Revving Up a Low Libido: Gentlemen, Start Your Engines

Conventional wisdom tends to be more convention than wisdom, and the idea that women have a low libido while men’s sex drive is stuck in high gear is a perfect example. Truth be told, a lot of guys don’t find their engines running as hot as they might like.

“It’s an interesting hidden problem,” says Louanne Cole Weston, PhD. Weston is a marriage and family therapist and board-certified sex therapist in Fair Oaks, California. “Men who have a reduced sex drive don’t want to talk about it, and the women with them don’t want to talk about it either. The women are afraid if they say much about it, people will think either the man’s really gay, or she’s a ‘bad lay’ or too unattractive to stir his passions. And the man has the myth that you’re supposed to want it all the time, anywhere.”

In her role as a sex therapist, and as former author of the WebMD Sex Matters board, Weston has found that low libido in men is a much more common complaint than our popular culture would seem to indicate. She says, “When people wrote in about the discrepancy of frequency and desire, about 40 percent of the time it was men wanting less.”

Exactly what is a low libido?

According to Weston, the definition of low libido is subjective - and defined by the person who has one. “A man has to perceive his libido as low, and it has to be distressing to him,” she says. A partner may have a vote in the matter and may have initiated a trip for both of you to the sex therapist, but it’s what works (or doesn’t) for you that counts.

Couples need not feel they have to have sex a certain number of times a week to have a good sex life. “It’s really about compatibility,” Weston says. She recalls a pair of married scientists who came to see her about the frequency of sex in their marriage because they were afraid they were freaks.

“They came in saying, ‘We have sex twice a year, once on Christmas and once on his birthday. Is there something wrong with us?’ We went through it all and found they didn’t really want to change. They were coming in out of cultural pressure. Their true joy lay in doing what they were doing together in the lab. They liked each other; they didn’t fight. Sex was not a high priority for either of them. They were real cerebral types. I think we met twice and then I sent them home. I said, ‘I’m not going to make you guys broken; I think you fit very well together.’'

don’t want to have sex tonight, honey; I’m medicated

Moved by her research on low male libidos, Weston wrote a blog entry entitled “Top Ten Reasons Men Don’t Want Sex.” That entry generated a great deal of traffic. Seems a lot of people were in on the secret.

The leading reason men don’t want to have sex is medication, usually SSRI-type antidepressants - such as Prozac, Zoloft, and Paxil - and antihypertensive drugs prescribed for men with high blood pressure. All of these drugs are known to have sexual side effects including low libido.

Fatigue is another oft-cited reason for a low sex drive, as is that all-encompassing nemesis, stress. But some doctors are skeptical of men who cite work-related stress as the cause of their low libido.

Mark Epstein, MD, is a psychiatrist in private practice in Manhattan and author of Open to Desire: Embracing a Lust for Life. He says that while men may indeed be preoccupied with their work, that’s usually a secondary reason for a reduced sex drive. “If there is not an illness,” Epstein says, “the main reason for a flagging libido in men is drugs or alcohol.”

According to a recent New York Times story, there has been a Viagra explosion in Spain where men take great pride in their reputed virility. The culprit? Western-style work ethics, according to Pfizer, the manufacturer of Viagra (sildenafil citrate). But Epstein points to the party-all-night culture as a more likely cause for low male libidos in that country. As one Spanish reveler confessed in the article, “After a night of hard drinking or taking Ecstasy, I take Viagra to make sure I can perform.”

So it seems that one answer to a low libido is to get your priorities straight.

Low libido remedy: Just do it

Once the more obvious causes for a man’s low libido have been eliminated - prescribed medications, drug or alcohol abuse, or low testosterone, which can be treated with topical testosterone creams such as AndroGel and Testim - couples must often work through discrepancies in their relationship to arrive at a solution.

“I start looking at what she says she wants in terms of frequency of sex versus him,” Weston says. “Then I start to look at the meaning they both give to being sexual together. For some people, it’s the direction they turn for feeling better about themselves, and they use sex in a self-centered way, not one that connects with the partner. Some people would take the sex even if their partner was just participating in a sort of lackadaisical kind of way. There are times when I suggest they look to see if there can be what I call ‘gift giving.’”

In Weston’s parlance, gift giving occurs when one person is not so interested in sex “but is willing to do things that are sexually stimulating for the partner to the point of orgasm.” This could be you, when your wife is interested and your mind is elsewhere, or it could be her, hoping to get you in the mood. “If they’re willing to do the gift giving and not the mercy-duty sex,” she says, “sometimes what I call the ‘coffee syndrome’ can kick in.”

The coffee syndrome is analogous to a host at a dinner party asking, “Who wants coffee?” Weston says, “And maybe one person says they do. You start pouring and someone says, ‘Did you make enough for me to have some, too?’ The whiff of coffee in the air makes you want it. Sometimes the feeling of sex in the air, if you’re doing something to pleasure your partner, can make you turn the corner and want it yourself.”