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Low Sexual Desire

Reprinted from PN August 2012

After spinal-cord injury, a significant number of people find their sexual interest and desire remain low for prolonged periods of time.

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It has only been in the last two decades that researchers have begun to understand and study the phenomena of low sex drive.

Low sexual desire (hypoactive sexual desire) was not even classified as a problem until the 1980s. Before that, most people thought it was normal if a person was not interested in sex.

During the 1960s and 1970s, Masters and Johnson, the founders of sex therapy, never included problems of sexual desire in their initial studies of human sexuality. The early work of those pioneers focused exclusively on the function or dysfunction of the genitalia. Their lack of attention on desire-related difficulties left out in the cold large numbers of people who had no interest in sex.

Once the sexual revolution of that era began, people with low sexual drive didn’t stay quiet for long. By the 1980s, approximately one third of the individuals or couples who sought help at sex therapy clinics presented problems related to low sexual desire. People with these issues began to believe something was just not right and started seeking an answer.

Missing Something

My own experience as a sex therapist has been similar.

There has been an increase in people reporting an absence of sexual drive or desire. Many of the individuals seen in the sex therapy clinic in my own institution complain of having no interest in sex.

Many times they come to the clinic because they have concerns about their relationship or because of pressure from their partner. Other times, they realize they’re missing something that has been important in their lives. They are not satisfied in just ignoring the problem.


There is no doubt sexual desire disorders due to medical conditions and drugs are on the rise. This increased prevalence is due, at least in part, to increased life expectancy of Americans over the last two decades.

Some researchers would estimate that life expectancy in this country has increased by more than 30% since the 1980s. The result is that more elderly people feel entitled to a good sex life and are looking for sexual healthcare.

Not a Priority

In many ways, the same can be said of people with spinal-cord injury (SCI).

Life expectancy after injury has steadily increased, and the focus has gradually shifted to long-term quality-of-life issues such as relationships, work, and leisure time.

As they should, people with SCI also believe having a positive sexual life is important and seek healthcare services aimed at improving their sexual functioning and satisfaction.

For a significant number of people after injury, however, sexual interest and desire remains low for prolonged periods of time. In the past, people were not overly concerned about this lack of interest. Most often it was considered to be a result of depression or seen as natural after SCI.

People with SCI seldom mentioned it to their doctors, and even if they did, the doctors tended to show little empathy with few solutions. In general, feeling good about one’s sexuality and being sexual after SCI was not considered a priority.

They Want It Back!

Today the situation has changed. Low sex drive is a problem for many people with SCI. It’s not something they are willing to accept so easily. They want a better sex life and a satisfying and fulfilling relationship with another person. They miss the sexual life and pleasure they enjoyed before the injury and want it back!

There are many reasons, physical and psychological, why interest in sex may be reduced after  SCI.

On a physical level, studies have shown that testosterone levels after injury are reduced in up to 70–80% of men with SCI. Testosterone levels are also frequently lowered in women after SCI, but much less is known as to how this affects their overall well-being and sexual appetite.

For men with SCI who have reduced testosterone levels, a lowered sexual drive is only one symptom. They also may experience fatigue, diminished muscle mass, dry skin, loss of energy, moodiness, and reduced bone density.

Testosterone replacement therapy is frequently considered after SCI and provides multiple benefits including an increase in libido and a positive sense of well-being. Hormone replacement therapy is often provided by endocrinologists and monitored by regular blood tests.

Primary care doctors, rehabilitation doctors, urologists and endocrinologists can order the necessary blood work to determine if testosterone levels are adequate or if androgen replacement therapy might be a consideration. Since testosterone plays such an important role in overall health, this is something you should discuss with your doctor.

Other Factors

Another area to explore is medications. Most antidepressants have a profound impact on sexual interest, as well as sexual functioning for men and women. Other medications that can affect sexual drive may be for spasms, blood pressure, heart problems, brain injury, and other neurological difficulties.

In addition, medications such as Propecia, steroids, and birth control pills, as well as withdrawal from drugs such as cocaine, can significantly impact a person’s sexual drive and functioning. Unfortunately, some of these side effects can last for months or years after the medication has been discontinued.

Emotional factors can also contribute to having no or low sexual interest. These issues may include depression, fear of failing, fear of rejection, and concerns as to how another person will react to your body after the injury.

Many guys fear they will not be able to satisfy a woman after injury; they prefer to avoid sex rather than be embarrassed by any problems in the bedroom.

Worth the Effort

All these types of issues are common after injury. It takes courage and confidence to face these fears and do something to reduce them. Most are unrealistic and the result of negative and distorted thinking.

Changing your thinking is always the first step in changing how you feel. Sharing them with another person is also a good way to get a reality check and is helpful in replacing negative thinking with more positive thoughts.

Having no interest in sex is not necessarily normal and not something you have to accept. If having a stronger sexual drive seems more like the person you want to be, it may be worth checking out what the problem is.

It may take work to get to the bottom of the problem or finding the right doctor, but the results may be worth the effort.

Contact: ducharme@bu.edu.

 

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