Reframing Sex Can Improve Well-Being in Men with Low Desire

A common social stereotype about sexual desire among couples assumes that men are always willing to engage in sex while women are the gatekeepers of the action. In addition to anecdotal evidence suggesting this isn't always the case, however, the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fifth edition, contains a diagnosis of hypoactive sexual desire disorder (HSDD) which is said to affect anywhere between 1 and 20 percent of men, suggesting that up to a fifth of men struggle with persistently low sexual desire.

Those diagnosed with HSDD experience an absence or deficit of sexual thoughts, fantasies, and/or sexual desire over the course of at least six months, with this causing significant levels of distress. Little is known about HSDD in men, and it is acknowledged as being a difficult problem to treat in sex therapy settings. However, one new study has found that the emotion regulation styles that men with HSDD adopt may affect their levels of well-being, particularly within the context of ongoing intimate relationships.

Low sexual desire in men can cause of shame and sadness, but new research shows how reappraising sex can be beneficial.

Source: Christian Erfut // Unsplash

Understanding HSDD

Although there is little research into male HSDD, a biopsychosocial approach is likely to best explain its onset. From a biological perspective, hormonal imbalances (e.g., relatively low levels of testosterone) may begin a cascade of decreased sexual desire (compared to male norms), which may impact self-esteem, self-image, and mood (these would be psychological factors within the biopsychosocial model). Socially, reduced sexual desire can cause issues in relationships, where men's sexual desire appears to naturally reduce over time even in the absence of arousal issues.

One research team led by Grace Wang, a graduate student in clinical psychology at Dalhousie University, and supervised by Dr. Natalie Rosen, a professor of psychology and neuroscience at the same institution, sought to explore whether sexual communication, moderated by emotional regulation style, might predict sexual well-being among couples where male HSDD was present.

In explaining the rationale for the work, Wang said:

"In this study, we sought to investigate how the different ways couples affected by HSDD manage their emotions are related to how they communicate about sex, which is a key determinant of sexual well-being.

We were interested in this topic for several reasons. First, while low desire is much more common in men than many people might think (rates ranging from 14 percent to 41 percent, depending on the study), men are far less likely than women to seek treatment, perhaps because they consider it less socially acceptable to do so and fear judgment from others.

Second, our research is unique in that it includes both members of couples navigating HSDD. In fact, our study is the first (that we know of) to investigate outcomes for both men with HSDD and their romantic partners, even though low desire often occurs in the context of a relationship and partners are likely to be affected. For example, partners may feel neglected or like their needs aren’t being met. Because romantic relationships are inherently interpersonal, a key aim of this research was to find ways couples can maintain open and direct communication, which in turn might enhance their ability to effectively navigate HSDD."

Cognitive Style, Sexual Communication, and Well-Being

The research team explored the impact of two different emotion regulation styles on assertiveness, relationship communication, and sexual well-being:

• Cognitive reappraisal: This style is characterized by people experiencing difficulties seeking to re-evaluate and reframe their positions. There is an attempt to interpret such experiences in more positive ways to reduce negative emotion and increase positive feelings.
• Cognitive suppression: This style is characterized by actively inhibiting an emotional response to a negative situation. Communication is typically reduced among people using this regulation style as there is an attempt to hide feelings and conceal emotion from others.

Wang and colleagues found different relationships between each of these emotional regulation styles and important outcomes related to dealing with HSDD, such as the use of relationship communication and shared understandings of sexual desire within couples. She said:

"Because romantic relationships are inherently interpersonal, a key aim of this research was to find ways couples can maintain open and direct communication, which in turn might enhance their ability to effectively navigate HSDD.

Our main takeaway is that emotion regulation is importantly linked to how couples navigating HSDD communicate about sex. While hiding inner feelings from a partner could get in the way of effective communication, reframing an emotional situation might encourage men with HSDD to be more assertive and direct about their sexual needs and desires (or lack thereof)."

The Way Forward

There is still much to learn about male HSDD. As Wang noted, "how hard it was for us to recruit our sample of 64 couples over six years suggests that many men with low desire are still not comfortable with sharing their experiences." This suggests that more needs to be done to decrease the stigma and shame associated with coming forward with such issues, and highlighting the relatively high rates of low sexual desire in men may help with this.

What is more hopeful, though, are potential clinical advances in this area as a result of these data. As shown by the researchers, reframing sex and reappraising low sexual desire can lead to improved sexual communication and, perhaps, in turn, relationship satisfaction—even within the context of HSDD. Wang said the following on this point:

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"From a clinical perspective, emotion regulation strategies may be an important target for psychoeducation and interventions to help couples coping with HSDD reduce its negative interference with their lives and more effectively navigate their sexual relationships."

This may be one route that sex therapists explore further with their clients presenting with desire-related concerns as they seek mutually satisfying outcomes for both partners trying to navigate low levels of sexual arousal.