Case study

Alex is 35 years old and Sharon is 33 (not their real names). They have been married for 7 years and have no children. Neither have had any major health difficulties, smoke, or use street drugs. She asked her family doctor to refer both of them because of his disinterest in "sex." Three injections of testosterone did not result in any sexual change. Alex was initially reluctant to talk with someone else about this issue but eventually acceded to Sharon's strongly worded request (and that of the consultant) that they been seen together.

When a consultation took place and when they were asked for details of their sexual difficulties, she said that the last time that any sexual activity occurred was 1 week ago but before that was 3 months, and before that was 5 months.

In talking with them of the history of their premarital sexual relationship, it became apparent that she particularly appreciated the fact that she did not have to fend-off his sexual advances as she had to do with other men, and more often than not, she would take the initiative sexually. The difference in sexual interest became more apparent immediately after their marriage. To her great distress, no sexual activity occurred on their honeymoon and since then, had been only a few times each year.

When she was seen alone, she related that in the first few years oftheir marriage, she would make her sexual interest known to him but stopped doing so because of constant rejection. She described regularly comparing herself to women friends who would complain about the opposite, namely that they were not particularly interested themselves and frequently had to resort to subterfuge to control the sexual insistence of their husbands. She initially blamed herself for this state of affairs and wondered whether he found her attractive anymore and if he, in fact, still loved her. She also considered the idea that maybe he was interested in another woman, or that he was gay and interested in a man. She eventually satisfied herself that those worries were baseless and concluded that it was he that had some sexual difficulty. She thought that his trouble related to his strong attachment to his mother.

While finding that sexual offers from other men bolstered her opinion of herself, these were consistently declined because "that wasn't what I wanted." She wondered if she should divorce Alex and find someone else but was also concerned about giving up the life that the two of them had built together.

When he was seen alone, he explained that the same thing happened on the two occasions when he lived together with women before he married, that is, that his sexual desire for them quickly disappeared. With considerable hesitation he revealed that nowadays, he would masturbate several times each week while looking at pictures of nude women on the internet. He knew that his wife would be angry and might even leave him if she discovered his private sexual interests. Given the fact that the testosterone injections did not prove helpful, he accepted the notion that psychologically oriented care might be fruitful. He started to wonder if his sexual difficulties related to his family-of-origin and growing-up years.

Acquired and Generalized

The major differences between the acquired and generalized form of a sexual desire disorder, and the lifelong and situational form, are twofold: (a) the present status represents a considerable change from the past when the patient's sexual desire was not problematic for either him or his partner and (b) sexual desire is presently absent in any form.

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