When you hear the words, “Not tonight, dear, I have a headache,” do you envision a woman politely rejecting her husband’s sexual advances?

You almost certainly do. But contrary to popular belief, about 15% of men say they simply aren’t in the mood for sex. Low desire in men can be caused by many different factors. One of them, of course, is erectile dysfunction (ED) or ejaculation problems—anticipating undesirable outcomes can make sex anxiety-producing rather than enjoyable, eventually leading to not being interested. Other reasons include…

Relationship Issues

Although most people believe that it’s women who need to feel close to their spouses emotionally before they’re interested in sex, believe it or not, men often feel this way, too. The following factors contribute to emotional distance…

Men brood. Rather than confront relationship conflict head-on, men hold their feelings inside and brood­—and often lose desire. Keeping anger and resentment inside is a surefire way to diminish ­desire for intimacy.

Men are visually oriented. Men often say that they have lost interest in sex with their wives because they’re no longer attracted to them. They complain that their wives have “let themselves go” and stopped caring about health and fitness. Men tend to be very visually oriented when it comes to sexual desire.

Men get bored. Sometimes men lose interest in sex because it has become routine or simply unsatisfying. Less-than-rewarding sex can be due to ­either partner’s unwillingness to experiment with new and potentially exciting ways of having satisfying sex. Sometimes couples lack information about ways to improve their sex lives. Other times, they’re simply too uncomfortable to talk about what might make their sexual relationship more vibrant and passionate. This problem is compounded if one person is eager to explore creative sexual solutions and the other partner is not.

Psychological issues

Sometimes disinterest in sex can be traced to self-sabotaging thoughts and feelings such as dissatisfaction with the changes in one’s body, feeling stressed out about work or excessive worry about finances, the kids, in-laws, health issues and so on. Also…

Questioning of sexual orientation. Sexual orientation is not necessarily etched in stone. For a variety of reasons, some happily married people eventually do sexual U-turns, seeking same-sex sexual partners and avoiding marital sex. Wives often are unaware of the reason why their husbands’ interest in sex with them has waned.

Excessive use of porn. Many couples use pornography to enhance and enrich their sexual relationships. But an excessive porn and masturbation habit can lead to difficulty becoming aroused “in real life.”

Infidelity. Countless married people have affairs. Frequently, marital sex suffers when an affair is ongoing. Because of the clandestine nature of infidelity, wives often are in the dark as to the reasons their husbands have pulled away emotionally and stopped initiating sex.

Depression can have debilitating effects on one’s sex life. Seventy-five percent of people who are depressed confirm a loss of sexual desire. It is important to note that signs of depression in men often are different from those in women. Women tend to turn their emotions inward, becoming sad and tearful, feeling guilty and worthless. Men, on the other hand, often are uncharacteristically irritable and angry, sometimes resorting to abusing alcohol and other substances to self-medicate.

Biological Issues

As people age, sex drive often changes. Although many men enjoy sex well into their 80s, over time, there is a decline in testosterone, the primary hormone responsible for sex drive. As a result, men often feel less focused on their sexual relationships. Also, they require more—and different—stimulation to achieve and maintain an erection. Orgasms tend to be less intense. These changes can be disconcerting and ­anxiety-producing to men who, in the past, have had sizable sexual appetites and can lead to a pronounced reduction in the desire for sex. Other biological issues that affect desire…

Illness. Cardiovascular disease wreaks havoc with a man’s blood flow, which in turn makes it difficult to achieve or maintain an erection. This can lead to a feeling of sexual inadequacy that dampens desire.

Other illnesses that can impact sexual desire include endocrine disorders (diabetes, hypothyroidism, hyperthyroidism), liver disease, kidney disease, pituitary disease, Parkinson’s disease, anemia and arthritis. Chronic pain can take a toll, too.

Medications. Many prescription and over-the-counter medications can greatly affect a man’s sex drive. These include antidepressants, antihistamines, tranquilizers, antihypertensives, antipsychotics, antiarrhythmia and anticonvulsant drugs.

Unhealthy lifestyle. If a man abuses alcohol or drugs, doesn’t exercise or eat healthfully or fails to get adequate sleep, sex may become unimportant.

How to Boost Desire

What a man needs to do to boost his libido depends on the reasons for the loss of desire. That said, it makes sense to begin by taking two commonsense actions…

Get a medical checkup. Rule out ­biological causes of low libido. Example: A blood test can offer information about testosterone levels and suggest the need for testosterone supplements, frequently a helpful remedy. Similarly, if medications are causing the drop in desire, alternative drugs can be prescribed.

Adopt a healthy lifestyle. To feel more vibrant physically and mentally, you know the drill—you must eat healthfully, exercise regularly, get sufficient sleep and avoid excessive alcohol and other harmful drugs.

Once you’ve taken these prophylactic measures, here are some other steps…

Learn skills to overcome ED and other sexual problems. If ED or performance anxiety is a problem, men can learn new skills to help them relax and maintain their erections by going to a licensed sex therapist. A sex therapist is specially trained to educate couples who are experiencing difficulties in the bedroom. The American Association of Sexuality Educators, Counselors and Therapists (AASECT.org) offers a directory of qualified sex therapists. Also, drugs such a Viagra, Cialis and Levitra are effective in helping men keep erections, which can help relieve anxiety about performance.

Talk about the changes you would like to make to your sexual relationship. Let’s face it—talking about your sexual needs can be dicey and uncomfortable. Plus, too many people expect their partners to be mind readers about what might turn them on. The fallout from this lack of communication is ­unsatisfying sex.

If you want to feel more enthusiastic about sexual encounters, be specific about what might turn you on. Talk about your fantasies, your likes and dislikes. Describe what you would like your spouse’s “come on” strategy to be—grabbing you, asking if you want to fool around, sexting earlier in the day. Discuss what you like about foreplay. Since what arouses people changes over time, share updated information about your sexual turn-ons. Also, talk about your need for nonsexual touch such as snuggling, holding hands, and giving and getting back rubs.

Take a relationship skill-building class. If a drop in desire is caused by underlying feelings of anger and resentment, get some new tools for your relationship toolbox. There are excellent marriage seminars where couples can learn specific techniques to stop arguing and start loving each other again. These classes are not group therapy—you won’t have to discuss your personal issues in front of the group. You will be given information about ways to improve your relationship that you can practice privately with your partner.

Just do it. It also is important to keep in mind that desire sometimes needs a jump-start. Rather than wait until the mood strikes you, start touching each other in sensual ways. Frequently, the desire to have sex follows rather than precedes touching.

It’s important to note that when there is a sexual-desire gap in a relationship, the person with lower desire tends to control the sexual relationship—if that person isn’t in the mood, sex usually doesn’t happen. When the frequency of sex is a unilateral decision, resentment builds and the relationship suffers. The higher-desire spouse feels intense rejection, hurt and anger. These unpleasant emotions are ever-present, leading to frequent arguments and ­general ­unhappiness.

An antidote to this relationship logjam is for a man to be willing to pleasure his partner even if he’s not feeling in the mood himself. Healthy, loving relationships are built on mutual caretaking. Helping one’s spouse feel wanted and attractive is an essential part of feeling connected emotionally.

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