Good morning, babies, and especially the best. I have two riddles for you.
Riddle number one.
What do you call a YouTube video featuring Sam Vaknin?
Yes, a YouTube. Not funny, eh?
Okay, let's try another one. What is the only thing?
The only thing, absolutely, better than wine and sex. The only thing better than wine and sex is a video by Sam Vaknin about wine and sex.
And indeed, you guessed it right. This is the topic of today's video.
People with low sex drive and people with no sex drive.
Now, believe it or not, there is a typology of these people. There is a huge confusion regarding people whose sex drive does not conform to social expectations, whose sex drive frustrates their intimate partners, whose sex drives cause them distress.
And today, I'm going to provide you with what Wikipedia calls a disambiguation page, a disambiguation guide.
Let's start with the most clear-cut case, people who are asexual.
Now, asexuality is not yet an accepted clinical category or diagnosis. Many psychologists reject the possibility of someone without a sex drive at all. Many clinical psychologists and many psychiatrists claim that if you don't have a sex drive, if you don't experience sexual cravings, if you don't act on sexual impulses, etc., etc., something's wrong with you. You have a problem.
But a growing body of evidence suggests pretty conclusively that actually 1% of the population are born without a sex drive. They are devoid of other directed sex inclination or tendency or propensity.
Now, that's a very important distinction. Asexuals are not sexually attracted to other people. In other words, it's a form of lacking or unusual object relations. Sex drive is other directed. It's relational. It's externalizing. It's outward facing.
And Freud linked the sex drive to the life force, which he called Eros or, later, libido. The sex drive is libidinal.
Because babies, newborns have a sex drive, they have a libido, they actually engage in sexual acts. We all know that babies must obey, for example.
But there is a very important distinction between autoerotic sex acts, sex acts which are directed or sex drive which is directed at oneself, the kind of sex drive that narcissists have, for example, well into adulthood, and other directed sex drive, sex drives that targets other people and regards other people as sources of pleasure and gratification.
Asexuals are devoid of that component, but they are not devoid of the first component. In other words, many asexuals are actually autoerotic. For example, the majority of asexuals must abate. They must abate as a form of release, as a form of physiological release, the same way people eat when they are hungry or drink when they are thirsty.
That part is true. The masturbation is not indicative of a full-fledged, mature, constellated, coherent and cohesive sex drive or urge, sexual urge, but still they do must abate. So this is indicative of a dormant, latent sex drive which is inwardly directed, self-directed, autoerotic.
However, the entire panoply of sex actions, sex motivation, sexual urges, sex drive which is directed at other people is missing in asexuals.
Now, some asexuals crave intimacy and companionship and romance. They actually have relationships which comprise these three. They have intimate partners, they have companions, they have romantic flings and engagements and assignations and what have you. They just don't engage. It doesn't culminate in sex. They don't engage in sex.
So some asexuals do everything with other partners, do have intimate relationships, but sex is not a part of the relationship.
Now mind you, 21% of marriages are sexless marriages. We define sexless marriage as marriage with fewer than 10 sexual encounters annually in a year. So if you've had sex with your wife fewer than 10 times last year, you're in a sexless marriage. So 21% of marriages are sexless and we believe the figure to be probably double that, maybe half of all marriages are sexless.
So asexuality makes appearances in very surprising places. The consumption of pornography, for example, is autoerotic. You could be asexual with your wife and still consume pornography in order to ratify yourself autoerotically. So you see, this is the problem when we try to delineate and delimit and demarcate asexuality from celibacy, asexuality from sexlessness.
It's a murky field. It's not entirely clear. If you've been celibate for 15 years, like I have been, are you asexual? If you then resume sexual activity, have you ever been asexual? If you are sexless with your wife, but not sexless with others outside the marriage, or are you asexual in some part of your life?
So it's very difficult to define.
But we tend to think that 1% of our population are born without a sex drive right now. It's still not accepted wisdom. It's still not the orthodoxy. We don't teach this in universities, but there's a community of asexuals online and you're well advised to visit their forums and see what they say about themselves.
