sex date
scheduled,” Alperstein says, “there’s nothing wrong with
psyching yourself up to become sexual. It’s part of your
frequency agreement. It’s for the good of your
relationship. You’ve been freed from the constant fights
about doing it. Chances are you’ll ultimately feel good
about the experience.”
* Embrace your schedule with good will.
Once you’ve negotiated a compromise sexual frequency,
accept it. Neither of you is getting what you truly want.
But both of you are getting a frequency you can live with.
Live with it. Try to see the glass as half full. Stop
making snide remarks reminding your lover of the huge
sacrifice you made accepting your compromise. Your partner
already knows this--and has made a similar sacrifice. Do
your best to put the bickering and divisiveness of your
desire difference behind you.
* Cultivate Nonsexual Affection.
Once you have regular sex dates, you both earn an immediate
dividend--the freedom to give and receive nonsexual
affection without it being misconstrued as a sexual
invitation. Recall from Chapter 4 that touch is deeply
nurturing and comforting, a nutrient transmitted through
the skin. Being touched, held, and cuddled are among life’s
most satisfying little pleasures. Affectionate touch gives
physical expression to the emotional connection you and
your lover share. It’s a tremendous boon to your
relationship. Once your sex is scheduled, affectionate
touch loses its sexual charge. Both of you can initiate
hugging and cuddling secure in the knowledge that all
you’re doing is sharing nonsexual physical affection.
That’s usually a relief--and it allows nonsexual
affectionate touch to resume its important place in the
relationship. Note to the partner who wants more sex: Don’t
misinterpret your lover’s affection as a sexual invitation.
Your sex dates have been scheduled. Stick to the schedule.
Note to the partner who wants sex less: Initiate nonsexual
affection. It won’t lead to sexual demands. But it may well
help you and your lover enjoy each other more.
* Put Your Best Efforts into Restoring Good Will.
Desire differences can poison relationships. A compromise
sexual frequency regularizes the sex, but doesn’t
automatically provide an antidote to the poison. You must
create that antidote yourselves with acts of love,
kindness, tenderness, and compassion. “When a relationship
is stressed,” Alperstein explains, “both partners typically
wait for the other to be nicer. I tell them: Stop waiting.
Just be nicer, both of you, starting now.” Alperstein
advises that both people initiate nonsexual affection at
least once a day, and look for moments to express
spontaneous appreciation for each other at least once a
day. “When I suggest this, people sometimes squirm,” she
says. “They think it’s too cookbook. Maybe it is. But after
some initial expressions of affection and appreciation that
may feel grudging, people usually get into it. Everyone
likes to feel appreciated. Everyone enjoys affection.
They’re key elements of relationship good will.”
* Savor Your Solution.
When couples negotiate a compromise frequency with
scheduled sex, at first, both people typically feel wary.
That’s reasonable. Good will has eroded. Trust has been
damaged. And both people may focus more on what they’ve
given up than on what they’ve gained. But over time,
assuming you both honor your agreement, return to nonsexual
affection, and restore good will, things improve.
Resentments slowly fade. The quality of your relationship
improves. As it does, so--usually--does the sex. The one
who wants less sex typically becomes more comfortable,
which improves that person’s responsiveness, and that adds
to the enjoyment of the one who wants more sex. As time
passes, you both realize you’ve weathered a hard time and
recreated good times. You still probably have your desire
difference, but you’ve negotiated a resolution you can both
live with comfortably.
THE MORE DIFFICULT PROBLEM: LIBIDO LOSS
IT’S MANY CAUSES--AND POSSIBLE SOLUTIONS
What exactly is sexual desire? No one knows. Some people
experience a physical need for sex comparable to hunger.
Others often feel neutral about sex, but get turned on by
non coercive lovemaking, as Rosemary Basson’s research
shows. And some people feel positively turned off to sex,
utterly lacking in libido. “Libido is a mystery,” Klein
says. “We know it has five components: biology; individual
sex drive, if any; relationship quality; psychology,
people’s individual emotional histories; and cultural
elements, what’s considered ‘normal’ and ‘appropriate’ in
people’s worlds. Each element can boost or reduce libido,
and each one can affect the others. That’s why desire is so
complicated.”
