Hypoactive Sexual Desire: Integrating Sex and Couple Therapy

The lack of sexual desire, known clinically as hypoactive sexual desire disorder (HSDD), is generally recognized as the most common sexual difficulty in America, affecting almost 20 per cent of men and 33 per cent of women in the general population. Sex therapists generally regard HSDD as one of the most prevalent problems in clinical practice. Over half of the couples presenting for treatment complain of insufficient sexual desire in one or both partners or a discrepancy in sexual appetite between partners. Unfortunately, the treatment of this disorder is remarkably challenging, complex and lengthy compared to other sexual dysfunctions. While clinicians are likely to encounter this prevalent problem in their individual and especially couple therapy practices, most have had little training in the physiological aspects of sexual functioning and the practice of sex therapy. This text presents an integrated approach that considers the many medical, psychological and relational factors contributing to the lack of sexual desire. The reader should learn to distinguish between organic and psychogenic aetiologies, the timing of medical and psychiatric referrals, and how to combine relational and sex therapy techniques. Most notably, this text stresses that the couple, not necessarily the partner with the lack of desire, is the focal point of treatment. The research and clinical literature is reviewed in an effort to understand this perplexing dilemma. Risk factors, assessment techniques, treatment principles and the most current medical and relational techniques are offered.