Sexual aversion disorder: the decline in female and male sexual desire

By Cristiano Antonino On Jun 4, 2023

Decreased male and female sexual desire, or its absence, are symptoms of so-called sexual desire disorders: hypoactive sexual desire disorder and sexual aversion disorder

The fundamental characteristic of hypoactive sexual desire disorder is the insufficiency or absence of sexual fantasies and the desire for sexual activity

This decrease in female or male desire can be global, and include all forms of sexual expression, or it can be situational, when it is limited to a partner or a specific sexual activity.

Low male or female desire, however, may also be secondary to other sexual dysfunctions, mental disorders (especially major depression, of which it is a real symptom) or may be induced by substances, alcohol or drugs (especially certain psychotropic drugs or birth control pills).

A professional assessment is therefore first needed to evaluate whether the decrease in desire in women or men is secondary to one of these factors or a symptom of a true sexual desire disorder.

Those who suffer from decreased sexual desire (hypoactive desire disorder) have little motivation to seek stimulation, do not take the sexual initiative (they are not proceptive) but are usually receptive, i.e., if stimulated adequately they accept the sexual offer and enjoy it adequately or, in the worst case, they do not experience great pleasure but nevertheless do not experience negative emotions about it.

Although the number of sexual experiences is usually low, pressure from the partner or non-sexual needs (e.g., for physical comfort or intimacy) may increase the frequency of sexual encounters, despite the decrease in desire in both men and women.

This aversion disorder, on the other hand, is characterised by active avoidance of genital sexual contact with a sexual partner.

The subject not only has low desire, but reports anxiety, fear or disgust when faced with a sexual opportunity with a partner.

Aversion to genital contact may be focused on a particular aspect of the sexual experience (e.g., genital secretions, vaginal penetration); some subjects, on the other hand, experience a generalised revulsion towards all sexual stimuli, including kissing and touching.

The intensity of the reaction of the subject exposed to the stimulus that produces aversion may vary from moderate anxiety, with lack of pleasure, to extreme psychological distress.

In these cases it is not a decrease in sexual desire, but a complete absence of desire, since the mere idea of sexuality produces aversive rather than positive feelings.

In contrast to the patient with hypoactive sexual desire (low desire), the patient with this aversion is neither proceptive nor receptive and feels aversion and disgust, or fear, for everything that is sexually connoted (even if only in imagination).

The immediate causes of sexual desire disorders are attributable to a dysfunctional learning process

In the case of hypoactive desire disorder, performance anxiety (or fear of failure) links sexual feelings and sensations to previous fears of loss.

This anxiety occurs at the onset of the response, when the subject anticipates the thought of sex, from which they defend themselves by suppressing it by processing negative antagonistic thoughts, resulting in a decrease in desire.

Performance anxiety can be generated by individual factors affecting only one of the two partners (strong religious convictions, an obsessive-compulsive personality, gender identity disorders, specific sexual phobias, fear of pregnancy, widower syndrome, worries about ageing, lifestyle factors such as stress and fatigue) or by relational factors (lack of attraction to the partner, poor sexual skills of the partner, differences in the degree of optimal mutual closeness, marital conflicts, inability to merge feelings of love with sexual desire).

In the case of aversion disorder, anxiety is linked to a phobia of sex.

It is associated, more or less casually, with specific aspects of sexuality and/or intercourse.

Once the anxiety reaction has become conditioned to certain sexual stimuli, the person tends to avoid them whenever they occur, in order not to experience the anxiety activation that is perceived as subjectively unpleasant.

The original conditioning that gives rise to this association can have various origins: negative parental attitudes towards sex, resulting from cultural conditioning, sexual trauma (rape), constant pressure experienced during a long-term relationship, confusion about one’s sexual identity.

The treatment of disorders involving decreased sexual desire, both male and female, must include, especially with regard to hypoactive desire disorder, a cognitive therapy phase aimed at restructuring the dysfunctional beliefs about sexuality that maintain the disorder.

An attempt is made to motivate the patient to resolve the problem by making an assessment in terms of costs and benefits and making him aware of the negative emotions he associates with sex.

The causes of the decrease in desire are explored, the patient is made to learn strategies to cope with anxiety, and finally, an attempt is made to induce the drive with gradual exposure to all environmental stimuli that induce sexual feelings.

It is only after such cognitive therapy that patients can benefit from traditional sexual therapy procedures, such as sensory focalisation, involving exercises in physical sexual contact.

For this aversion disorder, on the other hand, the treatment of choice consists of a graduated exposure that leads the subject to anxious ‘sexual’ situations that become increasingly intense and, therefore, capable of inducing increasing anxiety responses.

In any case, it is necessary to explore and re-elaborate those developmental or traumatic factors that may have contributed to the association between sexuality and negative emotions.

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