Male libido dysfunction Decreased sexual desire in men

Hypoactive sexual desire is set by the decrease or absence, persistent or recurrent, of sexual and erotic thoughts, fantasies or desire for sexual activity. A disorder is assumed to be clinically relevant in the individual with symptoms for a period of at least 6 months in duration.

This condition can be acquired or primary, generalized or situational, and mild, moderate or severe.

The prevalence ranges from 3% to 50%, depending on the literature. With aging there is a natural decline in sexual desire, ability and frequency of sexual activity. Levels of sexual interest in a man are relatively stable from the beginning of adulthood until  the age of 60, after which they naturally decrease. This situation can coexist with other changes, such as erectile dysfunction or depression.

Sexual desire is influenced by biological determinants, cognitive and psychological factors and the relational / marital dimension.

The decrease in sexual desire in relation to a single partner is not a sexual dysfunction, but a relational problem.

There are several situations or conditions that can determine or aggravate a disturbance of sexual desire. Amongst other conditions, psychiatric illnesses (depression, anxiety, psychosis); endocrine diseases (hypogonadism, hypothyroidism, hyperprolactinemia); systemic diseases (chronic kidney or liver disease, hematological or rheumatological diseases). In other cases it may be related to work, family or marital problems. It may be influenced by cultural or religious factors. At a relational level, it may also be affected by changes in the partner (sexual dysfunction or chronic illness).

Also, several substances may influence and reduce sexual desire: alcohol, opioids, amphetamines, cocaine; as well as other drugs such as antidepressants, antipsychotics or drugs that interfere with the production of androgens.

The main causes, currently, for dysfunctions of sexual desire are Depression and its treatment, Stress from work and family life and cases of long-standing Erectile dysfunction.

The clinical approach involves a personal, sexual, family and medication clinical history, a physical examination and an assessment of hormone levels.

Treatment is variable and may involve adjustments in substance or drug consumption habits, hormonal therapy, sexual psychotherapy or couple therapy.