There are two types of asexuals. Asexuals which do not need sex, do not require intimacy, do not seek or crave companionship and romance. And these are actually schizoids. These are people with schizoid personality disorder and they are mistaken for asexuals.
And then there's a group of asexuals which have relationships, social edge relationships, intimacy, companionship, romance, spending time together, loving each other, cuddling and hugging and you name it, but they don't have sex because they don't need sex. They are simply born without the sex drive or they had evolved to become adults without a sex drive.
So this is asexual.
Now there is a hyposexual. Hyposexual is a person whose sex drive is either infrequent or intermittent, but is also distressed by this fact.
So the hyposexual, to qualify as a hyposexual, there are two requirements, an intermittent or infrequent sex drive and distress, subjective distress caused by the intermittency and infrequency of the sex drive.
Some disturbance, some ego destiny and even problems in functioning, a self-perceived deficiency.
I will discuss hyposexuality a bit later at much greater length.
On we go, schizoid personality and especially people with schizoid personality disorder.
The schizoid finds sex unappealing, repetitive, tedious and in some cases although rarely disgusting. So such a schizoid would avoid sex and definitely not seek sex actively or passively. In other words, he would tend to reject or ignore or even not notice sexual advances by other people.
Most schizoids also abstain from having any kind of relationship, not only sexual. Most schizoids live alone, they have no family, they have no sex, they have no companions, they have no intimate partners and they barely communicate with their families of origin.
Some, a big proportion of schizoids end life completely isolated with not a trace of a hint of a hint of a shadow of any human interaction to the day they die, to their dying day.
So this is the schizoid personality of schizoid personality disorder.
There is a mild attenuated version of the schizoid personality. It is described by Len Sperry in his book on personality disorders and this is known as the schizoid style.
Unlike the schizoid personality, someone with a schizoid style actually does enjoy sex, but he doesn't go out of his way to find sex. So he enjoys sex the same way some people enjoy caviar. I mean, you enjoy caviar and you'll eat caviar, but you won't go out of your way to find caviar and you're definitely not going to eat caviar every single day. Caviar is tasty once in five years, once in 10 years, once a year.
Then this is the attitude of the schizoid style to sex. Sex is fun. Sex is lovely. Sex is gratifying. Sex is satisfying. Sex is a huge pleasure, but why pursue it? If it comes, it comes. If it doesn't, it doesn't. You don't watch the same movie day in and day out for the rest of your life.
So sex is just one of a myriad of a gamut of possibilities, entertainments, occupations, hobbies and so on and so forth. One of them is sex and you have sex, the person with schizoid style has sex infrequently not because he has a problem with the sex drive like the hypo-sexed, hypo-sexual person, but because sex is one of many options. So he doesn't go out of his way.
The person with schizoid style can go on for years, sometimes decades without sex, but when the opportunity presents itself, when the opportunity throws their self at his feet, the schizoid style thoroughly enjoys the proceedings. In other words, the schizoid style, for example, is likely to respond positively to sexual advances, likely to flirt and likely to seduce when the opportunity presents itself.
However, he is not likely to generate the opportunity. He is not likely to actively seek sex. He is likely to react. He is reactive and responsive when sex presents itself.
And then he enjoys sex thoroughly. He loves sex. He adores sex the same way he adores caviar or playing the piano.
These are things you don't do on a daily basis, presumably.
Then we have the cerebral narcissist. The cerebral narcissist is essentially sexless, but not asexual. The cerebral narcissist has an auto-erotic sex drive. He finds gratification with himself and within himself. He converts his body and his mind into erotic objects. He makes love to himself, in effect.
Indeed, cerebral narcissists consume pornography all the time and they masturbate as the main venue of sexual release and sexual expression.
And so cerebral narcissists derive narcissistic supply from intellectual pursuits. They leverage their intelligence. They are pyrotechnically intelligent. It's like a display of fireworks.
And when people are old and amazed and admire the cerebral narcissist and adulate him for his intellect, for his intelligence, that's the kind of narcissistic supply he seeks. That's the kind he wants.
