Unhappy Married Couple and Sexual Problems Concept. Frustrated Man and Woman Not Talking Feeling Offended or Stubborn. Concept of Impotence. Man Have Problems.

Hypoactive and aversion disorder: Helen Kaplan and sexual desire pathologies

By Cristiano Antonino On Nov 25, 2022

How sexual desire works: with Helen Kaplan the phases of sexual behaviour were recognised in the DEPOR model, which stands for: Desire, Arousal, Plateau, Orgasm, Resolution

Desire lies at the apex of this chrono-hierarchical scale.

From an endocrine point of view, testosterone is the main hormone that triggers desire, along with a dopaminergic action, but more likely it is the relationship and couple aspect that plays a central role.

Declining desire or hypoactive sexual desire is very often linked to environmental contingencies, ranging from a disabling illness to couple conflict to substance addiction or the use of psychotropic drugs.

What is hypoactive sexual desire disorder

Hypoactive sexual desire can certainly be situational, but when there is a high recurrence it crosses the border of pathology into DDSI: hypoactive sexual desire disorder.

The world’s most widely used manual of psychiatric nosography defines DDSI as a situation in which there are “persistently or recurrently lacking or absent sexual fantasies and desire for sexual activity…” (DSM IV TR, 2004).

This diagnostic classification also includes a form of discomfort that the patient experiences due to his or her total disinterest in everything related to sexuality, both in act and in potency.

What is sexual aversion disorder

Another form of desire pathology is sexual aversion disorder, which manifests itself through an avoidance and aversion to any possible contact with one’s partner’s genitals.

What characterises sexual aversion disorder is the phobic element towards sexuality.

The person with sexual aversion disorder tries to avoid at all costs situations that are considered ambiguous and sexual in order not to risk being uncomfortable, if not outright panic-stricken.

Very often, therefore, sexual aversion disorder originates from or is accompanied by phobic, anxiety and even traumatic traits.

Whom to turn to in case of sexual desire disorder

When desire pathology in a person or a couple becomes intolerable, the sexologist is called in.

At this point, treatment can be directed on various fronts, also with regard to possible causes.

Often there is a couple conflict to be resolved, or if it is daily routine that extinguishes desire, the intervention will be aimed at introducing new elements for the couple.

Sexual desire disorder therapy

Sometimes, on the other hand, it is enough to prohibit partners from all sexual practices, and paradoxically desire resurfaces.

In sexual aversion disorders, therapeutic interventions are supplemented with cognitive-behavioural treatments in the case of high phobic or anxious traits, or with a psychodynamic investigation in the case of traumatic causes.

In the male, to date, with the advent of phosphodiesterase type 5 inhibitors, erection problems are resolved in the majority of cases, but if there is a desire disorder upstream, not even pharmacotherapy is effective.

The desire phase is in fact modulated by a complex psychoneuroendocrine and relational mechanism that conditions the subsequent phases.

The area in which sexuality medicine has not entirely succeeded is the desire component, without which no sexual act can be performed.

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