Disorders of desire

Partners are not always satisfied

With subjects like cross-dressing and incest hot topics on talk shows and in tell-all books, it seems like anything goes with sexuality these days.

As society’s sexual mores constantly change, it’s hard to determine what constitutes a sexual disorder and what is acceptable in the sexual arena. According to sex therapist Alexandra Myles, of Boston’s McLean Hospital, professionals “normalize” many desire disorders — as long as they don’t hurt anyone, break the law or cause problems in a person’s work or social functioning. Desire disorders can range from common problems like low sexual desire to more unusual behaviors like cross-dressing.

Dennis Sugrue, a sex therapist and clinical psychologist at the Henry Ford Center Behavioral Services Program in West Bloomfield, Michigan, prefers to label sexual behaviors as typical or atypical rather than dysfunctional or abnormal. He views his role as a therapist as helping clients to feel okay about themselves, whatever their form of sexual behavior. “If one’s sexual expression happens to deviate from the norm, this isn’t necessarily a reflection of the person’s psychological health or worth as a human being,” Sugrue asserts.

Whether you label different modes of sexual behavior as disorders, problems, or just preferences, it helps to understand what they are and when to get help for them.

Low sexual desire

People generally come into treatment for low sexual desire when their partner notices it, according to Fay Heller, sex therapist at the Menninger Clinic in Topeka, Kansas. This most frequent complaint can stem from many sources, she says, including:

Medication. Many drugs can suppress sexual desire and functioning, including high blood pressure medicines, oral contraceptives and antidepressants. If you notice a sudden change in sexual desire after taking a medication, consult your doctor.

Hormones. Lower levels of estrogen or testosterone can affect sexual desire; it’s a good idea to have a physical exam to check for physical causes.

Relationship conflicts. Low sexual desire often results from interpersonal problems in a relationship. For example, one partner may withhold sex as a way of expressing hostility, according to Myles.

Psychological problems. Lack of desire can reflect a fear of intimacy. It can also be a symptom of depression or more serious disorders such as narcissism or character problems. These personality disorders make it hard to connect with others and integrate love and sexuality.

Sexual abuse. Many people with low desire have histories of sexual abuse, reports Myles, and have difficulty being sexually intimate in a safe, committed relationship.

Sexual boredom and aging. Even couples who were once strongly attracted to each other need to reconnect and learn new techniques for revitalizing their sex lives. “A lot of people believe that sex should be totally natural and you shouldn’t have to do anything to encourage it, but the truth is you do,” says Myles. He recommends using sex manuals and instructional videos to learn some creative ways to spice up lovemaking.

Therapists report a high success rate in dealing with low sexual desire. Once a medical cause is ruled out, sex therapists use a combination of psychotherapy and behavioral techniques to help individuals and couples reclaim their sexuality.

Sex addiction

When sex becomes compulsive and out of control, it is an addiction like alcoholism or any other drug. In fact, many sex addicts also have drug or alcohol problems, reports Heller. Some may even use sex to buy drugs.

Sex addiction can involve typical sex behavior such as promiscuity, or atypical behavior such as exhibitionism. Like low sexual desire, sexual addiction can have many causes. It can be due to a brain or biochemical abnormality; some new antidepressants like Prozac and Zoloft are being used to treat the condition. In cases involving rapists or exhibitionists, the drug Depo-Provera is prescribed to control sexual desire.

Psychological causes can include depression or the manic phase of bipolar disorder (also known as manic depression.) Compulsive sex isn’t about the desire for love or connection–it can reflect low self esteem and a need for validation, a need for power, a history of sexual abuse, or a lack of a solid sense of self. Sex addicts become locked in a cycle of guilt, shame, and disgust as their addiction affects their work and relationships.

Treatment can include 12-step meetings (Sex and Love Addicts Anonymous), medication, behavior therapy to control compulsivity, and psychotherapy to treat underlying emotional problems.


From the Greek for “beyond love,” paraphilias include a range of atypical sexual behaviors that are a person’s primary way of experiencing sexual satisfaction. Paraphilias are practiced predominantly by men, in a ratio of as much as 20:1. Some people may experiment with a paraphilia, such as domination and submission, for a thrill or novelty without it becoming their preferred sexual outlet. Some identified paraphilias include:

Sado-Masochism (S&M)— Real or simulated acts in which one person humiliates, beats, or binds another. S&M can be violent or exploitive, but there are people who act out these fantasies in a responsible way so that both parties control the activity and no one is hurt. Their motto, according to Race Bannon in his book, Learning the Ropes, is “safe, sane and consensual.”

Fetishes— Intense arousal by inanimate objects such as leather, lace or silk or body parts such as feet. Just experiencing sensual pleasure from certain objects doesn’t make you a fetishist.

Cross-dressing— Involves men dressing in women’s undergarments in order to be aroused

Pedophilia— sex with a child under 13; statutory rape is considered sex with a minor under 16. Many active pedophiles have been sexually abused themselves.

Exhibitionism— displaying genitals to unsuspecting people; can be a sign of shame around self or sexuality.

Necrophilia— sex with corpses; can be caused by severe trauma or a major psychological disturbance.

Just having fantasies involving a paraphilia doesn’t classify a person as “sick”. Neither does occasional experimentation with S&M or inanimate objects. However, therapists agree that people who regularly engage in behaviors like pedophilia, exhibitionism or necrophilia usually have major psychological problems.

Overcoming shame around sexuality

While paraphilias are more likely to produce guilt and shame, so can typical sexual behavior. “We live in a culture that has a long history of looking at sexuality with suspicion if not disgust, so it doesn’t take much to label a behavior as sick or perverted,” says Sugrue. When any sexual behavior causes feelings of shame or is self-destructive or exploitive, therapists advise getting professional help.

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