And he converts his celibacy into a proud ideology. The fact that he's not having sex makes him feel proud of himself. Because by not having sex, he renders himself superior to common people. Common people who are like animals, who lust and bang bestially. He's above sex. Sex is for animalistic, primitive, stupid people. It's not for him.
His intellect and his intelligence endow him with superhuman capacities. He's godlike. He's omniscient.
So sex drags him down. Sex contaminates him, adulterates him. Sex with others, mind you. Contaminates and adulterates him.
Also, sex is a challenge to grandiosity because it implies some kind of dependence on the other party, a collaboration. There's a need to reciprocate, a need to gratify the other party. There's a give and take. There's a bargaining phase.
And the cerebral will have none of it because he's so far superior and so endowed intellectually that no one has a right to demand anything from him. Any attempt to negotiate and to compromise, for example, in the sex act is perceived as undermining his grandiosity, his omnipotence, his godlike attributes and qualities.
And so he avoids sex.
The cerebral narcissist avoids other directed sex as a form of aggrandizing himself. He is inordinately proud of his accomplishment. I'm not having sex because I don't need sex and I don't need sex because I don't need anyone. I'm self-sufficient. I'm divine.
That's a cerebral narcissist.
Mind you, there is no type constancy. The cerebral narcissist does become somatic given certain circumstances. For instance, when the cerebral narcissist loses his main source of supply, he's likely to become somatic in order to find and groom and love bomb and acquire a new source of supply.
So cerebral narcissists make use of sex in order to guarantee the presence of an intimate partner in a future shared fantasy.
It's a part of the grooming and love bombing phase and it's of course a form of false advertising. They lie to the partner. They pretend to be sexually active and sexually interested. They pretend to love sex and to like sex, but actually it's all a facade. It's all a show intended to capture the future intimate partner, to convince her that it's going to be heaven, at least sexual heaven.
This is the cerebral narcissist that the histrionic person with histrionic personality disorder, most people diagnosed with histrionic personality disorder are women, which raises a red or a black flag over the whole diagnosis.
But histrionics are flirtatious, flirtatious, seductive, but studies have revealed that people with histrionic personality disorder are actually sex averse. They are what used to be called frigid.
So the more flirtatious the person is, the more ostentatiously and overtly and conspicuously seductive, the more the person engages in the chase and in the conquest, the less likely that person is to be actually interested in sex. It is histrionics regulate their moods and self-esteem via the chase, via the conquest, not via the sexual act.
They regard the sexual act as drudgery, as a chore. They're very reluctant to engage in it. They try to get it over with and sex with histrionics is seriously bad, very low quality. Histrionics therefore exactly like borderlines and others are far more likely to engage in casual sex and far more likely to be promiscuous because they don't want regular long-term sex. As I said, they want to just get it over with.
Psychopaths are the same for different reasons. So this is the picture of people whose sex drive is either very low or non-existent.
But you have noticed throughout this presentation, I was confined myself. I was talking exclusively about other directed sex.
Actually, all these people are autoerotic. The asexual, most asexuals masturbate as a form of physiological release, which requires absolutely psychologically requires autoeroticism.
Cerebral narcissists masturbate and consume porn and they're highly autoerotic.
Same with histrionics and all the others.
Autoeroticism is an infantile feature which survives into adulthood in everyone, by the way. That's why adults, healthy adults, normal adults, like to have sex facing mirrors because they can see themselves in the mirrors.
So in the mirror, and this arouses them, self-gaze, self-regard, seeing yourself in the act is very arousing, even for totally healthy and normal people. And it is irresistible for these types.
However, other directed sexuality is impaired or non-existent in all these aforementioned types.
And now I would like to discuss hypo-sexuality.
But before we go there, you could ask, why is other directed sexuality impaired in these people? What's wrong? Is it a psychological problem? Is it a biological problem? Is it a hormonal problem? Is it a neurological problem?
Where's the problem? Why do these groups of people, and by the way, it's not a small number. It's not a small number. It's estimated that something like 15, that's one five percent of the population, fall into one of these groups.
