The concept of sexual desire in men involves biological, psychological, and social aspects. It is generally viewed as a motivational state. Its emergence is considered a critical element in the sexual response trajectory. Recent theories suggest that desire is the cognitive component of arousal, and both desire and arousal measures have a great overlap.
Despite the considerable amount of research on sexual desire, it has been addressed more often in women than in men. However, recent studies suggest that more men are reporting significant distress associated with low sexual desire (Carvalheira, Træen, & Štulhofer, 2014; Meana & Steiner, 2014; Janssen, 2011).
The DSM-5 and ICD-11 provide formalized criteria for disorders of sexual desire. While DSM-5 presents different criteria for men and women, the ICD-11 includes gender invariant criteria. In men, sexual desire difficulties fall under the label male hypoactive sexual desire disorder (MHSDD), which is characterized by a persistent and recurrent lack of desire for sex, lasting at least six months and causing significant distress.
There is some evidence that men also merge the concepts of desire and mental arousal, but further studies are needed to determine if there is a gender difference. Hypoactive sexual desire dysfunction is included in the new chapter of ICD-11 dedicated to conditions related to sexual health, and it is defined as the “absence or marked reduction in desire or motivation to engage in sexual activity.
Men with low sexual desire often report erectile difficulties. It may be comorbid with other sexual dysfunctions, making it difficult to determine whether low sexual desire may be a cause or a consequence of other sexual dysfunction (Corona et al., 2013).
Studies (Quinta-Gomes & Nobre, 2014) estimate that 3-28% of men experience low sexual desire or interest, with higher prevalence rates in older age groups. Reduced sexual desire may also be felt as more problematic in younger men. Low solitary sexual desire is more common than low dyadic sexual desire, and low sexual desire is more prevalent in gay men compared to heterosexual men.
Women are more likely to experience low sexual desire than men. Cohort effects have shown increasing sexual desire from the 1990s to the 2000s, but decreasing reports from 2005 to 2016, which require further investigation to determine the underlying causes.
Studies (Carvalho & Nobre, 2010b) have increasingly taken a biopsychosocial approach to the study of male sexual desire, which involves considering the interplay of biological, psychological, and social factors. Research has identified various psychosocial factors that can influence male sexual desire, such as low confidence in achieving an erection, reduced attraction towards one’s partner, long-term relationships, sexual boredom, and professional stress.
Studies have also focused on cognitive-behavioral approaches to understanding male sexual desire, finding that negative/distractive thoughts during sexual activity, restrictive sexual beliefs, and negative automatic thoughts can predict low sexual desire.
Additionally, recent research has examined new dimensions such as quality of life, sexism, alexithymia, and sexual functioning, showing dysfunctional sexual beliefs, negative automatic sexual thoughts, an emotional response associated with these thoughts, and overall sexual functioning can significantly influence male sexual desire. (1)
Theory and Models
Nobre and colleagues developed a conceptual model of sexual dysfunction for men, which postulates three levels of factors: predisposing, processing, and maintaining.
They refer to the conditions that keep a particular mental health issue or problem going. These can include things like ongoing stressors or negative life events, chronic health problems, substance use, or unhealthy coping mechanisms.
For example, someone with depression might have ongoing financial stressors contributing to their low mood and feelings of hopelessness. Addressing maintaining factors is an important part of treating mental health issues, as removing or reducing them can help to alleviate symptoms and improve overall well-being.
Cognitive Processing Factors
Referred to the patterns and beliefs that can contribute to developing or maintaining mental health issues. For example, someone with social anxiety may have negative automatic thoughts that arise in social situations (e.g., “I’m going to say something stupid, and everyone will judge me”), contributing to their anxiety and avoidance of social situations.
Addressing cognitive processing factors often involves identifying and challenging these negative thought patterns and replacing them with more adaptive, helpful thoughts.
These are the factors that make someone more susceptible to developing a mental health issue. These include genetic factors, early life experiences, and personality traits. For example, someone with a family history of depression may be more predisposed to developing depression themselves.
Understanding predisposing factors can help with prevention efforts and inform treatment approaches. For example, someone with a history of childhood trauma may benefit from trauma-focused therapy to address the underlying trauma contributing to their mental health issues.
When couples experience problems with their sex life, a common issue is differences in sexual desire. Some people want to have sex more often than their partner, and this can cause problems and dissatisfaction. Instead of just focusing on the person who may have lower sexual desire, some experts suggest that it’s important to look at how the relationship as a whole is affecting the couple’s sex life.
For example, suppose one person in the relationship feels pressure to always be ready for sex because of traditional gender roles. In that case, this could negatively impact their sexual desire. It’s also important to consider whether the low sexual desire results from issues in the relationship or other factors outside of the relationship.
Overall, it’s important to take a “dyadic” approach, which means looking at how the relationship is affecting the couple’s sex life instead of just focusing on one person’s individual experience. (Levine, 2002; Mark & Lasslo, 2018; Tiefer, 2001)
Possible medical causes of low sexual desire in men include low testosterone levels or high prolactin levels (Conaglen & Conaglen, 2009), which may be seen in conditions such as hypogonadism, hypothyroidism, and hyperprolactinemia.
Aging is also a factor in decreasing testosterone levels, which could contribute to low sexual desire in older men (Buvat, Maggi, Guay, & Torres, 2013). Medications such as antidepressants, antipsychotics, or antiepileptics may also cause low sexual desire.
To diagnose male hypoactive sexual desire disorder (MHSDD), clinicians should assess the level of desire for sexual activity and the lack/absence of sexual thoughts and fantasies. These symptoms should be persistent and cause significant clinical distress. The frequency of sexual activity should not be used as the sole marker of sexual desire, and the discrepancy between partners’ levels of sexual desire should be assessed.
A thorough clinical interview should include detailed information on partner factors, relationship factors, individual vulnerability factors, psychiatric comorbidity, and medical factors. Self-report measures such as the Sexual Desire Inventory, the Sexual Arousal and Desire Inventory, the International Index of Erectile Function, and the Sexual Distress Scale for men may also be used to assess sexual desire and associated features.
There are several biomedical treatments for low sexual desire in men, including testosterone replacement therapy for hormonal disturbances (Corona et al., 2013, 2016) and treating underlying medical conditions such as hypothyroidism or hyperprolactinemia. If medication is causing low sexual desire, alternative medications can be chosen.
However, no approved pharmacological treatment exists for low sexual desire in men. Recent reviews suggest that testosterone replacement therapy may increase sexual desire and erectile function, particularly in men with severe hypogonadism (Corona et al., 2017; Snyder et al., 2018)
Cognitive-behavioral therapy (CBT) and mindfulness-based approaches have shown promising results for treating sexual dysfunctions, particularly in women. However, there is limited empirical evidence on the effectiveness of these interventions for men with low sexual desire.
One randomized controlled trial that included men with low sexual desire found that CBT was effective in improving sexual functioning and increasing the frequency of sexual interactions, regardless of the sexual problem. This suggests that CBT approaches may address common psychological factors of male sexual dysfunctions.
Sometimes people assume that low sexual desire is only a problem for women. However, recent studies have shown that more and more men are experiencing this issue. While there may be some gender differences in sexual desire, studies have found that similarities between men and women outweigh the differences.
Factors like sexual beliefs and thoughts during sexual activity are important predictors of sexual desire for both men and women. When it comes to treating low sexual desire in men, there are no approved drugs, and there is a shortage of research on the effectiveness of psychological interventions. This is important to address because more men report low sexual desire, and more research is needed to better understand how to help them.