Lack of sexual desire is quite common. The University of
Chicago survey, discussed in Chapter 2, asked respondents
about their interest in sex. The survey did not distinguish
between feeling neutral and feeling actively negative.
Nonetheless, the results are telling. Overall, about
one-third of the women and one-seventh of the men said that
during the previous year, they had no interest in sex:
Women Who Said They Lacked Interest in Sex
During the Previous 12 Months
18-29 32%
30-39 32%
40-49 30%
50-59 27%
Men Who Said They Lacked Interest in Sex
During the Previous 12 Months
18-29 14%
30-39 13%
40-49 15%
50-59 17%
While the actual cause(s) of libido loss in any individual
often remain unclear, many factors can contribute to the
situation. Here are the most common:
* Chronic Desire Differences.
A frequent prelude to libido loss is a chronic desire
difference. As the problem festers and good will erodes,
the acrimony may cause the lower-desire partner to turn off
to sex.
* Relationship Problems
Other relationship stresses, may also lead to libido
loss--from major conflicts to accumulated resentments
involving minor but persistent hassles. Couples faced with
one partner’s libido loss should seriously consider
professional counseling. If relationship issues cause or
contribute to the libido loss, counseling may provide some
resolution. If not, counseling may be able to help you
adjust to the situation with a minimum or rancor.
“Sometimes,” Weston says, “I see couples who still love
each other but are no longer infatuated with one another.
It takes courage and a big heart to work up a sexual
attraction to someone whose flaws you recognize, and who
knows yours.”
* Sex Problems
When a man suffers chronic involuntary ejaculation, recital
dysfunction, or ejaculation difficulties, and the problem
remains untreated and unresolved, lovemaking may become
quite stress-provoking. The same is true for women
suffering pain on intercourse or an inability to express
orgasm. In such situations, having sex may become more
distressing than completely withdrawing from it. If a sex
problem contributes to libido loss, try the self-help
approaches discussed throughout this book, or consult a sex
therapist (Chapter 14). Sex therapists enjoy good success
helping people resolve sex problems that may contribute to
libido loss.
* Other Emotional Stress
Sexual desire is a fragile, mysterious appetite. Just as a
tiny pebble in a shoe can cause a major limp, stresses
other than relationship and sex problems might destroy
libido. Review the material on stress throughout this book.
Assess your stress level and coping skills using StressMap
(see Resources for Chapter 6). Incorporate an ongoing
stress management program into your life (Chapter 3). If
self-help approaches do not provide sufficient benefit,
consider professional counseling. But be careful about
using anti-anxiety medications. Many of them cause sex
problems and libido loss (see Drugs, page xxx).
* Illness, Injury, and Disabilities
“Any physical problem from the common cold to cancer, can
reduce or eliminate libido,” Weston says. During illness,
the body invests its energy in healing, leaving less energy
for other pursuits, including sex. In addition, illness,
injury, and disability often cause pain, another
libido-suppressor. Compounding this problem, many of the
drugs prescribed to treat pain (see Drugs) also compromise
libido. Finally, illnesses, injuries, and disabilities are
depressing. Depression is a major libido-killer. Compared
with the healthy population, those with chronic medical
conditions have significantly higher rates of depression.
To make matters worse, many antidepressant medications also
cause loss of sexual desire (see Drugs). If an
antidepressant is impairing your libido, consider taking
Viagra in addition to your antidepressant. University of
New Mexico researchers worked with 76 men who complained of
sex problems--libido loss, ED, trouble ejaculating--after
taking SSRIs for an average of two years. They were giving
either a placebo or Viagra (50 or 100 mg as needed). After
six weeks, those who took Viagra reported significantly
improved libidos, erections, ejaculation, and overall
sexual satisfaction.
“Some people place great value on remaining sexual despite
serious medical problems,” Weston explains. “Their attitude
is: ‘I know what I can no longer do, but I’m going to focus
on what I can do, and make the most of it.’ Others develop
a minor health problem and say, ‘That’s it. I’m through
with sex.’”.
