A Woman Complaining of Lack of Sexual Desire: Sexological Counseling

• Published in: Bio-Psycho-Social Obstetrics and Gynecology pp. 343 - 363
• Main Authors: van Lunsen, Rik H. W., Laan, Ellen T. M.
• Format: Book Chapter
• Language: English
• Published: Cham Springer International Publishing
• Subjects: Female sexual interest/arousal disorder; Hormones; HSDD; Psychological factors; Relational factors; Sexual arousal; Sexual desire; Sexual dysfunction
• ISBN: 9783319404028; 3319404024
• DOI: 10.1007/978-3-319-40404-2_20

Absent or reduced sexual desire and/or arousal is a prevalent and often distressing complaint. In general, women present this problem only when the gynecologist proactively inquires about possible sexual difficulties. Incentive motivation theories, the abundance of evidence that spontaneous sexual desire does not exist, and the knowledge that sexual desire is the result of competent sexual stimuli that activate the sexual response system have changed the way science defines arousal and desire. Desire for sexual activity is more determined by the expectation of rewarding experiences than by a biological “drive.” Biological factors—neurotransmitters and hormones—are not the source of sexual desire but mainly determine the sensitivity of the sexual system for sexual stimuli. Based on these changed views, in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), the distinction between arousal and desire is abandoned. In women experiencing reduced sexual desire and/or arousal, the diagnosis female sexual interest/arousal disorder should not be made if the sexual difficulties are the result of inadequate sexual stimulation. If the problem is situational, a biological cause is most unlikely. Sexuality is a biopsychosocial phenomenon. Whatever may be the most important initial precipitating factors, there always are secondary psychological, relational, and contextual maintaining factors that must be taken into account in the diagnostic and therapeutic process as well. Treatment of sexual desire and arousal disorders therefore by definition is multidimensional, taking into account all these factors. Therapy might include psychoeducation, basic counseling, individual and couple psychosexual behavioral therapy, and hormonal and pharmacological treatment.