The Sex Therapists' Approach to the Evaluation and Management of Low Sex Drive in Men

Desire represents the most complex and fascinating among sexual response phases. It is often defined as "the subjective psychological status for initiating and maintaining human sexual behavior, triggered by internal (erotic fantasies, emotions) and/or external (attraction, pornography) stimuli."1 In other words, desire refers to feelings and thoughts that motivate individuals to approach or be receptive to sexual stimulation.2 Over time, researchers and clinicians seemed to agree that sexual desire is a complex construct, moving away from simplistic unidimensional definitions toward multidimensional models. For example, Levine3 described desire under a biopsychosocial model (BPS) that highlights 3 components: drive (biological substratum such as anatomy and neuroendocrine system physiology), motivation (psychological components such as mental states, relationships, and social influences), and wish (cultural ideals, values, and scripts concerning sexual expression). This subdivision could be very useful in emphasizing the central role of the biological, psychological, and sociocultural components that are present in every sexual expression. On the one hand, it is important to recognize the specific role of these 3 components, for example, by exploring them in detail during the assessment phase in the evaluation of a desire problem. But on the other hand, focusing only on one component in spite of the others would imply a great loss of information, a theoretical and practical reductionism which does not help clinicians and researchers to understand desire function and related problems or to find effective treatments. In our perspective, it is fundamental to always keep an eye on the overall experience of sexual desire as reported by individuals and couples in order to be able to navigate desire.