Inhibited Sexual Desire

Inhibited
Sexual Desire

Getting Back in the Mood

Movies, music videos, magazine articles and radio talk shows send out a resounding message: sex, sex, sex.

Yet some women's bodies say no, no, no.

These women have inhibited sexual desire (ISD), a common disorder in which there is a chronic disinterest in sex. Forty to fifty percent of couples who show up at sexual dysfunction clinics are said to have it, making it the most common issue for couples who seek help for sexual problems.

Men are as likely as women to have it, says Richard A. Carroll, Ph.D., director of the Sex and Marital Therapy Program at the Northwestern Medical Faculty Foundation of the Northwestern Medical Center in Chicago. But women tend to get it at a younger age than men--in their midthirties as opposed to their fifties--and they tend to experience more emotional distress with it and go for longer periods of time without seeking help, he says.

When Desire Drops

Women with ISD experience more than just an occasional ebb in desire, says Jo Kessler, a licensed nurse practitioner and certified sex therapist in San Diego. These women can go for long periods of time--maybe six months, nine months, a year or longer--without feeling the urge. They go without masturbating, thinking about sex or having it. Some say they don't miss it at all, Kessler says. If it weren't for their partners, they wouldn't really care about having sex.

The situation can be a difficult one, says Kessler. With all the information about sex and sexuality that's available, women know that some amount of sex is considered "normal." "The woman knows if she's not having sex, or if she's not interested in sex, something is wrong. She feels defective, she feels guilty and she feels helpless." And if she perceives her partner as always ready to have sex, the woman may feel that she's the one with the problem and that she's totally to blame for the unsatisfactory sex life, says Kessler.

What's Really Wrong

ISD is probably best thought of as a symptom of an underlying problem, says Dr. Carroll. The most common causes are more likely to be psychological than physical, he says. At the top of the list is depression, he says. "Depression can affect one's ability to enjoy anything. Sex is just one of those," he says.

Next in line is interpersonal conflict. Problems in a relationship often manifest themselves in sexual problems, experts say. "Sex is a metaphor for the relationship," says Susan E. Hetherington, Dr.P.H., a certified nurse-midwife and sex therapist and professor in the School of Nursing at the University of Maryland in Baltimore. "People end up fighting out in the bedroom what they should be fighting out in the living room and dining room," she says. When the couple doesn't deal with issues or problems by talking about them as they occur, the conflict comes out in other ways--often through the sexual relationship. Unexpressed anger is often part of the picture. With ISD, "in general the relationship isn't working or isn't providing the woman with what she wants or needs to be sexual," says Kessler.

The problem often develops gradually, she says. It may begin with a lack of enthusiasm for sex that causes the woman to decline sexual overtures sporadically, she says. Then, often without deliberately planning it as a sexual avoidance maneuver, the woman may get involved in activities that keep her chronically busy, unavailable or tired, so the likelihood of sex is reduced.

"Eventually a couple comes in and they haven't had sex for six months," she says. "The partner is frustrated and angry and upset. The woman is puzzled and upset and feeling pressured by her partner or by her own expectations. She's feeling overwhelmed. If she was depressed before, she's even more depressed. It can be a real downward spiral for the woman as well as for the relationship."

Physical changes, such as those occurring after pregnancy, might also trigger ISD. "It's not uncommon for a woman to be less interested in sex when there is a new baby at home. The woman is recovering physically and she's adapting to motherhood. All of the demands that having a new baby put on a woman contribute to fatigue," says Kessler. Often women will have a lower sex drive for six to nine months after having a baby, she says.

Despite common belief, women going through menopause won't automatically experience ISD. "If she's had a healthy sex drive and a healthy attitude about sex and has liked it and it's been a positive force in her life, unless there's some untoward problem with the menopause, it doesn't really affect her drive at all," says Kessler. "There used to be the notion that when women got older or went through menopause they lost interest in sex, and that's just not holding true." The sex drive of some women actually goes up after menopause, she says. "There can be such a sense of freedom that women are more interested sexually. Some report it as the best sexual time of their life."

Keeping Desire Strong

ISD can be prevented. Here's what you can do.

Pay attention to problems. "Have some mechanism to resolve conflict in the relationship. When couples are fighting, they don't feel particularly congenial," says Kessler, and they usually won't want to have sex. Instead of letting one issue color the whole relationship and all your interactions, set aside a specific time to address it. "For example, talk about the issue for 30 minutes, then set it aside. Agree that you'll do that every second or third day for two weeks and that at two weeks you'll have formed some resolution. That's one way to keep it from constantly being up in your face and being the total focus of your relationship with each other," she says.

Keep the lines of communication open. When you are upset, try to deal with the problems instead of pushing them under the rug, says Dr. Hetherington. Try using "I" statements and avoid using "you" statements, she says. Start with "I feel this way" or "I am frustrated," instead of "You make me mad." Another way to express and defuse feelings of anger or resentment is to write them out first, says Dr. Carroll. Then figure out how you can relay the message in an effective way, he says.

Make time for intimacy. Couples need to set aside time to be together in an intimate way, says Dr. Carroll. "Set one night aside to be together--alone--without the kids or distractions. Make a commitment to time for the relationship," he says.

Vary your sexual routine. Try new things with your partner to keep from getting in the same old habit. "People with ISD have fairly rigid sexual scripts. This is how sex is done--A, B, C and D," says Dr. Carroll. "A varied sexual repertoire can help prevent ISD."

Think about sex. "One way to keep sex drive alive is thinking about sex. Have three erotic thoughts a day, from mildly romantic to whatever any individual woman thinks of as sexually explicit," says Kessler. "If you don't ever think about sex, then it's not very likely that you're going to keep your appetite stimulated. It's important for a woman to help get herself in the mood," she says. Having some romantic or sexual thoughts during the day can serve as a kind of warm-up for sex later that night, she says.

Coping with ISD

If you have ISD or think you may be developing it, experts have some suggestions.

Take time to touch. One way to stay physically close when desire is low is to defocus from intercourse and orgasm and refocus on more generalized touching of the body, says Kessler. No breasts or genitals at first; wait until you are both ready before you include those parts. Set aside periods twice a week when you and your partner spend up to half an hour touching each other in affectionate, nonsexual ways. Do this in a room that's warm and relaxed, and perhaps light candles or play a tape to augment the mood. Be sure to talk to each other, too, expressing feelings.

"Use a touch with no sexual expectations or demands in the beginning," she says. "The idea is for each to get comfortable with themselves and their partner's bodies, not immediately turn each other on." The 'turn-on' will follow as you learn how to 'tune in' first, she says.

Put yourself in the mood. Try reading romantic novels or short stories that you like that have a romantic story line, says Kessler. Or rent a movie geared toward sensuality. "Find a love story you like that will create the mood," for sex for you, she says.

Make time for sex. If a woman's desire is low and she's not too interested in sex, she may avoid her partner for fear that if she touches or kisses him, it will be interpreted as an overture for sex, says Kessler. If the couple sets a time when they both agree to have sex, that can take the pressure off. The woman will feel free to kiss or touch her partner affectionately at other times and know it won't have to lead to sex. And "making a date for sex can be a lot of fun," she says.

Get help early. If you feel that you're starting to have problems, take care of it sooner rather than later, says Dr. Carroll. "If it goes on a long time, it's likely to get worse," he says. Consult a neutral third party, says Kessler. You might try calling a therapist who specializes in sexual dysfunction and asking if what you're experiencing sounds like something you should be worried about, she says. When you decide on therapy, ideally both partners should be involved, says Kessler.