Sex

Not In The Mood? How A 'Sexual Desire Disorder' Diagnosis May Help — Or Make Things Worse

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Stepping into the office of a sex therapist can be daunting. You’re nervous about opening up to a stranger about something you can barely talk about with your partner.

And worst of all, you worry your therapist will tell you the thing you fear the most: That you actually have a sexual desire disorder.

As a formally trained sex therapist myself, I’ve been on the other side of this conversation more times than I can count. And I feel it’s important to share that even though diagnoses can be helpful — they can also be pretty unhelpful, too.

Because within the diagnosis of a sexual desire disorder itself lies the very idea that most of us don't want to be true. That there, in fact, is something wrong with us.

There may be, however, a different way to look at the conversation around low libido, low desire and mismatched desires within relationships.

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What is sexual desire disorder?

Before we get into the nitty gritty about the pros and cons of diagnoses like these, let’s first establish what a sexual desire disorder is.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) there are actually several classifications.

Here, we’ll focus specifically on desire disorders that center around low or reduced desire (as opposed to feeling like we have too much desire).

Specifically, these are Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder.

A few important points to know:

The very nature of the word “disorder” tells us something is out of order, something is wrong.

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Please keep in mind that when I write "disorder," this isn’t my personal view of the matter, but rather the way the scientific literature discusses it.

And we’ll get more into the potential negatives about this a little later on in this post.

You will notice the diagnoses are broken up into gendered categories — male and female. 

For instance, how do we diagnose people who neither identify as male nor female? And are the diagnoses gendered because desire is so different between the sexes?

Female desire disorder encompasses both difficulties with desire and arousal, which are in fact different things. However, the male diagnosis consists of desire difficulties alone.

There’s an entirely separate disorder for arousal difficulties for men (erectile difficulties).

But while the points above are important to discuss and there’s a lot of debate in the field of Sexology about them — you’re (probably) not here (just) for the scientific debate.

What matters to you is likely how to know if you are suffering from a sexual desire disorder and what to do about it.

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Similarities between male & female sexual desire disorders

While male and female desire disorders are separate diagnoses, there are a lot of unifying principles between the disorders.

These similarities are:

1. Symptoms have lasted for at least six months.

2. Symptoms aren't better explained by other mental health or physical health difficulties.

This means you could, for instance, have started a new drug for pain, which then led to low or reduced desire.

But your low desire is actually more about your medication having a knock-on negative effect on your desire than a "true" desire disorder.

3. You should experience significant distress caused by your desire difficulties.

This means if you feel totally fine about your lack of desire, and you aren't worried or anxious about it, you likely won’t be diagnosed with a sexual desire disorder.

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Beyond these unifying principles, here are some of the specifics.

Diagnosing sexual desire disorders

In order to get a diagnosis of Female Sexual Interest/Arousal Disorder you need to experience a few different symptoms. Some of them are:

  • A lack of sexual thoughts and fantasies
  • A lack of or lowered sexual enjoyment
  • A lack of or lowered interest in sex in general
  • Avoiding sex with your partner or not initiating sex
  • A lack of or reduced sexual activity with a partner and/or self

In order to get a diagnosis of Male Hypoactive Sexual Desire Disorder you need to experience:

  • A lack of sexual thoughts and fantasies
  • A lack of or reduced sexual activity

Looking at the symptoms above, you can probably see that the symptoms are by and large similar. In conclusion, a lack of desire is something that people regardless of gender experience.

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Let’s dig a little deeper into the question: What is sexual desire disorder?

We’re going to have a look at the way a disorder can both be helpful in order to get your desire back — and how it can also be not so helpful at all.

Will knowing you have this diagnosis help increase the sex drive?

Yes and no. It kind of depends on the therapist you’re seeing and how they like to work.

What a diagnosis essentially does, beyond affirming your very real experiences of low or no sex drive is it informs your treatment plan.

Because as therapists, we need to know what the problem is in order to offer you a fitting treatment plan. And without a diagnosis, we simply cannot do this.

Diagnoses also ensure that treatment plans are based on sexual science research. And we need research to know what works.

For this research to be conducted it needs to be funded. And the thing about research is, funding for a research project is often more easily granted if it’s tied to a medical diagnosis, as opposed to a non-diagnosed sexual health issue.

So, if you want treatment to get your sex drive back, that is based on evidence and science. And to get this help from a sex therapist, yes, a diagnosis can be tremendously helpful.

However, if you don’t want the label of a sexual desire disorder, and this very label makes you feel hopeless. The diagnosis itself can hamper progress.

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The other benefits of getting a sexual desire diagnosis

There are lots of benefits of a diagnosis! As previously stated, getting a diagnosis means you can also get treatment, and thus hopefully get your desire back.

And sometimes, this also means your treatment is covered by health insurance — because it’s labeled as a disorder.

However, a lot of times sexual health disorders, aren't covered by insurance. And the only explanation behind this is that they’re kind of seen as champagne problems by insurance providers. But if you’re here reading this, I assume you agree with me that they most definitely are not luxury difficulties.

They have real-world impacts. Impacts on our general self-esteem, the longevity of our relationship or marriage, and our mental health at large.

