Most sex therapists would agree that of all the problems presented in their offices, the largest category of concerns are those centering around levels of sexual desire. They would also agree that these cases are the most difficult to understand and the hardest to treat. But, let's begin at the beginning and try to understand what sexual desire is and where it comes from.

Sexual Desire Defined

Sexual desire is the internal motivator that signals the biological hunger for arousal and orgasm. In the past it has been called "libido," and today its stirring is commonly known as "getting horny." It is a biological hunger, not too unlike our hunger for food, although no one has ever died from lack of sex. The sexual hunger begins as a subtle yearning and might stay at that level, or it might escalate in intensity and become quite demanding. Given the opportunity for arousal and the eventual orgasmic satisfaction, the level of biological desire decreases. This biological need will, however, resurface in a period of time, this cycle being different for each one of us depending on our biology and our environment. By "our environment" I mean, of course, the amount of sexual stimulation around us, in the form of a desirable and interested partner, exciting visual stimulation, and sensual sounds and aromas.

I'll back up again to point out that there might be confusion in our definition of "sexual desire," for it is often used to identify sexual thoughts, as well as physical urges. I prefer to refer to the former, the sexual thoughts, as "sexual ideation," and reserving the term "sexual desire" for that biological ache that captures a person's attention and directs his or her behavior toward a sexual goal. Thus, someone might honestly say they think about sex, but they have no desire to do it. They might say that their sexual ideation includes memories of wonderful sexual encounters, but there is no physical need to repeat them.

There are those who have positive thoughts about sexuality and a biological sexual need that periodically arises. The satisfaction of a sexual appetite does not automatically require that it be done within the context of a relationship. Some people might abstain from a sexual exchange for reasons relating to their morality or personal values, or just because a suitable partner is not available. Therefore, there are obviously those who respond to their sexual drive with masturbation. Self-pleasuring is an option for one who is waiting or one who is without a partner, and self love should always be practiced without guilt. It is interesting, on the other hand, there are also those with strong physical needs, but with negative sexual ideation and this prevents them from seeking fulfillment of their sexual appetites, alone or with a partner. Celibacy is a matter of choice, but a lot easier for one who has little or no desire.

Three Types of Sexual Arousal

Let me back up again, for this topic of sexual desire is complex and I need to make another point about arousal. (Remember, the physical sexual response cycle begins with desire, which leads to arousal, and, with effective stimulation, culminates in orgasm.) There are essentially three types of arousal. First, there is that spontaneous arousal that is closely intertwined with desire and springs up without provocation. The horniness suddenly emerges, closely followed by the physical manifestations of arousal (men get firm, women get wet). This spontaneous arousal is most likely the result of a biological cycle driven by the person's hormonal system, and the most obvious example are the spontaneous erections of the adolescent boy which occur with no external or mental stimulation. The desire and arousal just appear.

With age, other physical changes, and a lot of unknown factors, the incidence of spontaneous arousal diminish. However, there is another avenue to arousal that we can call "psychogenic." The genesis or beginning of the arousal is in the person's psyche or mind, although the biological/hormonal component is still operative. Psychogenic arousal occurs when a person, with positive sexual attitudes and a subtle but growing biological need, begins a sexual fantasy; or sees, hears or smells a desired partner; or sees or reads something erotic or explicit. Psychogenic arousal can be stimulated by a nonsexual touch, a gentle kiss, or some other sensual touch other than on the erogenous areas. We could guess at a percentage and say that the origin of psychogenic arousal is 65% within the mind and 35% within the body. It should be obvious, however, that the percentages can change, but arousal might still occur if the numbers add up to 100.

All is not lost if the percentage of the spontaneous biological contribution is low. This is when we must rely on nature's backup plan. This we can call "neurogenic arousal" or "reflexogenic arousal," for the pathway to arousal is via a neurological reflex. Remember this avenue, for it is important and I will get back to it.

Sexual Issues Centering Around Desire

Now, let's look specifically at the types of concerns that center around issues of desire. However, I first want to remind the reader that there is no national standard that everyone must meet. If both partners enjoy there mutual sexuality once a month and are both happy about that, there is no problem. If another couple mutually enjoys their sexuality twice a day, seven times a week, and still makes it to work on time, there is no problem. Too often there is a tendency to label someone as "undersexed" or "oversexed" based on some statistic or, more likely, the level of desire of the persons doing the labeling. This is subjective at best, disrespectful at worst.

