So this is often neglected topic when we talk about sexual disorders in males, we talk about premature ejaculation, but lack of desire is something that we don’t really talk about and its unfortunate because Doctors said that “15-20% of men do have this problem and the medical term for this problem is called Hypo sexual Desire Disorder (HSDD)
So, how do we define HSDD?
Its basically significant lack of sexual thoughts, sexual fantasies and sexual desire in general.
Another clinical definition for HSDD
It’s an illness that has been causing significant distress to the person, and has been continuous for at least 6 months.
Now What are the factors that lead to the development of HSDD?
It has been founded in almost 90% of cases, that HSDD is secondary. What do we mean by that?
It means that they are some disorderliness that is leading to HSDD, and it’s not difficult to understand because you tend to repeat only those activities that are not pleasurable in nature, and it applies to sex too.
If sex is pleasurable, if sex is satisfactory, You might want to have more of it. But if because of any exposing reason sex is no longer pleasurable, or it’s a cause of embarrassment or humiliation, People tend to avoid it.
This is an exactly what happens in people with erectile dysfunction or premature ejaculation. People who have its tends to feel very insulting because of the problem. And this remains full irrespective of the duration of the relationship.
In my own perspective I have seen patients who are 50 years and in there late 40s who haven’t married in there late 20s, even they, when they have difficulties like erection problems, They can be very moody with it. And the Tendencies ‘what would my wife think of me’ like ‘ I really got embarrassed in front of my wife ’So this male psyche thing, every any sexually concern is related to clinically equated with you know lack of masculinity is a driving force.
So, 90 % cases, if the person has a sexual disorder like premature ejaculation, erectile dysfunction that could lead to development of hypo sexual desire disorder.
But, that is not the only thing, there are other factors that may contribute to decrease levels of desire.
When we talk about these factors we divide them into
1. Biological Factors &
2. Psychological Factors
Both are equally Important, but in a particular individual, one of them might be leading all.
1. Biological Factors;
When we are talking about biological factors, the most important sector is the age.
It has been found out that as age increases after the age of 40, sexual desire tends to decrease.
Another biological factor sector is physical health.
It has been found out that people who have medical illnesses like hypertension, Diabetes, cardiac conditions, all of them tend to have low sexual desire in comparison to those who are physically healthy.
Further, if somebody has this medical conditions, and they are not really controlled, all there sexual desire will decrease.
The third sector perhaps quiet important is hormonal sectors.
the level of testosterone tend to have a corporation with sexual desire.
When testosterone becomes too less, the sexual desire tends to decrease. Now one thing that must be kept in mind is the range of testosterone.
In Male: 300 to 1,000 nanograms per deciliter (ng/dL) or 10 to 35 nanomoles per liter (nmol/L) Female: 15 to 70 ng/dL or 0.5 to 2.4 nmol/L.
If you go beyond the normal range then they might be a problem.
Testosterone is essential but it’s not the only hormone important. There are other hormones that do play a role. For example, the prolactin hormone. Secretion of prolactin if it is increased is known to have a significant effect in sexual desire.
Apart from testosterone and prolactin, we have luteinizing hormone. Luteinizing hormone is hormone that drives the secretion of testosterone, Even though the range of the hormone beyond the normal range, that could be a cause.
So these are some of the hormones that play a role in the sexual desire.
Another significant biological sector is the medications;
There are many medications, which can decrease sexual desire as a side effect.
Some common ones include:
Antidepressants, antipsychotic, medications that are used in the treatment of hypertension (HBP), some of the medications that are used for cardiac conditions.
All these medications can cause decrease in sexual desire as a side effect. The good thing is it’s not difficult to fix this problem. For example, talking about antidepressants and antipsychotic, they are other medications from the same group which do not cause sexual side effects.
So when we see a patient having decreased sexual desire disorder, because of a medication, you shouldn’t replace it, all is you can add another medication that nullifies the side effect. So that thing can be taken care of.
Apart from this biological factors, psychological factors also plays an important role
The first one being
The diagnosis of depression or anxiety;
If someone is having depression, the desire for almost everything goes down. And sexual desire is also part of that. If you’re not feeling like to do anything, you will not even feel having to do any sexual activity.
And as far as depression and decreased sexual disorder are concerned, somebody having decreased sexual desire is also likely to have depression symptoms.
So, apart from medical diagnosis of depression or anxiety, they’re other psychological sectors, which one of them is relationship issue
How is the relationship issue between the partners?
It is very important for them to understand that sex is a very intimate thing. To have sexual activity, its essential that you have the connection, psychological connection with your partner.
Sometimes young many couples come to me and said that usually the Wife complains that the Husband is not interested in having so much sexual activity. When the Husband insists, they will fight and the fight are so often, that I don’t feel like having it.” And It’s true, You cannot fight with same person in the morning and also have sexual activity with the same person in the night. It doesn’t work that way.
This is also one of the reason why large number of people are not able to have sexual activity when they drive with commercial sex workers, because you don’t have any connection with the person. And you don’t feel like having it.
So having a good relationship is extremely influential, if you want to have good sexual relationship.
They are other sectors like previous sexual experience
Previous sexual experience;
This is very essential for younger individuals who do not have sex acts frequently. Rather than saying younger individuals, I should have said people who are not in stable relationships and have sex infrequently.
So what happens means that, when they have sexual activities for the First 2 times, and they do not go as well. The partner makes comments like “You don’t get good erections” or something of that sort.
So if your initial sexual experience is not so good, then you does not feel like indulging in the same activity again and starts avoiding it. That maybe another reason for a decreased desire.
Even when giving commercial sex workers concern, many of the commercial sex workers comments on the size of erection and oral performance, those thing stays with people, and they are like, ‘I couldn’t perform as good with sexual worker, so the same thing will continue if they have sexual activity with the wife or the girlfriend.
So previous sexual experience, also play a very important role.
Another psychological sector is body image disturbance
Body Image Disturbance;
There are many people who are not happy with their body.
They think they are not attractive enough and you know all this commercialisation stuff whereby an industry flaunts bodies of Actors , Models, People will start believing that’s how everybody should look like an they develop inferiority and also develop body image disturbance. They forget that those models, actors , they don’t do same thing.
There is primary job to look good and if you’re doing some other work, you cannot spend that much thing to look good or to be in shape.
Now if they do not look attractive enough as it comes to there mind, there thought is ‘the partner will not find me attractive and again the same thought decreases the desire to indulge in any sexual activity with the partner.
This is another important reason.
So as you must have understood by now, they are multiple factors and varied factors that leads to decreased desire. But by 90 % of case, It is secondary to another sexual problem.
Now before we talk about the treatment, we must talk about the pathway meta physiology of the dependent upon the chemicals in the brain.
Whenever there is a sexual cue whether you listen to something erotic whether you watch pornography you are with your partner in a particular situation these are the cues and when these things happen there is release of chemicals called Oxytocin in there brain.
When this chemical get to release little activation of other chemical, like mineralocorticoids and dopamine, when those get released, the process afflicts sexual desire.
There is whole pathway to lead to desire, and anything that interrupts this pathway, will lead to decreased desire.
Now for the last part.
So giving a shot of testosterone from outside the body when the patient has normal testosterone level, will stop the body from producing the hormone naturally.