And I didn't even mention the somatic narcissist who has his own problems with sex. He doesn't really engage in sex and he doesn't really like sex. He likes masturbation with other people's bodies. And if he's sadistic, he likes despoiling. He likes degrading the other partner.
But we'll leave that aside.
The people I've mentioned, histrionics, cerebral narcissists, asexuals, schizoids, hypo-sexuals, they don't have sex at all. The somatic has sex. These people don't have sex at all. Or they have sex very, they have sex very rarely, extremely infrequently, very intermittently.
And none of them, none of these people, except the histrionic, none of them seeks sex actively. None of them engages in behaviors which are likely to result in sex.
For example, cruising or going to bars and bars or restaurants to pick up people or joining dating apps. None of them does this.
Only the histrionic is engaged in behaviors which are misinterpreted as sexual behaviors. They're not, they're about power. They're about regulation of self-esteem. They're about regulation of moods, the histrionics behavior and the borderline behavior in a histrionic phase.
Because borderlines can have histrionic phases. The histrionic and the borderline histrionic, they don't like sex at all. They actually hate sex. They're frigid. And they just want the conquest.
Now the histrionic wants the conquest to regulate her internal environment. The borderline wants the conquest in order to capture an intimate partner because she has abandonment, anxiety, and because her grandiosity, she needs to feel irresistible in order to avoid the risk of abandonment, humiliation, and rejection.
These are complex issues. And so we are led to believe that essentially it's a psychological issue, not necessarily a physiological issue.
That's a psychological issue which is a reaction to the physiological issue.
There is a wide spectrum, wide diapason, wide range of intensity of the sex drive.
Some people need to have sex three times a day. Some people need to have sex three times a year.
And both ends of the spectrum are legitimate and healthy and normal. Mismatching sex drive is often cause for divorce and marital problems and cheating and other untoward phenomena.
People don't bother to check how match they are, how compatible they are as far as the sex drive. And it's a great pity.
But this is still the healthy and the normal bit, normal portion of the spectrum. We're talking about the very end of the spectrum where sex is utterly shunned, unneeded, ignored, not a part of life. These people are capable of arousal and happiness and gratification and satisfaction with the exception of the schizoid.
Schizoid's emotions are.
But with the exception of the schizoid, these people lead totally normal lives. They're creative, they're happy, they just don't need or don't want sex, or they use sex in ways which are autoerotic, or they use sex to regulate their internal environment.
But none of them wants sex. Sex is a mode of communication and interrelatedness to another person. It's an interaction that binds people together, even if only fleetingly and for an hour, but still binds them together. There's a modicum of intimacy, even in a one night stand. There's warmth and acceptance and gratitude and even in a casual encounter, these people don't need it.
So the underlying psychological issue is that these people don't need other people. The sexual thing, the sexual absence, the sexual withdrawal and sexual avoidance, this is the tip of an iceberg. And the iceberg is self-sufficiency, essentially a schizoid core.
In other words, these people don't need other people. They don't use other people. They don't interact with other people. They don't like other people. They are loners, essential loners, and quintessential loners.
And this lack of interrelatedness to other people, of course, manifests and expresses itself in their sexuality, because there's no such thing as sexuality. There's only psychosexuality.
When you see someone whose sex drive is extremely low or totally absent, you can bet you better that this person is also a loner, also avoidant, also schizoid, also loner, and so on and so forth. With the only exception being biological asexuals. People who are born without sex drive. These people can be very gregarious. They can have romantic relationships and so on. But because they don't have a sex drive biologically, physiologically, they don't engage in sex.
But this is a tiny, tiny, tiny fraction of a minority of the general population.
In all other cases, when sex is missing, is an attribute of life. When the furniture of sex is missing in the apartment, something is wrong with a person and with a person's object relations, ability to relate to other people. Something is seriously wrong with a histrionic of course, with a cerebral narcissist needless to say, and of course with a schizoid.
