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.