Not long ago, I saw a young woman in her twenties who complained that she had no sexual desire. Previous lab tests had revealed that her hormone levels were normal. I asked her when the problem began and she told me that she had never experienced sexual desire. She had a lifelong absence of libido.
Her attitude toward her situation was interesting. Although she said she was distressed about her situation and concerned about its impact on her current new relationship, she also seemed blase about her problem. She joked about never having had a boyfriend in high school. During college she had only had one previous platonic relationship. She had never had sexual intercourse and rationalized this absence of intimacy in her life by saying that it didn't make sense for her to be emotionally invested in something she had no desire to do.
A careful history revealed that she had never gone beyond casual petting in her limited dating experience. Requests to be more sexual made her uncomfortable. And although she was outgoing and liked to socialize, she felt uneasy and typically tried to change the subject when the conversation turned to sex. On the rare occasions she was confronted directly about her sexual interests and experiences, she crafted her answers carefully and in general terms.
I asked her what she hoped to achieve from our work together, in light of the fact that she was completely disinterested in sex. At this point, she revealed that she had recently tried to have sex with her new boyfriend -- at his insistence -- but couldn't go through with it. The experience of him digitally stimulating her vagina had thrown her into a panic. After she calmed down, he had tried, unsuccessfully, to enter her vagina with his penis. She was upset, embarrassed, and confused. The patient had experienced an involuntary spasm of the muscles of the vaginal opening termed vaginismus.
But her problem was broader than this. This patient was experiencing a lifelong case of sexual aversion disorder, a condition, while uncommon, isn't rare, either. Sexual aversion disorder is anxiety-based and usually affects the patient's entire sex life. Most sufferers are women, but men can also suffer from the condition.
The interesting thing about this disorder is that the patient's anxiety-based aversion to sex is often masked by a stated disinterest in sex and sexuality. It is unclear whether the masking is partially or completely unconscious. In any case, it exerts a powerful hold and is exposed only when the patient is forced into a sexual confrontation.
The patient is currently in treatment with an experienced sex therapist and is making slow but steady progress with her problem.