Lack or loss of sexual desire
Essential information for patient and partner
Sexual desire varies at differing times in an individual’s life and varies widely between individuals. Research shows that at any one time 30-40% of women will claim low sexual desire. Loss of or low sexual desire has many causes, including relationship problems, earlier traumas (eg sexual abuse/assault), fear of pregnancy, postnatal problems, loss and bereavement, physical and psychiatric illnesses, stress (including long working hours) and many more. Women with low/no libido do not usually initiate sexual activity or may only engage in it reluctantly when it is initiated by a partner.
General management and advice to patient and partner
Discuss patient’s beliefs about sexual relations. Check whether the patient and/or the partner have unreasonable expectations. Ask the patient about traumatic sexual and relationship experiences and negative attitudes to sex. Accept that this may take more than one appointment.
If possible, see partners together as well as individually. Try to find out if this is a problem for the woman or the relationship. If the latter, consider a difference in sexual need rather than dysfunction. Suggest development of an understanding and acceptance of what each partner wants during intimacy and help them to communicate these wants. Suggest introducing this communication into intimacy in a planned way (ie ‘I would like this…’).
Over several weeks, encourage patient and partner to practise pleasurable physical contact without intercourse, commencing with non-genital touching and moving through mutual genital stimulation to a gradual return to full intercourse. Partners must take it in turns to be active and passive in terms of touching and to initiate/go second (‘sensate focus’ therapy).
Consider ways of building self-esteem (eg exercise, education) and advise time and space to herself.
Last edited: 22/8/2003
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