Each couple must decide what is right for them and, if in agreement, no one should judge their performance. However, a problem might arise if one partner feels the need for sex once a month and the other partner desires it more frequently. This has been called a "desire discrepancy," and can become a major issue in a relationship. I should hasten to add that the old sexist jokes always have the woman saying, "Not tonight," and then claiming the proverbial headache. In reality, a good estimate is that the ratio between women and men is about six to four. That is, out of 10 people with a level of desire lower than their partner's, six will be women. Four of these 10 people will be men.

Issues of desire are further complicated by the fact that newness or novelty are very powerful aphrodisiacs. There might be a lot of spontaneous and psychogenic arousal early in a relationship, but as time goes on, the level of desire diminishes. Although not exclusively, it is often the man who continues to feel the biological desire when time cools what had begun as a passionate relationship. It is recognized that testosterone plays a major role in triggering sexual appetite... women produce it also, but not in the same quantity as men. So we have issues of familiarity and issues of hormone production, and these are not easily sorted out.

Two Categories of Low Desire

I need to get academic again... forgive me. Low desire might be life-long (chronic) with the person saying, "I never really had a need for sex," or it might be a more recent change and the person reports once having a strong desire but somehow losing interest. With the former, blood chemistry might be involved. With the latter, biological changes (e.g., a pregnancy, menopause, or medication side-effects) might be the culprit, or the introduction of mistrust, disrespect or anger into the relationship could undermine the desire.

Typically, if the lose of desire is related to some physical change, it is "global." That is, the person never feels desire. However, if a decrease or loss of desire has something to do with a change in the relationship or something to do with the partner, it is called "partner-specific." In this case the person feels desire, but is not attracted to their partner. Such a person might report that they are avoiding sex with their partner, but are masturbating on a regular basis.

The Partner's Reaction

Even in a relationship that is otherwise good, partners with a higher sexual interests and drive often have difficulty understanding why their mate is indifferent. All too often they think it is intentional (e.g., withholding sex to punish) or a sign of the loss of love ("If you loved me, you'd want me"). Feelings might be hurt, self-esteem might suffer, and rejection might be perceived when this is not what it is. The one with the higher desire might feel abandoned and undesirable, but the partner with the lower level of sexual drive might be equally bewildered. Not having the appetite, this partner might wonder why their hornier mate has placed so much importance on something that holds so little interest for them. They might feel pressured, could feel guilty, and may even wish they could feel more desire but do not know how to make it happen.

Unfortunately, a chain of events might begin. One partner shows little interest, but tries. The other partner senses disinterest and begins to question. The one with the lower desire could then feel self-conscious and back off. The hornier partner might then lay on a guilt trip. The one with the lower appetite might begin to resent this and shut down even more. The hornier partner might then begin to pressure and the one with less drive becomes angry. This couple is now in serious trouble!

The Place to Start

Let's begin with two first steps that many many people resist. If the absence or lose of sexual desire is global, the person with the lower sexual appetite should consult a physician and request a complete evaluation of his or her hormone levels. If the absence or lose of libido is partner-specific, it is time to take a good look at the quality of the relationship, both emotional and sexual. Look for anger, resentment, or maybe just boredom! If sex has become mechanical, routine, hurried and one-sided, without a powerful push from hormones, desire will plummet.

People with higher desire than their partners should be aware that the more they push, the more likely it is that their mate will back down. Sexual desire is a natural biological drive and can not be talked, coerced, or shouted into action. The other thing people must learn is to avoid what I have called "all-or-nothing sex." That's when the only time one partner touches the other is when he or she wants physical gratification and does not stop until they get it. There is nothing in- between. This can be particularly devastating to a woman who has low desire for sex but a high need for nonsexual physical affection. Perhaps is she was touched more she would be more willing to try. Men need to remember that for many women, sex is more about the total relationship than about having an orgasm!

