Differentiating Between Sexual Problems and Asexuality
One of the best things I’ve done recently, since starting a private practice, is to join a book club. In a recent meeting, one of the members asked me a question that sparked this post: how do I know if a someone is asexual or having a sexual problem? It occurred to me that they’d posed a truly excellent question, which deserved more attention. So, here’s my long-winded answer.
Let me start by saying that sexual problems arise for extremely logical reasons and tend to have causes that have some combination of biological, psychological, or sociological origins. For instance, thyroid problems can contribute to low interest in sex. Cardiac problems can cause erectile disorders. Breastfeeding contributes to low desire. We know that folks who are experiencing depression have less interest in sex. Furthermore, a common medical treatment for depression, an SSRI, can exacerbate low desire and low arousal. People in poor quality relationships may also lose interest in sex and affairs can dramatically halt a couple’s sex life (though sometimes the opposite happens!).
In other words, life happens and one’s sexual self isn’t on an island.
Ok, let’s get to my friend’s actual question…. Hypoactive sexual desire disorder is experienced by women and people assigned female at birth and characterized by limited interest in sex and/or limited physiological response during sex. It can occur in every context, or only specific situations. This condition might have always been present, or could have emerged after a major life event such as a medical change or trauma. The distinguishing feature is that it’s distressing to the individual in whom it’s occurring. For men, or people assigned male at birth, the terminology is different, but the overall experience is quite similar. The condition is called male hypoactive sexual desire disorder. The different terms for different genders is a bit dubious to me in general given the similarity of symptoms. However, my understanding is that there is a difference because an arousal disorder for a male has a different name: erectile dysfunction. In addition, there is such a thing as an aversion to sex, which is quite like it sounds: experiencing disgust or anxiety related to the idea of having sex. Often, these issues, particularly low desire, can result in a desire discrepancy in couples.
Asexuality has some overlap and also some important differences. The biggest area of overlap is limited interest in sex, but the overlap tends to end there. For folks who are on the asexuality spectrum, they may have never been all that interested in sex and/or never have experienced sexual attraction to other people. One of the most important differences is that it’s not upsetting to the individual. Bear in mind that these are generalizations and asexuality and can be different for different people. Most importantly, asexuality is not a disorder. While technically sexual dysfunctions are diagnosable disorders, it’s really an injustice to call it that, for the reasons I outlined earlier. However, sexual problems are treatable. Asexuality isn’t an issue to treat. For further reading on asexuality, I recommend Angela Chen’s book, “Ace: What Asexuality Reveals About Desire, Society, and The Meaning of Sex.”
There you have it! That is the long-winded, and perhaps, anticlimactic (no pun intended) answer!
