Lacking Libido - Inhibited Sexual Desire (ISD)

What is Inhibited Sexual Desire?

Inhibited Sexual Desire (ISD) is a sexual dysfunction which is characterised by a lack of desire for sexual activity. More common names include sexual aversion and sexual apathy.

ISD is different from asexuality. It is a condition focussed on a lack of sexual desire, whereas asexuality is a type of sexual orientation defined as a general lack of sexual attraction.

ISD affects both men and women. A person with ISD rarely, if ever, engages in sexual activities. They are unwilling to initiate, or respond, to their partner's desire for sexual activity.

For ISD to be regarded as a disorder, it must cause tangible distress and interpersonal difficulties, and it cannot be better accounted for by a different mental disorder or other medical condition.

There are various sub-types of ISD. Men have more sub-types than women, of which there are three which are the most prominent. The 3 types reflect that ISD can be a primary or secondary condition, primary indicating there has always been a lack of sexual desire, and secondary that the lack of interest in sexual activity has developed over time;

  • Lifelong/generalised: The man has always had a general lack of sexual desire (primary)
  • Acquired/generalised: The man has previously had sexual desire but now lacks sexual interest (secondary)
  • Acquired/situational: The man still has sexual desire, but lacks desire for his current partner (secondary)

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What are the causes of ISD?

There several factors that can bring about ISD and constrain sexual desire.

ISD can be an intimacy issue brought on by common relationship factors including a lack of emotional connection, toxic communication, controlling attitudes and a breach of trust (infidelity).

There are many medical factors that can contribute such as stress, alcohol abuse, drug abuse, chronic illness, chronic fatigue and pain, erectile dysfunction (impotence) and delayed ejaculation.

Psychological factors that can also hamper sexual desire such as negative thinking patterns (feelings of rejection, fear of intimacy) and mental health problems (depression, anxiety, low self-esteem).

ISD incidence is higher amongst those who have experienced trauma (e.g. rape or sexual abuse) and who have developed negative thoughts about the act of having sex.

Human biology may play a part too. Some researchers believe that sexual desire may be suppressed by an imbalance of hormones and neurotransmitters which are responsible for inhibitory (e.g. serotonin) and excitatory activity (e.g. dopamine, norepinephrine).

How do you diagnose ISD?

Unlike other medical conditions, there is no specific test to diagnose ISD. The most common approach by a doctor is to try to determine an underlying cause of the condition, which will be guided by the type of ISD (primary or secondary).

A diagnosis of ISD requires the lack of sexual desire to be causing interpersonal difficulty, and for the distress not to be better accounted for by another disorder. A diagnosis also requires the symptoms to have persisted for at least six months.

At the moment, the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) states that the male version of the disorder is characterised by "persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity". The definition states that any diagnosis must also consider the patient's age as well as the cultural context.

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What are the treatments for ISD?

The main treatment for ISD is counselling which usually takes place as a couple. The clinician tries to find an underlying cause. If it is psychological, the clinician is likely to recommend therapy, and if it is biological the clinician is likely to recommend treatment.

The nature of the treatment will depend on the type of ISD. If a man has lifelong ISD, the ability to increase his sexual desire is unlikely. In this instance, the focus of the therapist may be to help the couple adapt. In contrast, if a man has a acquired ISD, there is likely to have been a recent trigger which the clinician can try to identify and then treat.

There is general advice for ISD around lifestyle and communication. Certain lifestyle changes are promoted which include exercising, which improves mood, raises stamina and increases libido. Communication with a partner can also have benefits, such as talking open and honestly, thereby fostering a closer emotional connection.

In general, there is no medication solution to ISD for men (there are two FDA approved medications for women). In some circumstances, testosterone supplements may work, albeit this is on a case-by-case basis and are only believed to be effective in the short term.

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Written by Mike Firth, GP and Medical Director

This article is for informational purposes only and is not a substitute for professional medical advice or diagnosis. Always talk to your doctor about the risks and benefits of any treatment.