To be a schizoid is to be emotionally dead. All emotions are dead. Not only sexuality or psychosexuality. All forms of relating to other people. All of them are defunct and disabled and deactivated and actually frankly non-existent.
So let's talk about hypoactive sexuality. The clinical term for hypo sexuality is hypoactive sexual desire disorder. H.S.D.D.
We clinical psychologists love to invent these long phrases and terms because it gives psychology the air of medicine. It makes us look very scientific and very knowledgeable and very erudite. And it gives us an advantage over you because you can pronounce these words and they're very, very long. They're 10 dollar words.
H.S.D.D. Hypoactive, hypoactive, not hyperactive, hypoactive sexual desire disorder is commonly known as hypo sexuality or inhibited sexual desire. H.S.D.
It's a sexual dysfunction. We consider it to be a dysfunction. It's the lack or absence of sexual fantasies, desire for sexual activity and sexual activity.
So fantasy, desire and activity, all three are missing.
Now this should be distinguished from asexuality because some portion of asexuals actually lack sex drive. I have to repeat it. I don't know how many times because there is a huge resistance in the community of psychologists, clinical psychologists, psychiatrists and professors of psychology to the construct of asexuality.
But it tends to reason that some people, a tiny, tiny, tiny fraction, a tiny number of people are born without a sex drive. It's an accident of biology, an accident of genetics. It tends to reason. I don't know if it's 1% of the population as asexuals claim, asexual activists claim that about 1% of the population are asexual. I suspect the number is much smaller.
I think they misidentify biological asexuality with schizoid personality.
But there is a number of people who do not have a sex drive. And yet these people are pathologized via this diagnosis of H.S.D.D., hypoactive sexual desire disorder. And it's wrong to pathologize them. Nothing is wrong with them. They were just born without a sex drive.
But majority of people who don't have sexual fantasies at all, who don't have any desire for sexual activity and do not engage in sex, something is wrong with them.
Now many people are simply depressed. Clinical depression yields and results in hypo sexuality. When you're depressed, you don't want to have sex. Most people don't want to have sex.
So depression, anxiety disorders, other mood disorders, some personality disorders like schizoid personality disorder. These are general clinical diagnosis, one feature of which is hypo sexuality.
But there are people who are not depressed, and they're not anxious, and they don't have a personality disorder. But they still have a problem with their sex drive.
Still, if the person is happy with his lack of sex drive, if the person has no interpersonal difficulties, if the person has no mental health disorder, if the person functions perfectly in all settings like the workplace, in other words, if nothing is wrong with the person's life, except the fact that sex is not his cup of tea, is not his thing. He doesn't fantasize on sex. He has no desire for sex. He doesn't seek sex actively, doesn't engage in sex, but he's not distressed, he's happy. He has no problem with his spouse, etc.
We don't regard this as a mental health issue, or is a problem and we do not intervene.
There's no value judgment here. You must have a sex drive. We're not saying you must have a sex drive. We're not the sex drive. Something's wrong with you. We are going to force you to have sex.
It's not the thought police.
But many people, because their sex drive is depressed or suppressed, this creates serious difficulties in their relationships. It creates serious difficulties in social situations.
For example, when they reject sexual advances openly and ostentatiously, it raises questions. It creates a lot of awkward moments in situations and so on, and they're distressed.
They're unhappy with it.
And so then we say that there's a problem. These people don't react, don't respond to any sexual cues, indications of desire, or even outright invitation to have sex.
And we know that, for example, in studies, 10% of all women react this way. The 10% of all women are clinically hypersexual.
So it's not surprising that hypersexuality is a field. And the study of hypersexuality started among women, because there was this stereotype of the frigid women. Women don't want sex.
Men always want sex.
But today we know it's not true. We know it's not true. Hypersexuality is common among men, as much as among women. There are grounds even to assume that hypersexuality is more common among men than among women.
But men were trained culturally and socially to hide it. It was shameful. It was unmanly. So women reported sexual problems much more than men did.
And so hypersexuality could be a problem, could be a problem, especially in a society and a culture and a civilization which is over-sexualized, over-sexed, hyper-sexed.
