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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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Male Sexual Response: But, What if It's Not the Woman???

Allan N. Schwartz, LCSW, Ph.D. Updated: Jun 21st 2008

 One woman writes to Mental Help Net:

I have heard so many comments about the woman having no sex drive, but what if it's the man? My husband's sex drive has considerably lowered in the past two years or so, and talking about it has made it worse. He used to work away from home and told me multiple times he sometimes masturbated as many as three times a day. Now, living back at home daily, he no longer masturbates, yet, we rarely have sex. I feel constantly rejected but, while I do not want to seek other companionship, I can't help but worry that it's my fault. My husband is unbelievably honest and trustworthy. He is home every night and we spend every second together during the weekends. He's not gay, that's a cop out bad answer...what is it???

This woman raises an important question and makes a very good point. The point she makes is that it is not necessarily the woman who has a low sexual drive. There are many men who experience low libidinal drive or who want to avoid engaging in sexual relations with their partner. Although this contradicts the commonly held view that the male sexual appetite is endless, the fact is that many men have either a low sex drive or none at all. This writer then wants to know what is the problem with her husband? He is not homosexual, he does not have sexual affairs and there appears to be no reason for his lack of sexual interest in her. Typical of many people in this situation, whether it is the male or female sexual partner, she becomes anxious that her partner's problem may be her fault.

What does cause male sexual problems?

There are many problems that can cause a male to experience a low sexual drive or a wish to avoid sex. Some of them are listed here:

Possible causes of male sexual problems:

1. The problem that usually comes to mind first is ED or Erectile Dysfunction, the inability to maintain an erection long enough to have sex. However, this is far from the only problem that can exist.

2. Another well known problem is premature ejaculation. In other words, ejaculation occurs prior to penetration. This is frustrating for both the male and female partner.

3. On the opposite end of the spectrum is delayed or inhibited orgasm. In this case, it takes an extremely long time before the male achieves orgasm or it may not occur at all.

4. Problems in the relationship can cause each of the partners to avoid sexual relations. Constant arguing, distrust or other types of conflicts and difficulties lead to avoidance.

5. Low levels of testosterone, the male sex hormone, can cause the male to experience a lack of or a low desire to have sex. In actuality, the aging male does experience a variation of the menopause that women experience during middle age, but not as suddenly or abruptly as experienced by women. As with women, there is a lowering of sexual hormone levels leading to a decline in interest.

6. Many types of medications can cause complications in the sexual response in both men and women. For example, many types of anti depressant medications have a dampening effect on the sexual urge and can cause men to experience delayed orgasm. In addition, blood pressure medications can also have this dampening effect.

7. Arterial disease, such as hardening of the arteries, whereby, blood flow is partially blocked and diminished to many parts of the body, negatively impacts the male sexual response.

8. Alcohol addiction as well as addiction to other drugs interferes with sexuality.

9. Diabetes, which leads to arterial disease, dampens sexual desire.

10. Depressive and anxiety disorders lead to decreased libido in both men and women.

I am certain that this is not a thorough list of all the possible problems, both emotional and physical, that lead to sexual dysfunction in men.


Men of all ages do not like to go to the doctor. When the problem is sexual in nature they are even more discouraged from seeking medical help because of feelings of embarrassment and shame that there may be something wrong with their "masculinity."

These issues do not reflect negatively on a man's masculinity at all. In fact, there is now treatment and relief for the conditions that cause sexual dysfunction.

Some treatments are as follows:

1. If there are problems in the relationship between partners both couples and individual psychotherapy are extremely helpful in removing barriers to a happier sexual life together.

2. There is treatment for depression and anxiety that may not require the use of medications. Cognitive Behavioral Therapy (CBT) has been found extremely effective in relieving both sets of symptoms.

However, in those cases where medication is necessary, the Psychiatrist can make adjustments in the dosages of an anti depressant or make a change in medicine in order to relieve the sexual side effects that are causing problems.

3. There are prescription medications for ED or Erectile Dysfunction that are effective in relieving that problem.

4. Hormonal treatments can boost libido or desire for those men who, for a variety of reasons, may have lowered testosterone levels.

5. Quitting smoking can relieve many breathing problems that have a dampening effect on sexuality.

6. Exercise rather than being a "couch potato," can increase libido.

7. Sometimes surgery is necessary and successful in bringing about a cure if there is something organically wrong the male sexual organs.

The point is that there is help available and there is no reason to continue suffering, except for feelings of shame in connection with these issues.

If you or the male partner you are with experiences these types of problems it is important to consult a urologist or endocrinologist to identify and treat the problem. If the issue is psychological or relational then seeing a psychotherapist is the way to go.

Your comments are welcome and encouraged.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
Discuss this issue below or in our forums.

newly-wed - Claire - Apr 14th 2009

My relationship with my husband started 5 years ago. From the beggining it was a very sexual relationship. Sex was not only very good in quantity but it was great in quality.Nine months ago we got married....and that is when all the problems began...I should say that prior to the marriage my husband worked abroad and came home for the weekend. we would have at least five times sex in that two day period. After the marriage he works were we live and its now a good thing if we have sex two-three times a month!I know he isn't cheating and he has experienced no erectile dysfanction. he's just not in the mood and when I try to make a move he usually is so indifferent that I loose my apetite as well.I don't know what to do, since talking about it doesn't help at all and this has happened so early in our life together that I can't help feeling totally rejected. He says he loves me and there is no problem and he's making plans for the future but I don't want a future in a relationship that is dead...What should I do?

