Recently, I was interviewed in a Huffington Post article about the most common sexual issues that sex therapists see in their office. To see more on this article, you can click here. Anyway, since the interview response that they posted was a bit abridged, I wanted to spend a little more time exploring this difficulty since it is so prevalent.

When I work with individuals struggling with low libido, I first want to understand the context in which they are having this experience. For example, I would want to know answers to the following questions. What is the relationship status of the person– are they single, dating, in a committed relationship? If in a committed relationship, for how long? When did this problem begin? I would also want to rule out medical issues, so I will refer the individual to a physician for blood work to determine levels of testosterone and other hormones. Sometimes testosterone is a major player, but more often not. In my experience, with individuals low libido tends to be more emotional, rather than physical in nature, while with couples it is more often than not it stems from relational problems.  For more info on the relational aspects of low libido difficulties within couples, you can check out my article “Three Main Reasons Behind Loss of Sexual Desire in Couples”, which was picked up and syndicated by numerous other websites.

As I indicated in my response to the HuffPost journalist, relational issues include stuff like resentment (which is basically a euphemism for anger) and lack of trust, along with other elements I didn’t mention such as inequitable power dynamics and passive aggressive behaviors. With couples it is often the case that the partner presenting with low libido actually doesn’t have low libido at all. He/she may masturbate regularly, it’s just that he/she has low libido for the other partner not for sex in general. At first blush, it may seem that the partner has experienced loss of physical attraction, but that is rarely the case (outside of some extreme cases of appearance change) and instead, the cause again comes back down to interpersonal relational issues.

With individuals it often comes down to a general feeling of somatic numbness primarily driven by underlying emotional numbness. In other words, when a person has learned to numb down painful feelings for long enough, they also inadvertently learn to numb out their entire bodies, including their normal sexual response. Depression is often co-morbid with low libido and often also stems from similar dynamics of emotional repression.

I think it is also important to point out that loss (or lack of libido) is not the same as someone who identifies as asexual. As sexologists, we really don’t have very much accurate knowledge and data about asexualism, but suffice it to say asexuals present differently from folks who complain of low libido, in that they never really felt strong sexual impulses ever in their lives and they generally don’t have a strong desire to be sexual at all. Folks with low libido, on the other hand, can point to a specific timeline of when they began to lose their desires and are generally dissatisfied and unhappy with the present state of their libidos.

Anyway, I think I’ve explored this topic for now as much as I had initially intended, so I’ll stop here. Below is the full text of my response to the Huffington Post.

What’s the most common sex problem brought to you? What’s your solution?

The most common sex problem I see is lack of sexual desire, and I particularly see this with couples, where one person has much higher sexual drive/desire than the other partner. The solution depends on a number of factors. First, I want to find out how long this situation has been going on and what were the circumstances in which it first started. Often, the sexual problem is caused by relational issues, such as feelings of anger, resentment, betrayal, and so on, that need to first be resolved before the sexual issues can be addressed. I may have to help a couple learn to express their needs directly or to see each other’s point of view from a less reactive position. Once the relationship is repaired, the sexual difficulties may often improve on their own.

When I work with individual clients struggling with lack of sexual desire, the cause is again often emotional, but more due to the way that they’ve learned to manage their own emotions, rather than the feelings they have towards another person in a relationship. So, for example, these individuals often have trouble identifying their feelings and may report feeling numb when asked to identify sensations in the body. For whatever reason, but often due to intense emotional pain, they have learned to disconnect from their feelings, and as a result they have also disconnected from feeling states in the body. If one’s body is numb, the ability to enjoy sexual pleasure will be comprised, and so sexual desire will decline as well. The ability to experience sexual pleasure necessitates the ability to feel in general, and so helping clients to experience their emotions in a graded format often becomes a major focus of my work.