A sexual difficulty
Loss of desire
Not always a symptom. It becomes a subject when it weighs on you, or when it opens a distance.
It is not that I don't love him. It just doesn't cross my mind.
What loss of desire is
It is a reduction in sexual interest relative to an earlier period. Put like that it sounds simple, but the delicate part is elsewhere: there is no correct level of desire, so a decline cannot be measured against a norm.
It is measured against two things instead. How much it weighs on you, and how much distance it opens with the person you are with.
When it is a problem and when it is not
A period of reduced interest after a significant change — a move, a bereavement, the birth of a child, a workload beyond scale — is an ordinary response rather than a dysfunction.
In couples, what presents as "loss" is often a discrepancy: two people at different levels, where the one with less gets defined as the problem. Reframing it as a difference rather than a deficit already changes how it can be discussed.
Possible causes
There are many, and they need considering together. Medical: hormonal changes, thyroid conditions, chronic illness. Pharmacological, and this is the most underestimated entry — several antidepressants and some contraceptives alter desire, and often nobody told the person taking them.
Then sleep, prolonged stress, pain during sex, and the history of the relationship itself. There is rarely a single cause.
Spontaneous and responsive desire
Many people expect desire to arrive first, as an impulse that appears on its own. For a substantial proportion of people it works differently: desire appears in response to a context, after intimacy has begun rather than before.
This is not a lesser version. It is a widespread way of functioning, and people who work this way have often spent years convinced something was wrong with them, simply because they were waiting for a signal that does not arrive in that form.
When it enters the couple
Loss of desire rarely stays an individual matter. It organises itself around initiative: the person who takes it starts fearing refusal, the person who receives it starts fearing the request. At that point even non-sexual gestures become ambiguous, because any of them might be a prelude.
It is one of the situations where a session with both people can unlock something. It is assessed rather than assumed.
How the work goes
We start from the history: since when, in what circumstances, what else was going on at the time. And from medical assessment, if that has not already happened.
The psychological work concerns the context in which desire can or cannot appear, the expectations about how it ought to work, and the pressure that waiting itself produces.
Frequently asked questions
Some variation across a lifetime is common, and hormonal changes play a part. But "it's my age" closes the conversation too early: many potentially reversible causes — medication, sleep, prolonged stress, undiagnosed medical conditions — get attributed to age and therefore never checked.
It can be, and this is one of the most underestimated factors. Several antidepressants and some contraceptives alter desire, and it is often not mentioned at the point of prescription. I am not a physician and I do not prescribe: if you suspect this, it belongs with whoever prescribed the medication, and it should never be stopped on your own initiative.
Not necessarily, and for many people the answer is clearly no. Sexual desire and affection are distinct processes with distinct causes: it is entirely possible to love someone deeply and have reduced desire for medical, pharmacological or contextual reasons. Conflating them is understandable, and it adds a worry that is often unfounded.
Dr. Giuseppe Iannone — Psychotherapist
FIRST STEP