We sexualize everything. We sexualize advertising. We sexualize movies. We sexualize entertainment forms. We sexualize relationships between people. Dating apps and casual sex and hookups, this is to sexualize and objectify people, to relate to them via a single dimension, the dimension of sex, to reduce them to sex machines, animated dildos or animated sex dolls.
And in such an environment where everything is about sex, everything is sexualized, everything from advertisements to movies to books to your friends. You don't think sex is constantly on everyone's mind one way or another. And you stand out. You are the outlier. You are the misfit. You are the outcast because you don't get it. You don't want sex. You don't need to interest in sex.
So this creates distress, subjective distress.
And actually all treatments are intended to cope with this distress.
Hyposexuality can be a general lack of sexual desire, but it can also be a situational lack when you don't have a sexual desire towards a specific partner or in given circumstances or in a given environment.
So hyposexuality can arise suddenly, circumstantially and situationally. It can even be acquired.
There are people who were totally normal sexually, functioned normally, had desire, fantasies, were active, sought sex and suddenly stopped. And then they became totally asexual or hypersexual.
So it can be acquired. It can be lifelong. Someone who has never had time for sex, never had interest in sex. Lifelong from adolescence to his dying day.
So hyposexuality is reactive in the sense that it can arise suddenly or it can be a lifelong feature, actually a trait.
And erectile dysfunction and premature ejaculations are actually indicators of symptoms or expressions of situational, circumstantial or acquired hyposexuality.
It's a way of rejecting the partner in effect. It's largely psychological. There are very rare cases where it's biological, medical, hormonal, vast majority of cases, it's psychological.
The Diagnostic and Statistical Manual 5, my favorite edition of the DSM, by the way, because it started to go the right way in many, many fields. The DSM-5 split hyposexuality, divided it to two parts, male hypoactive sexual desire disorder and female sexual interest arousal disorder. So they recognize that this problem is common among men and women, but manifests differently.
In men, the problem is desire, actually lack of desire. In women, the problem is interest and arousal. Women may want to have sex, but women are much more specific and particular as to who can arouse them. Their arousal is much more complex process. It involves emotional dimensions, cognitive dimensions, past history, interactions, smells, women's brain is wired differently to a man's brain when it comes to sex.
For example, a woman could react with arousal vaginally, but at the same time she's utterly unaware that she's aroused.
So there is a divorce between the genitals, genitalia of women and their brains. The genitalia totally autonomous and they react with lubrication and arousal and everything, blood flow, everything, while the mind, the brain is totally unaware of any sexual arousing. This never happens with a man.
So women have mostly arousal problems. Men have mostly desire problems and this distinction was first made in the DSM-5.
In the DSM-5, male hypoactive sexual disorder is described as persistently and recurrently deficient or absent sexual erotic thoughts or fantasies and desire for sexual activity.
And this is a subjective measure of course, because you have to take into account culture, society, age, expectations, relationship status, is it marriage, is it situation, is it real relationship, is it love, is it last, is it infatuation, is it limited.
There's so many factors at play. Peer pressure, group pressure, I mean work, depression, anxiety, mental disorders, substance abuse, alcohol, drugs, I mean you need to really, really, the intake interview needs to be really, really detailed. Everything has an effect on sex. Sex is the most sensitive barometer seismograph of the total well-being and welfare of the person. Sex is the first thing, first thing that responds, sex aversion among couples is very common because sex reflects the deteriorating state of the relationship for example, it's very conflictual.
And so sex also is intimately linked with other attributes such as novelty seeking, risk-taking, some people are aroused by the forbidden, some people are aroused by cheating, deception. Sex is not a monolithic entity and it's definitely not about inserting one genitalia, one genitalia, set of genitalia in another set of genitalia, it's not about the body.
This cliche happens to be right, the brain is the largest sex organ and the brain as we know is something we don't know. So it's very complex.