Help at home - PHF needs help - Mar 25th 2009

My husband is a wonderful christain man.  But for the last ten years, he has no desire for sex.  He has only initating sex 4 times in the past ten years.  We have only had sex 15 times in the past ten year and that is with me initating and controlling everyting.  He is able to get a hard on, but if I stop messing with him after he get the hard on, he will just go to sleep.  I want him to want me, I want him to make the moves.  I want him to initate making love to me.  He does not masterbat himself.

To Frustrated - Allan N Schwartz - Feb 5th 2009

Hi Frustrated, you do have a difficult situation. Have you talked to him about couple's counseling? Of course, if he gets angry at that idea, too, and will not go for any help at all then you may have no other choice than to leave him. Fifty years of age is way too early for him to have such a low libido. Yes, medications can have a major impact but there are medicines like Viagra and those types. I would suggest that you both see his doctor together and discuss the problem. You could also both see a urologist to find out what his problem might be. But, again, if he is unwilling, then, there is no hope other than for you to leave him.

Dr. Schwartz

Male Sexual Response - frustrated_2_no_end - Feb 5th 2009

In regard too the post of sexual decline in men, I feel this womans frustration and frankly don't know what to do.

 I've been with a man for 6 years, I've known him for 25 years. Our sex life since day one has had SOME good days but  a lot of arugments and rejection in between.

 I've asked him are you bi-sexual? He was in prison for two years, and I began seeing him shortly after, secondly, he does take some medications that i know can cause him not too salute, BUT, he CAN salute WHEN HE WANTS, but for some reason when I want sex he cant, and if we have sexual relations 4 times A YEAR WE'RE doing good! 

 I'm 43 and he just turned 50. While i know he has some underlying medical issues, I feel pushed away, and i KNOW his previous sexual relationships were ok, but he continues too push every excuse under the sun from stress too we cant have sex in the shower now because it reminds me of prison? what the heck is that.

I feel like i'm only here for when it's convenient for him, otherwise he sleeps, complains, if i get a kiss or a i love you out of him daily that also has stopped, but yet he states when asked, he loves me but actions speak louder than words but i'm confused but hopeful, yet frusterated, but mostly fed up. He'll get angry with me and say maybe you need a young guy which will really get under my skin because thats NOT what i was referring to. He can climb on, climb off for a full 2 minutes, when HE WANTS but never ever when i'm in the mood, he'll throw out an excuse, "i want too watch this on tv, or, i'm tired, or my stomach hurts, ANYTHING under the sun.

I have only been with five men in my entire life, one of them was for 20 years, NO i'm not comparing the men themselves, i'm only comparing what i'm use to, and 4 or 5 times a year is NOT getting it but i dont want too leave him but my desires seem too be nothing to him and he'll get angry with me.Why? Suggestions?



Marriage and sex - Allan N. Schwartz, PhD - Aug 17th 2008

Clearly, something is wrong in the marriage and it is causing a problem in your sexual life together. I recommend that you find a good marriage therapist, either a clinical psychologist or expienced licensed clinical social worker. In marriage therapy you can both be helped to uncover what has gone wrong and get your marriage back on the right path.

Dr. Schwartz

My Husband - - Aug 16th 2008

I have been married for over a year.  It is our second marriage.  We dated for three years prior and had an amazing physical relationship.  One year post marriage, there is nothing.  If we have sex once a month, that's a good month.  It only happens when I make not being intimate an issue.  He never looks at me lovingly or initiates any affection unless I complain about him not showing affection.  I was very affectionate toward my husbadn, but recently have just given up.  It just isn't enjoyable when I have to beg for it.  Now that I've given up, sex is nonexistent.   He could be having an affair, I don't know.  I;ve asked him, and naturally he tells me that he is not.....WHAT DO I DO?  Our marriage is becoming fake and empty.  I almost feel as though it is too late for us.

Traumas as Causative of Sexual Issues - Samuel Lopez De Victoria, Ph.D. - Jun 24th 2008

In many of the cases I have treated via psychotherapy, I have found that men who have sexual issues such as Erectile Dysfunction can also be traced to trauma(s) relating to male emasculation by a father, absent father thus not feeling affirmed in male sexuality, an over-controlling and/or protective mother who also ends up emasculating her son(s), etc. I have even treated men who have been verbally trashed by their wives which, in turn, is tantamount to an emasculation also.

Just my two cents,

Samuel Lopez De Victoria, Ph.D.

Drooping towards Reality. - JR - Jun 23rd 2008

A Long Time Ago, I was very interested in sex, exclusively with my wife. I went through Depression, Exhaustion, Alcoholism, Anti-Depressant Medication ... not sure that any of these, in themselves, had any much effect on my level of interest. Fortunately, old age has. Fortunately - because my wife never has had much interest in our physical relationship, even before my various "problems" kicked in. More than anything else, my being Just Worn Out (partly with Asking) has brought us into equillibreum. At this stage, I rather hope that she will not develop belated interest (there are some signs to the contrary) - she was well aware of this as a problem, in the past. I am at this stage past returning on this road.

I do not want anybody else - not that I am not attracted to anybody else, but I do not believe in spreading misery in the world, more than I have done, in other ways, already. My counsellor and my psychiatrist have asked me have I ever "strayed" - no, I never have, and I never will. Once, I would have said that this was a miserable way of being but now, I am happy that I am becoming calm. There are joys enough in this.

Best regards,

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