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Key points
- Hypoactive Sexual Desire Disorder is a diagnosis for when a person does not want much sex, or any sex.
- A better way to think about this may be “discrepant desire” because this difficulty only emerges in the context of a relationship.
- Resolving this difference, like many things, requires negotiation, commitment, and work.
One of the most common sexual complaints that couples report is a lack of desire on the part of the woman. There is a diagnosis for this—Hypoactive Sexual Desire Disorder or HSDD—and pharmaceutical companies have been hard at work developing treatments. I am all for developing interventions to help couples have satisfying sexual relationships. However, in my experience, physiological factors may only be a part of the problem. For lots of couples, I find the expression “discrepant desire” much more appropriate. In fact, in my practice, I have found that for about 25 percent of couples presenting with discrepant desire, the low desire partner was the man.
Differences between men and women
Because of cultural expectations, it is much easier for a woman to admit to a lack of sexual desire than for a man. For men, there is additional shame associated with this low desire, which is related to stereotypical expectations about male sexuality. When I mentioned to these men my 25 percent observation, the relief from their associated shame was palpable. But in our highly sexualized culture, low desire is a problem for both men and women, regardless of their relationship status.
I have found that in some cases, low desire masks another underlying physical problem. For women, it may be painful intercourse or pelvic muscle spasms, or a hormonal imbalance produced by an oral contraceptive or some other pharmaceutical agent. For men, it may also be a hormonal imbalance, or it may be a way of avoiding addressing erectile dysfunction. For both, there are also psychological issues behind the lack of desire, ranging from a sexual abuse history to inadequate or harmful education about sexuality. Before deciding on what kind of help is needed, it is important to accurately identify the source of the difficulty.
Disorder or difference?
However, sometimes there is no disorder or dysfunction per se. Sometimes there is just a difference. In these two couples, which partner would you label HSDD?: One couple says that one isn’t interested in ever having sex, and the other would like to connect sexually every week or two. Another couple says one partner wants to have sex every day, and the other only wants to be sexually engaged a few times per week. In my experience, very few couples are exactly evenly matched in sexual desire. Therefore, almost every couple must deal with some level of discrepant desire. It is a part of negotiating relationships.
When individuals enter into new relational commitments, they typically negotiate many aspects of how they will join their lives. They each have unique family of origin experiences that shape their expectations of how they will live together. They decide where to live, what kind of budget they will work with, who cooks, what kind of food, do they have children and, if so, how many, where will they spend holidays, what kinds of family traditions will they establish, etc. But sex, they believe, will just happen. There is often an assumption that there is nothing to negotiate.
Working on the relationship
We are familiar with the adage “relationships take work,” and sexual relationships also take work. Just like our families of origin shape our expectations about the decisions I mentioned above, they also shape our expectations about sexual relationships, whether we talk about them openly or not. Discrepant desire is common and need not become a problem if couples will talk about it and come to an agreement about how to handle it, just like coming to an agreement about where to spend holidays.
I often ask couples to establish date nights — in particular, I ask them to establish an erotic date night. Most couples resist. The reasons? Maybe they say they don’t have time. But of course, we always have time for the things that are most important to us.
More often, when pressed, they say that if they schedule it, it is not as meaningful or valuable or loving. My answer is we make the things that are important to us a priority. So when we schedule an erotic date, we are saying to our partner, “You and our sexual relationship are so important to me that I am going to make sure we connect sexually and enjoy our relationship.” In doing this, we are not just expressing the importance of the relationship, but also saying, “I desire you.”
We long to be desired and taking the time and effort to understand each other’s sexual needs and desires is a profound gift to our loved ones. When there are discrepant sexual desires, as there nearly always are, we need to add compassion and understanding to our relationship. Then, our hope for a loving, satisfying sexual relationship may become a reality.