* Convalescence
Have you ever recovered from the flu, only to feel
surprisingly lethargic for another week or 10 days? Viral
infections--including the flu, mononucleosis,
hepatitis--are notorious for causing lingering sluggishness
long after you think you’re better. Most people, especially
men, have little patience for the time it can take to fully
convalesce. They charge back into their lives--and into
sex--and may be mortified at how little energy they have
for lovemaking. Attempts to shortcut convalescence can
compromise libido.
* Desire vs. Feeling Desirable.
Both American men and women are raised to value personal
attractiveness, and to invest considerable self-esteem in
being attractive. But for men, financial success or a
high-status job can offset physical shortcomings. This is
less true for women. “Despite greater gender equality,”
Weston explains, “women are still judged physically. Even
if women are successful in their work, if they don’t fit
society’s standards of desirable, their chances of finding
a mate are greatly diminished.” As a result, women invest a
great deal of time and energy in being desirable, so much
that many women don’t focus much on their own sexual
desire. “It’s just not an issue until they’ve established a
relationship,” Sugrue explains, “and then some women
realize that they don’t feel much, or any, desire. Beyond
all the other possible causes of low libido, some women
just don’t have much experience feeling their own desire.”
Sex therapy can help them get in touch with it.
* Body issues.
Men love to look at naked women, and the women in
pornography can’t seem to get enough of flaunting their
bodies. But many woman have body-image issues that make
them feel fat, flabby, ugly, and undesirable. Poor
self-esteem can dampen libido. Meanwhile, as the years
pass, a lover’s body can change in ways that might turn you
off. Weight gain or other changes might make you feel that
your lover is no longer the person you fell in love with.
Loss of attraction can destroy libido.
* Physical Exhaustion.
If you’re working overtime, your libido might take a
vacation. People have only so much energy. If you’re
investing all of your energy in work, or others (caring for
a sick relative), or recreational pursuits (training for a
marathon), you may not have enough left over for sex.
* Premenstrual Syndrome and Menstrual Cramps.
Women who suffer severe PMS and cramps may feel sexually
out of commission for a week to 10 days every cycle. If
they feel that the men in their lives are insensitive to
their suffering and unsupportive, they may withdraw from
sex altogether.
* Nutritional Deficiencies
Certain vitamin and mineral deficiencies can depress
libido, for example, abnormally low levels of zinc. In
addition, starvation diets and anorexia nervosa often
depress libido. A medical work-up for libido loss should
evaluate nutritional status.
* Testosterone Deficiency in Men, Androgen Deficiency in
Women
In both sexes, male sex hormones fuel libido. Men produce
testosterone. Women produce similar but slightly different
hormones, collectively known as androgens. (Men produce
higher levels than women.) In cases of libido loss, many
people view testosterone or androgen supplementation as a
potential quick fix. It may be--but only in cases of true
deficiency. If you’re solidly within the normal range,
supplemental male sex hormones produce no benefit--and in
men, they may stimulate the growth of prostate cancer. If
you’re “low-normal,” recent studies show that
supplementation might help.
In both sexes, male sex hormone levels decline with age,
and may fall to levels that destroy libido. In men,
age-related testosterone loss is less pronounced than many
men believe. Most researchers consider testosterone normal
at any level above 325 nanograms (one-billionth of a gram)
per deciliter of blood. The vast majority of men under 30
(97.5 percent) have higher testosterone levels.
Testosterone deficiency remains rare until after age 60.
Researchers with the Baltimore Longitudinal Study on Aging
measured the testosterone levels of 890 older men. Among
those in their sixties, about 20 percent were below normal.
For men in their seventies, the figure was 30 percent, and
for men in their eighties, 50 percent. In other words,
until age 80, the majority of men are not
testosterone-deficient. On the other hand, when trying to
figure out the cause of libido loss, it’s prudent to get
tested. Consult your physician for the blood test.
Testosterone levels fluctuate during the day. To get a true
picture of your level, you may have to get tested at
several different times during the day.