But beyond the potential treatment perks of a sexual desire disorder, getting a diagnosis can also be incredibly validating.

It can help put into perspective why your feelings surrounding sex are intense in terms of anxiety or stress. But also, in terms of why sex feels like nothing anymore. Or why you barely have any sexual thoughts or fantasies anymore in your day-to-day.

It can be the thing you need to hear that gives you hope you’ll be able to revive your relationship.

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Does a sexual desire disorder mean there’s something wrong with me?

This question really does depend on who you ask.

As a sex therapist and coach, my main objective is to help you feel whole again, sexually. This means getting you to a place where we flip the script from something being wrong with you — to something being right with you.

Because when you don’t want sex anymore it usually makes complete sense.

You just need help to see the sense that it makes. And enlisting the help of a professional can do that for you.

I like to come at low desire from lots of angles. But never the angle that something is wrong with you.

We turn over all the stones and do our best to find the deep-seated (often psychological and relational), reasons why you don’t want sex.

This way, we can move forward basing your action plan on real understanding and compassion. Compassion for why your desire is the way it is right now.

Because once you get to a place of understanding and knowing nothing is wrong if you don’t desire sex anymore, you can more easily decide whether you want to get your sex drive back. Because not everyone wants this.

And you can take steps toward increased desire from an empowered place, as opposed to a “disordered” place.

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The downsides of a sexual desire disorder diagnosis

It can be helpful to know there are some very real downsides to the diagnosis.

And while I generally tend to veer away from sharing my opinions on these matters in my articles (because my work is based on science and not my opinions), I need to get personal here for a moment.

Part of why I do sex coaching nowadays is because I'm tired of the stigmatizing diagnoses surrounding sexuality. I didn't like the rhetoric that is used so often in psychotherapy where we talk about disorders.

As with everything, there is, of course, a place and time for them. And they do truly legitimize conditions that have previously gone underlooked and therefore untreated, causing massive amounts of psychological pain.

As with most matters, the way therapists refer to disorders varies.

But there is still so much to uncover and learn in the burgeoning field of Sexology. So much nuance to discover. Things that tell a different story than the one we’ve been sold about sexual desire to date.

Because libido isn’t a linear, hormonal reaction that occurs in precisely the same way for everyone. Especially not when we take into account the other factors in life that make our experience of desire so diverse.

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Desire is so much more complex than we give it credit for

Sometimes, the diagnosis of a sexual desire disorder can make us feel like we’re broken.

Because to receive a diagnosis is to be told there’s actually something wrong with us.

And these negative-sounding titles (that are often needed in order for us sex therapists to get your insurance to pay for the help we provide you) have a backside.

These titles can have real-world negative effects that create specific, cookie-cutter models of how sexuality and desire “should” work.

They tell us how our bodies and minds are “meant” to function in very specific ways. And that if they don’t, well, Houston, we have a problem.

Being in this field for many years now, I’ve come to be humbled by how multi-faceted desire difficulties are. And have learned just how rooted they are in the very fabrics of our lives.

And this means experiencing desire in ways that don’t mimic the stories we've been told about desire (that it's always spontaneous, and hungry) can sometimes be misconstrued as diagnostic criteria for a sexual desire disorder.

One that we might not actually have. 

Because how much sexual desire is actually normal? It, again, depends on who you ask. And that, in and of itself, says a lot about how careful we should be in labeling people as either having a disorder or not.

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What a therapist will and won't tell you

All of this being said though — when discussing the question of "what is sexual desire disorder, really?" this isn’t a black-and-white discussion. At least not from my perspective as a therapist.

I’m grateful Sexology is a legitimate field. And to continue researching and unearthing more knowledge, we kind of need these labels.

Because that’s, unfortunately, the way the system works.

However, in my work with my clients, I find it important not to label.

This means you won’t find me telling you something is wrong with you, because there likely isn’t.

You won’t find me saying you should experience desire or arousal a certain number of times a week because you shouldn’t.

And you most certainly won’t find me telling you that you’re broken.

I will tell you how much sense it makes that you don’t want sex anymore.

How understandable it is you can't get aroused when you’re brimming with performance anxiety.

Everything you’re telling me is experiences shared with millions of people. Because you're not alone — and you're not damaged goods.

And change is possible, too. If you want it.

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Disorder or not — low desire can be increased

When answering the question of what is sexual desire disorder (and do I have it), it’s important to expand the conversation.

Because for all of the good that disorders do; validate our lived experiences, enable treatment funded by insurance, and quality research — there’s another side. One that can make disorders less appealing.

That the very diagnosis can be the thing that makes us feel broken. That we risk boxing in human sexuality and desire into very standardized ways of functioning. Ways that actually hamper our desire and our self-esteem.

There are lots of steps you can take to get your desire back.

Stuff that doesn’t hinge on treatment plans — because you likely don’t need treatment. You need to be seen and heard.

And this can be done, sexual desire disorder or not.

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Leigh Norén is a sex therapist and coach with a Master of Science in Sexology. She helps people reduce stress, shame, and anxiety surrounding sex so they can get their sex drive back and enjoy their partner again. She is author of the free resource, The Desire Test.​

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This article was originally published at Leigh Noren's website. Reprinted with permission from the author.