Help With Low Libido

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Reader’s Question

I am a 62-year-old male who has been married for 32 years to a very amorous woman. I have always had low sex drive in our marriage, although I was active before marriage. In fact, I do not recall ever initiating a sexual encounter with my wife — a fact that is, of course, discouraging to her. The problem has intensified with the onset of BPH (Benign Prostatic Hyperplasia) and use of Finasteride, although I do not blame the problem much on the medication. This is more than ED. Products like Viagra and Cialis are of no help. I am able to achieve an erection with those products but it is very short-lasting, and does not continue even for a single complete sex act. Any thoughts?

Psychologist’s Reply

This sounds like a very frustrating situation for you, your wife and your marriage. From what you describe, this is a desire/arousal issue that has existed for many years. When couples present with the issues you describe, there are three areas psychologists typically assess:

  1. medical or physiological issues that may affect libido and/or performance;
  2. previous functioning and sexual history with the current partner and with previous partners;
  3. issues currently (and previously) affecting the partners’ relationship (particularly sources of conflict).

Let’s first address the medical and physiological issues. Finasteride is a medication that may result in decreased libido as a side effect. As you mentioned, it does not seem to be the source of the problem, but it may certainly be exacerbating it. Because you reported that you “have always had low sex drive in [your] marriage,” it is possible that at the time you were married (which appears to be in your early thirties), you may have experienced a significant decrease in testosterone levels. Clinically low levels of testosterone are not unusual among men in their thirties and forties, and can impact libido as well as overall energy and cognition. As you have acknowledged, this is more than a mechanical/performance-based erectile dysfunction (ED) issue. Because you are taking a medication that can cause decreased libido as a side effect and because you have tried ED medications (hopefully under your physician’s supervision), it is important to first discuss these concerns with your physician.

Secondly, because you seem never to have initiated a sexual encounter with your wife in your 30+ years together, the two of you likely have this long-established pattern (or ‘dance’) within your relationship that may be difficult to change. You mention that it is “discouraging to her,” but you do not mention how it is for you. You may want to consider some of these questions: Has this pattern been satisfying for you until now? Is it still satisfying to you, but difficult to see her frustration? Although you indicate having been “active before marriage,” was the pattern any different with your previous partners? It may also be worth exploring what was different for you before you were married. For example, how were your previous partners different from your wife? Did you ever initiate sex with them, or were they usually the initiator? Is there anything that is arousing to you when you are not with your wife? It could also be helpful to think about what gets in the way of initiating sex, which leads us to the third, more complex area that might be at work.

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Thirdly, the pattern that has been established in your sexual relationship with your wife may have also been influenced by other factors in your relationship. After ruling out any physiological factors that may be impacting sexual desire, there may be conflicts that play out in a couple’s sex life. In these instances, sex can be a way for one partner to obtain more power in the relationship. You did not mention how often you accept or reject your wife’s bids for sex. Perhaps waiting for her to initiate gives you more power in the relationship, when you can then decide whether or not to accept her bid. Perhaps there are other issues within your relationship that influence your hesitation to initiate sex with her (such as not wanting to risk rejection). There may be other stressors (for example, your financial situation, work, or other family obligations) that have also affected your sex drive over the years. It may be helpful to explore these possibilities, and begin to ‘unpack’ how your sexual relationship with your wife has developed.

If you have explored many of these issues already, it is possible that you and your wife simply have mismatched sex drives. It is fairly common for partners to differ in the amount of sex they desire, and finding a satisfying compromise for both individuals can be a goal to work on in couples’ therapy. I would recommend consulting with your physician first, then perhaps seeking the help of a qualified mental health professional who specializes in couples’ therapy (and particularly in sex therapy). If you see a urologist for your BPH, that physician may have a referral for you. Otherwise, you can always find a qualified psychologist in your area through APA in the US. Another helpful website with referrals to qualified professionals is AASECT. In the meantime, you and your wife may benefit from reading the book Inhibited Sexual Desire to help you better understand and work through this common issue that affects many couples.

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