Sandra Leiblum, Ph.D.
Workshop On Low Sexual Desire
Sandra Leiblum addressed 49 ACT members at our September 14 workshop on low sexual desire. Dr. Leiblum emphasized that sexual desire develops very differently in men and women.
For men, physiological arousal leads to sexual desire and finds outlet in orgasm. Men have 10 times as much androgen as women, and their sexual desire is more urgent and more focused on orgasm. Men fantasize and think about sex frequently and masturbate at a younger age.
For women, connection to their partner leads to desire, and desire causes women to engage in activities that will cause sexual arousal. Context is also more important for women. Women are more easily distracted from sexual feelings than men and women experience sexual feelings sensually rather than genitally. One third of women never fantasize about sex, and orgasm is not as important to women as it is to men.
Given these striking differences, it’s no surprise that desire discrepancy is the most common complaint among couples who present for sex therapy. Each partner blames the other. The man is usually the high-demand partner who resents his “cold and withholding” female partner. The less interested partner, usually the woman, complains that the man is selfishly interested in her only for sex.
In treating couples, Dr. Leiblum recommended educating each partner about the other’s sexuality. Instead of interpreting women’s sexual behavior as withholding, men should understand women’s need for a comfortable relationship in order to become sexually aroused. Sex is not a right in a relationship, but is a matter for negotiation and compromise.
Women need to understand men’s physiological drive instead of viewing men as sexual “pigs.” Women should not expect to feel desire (or “horny”), but should decide to experiment with sexuality in order to get “in the mood.”
Making these changes can be difficult. If the couple likes each other when they come for treatment it’s easier than if they’re mired in anger or if one of them is having an affair. It’s virtually impossible to help a couple that never really liked each other or never enjoyed sex together. Sex therapists should see both halves of the couple, and resolve any relationship problems.
Intrapsychic problems should also be addressed because they can impede sexual desire. Is the low desire partner depressed? Has either partner experienced abuse? Is either partner rigidly moralistic or anxious about sex? Do body image issues interfere? Are there pre-existing sexual dysfunctions such as erectile dysfunction, dyspareunia, premature ejaculation, failure to experience orgasm, or unsatisfying or inadequate stimulation?
Many commonly prescribed pharmaceuticals also depress sexual desire. The SSRIs are common offenders (Paxil is the worst), although about 30% of both men and women report increased desire when taking Wellbutrin. Physical illness, psychoactive substances, and drugs, both licit and illicit, may also disrupt sexual desire.
In summary, Dr. Leiblum stated that treatment of low sexual desire is extremely difficult. Try as they may, the pharmaceutical industry has not found a solution. Viagra and other drugs do improve mechanical functioning, but they do not increase sexual desire or satisfaction. Low sexual desire is fertile ground for the perceptive, multi-focused, and tenacious psychotherapist.
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