Low libido

One of the most common problems I see as a clinical psychologist in a sex therapy clinic is the issue of low libido (sexual desire). I find that one of the most important issues that impacts a person, or couple’s distress is simply a lack of understanding about what affects libido and a general belief that sexual desire is something that should just happen. For a significant portion of people, simply getting to know the factors or context that gives the best opportunity for sexual desire to arise is enough to change the narrative and engage in pleasurable experiences.Let me quickly preface the rest of the content here by acknowledging that I will be writing as if there is not a primary biological mechanism for the low libido. If you have experienced a change in your libido and it is now lower than what it used to be, then you should talk to your GP for an appropriate biological assessment. A change in hormones, for example, particularly around menopause can, for some people, have a profound impact on their sexuality so definitely get this checked out.

One of the first things I discuss with clients is the Willingness-to-Pleasure model of sex, discussed here. Then, I introduce the idea of a dual-process model of sex, discussed at length in Emily Nagoski’s book, “Come as you are” (highly recommended read).This model of sexual desire incorporates two components: as accelerator system(the things that turn you on) and a brake system (the things that turn you off). To give your desire the best opportunity to arise, we must produce a context that turns on the accelerator and turns off the brake.This means, it is your job to understand the factors that hit your accelerator system and the factors that hit your brake system.

There is a belief that for some people desire is spontaneous. This would mean that both physical and psychological arousal just pops up, as if out the blue, completely at random.Yet, rarely have I actually encountered someone who, with no awareness or understanding, magically gets an erection or experiences vaginal lubrication.It is nearly always cued. The cue may be external (noticing an attractive person) or internal (noticing an erotic thought) and for some people they may need very few cues to experience desire (these are the people who look like they have “spontaneous” arousal/desire) but this still means the arousal is responsive. All arousal is responsive, we just need to encounter enough cues that turn on our accelerator and minimise exposure to the cues to our brake system, to give our arousal the best opportunity to arise.

So, what the hell are my cues?What is the context that gives rise to my desire and arousal? What are the things that slam the brake on?

At this stage, I ask my clients to do some exploratory homework and reflection. I ask them to start to engage in material and stimuli to understand what are the things that push their accelerator. This may be specific erotic material (e.g., porn, erotic literature), TV shows or movies that have sexual scenes or themes they have previously watched, or fantasy material based on memories or idealised scenarios. Importantly, this phase is not meant to be about merely engaging in erotic stimuli, the purpose is to understand what is it about these stimuli that turns my accelerator on? Is it the dynamic between the people involved, is it the physical scenery, is it the music, is it about the tense lead up to a sexual experience, etc? We want to understand the breadth off actors that impact your accelerator to understand how to replicate these in your life.

Simultaneously, we need to understand the brake system. For this, as above, I ask individuals to reflect on stimuli they did not want to engage in. Let’s say you watch porn, and you find yourself scrolling past certain types of videos, ask yourself, what is it about these videos/scenes that I just don’t connect with? Similarly, we explore specific scenarios that the individual has been in whereby their partner wanted to have sex, but they did not. We reflect on what was happening for them and the factors that impacted their desire or willingness to engage in the sexual activity. This may include factors such as a messy environment, stress, physical fatigue, expectation that all sexual activity will end in penetrative sex, low mood, etc.

More often than not, when someone experiences low libido, they also rarely initiate sex. This may further exacerbate a pursuer-withdrawer dynamic. Such a dynamic is problematic for many reasons, one of which is that the withdrawer (i.e., the person with low libido)often loses touch with the factors that affect their accelerator and brake system. Therefore, after we have explored these factors, I ask for the individual to initiate an intimate experience at least once a week. This means, at least once a week, the person needs to take ownership of curating a context that is going to give them the best opportunity to experience desire and to move their mindset to be willing (from the willingness-to-pleasure model) to have an intimate experience. I’m being specific in using the words“intimate experience” here because this does not have to end in penetrative sex. It can be any experience that is pleasurable (this may be kissing, touching and may or may not even include genitals).

If you know that some of things that press your brake are incomplete chores and feeling like you have enough time, then pre-plan your intimate night on a day where you can ensure all the chores are done in the morning and you have set aside enough time to not feel rushed. If you know that some of the factors that press your accelerator are clean sheets, feeling sexy in nice clothes, and flirting, the pre-plan a day when you can get the sheets in the wash, that you have a place to wear your special clothes, and that your partner is aware that you want to go out and be flirty and light-hearted together. While it may seem “unromantic” or “unerotic”to plan your sexy/intimate times – how else can you ensure your context is right, the brakes are turned off, and the accelerator is turned on. We must move past the idea of “legitimate” sexual experiences being spontaneous (all desire is actually responsive!) and must end in penetrative sex.

After this, there is a whole lot of practice and reflection in here.

I do want to point out, this isa simplified version of what actually happens in therapy as typically we want to explore factors such as stress management, low mood, anxiety, or pain that may be impacting libido. Similarly, other relationship factors may be impacting an individual’s willingness to connect with their partner. It also isn’t uncommon for us to make these processes more structured by putting in rules such as no penetrative sex for a time period, then slowly allowing erotic touch and genital touch before finally, if desired, incorporating penetrative sex. We might implement this to help re-write the expectations that all intimate experiences must end in orgasm or penetration. If unsure, I would recommend finding a therapist/psychologist who is comfortable working with these issues.

Dr Daniel Brown

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