bubble_chart Overview

Sexual hypoactivity is a condition characterized by a decrease in both the ability to engage in sexual activity and the initial level of sexual behavior. Women report experiencing sexual hypoactivity more frequently than men, with literature indicating rates of 16–20% in men and 20–37% in women.

bubble_chart Etiology

Inhibition of sexual desire can occur as a secondary reaction to organic diseases, mental disorders, other sexual dysfunctions, or the use of psychotropic drugs, or it can be directly caused by psychosocial factors. Low self-confidence, dissatisfaction with body image, guilt about sexual behavior, neuroticism, sexual depersonalization, and repressed sexual life can all lead to decreased libido. Daily life stressors can affect sexual desire or limit sexual activity. Tension and emotional discord between spouses can weaken mutual sexual attraction. Decreased libido may also occur after traumatic experiences such as rape or incest, or due to fears, such as concerns about sexual hygiene, fear of pregnancy or sexually transmitted diseases, fear of losing physical or mental control during sexual arousal, fear of spousal disapproval, or interference from factors like incest or adultery in the context of sexual life. The above factors can lead to reduced physical strength, exhaustion, diminished interest in sexual activity, and declining hormone levels, all of which may contribute to decreased libido.

bubble_chart Clinical Manifestations

Clinically, problems caused by difficulties in accepting sexual activity are the most common. Repeatedly rejecting a spouse's sexual demands can easily make the other party feel abandoned, leading to feelings of loneliness and neglect, while the patient themselves may feel deep guilt for being unable to meet their spouse's sexual needs. Sometimes, the patient's spouse may try to compensate by increasing efforts to fulfill their own sexual expectations and demands, which can create a vicious cycle, often resulting in marital dissatisfaction and an increase in sexual problems. If the initial level of sexual behavior is low, the patient may show no interest in initial sexual activity, and couples may often experience marital breakdown due to the absence of sexual relations.

Decreased libido does not exclude sexual pleasure or arousal. In some patients, sexual response remains unaffected, with normal erectile function or vaginal lubrication, and no orgasmic dysfunction during sexual activity. For certain patients, denying interest in sexual activity may also serve as a form of self-defense to alleviate feelings of guilt. Decreased libido is often accompanied by anxiety or resistance, which is generally more persistent and severe than cases involving orgasmic or arousal phase disorders. Individuals with decreased libido are more prone to anger, more emotionally fragile, and engage in harsher self-defense mechanisms compared to those with sexual dysfunction.

bubble_chart Diagnosis

Loss of sexual desire is the primary issue in this disorder. As long as there is an impairment in the ability to engage in sexual activity or a reduction in the initial level of sexual behavior, and sexual activity is difficult to initiate—rather than being a secondary symptom—the diagnosis can be established.

The diagnostic criteria for decreased sexual desire in CCMD-2-R are as follows: ① Adult but not elderly; ② Lack of interest in sex and absence of sexual activity demands; ③ Persistence for at least three months; ④ Not caused by organic brain disease, physical illness, alcohol or drugs, nor is it a symptom of another mental disorder (such as neurosis, depression, or schizophrenia).

bubble_chart Treatment Measures

The treatment principle for this disease should primarily focus on disease cause therapy, while incorporating emotional therapy and sensate focus training is expected to yield good results.

(1) Disease cause therapy: For those with decreased libido caused by depression, medication, or organic factors, active treatment of the primary disease is necessary.

(2) Emotional therapy and sensate focus training: Most patients can achieve good results with this method. However, the following points should be addressed before training: ① Assess whether the patient has motivation for treatment. If the individual with decreased libido has no interest in receiving treatment, the therapy will not be effective and may even backfire; ② Help the patient correctly understand and cope with the condition. At the beginning of treatment, identify the relevant disease cause as much as possible. If the disease cause is unclear, inform the patient that successful treatment depends on current changes in attitude, desires, or behavior. Avoid making excessive promises; ③ The focus of treatment should be on improving the couple's sexual relationship, rather than labeling who is "healthy" or "sick"; ④ Help correct harmful beliefs about the mutual influence of couples' sexual activities. Common misconceptions include three types: a. Individuals with decreased libido believe that the satisfaction and pleasure of sexual activity depend on their initial sexual interest. b. Stereotypical sexual norms, such as the belief that men should initiate sexual activity and quickly exhibit sexual arousal, and that when women first propose sexual activity, it may trigger emotional changes in men. c. The belief that sexual activity must lead to intercourse or orgasm; ⑤ Treatment should involve multiple approaches to promote communication between the couple and discuss the autonomy of sexual activities, emphasizing emotional exchange rather than treating sexual arousal or intercourse as the goal of training, and encouraging the formation of a natural relationship where either partner can initiate sexual activity.

bubble_chart Differentiation

It is often difficult to distinguish between organic and psychosocial causes of decreased sexual desire, as only extensive clinical diagnostic methods can be applied, and precise laboratory measurements are unavailable. Generally, situational decreased sexual desire is psychosocial in nature, while most biological factors leading to decreased sexual desire tend to be persistent and unyielding in character.