In women, as ovarian production of estrogen declines with
menopause, so does production of androgens. Many women
experience libido loss during menopause. Italian
researchers studied 355 menopausal women, 22 percent of
whom complained of decreased sexual desire. Another 30
percent said they experienced pain on intercourse,
typically from vaginal dryness, which can also contribute
to libido loss. A Swedish study of 5,990 menopausal women
produced similar findings. Other menopausal complaints that
might decrease sexual interest--hot flashes, irritability,
depression. sleep problems, and muscle and joint
pain--affected half of these women.
“When menopausal women tell me they’ve lost their libido,”
Weston says, “I urge them to have their androgens checked.
Sometimes, they’re low.” If so, androgen supplements can be
taken as pills or applied topically. Weston recommends
topical androgen cream, applied daily to the genitals,
custom-prepared by a compounding pharmacist (see
Resources). “The creams help,” she says. “Androgen levels
return to normal, and so does libido.” Some gynecologists
warn that androgen supplementation masculinizes women, for
example, by causing facial hair growth. But Weston says
that in her experience the creams don’t cause masculinizing
side effects.
Each year some 250,000 American women experience sudden
androgen loss because they have their ovaries surgically
removed, often years before menopause. To maintain libido,
these women need supplemental androgens. Recently, Harvard
researchers tested an androgen patch on 75 women who’d had
their ovaries removed. The researchers asked them to keep
diaries of their sex fantasies, masturbation, and partner
sex before and after wearing the patch. While wearing the
androgen patch, all three measures of sexual interest and
activity increased significantly.
Until recently, sexuality authorities believed that women
did not suffer androgen deficiency until menopause, and did
not test androgen levels in women complaining of lost
libido who were still menstruating regularly. However,
recent studies at Harvard’s Center for Sexual Function show
that young, menstruating women may, in fact, develop
androgen-deficiencies. Any woman complaining of libido loss
should have her androgens tested.
* Birth Control Pills, Other Hormonal Contraceptives, and
Hormone Replacement Therapy (HRT)
One little known side-effect of the Pill is loss of sexual
desire. Researchers with the Kinsey Institute at the
University of Indiana followed 107 women who began taking
birth control pills. A year later, 47 percent had switched
methods. The most common reason was the Pill’s physical
side effects. However, quite a few of the participants said
they went off the Pill because of decreased sexual
thoughts, reduced libido, and difficulties becoming
sexually aroused. It’s not entirely clear why hormonal
contraceptives decrease libido, but most researchers
believe that the estrogen they contain either decreases
androgen levels or interferes with androgens’
libido-fueling effects. Other hormonal contraceptives have
similar effects (Chapter 15).
However, not all birth control pills diminish libido. San
Francisco State University researchers compared the sexual
effects of monophasic pills, which contain constant doses
of estrogen and progestin, with triphasic pills, which vary
progestin levels throughout each cycle. Women taking
triphasic pills not only reported greater interest in sex,
but also more sex fantasies, greater arousal during sex,
and greater satisfaction from lovemaking. Compared with
monophasic pills, triphasics have somewhat different
effects on women’s sex hormones. Most women in the study
who used triphasic pills took Orthonovum 7/7/7. If a woman
feels less libido after starting the Pill, she can ask the
prescribing clinician to switch her to a triphasic oral
contraceptive. If that doesn’t help, she can consider
switching to another method.
Postmenopausal hormone replacement therapy is less popular
today than it was in the 1990s, but many women still take
it. It, too, is associated with diminished libido.
* Depression
An estimated three-quarters of people who are seriously
(“clinically”) depressed report little or no libido. But
you don’t have to be clinically depressed to have a blue
mood crush your interest in lovemaking. As pyschological
distress increases, libido decreases. Meanwhile, many drugs
used to treat depression are associated with libido loss
(see Drugs, page xxx).