Female sexual interest arousal disorder is defined in the Diagnostic and Statistical Manual 5 as a lack of or significantly reduced sexual interest or arousal manifesting it as at least three of the following symptoms, no or little interest in sexual activity, no or few sexual thoughts, no or few attempts to initiate sexual activity or respond to partner's initiation, no or little sexual pleasure or excitement in 75% to 100% of sexual experiences, no or little sexual interest in internal or external erotic stimuli and no or few genital, non genital sensations in 75% to 100 of sexual experiences.
And if these sounds like your wife, you're probably right.
For both diagnosis, the male diagnosis, the female diagnosis, the clinician tries to rule out circumstantial, situational or acquired hypersexuality. Sometimes we don't feel like having sex for six months.
For example, victims of complex post-traumatic stress disorder and victims of abuse in general, they very often become asexual or hypersexual. They become sex averse. They don't want to have sex anymore. If this lasts for six months, it's normal. It's a normal reaction to abuse because abuse is a breach of boundaries. Abuse is emotional rape. Abuse is mental rape.
And we know, for example, that rape victims develop hypersexuality, reactive hypersexuality. Rape victims don't want to engage in sex for months after the rape or the sexual assault because their boundaries have been breached, in this case, the physical boundaries.
Abuse, verbal abuse, even, doesn't have to be physical abuse. Just verbal abuse, psychological abuse, is perceived as rape. It's a rape of the mind.
And like classic rape victims, victims of abuse avoid sex because sex is also a breach of boundaries. Sex is a consensual breach of boundaries, of course. In sex, even a one-night stand, even a casual quickie, we are vulnerable. We are open. We throw away our defenses and protections and fears and we just let it go.
And we open our borders to a wave of immigrants, which is the sexual apartment.
So if the hypersexuality lasts longer than six months, if it causes significant distress, it is not explained by any other condition.
For example, people after operations, surgeries, they are sexually hyperactive. People who use alcohol, alcohol is actually a depressant. People believe that alcohol makes you more sexual, makes you actually less sexual. People who use certain drugs, not all.
You know, you have to, people with tumors in the brain, specific areas, all these conditions create hypersexuality and we have to rule them out. So let it be clear, if you have lower desire than your partner, nothing's wrong with it. If you don't have any desire, nothing's wrong with it. If you have desire, but it's mostly self-directed, it's a pity you're missing out on a lot, but technically nothing's wrong with it. If you have desire only towards other people, never with your partner, it's a problem with your partner maybe, but it's not a clinical or medical problem.
Only if you're distressed, only if you have problems in your relationships, only if your hypersexuality affects your life, then clinical psychologists can offer some help and have a justification to intervene.
People sometimes self-identify as asexuals. They lack sexual desire and so the minute someone comes to the clinical psychologist and says, doctor, I don't have a sex drive, I'm asexual. That's a problem because we should not intervene in such a case. We should not provide, for example, therapy.
You know, up until very recently, relatively speaking, up until a few decades ago, there were these programs to convert homosexuals into heterosexuals because homosexual sexuality was considered to be a mental illness. Up until 1973, homosexuality was defined as a mental illness in the Diagnostic and Statistical Manual, so we were trying to cure, reprogram homosexuals and convert them into normal people, heterosexuals. It was sick. We're doing the same to asexuals.
The minute someone comes and says, I don't have a sex drive, our instinct, our initial reaction is, oh, something's wrong with this guy, oh, girl, I mean, we need to fix them. Something's wrong with us. It's okay to not have a sex drive. It's wrong to sexualize everything.
The role of sex has changed dramatically throughout history.
There were very long periods in history where sex was considered dirty and prohibited and was very rare. Sexual activity was extremely rare and targeted at procreation only. There were other periods where sexuality was rampant, defined joy and cheer and love and gratification and so on, and so was celebrated.
Depends on the context, on society, on culture, on period, and depends on your physiology, your hormonal balances, your biology.
So low sexual desire alone is not hyposexuality. It's not H-S-D-D because if there's no distress, there's no interpersonal difficulty, then essentially there's no problem.
Moreover, we don't really know what causes these fluctuations in sexual drive and sexual urge and sexual desire. We don't know what is the role of sexual fantasies.