It's a Tough Problem

I'll be honest and state that the chances of someone going from zero desire to full steam ahead even with the help of a qualified sex therapist is pretty slim. Hormone supplements might help, but folks should always be aware of any possible side-effects. I do feel, however, that there is a way to deal with a desire discrepancy within the context to a loving and committed relationship if both parties are willing to compromise.

The strategy begins with the couple's mutual agreement to redefine what their sexuality is all about. If one insists sex is only about orgasms, there is going to be trouble! Sexuality must be redefined as the intimate expression of caring, with or without orgasms. It must be viewed as the physical expression of their emotional passion, with or without arousal. This new definition of sexuality should include sensual massage, nonsexual fondling, and the verbal exchange of positive thoughts, fantasies and memories.

It must be understood that no one is purposefully rejecting the other, and love still exists even in the absence of frequent and spontaneous arousal. It must also be accepted that strong overwhelming feeling of desire are unlikely, and that this is as much a loss for the one with less desire as it is for the one with the stronger drive. However, it must also be recognized that some compromise must be met if the relationship is going to continue undamaged.

There is Hope

I had written of spontaneous arousal generated by a powerful biological drive. Forget it! I had also written of the influence of the environment in allowing psychogenic arousal, even in the absence of strong desire. To do this, all-or-nothing sex must be avoided. The level of romantic encounters should increase as should the amount of nonsexual touch and loving caress. Turn-ons and turn-offs should be openly discussed, and the couple should reminisce about their past loving and erotic activities together. Communication about pace and timing is essential. Novel and creative activities acceptable to both might be explored to bring some novelty into the bedroom... in fact, novelty can be added by playing in locations other than the usual room of the house where sexual attempts typically occured.

Now, all of that probably is something you have read elsewhere. But, the main element in the intimate compromise is to agree to set aside time in advance to relax together and, in a non- pressured atmosphere, to play. Bathing or showering together could be a start. Candle lite and soft music might help set the mood. Nonsexual caress with a warm massage oil would help the relaxation. I might happen that in the sensual process, the desire of the less interested individual might be stirred, and the session might move slowly into sexual activities. The partner with the stronger desire should realize that even if it moves in this direction and even if his or her mate experiences a pleasurable orgasm, the level of spontaneous desire of that partner will not increase. This is a strategy, not a cure!

Focusing on the Process, Not the Goal

In this process that begins almost from ground zero, it is absolutely essential that there is agreement that when one partner says something like "I'm gone about as far as I am going to go," that the other partner will not push. The contribution of the hornier partner to the success of this strategy is his or her agreement to back away from the urge for completion so as not to pressure the other participant. However, the contribution of that partner with the lower desire is the promise to try the next level before asking that the progression end. In other words, if the nonsexual massage feels good and relaxing for a woman with a low sexual appetite, breast stimulation should be tried even in the absence of desire. If that feels good, the next step including genital stimulation should be tried, even in the absence of arousal.

Ignition Problems

Do you remember what I wrote about reflexogenic arousal. It is a neurological reflex that is triggered by direct stimulation of the clitoris of a woman or the penis of a man. With a woman who is not aroused, this should happen only with the added slipperiness of a safe and water- soluble lubricant (like K-Y or Astroglide), or with oral stimulation. There is a chance, if the person without spontaneous desire was able to relax and if the touch was unhurried and in just the right places and just the right time, that arousal will occur with this direct stimulation of the most erogenous areas. This is what I have called the "jump start" for people with "ignition problems." Many people discover that even though their starters are broken, their motors will run just fine.

But, the jump start might not always occur and so the agreement to back up when something is not working holds true, even when the activities have moved to this level of genital involvement. When a limit is reached, it is very important to back up and slowly back out, even when there has been manual or oral caress of the genitals. However, care should be take to maintain the expression of sensual caring in this "cool down phase." The person with the higher desire can always ask permission to masturbate while their partner holds them, and some partners might even be willing to help. This must never, however, be done to embarrass or intimidate a mate, but rather as the conclusion to an understandable, one one-sided, hunger that craves satisfaction.

Desire discrepancies can be troublesome, but with understanding, compassion, and a willingness to risk starting something that might not get finished, partners can avoid the anger and avoidance that might otherwise occur. The physical bonding in a long-term relationship is important enough for couples to seek a compromise that both can live with.