* High-Fat, High-Cholesterol Diet. Review the information
in Chapter 3 on the sexual benefits of a plant-based diet,
one low in fat and cholesterol. A high-fat,
high-cholesterol diet--one based on meats, whole-milk dairy
products, fast food and junk food--increases blood
cholesterol levels, which contributes to erectile
dysfunction in men and loss of natural vaginal lubrication
in women. These sexual issues can contribute to libido
loss. A high-fat, high-cholesterol diet is also associated
with weight gain, which often interferes with sexual
desire.
* Weight Gain
Some people who are overweight have robust libidos.
However, excess weight makes many others feel less
attractive, less desirable, and more anxious about being
seen naked. In other words, extra pounds can cause
stress--sometimes severe stress-- that might dampen sexual
desire and responsiveness. In addition, carrying extra
weight requires energy, which may contribute to fatigue,
and sap energy from libido.
Losing weight often boosts interest in sex. Psychologist
Ronette Kolotkin, Ph.D., of the Duke University Diet and
Fitness Center, noticed that people who lost weight at the
Center often remarked that they felt more sexual. Curious,
she surveyed 70 men in the program, aged 18 to 65, before
and after they lost up to 30 pounds. “After losing weight,”
she says, “they all reported more sexual desire.” Weight
loss increases energy, vitality, and self-confidence, all
of which are factors in libido.
* Infertility
When couples who want to get pregnant don’t, sex often
becomes a tedious chore. You have to coordinate lovemaking
with the days each month the woman is most fertile (see
Fertility Awareness in Chapter 15). If several months pass
with no pregnancy, the sex suffers--and quite often so does
one or both partners’ libido. If the situation becomes
medicalized--if the woman has to take fertility drugs, or
if the man has to provide sperm for artificial insemination
or in vitro fertilization--that can contribute to even
greater alienation from sex. “You set out to do something
great, becoming parents,” Alperstein says, “and not only
can't you, but you wind up feel something's wrong with you.
That usually depresses self-esteem, which can interfere
with sexual interest.”
* Pregnancy
Pregnancy has wildly unpredictable effects on women’s
libidos. To write their book, The Mother’s Guide to Sex,
Anne Semans and Cathy Winks, surveyed 700 mothers. “Some
women said they had more desire and the best sex of their
lives while pregnant,” Semans says. “Others’ libidos went
down the tubes.” When pregnant women experience extended
morning sickness and other pregnancy-related discomforts,
they may turn off to sex.
A wife’s pregnancy also has unpredictable effects on libido
in many men. Some get turned on. Other become turned off.
For more on the sexual implications of pregnancy, see
Chapter 8.
* Nursing
Postpartum, women's estrogen levels drop, and levels of
other hormones, notably,
prolactin, rise. New fathers also experience an increase in
prolactin. Prolactin has a libido-dampening effect. In
addition, the woman is still recovering from labor, and
dealing with the exhaustion and stresses of new motherhood.
As a result, most women don't feel very interested in sex
during breastfeeding. “In addition,” Semans explains, “the
woman’s breasts are engorged with milk, which can feel
uncomfortable and raise body-image issues. Some men get
turned on by the wife’s nursing. But others get turned off
by huge boobs dripping milk.”
* Parenthood
Our culture desexualizes parents. Women are supposed to be
sexy--until they become mothers. Then they’re supposed to
focus on motherhood, not lovemaking. Men are supposed to be
horny studs--until they become fathers. Then they’re
supposed to buy life insurance, start saving for the
child’s college education, and focus entirely on their role
as breadwinners. In addition, parenthood is physically
exhausting, and as emotionally draining as it is rewarding.
One emotion that can drain away is libido.
Unfortunately, few couples are prepared for the sexual
changes of new parenthood. “Doctors typically advise
abstaining from intercourse for six weeks,” Winks says,
“and then they say that everything should be fine. They
don’t talk about hormone-related loss of desire that can
last much longer, or postpartum depression, or the
exhaustion new parents feel, or the other emotional changes
that take place when a ‘couple’ becomes a ‘family,’ All
these changes can reduce libido.”
It takes a tremendous amount of energy to raise children.
“Until the youngest child is at least three, most people’s
sex lives suffer,” Weston says, “but if there was good sex
before parenthood, most people return to satisfying sex as
the kids get older.”