For example, it's the role of sexual fantasies to actually prevent action in reality because many sexual fantasies are socially forbidden, socially wrong, anti-social.
People have sexual fantasies of acts which would lend them in jail, in prison.
So is the role of fantasy to prevent action in reality? For example, if someone fantasizes about having sex with children, does this preclude actual pedophile activity? Or is the role of fantasies actually to flesh out sexual desire and then act on it?
We don't know even this. We don't have enough data.
Sex has been a very, very neglected area in psychology because of social prescriptions and inhibitions.
So we don't know what causes hyposexuality. We don't know why some people are stimulated and aroused with the same partner for life and why others need constant novelty. They need new partners all the time.
We don't know why suddenly sexual interest stops.
You know, there's sexual interest in the same person for five years and then suddenly it vanishes. It stops and we don't know why. We don't know why some people prefer solitary sexual activity and some people prefer partnered, object-oriented, other-oriented sexual activity.
We don't know what differentiates the first kind of people from the second kind of people.
We don't know how we acquire, what modulates our sexual desire, renders it extreme, renders it low, eliminates it all together, creates it suddenly ex nihilo. We don't know.
So because we are largely ignorant, it would be very presumptuous of us and potentially dangerous to intervene because we don't honestly know what we're doing and we need to rule out so many possibilities that it's a huge problem.
We need to rule out medical issues, hormonal issues, physiological issues like for example obstruction, maybe somewhere. We need to rule out mental health issues, psychiatric problems. We need to rule out testosterone issues, prolactin issues. We need to rule out inhibitory and excitatory factors.
We need to conduct a whole huge study of the individual. We need to study the brain, neurotransmitters. We need to because neurotransmitters have excitatory activity and inhibitory activity, dopamine excites, norepinephrine, serotonin inhibits, serotonin inhibits.
So low sexual desire can also be the outcome of certain medications. Antidepressants for example.
Then there is issue of intimacy, fear of intimacy, commitment phobia, intimacy difficulties, relationship problems. Sexual addiction sometimes manifests ironically as fragility because a person is so scared of his uncontrollable impulses that he suppresses the sex drive altogether.
Chronic illness of the person or chronic illness of the partner.
We communicate the sex drive to each other. We resonate. Our sex drive is like an echo chamber. There's resonance like two frequencies that enhance each other and so everything is in question.
There's very little empirical evidence.
Nothing very little is evidence-based. We don't know and because we don't know we need to be really really modest and really really humble. We know even less about the causes of HSDD in women.
We know a bit more about men. We know we are just beginning to understand mood disorders.
That's why we are medicating down mood disorders because we understand the interrelationships between the brain and mood disorders.
It's new knowledge relatively speaking and we're just discovering the gastrointestinal impact on mood disorders. That's totally new knowledge.
So maybe nutrition has something to do with it.
Relationship problems, stress, stress hormones, we know they reduce sexual desire in women but not in men.
Why is that? Why the different reactivity in men and women? Is it hormones? Is it something else? Is it something in the brain?
Effective responses, attentional capture of sexual stimuli. What about deciphering, decoding sexual cues? It's very rare for someone to come to you and say, listen, I'm dying to have sex with people. People signal very subtly. They're kind of testing the waters and so you need to be able to pick up on these cues and if you are for example someone with autistic spectrum disorders or someone even with narcissism, you would have severe difficulty to pick up on the cues to interpret them correctly.
You may have sexual overperception, interpret benign non-sexual cues as sexual or the opposite. You may be flooded with sexual advances and sexual hints and sexual requests and not realize actually that you are being courted and flooded with and being seduced and so there is also cultural and social issues.
Sex has negative associations. Sexual stimuli have negative associations and there are also positive associations. So we need to see the balance between negative and positive reinforcements, associations and conditioning.
There's a lot of operand conditioning and other forms of conditioning in human sexuality. You see it's not clear. The field is far from clear but I hope I helped to disambiguate some of it.
Oh wine and sex. At least I have wine. The glass is half empty.