A cool new study suggests that approaching sexual inhibition in therapy might be best done in a gender-specific way
A fascinating new study published in Nature Scientific Reports compares the patterns of brain activation and inhibition between men and women with low libido.
Perhaps unsurprisingly for psychotherapists, given what Dr. Freud proposed over 120 years ago, previous studies have found that low libido—scientifically termed Hypoactive Sexual Desire Disorder (HSDD)—may originate from the hyperactivation of some cortical brain areas involved in higher-order cognitive functioning. These areas, often referred to as the "inner critic," "critical parent," or "cultural parent" depending on therapeutic terminology, can suppress "lower-level" limbic emotional and sexual brain regions. This hypothesis was named "top-down". However, these earlier studies focused exclusively on women with low sexual desire.
To a therapist, this bears an uncanny resemblance to Freud's theory of superego repression, doesn't it?
The present study, while confirming the "top-down" hypothesis in women, identifies a different set of neural correlates for men with chronic lack of desire. In other words, the "top-down" hypothesis does not seem to apply to men. For men, cortical activation in response to explicit sexual content is similar to that of men with normal sexual desire. Yet, something appears to be amiss when it comes to visual stimuli reaching the limbic areas and triggering the appropriate emotional and sexual responses.
Thus, according to this study, when it comes to concupiscence (or rather, the lack thereof), men and women are not made equal!
Interestingly, the authors identify the "sex network"—unfortunate naming, to be sure—consisting of familiar limbic structures: the amygdala, hypothalamus, insula, pre-central gyrus, striatum, and thalamus.
From a clinical perspective, this suggests that different therapeutic approaches are necessary for men and women presenting with low sexual desire.
As a therapist, I find that discussing sex remains a taboo topic in therapy. Roughly estimating, I would say only 10-20% of clients engage in a candid discussion about their sex lives. Women seem more open to these discussions, but that might be influenced by the fact that I am a female therapist. I understand the hesitation; I remember my own therapy sessions where I attempted to broach the subject, only to sense my therapist's discomfort and unspoken plea to change the topic. We never brought it up again.
I would love to hear about your experience and thoughts, please share here or from today you can also follow me on BlueSky (or Xed Twitter if you must ) and share your comments there.
References
Ertl N, Mills EG, Wall MB, Thurston L, Yang L, Suladze S, Hunjan T, Phylactou M, Patel B, Bassett PA, Howard J, Rabiner EA, Abbara A, Goldmeier D, Comninos AN, Dhillo WS. Women and men with distressing low sexual desire exhibit sexually dimorphic brain processing. Sci Rep. 2024 May.
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