* Frequent Masturbation
It’s fine to masturbate. Virtually everyone does. It’s
perfectly normal and healthy, even when you’re in a couple
(Chapter 1). But sometimes, frequent masturbation can
reduce interest in partner sex. If you masturbate more than
a few times a week, and notice decreased libido, try
masturbating a little less, and see how that affects your
interest in partner sex.
* A History of Sexual Trauma
According to the University of California survey discussed
in Chapter 2, about 15 percent of the women, and 3 percent
of the men reported that as children, they could recall
feeling forced or frightened into having sex. For some
people, abusive childhood sexual experiences leave no
lasting scars. But for many others, the experience causes
sex problems, mental health problems, and libido loss. A
history of rape or other sex-related trauma can also
deflate libido. Fortunately, it’s possible to recover from
sexual trauma (Chapter 13).
* Sleep Apnea
Sleep apnea is a particular type of snoring. “Apnea” means
“no breathing.” Ordinary snoring does not interrupt
breathing, but apnea does. People with sleep apnea suck
their airways closed when they snore--and stop breathing,
typically for a few seconds, but possibly for up to a
minute. A choking silence replaces the sounds of snoring.
Apnea reduces the amount of oxygen in the blood, which sets
off an internal alarm, and the brain rouses the person,
which restores breathing. But every apnea episode--and
people with sleep apnea typically have dozens a
night--causes subtle physical harm. Blood pressure rises.
The heart must pump harder. Sleep quality plummets, causing
daytime fatigue and drowsiness. And according to a recent
Israeli study, testosterone levels can fall low enough to
compromise libido.
An estimated 18 million Americans have sleep apnea,
particularly overweight middle-aged men. Apnea affects many
women as well.
Bedmates can diagnose apnea fairly easily. Just listen for
a combination of loud snoring and choking silences. If you
hear what sounds like apnea, send your spouse to a
physician.
Sleep apnea is easy to treat. All it takes is a “continuous
positive airway pressure,” (C-PAP) machine. C-PAP devices
include a mask that fits over the person’s nose connected
to a small pump that gently pushes extra oxygen into the
lungs with each breath. C-PAPs prevent airway collapse and
maintain a healthy level of oxygen in the blood. They cost
about $1,200 and are available from sleep centers (see
Resources). Health insurers typically cover the cost of
C-PAP machines. Unfortunately, many people find C-PAPs
uncomfortable or impossible to use.
* Alcohol
The first drink is “disinhibiting,” meaning that lovers are
more likely to accept sexual invitations. But if you drink
more than two beers, cocktails, or glasses of wine in an
hour, alcohol becomes a powerful central nervous system
depressant that interferes with erection in men and sexual
responsiveness in women. In addition, alcohol has
estrogenic effects on the body. In alcoholics, chronic
alcohol abuse can tilt the hormonal balance away from
testosterone and depress libido.
* Smoking.
Review the discussion of smoking in Chapter 3. Smoking
contributes to physical problems that can reduce libido.
* Other Drugs
Some drugs depress libido directly, for example, central
nervous system depressants colloquially known as “downers:”
narcotics, tranquilizers, sedatives, and many psychiatric
medications.
Other drugs have side effects that may impair sexual
interest. The key word here is “may.” If you take any of
the drugs listed below, you’re not necessarily fated to see
your libido decline or disappear. Sexual side effects are
highly individual. But if you believe you’re experiencing
libido-depressing side effects from any drug, consult the
physician who prescribed the medication. It’s possible that
another drug might be substituted, or that some other
treatment might minimize the sexual side effects.
This list of libido-depressing drugs has been adapted from
an article published in the Journal of Family Practice by
authors who combed the medical literature for reports of
drugs with sexual side effects. Drugs frequently associated
with libido loss are starred (*).
Over-The-Counter Drugs
Benadryl. Antihistamine.
Tagamet. Stomach upset. Ulcers.
Zantac. Stomach upset. Ulcers.
Any drug whose label says, “May cause drowsiness.”
Narcotics
Codeine.
Darvocet.
Darvon.
Demerol.
