Disorders of sexual desire

Sexual desire is an extraordinarily complicated aspect of human life and thus requires a multifaceted approach to its understanding. (20) Levine^ 22) has proposed a tripartite model wherein sexual desire is conceptualized as the product of the mind's capacity to integrate three separate elements: drive, wish, and motive. Drive is the neurophysiological generator inducing the internal phenomenon labelled as 'horniness or randiness'. Wish is the cognitive component through which intellectual motives are translated into behaviours, for example 'it's our anniversary, so we should make love'. Motive refers to a combination of affective, transferential, and attachment response that impel one to engage in or avoid sexual experiences.

In men, the biological component underlying sexual desire is circulating levels of testosterone and, more specifically, bioactive or free testosterone. Schiavi et al.(23) found that men with hypoactive sexual desire had significantly lower levels of testosterone than matched controls. In women, however, hormone-behavioural relationships are more difficult to identify because baseline levels of androgens are substantially lower and less variable than men's and thus more difficult to measure. Measurement is further complicated in women because endocrine profiles are considerably altered during periods of menstruation, pregnancy, lactation, and the menopause. Schreiner-Engel and Schiavi(24) failed to find significant differences in mean levels of free testosterone in young women with hypoactive sexual desire compared to matched controls.

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