The Fundamentals of Sex

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Desire isn't simply driven by love or perceived beauty.

Non-sexual issues can have a decisive effect on sexual desire.

Factors that affect libido are similar for all genders.

Sex therapy can sometimes help a couple's desire discrepancy.

Every week, people come for therapy about desire issues. Someone wants higher libido. Someone wants their partner to have a higher libido. Someone wants to know why all men are, apparently, a bunch of horny dogs—except for the ones who have completely lost interest. Someone wants to know why it’s so hard to satisfy women.

My thoroughly therapeutic answer is, frequently: Let’s talk about something else.

Not something at random, of course. Depending on the case, I suggest we talk about:• Power dynamics• Body image• Self-esteem• Conflict management• Old wounds—the individual’s, the partner’s, or the couple’s• Religion• Alcohol and drugs• Aging, health, chronic pain, menopause, contraception.Not libido, and not even sex.

Sometimes the problem is easy to diagnose. So I encourage some patients to:• Drink less alcohol (maybe way less);• Get a health checkup, especially regarding hormones, diabetes, hypertension, weight;• Explore possible medication side effects.

When these approaches don’t work, we have to get into the more difficult........

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