Dolopine.*
Methadone.*
Morphine.*
Oxycontin.
Percodan.
Percoset.
Roxanol.
Vicadin.
Tranquilizers
Anafranil.*
Atavan.
Barbiturates
BuSpar.
Compazine.
Haldol.
Librium.
Mellaril.
Mitran.
Navane.
Risperdal.
Thorazine.*
Valium.
Xanax.
Zetran.
Sedatives
Dalmane.
Restoril.
Halcion
Phenobarbital.*
Blood Pressure Medication (Antihypertensives)
Aldactone.*
Aldomet.*
Arfonad.
Blocadren.
Catapres.
Hygroton.*
Hylorel.*
Inderal.
Inversine.
Ismelin.*
Lopressor.
Lotensin.
Lozol.
Midamor.
Normodyne.
Prinivil.
Reserpine.
Thalitone.*
Toprol.
Trandate.
Zestril.
Antidepressants
Adpatin.
Anafranil.
Ascendin.
Aventyl.
Effexor.
Elavil.
Janimine.
Ludiomil.
Nardil.
Norpramin.
Pamelor.
Parnate.
Paxil.
Pertofrane.
Prozac.*
Sinequan.
Tofranil.
Vivactil.
Wellbutrin.
Zoloft.
Other Psychiatric Medications
Compazine.
Eskalith.*
Klonopin.
Lithium.*
Lithonate.
Orap.
Permitil.*
Prolixin.*
Serax.
Seizure Drugs
Atretol. Seizure.
Diamox. Glaucoma. Seizure.
Dilantin. Seizures.
Mysoline. Seizure.
Tegretol. Seizure.
Other Prescription Medications
Amen. Female sex hormone.
Anxanil. Antihistamine.
Atarax. Antihistamine.
Atromid. Lowers cholesterol.
Cordarone. Cardiac arrhythmia.
Cycrin. Female sex hormone.
Danazol.* Endometriosis.
Danocrine.* Endometriosis.
Daranide. Glaucoma.
Depo-Provera. Contraception.
Diamox. Glaucoma.
Digoxin.* Congestive heart failure.
Estinyl.* Menopausal complaints.
Fastin. Weight loss.
Flagyl. Parasitic infection.
Interferon. Immune stimulant.
Lanoxin.* Congestive heart failure.
Lopid. Lowers cholesterol.
Mexitil. Cardiac arrhythmia.
Neptazane. Glaucoma.
Niacor.* Lowers cholesterol.
Nicobid.* Lowers cholesterol.
Nicolar.* Lowers cholesterol.
Nizoral.* Fungal infections (oral only, not the cream).
Novaldex (tamoxifen). Breast cancer.
Protostat. Parasitic infection.
Reglan. Nausea. Vertigo. Heartburn.
Robinul. Ulcer.
Vistaril. Antihistamine.
Recreational and Illicit Drugs
Alcohol.
Amphetamines.
Amyl nitrate.
Marijuana.
Narcotics.
THE MOST FRUSTRATING SEX PROBLEM
Contemporary sex therapy enjoys considerable success
treating every sex problem--except libido loss. Sometimes
sex therapy helps restore lost or flagging libido. All the
members of this book’s Advisory Board have helped couples
overcome one partner’s libido loss and restore the
relationship to regular lovemaking. But frequently, even
after extensive medical work-ups, doctors, sex therapists,
and the couple cannot figure out why one partner’s libido
has disappeared.
“When I see couples with libido loss,” Klein says, “I run
down the check-list of possible causes, and address each
one. Relationship problems, sex problems, sexual trauma
history, and other stress problems usually respond to
therapy. Illnesses, injuries, and sex hormone deficiencies
can usually be treated medically. People can learn to
adjust to disabilities. Pregnancy and parenthood issues
usually respond to time, education, and counseling. Drug
problems usually respond to treatment. But more often than
with other sex problems, the combination of medical
treatment and sex therapy doesn’t fix libido loss. It’s the
most frustrating problem I deal with.”
Distress over libido loss has focused unprecedented
attention on sex stimulants. That’s the subject of next
chapter.