“Jane” is a pretty young woman in her 30s who came to see me for disinterest in sex. She is married with two children, and explains that she loves her husband but has no interest whatsoever in having sex with him, which is problematic in their marriage.
In fact, she reports never having an interest in sex, for as long as she can remember. She recalls when she was in grade school other girls had “crushes” on boys and played kissing games on the playground, and how absurd this concept seemed to her. As a young adult everyone else was having romantic relationships and having sex, so she married like her friends did, and made herself try to be sexual thinking maybe she would get the hang of it eventually.
But she never found anything pleasurable or enjoyable about intercourse, or any other sexual activities, and she doesn’t understand why no one will believe that sex is just not for her. She always has and continues to crave intimacy and closeness in her relationship with her husband, but bemoans that her love isn’t enough for him. She is completely fine with not having a sexual life but she scheduled this appointment at the threat of her husband leaving her if she did not, and she sits in our exam room deeply distressed and weeping.
What is Asexuality?
Asexuality is defined as a lack of sexual attraction to anyone or anything. Prior to 2004, asexuality was a term that was largely reserved for describing the reproductive patterns of many single-celled organisms. That year however a large British population study revealed 1 percent of people reported a lack of sexual attraction.
Since then interest in the construct of asexuality from theoretical, academic, clinical, and feminist perspective has become a neuvo topic of debate, and the internet has exploded with numerous online communities, blog spots, and dating services exploring the experience of and demanding recognition for asexuality.
Asexuality is defined as the lack of sexual attraction towards other people, yet it is recognized that there is a variation among asexual individuals in their experience of relationships, attraction, and arousal. Studies have found some asexual individuals engage in masturbation, yet their sexual fantasies do not usually depict images of themselves as sexual or engaging in sexual acts, and they will often report masturbation is more of a physical release activity. Most asexual people will assert they do crave romantic feelings or wish for intimacy in relationships with friends and partners, but that sexual experiences at large are not of interest to them. Others identify as “aromantic asexuals” and do not desire sexual or romantic relationships.
Asexuality is not the same thing as celibacy, as celibacy is behavioral, and typically has a belief system behind it, such as personal convictions or religious beliefs. Asexuality, by comparison, is not a decision or a temporary lacking of sexual interest, it is a sexual orientation. Human sexuality has long been understood to exist on a spectrum, and whereas some identify as heterosexual or homosexual, a small percentage of the population feels they are not sexual at all. One could argue from a sex researcher standpoint that we can’t attempt to understand the broad spectrum of human sexual desire unless we also understand those who never experience it.(2)
Asexual people are often considered to have a lack of knowing of who they are sexually attracted to, as if they are not gay or straight, yet. For people who identify as asexual, however, they report they always have and will continue to be entirely disinterested in sex, and that this is an authentic experience of their true selves. Asexual people are often judged, criticized, or otherwise condemned by people close to them, as well as society at large, for these assertions. Friends and even health care professionals can often relate to asexuality as if it is something that can be cured, or is a symptom of something larger such as an endocrine disease, mood disorder, or bad relationship. Most asexual people will report periodic to persistent discrimination against their declared sexual orientation.
Asexuality is not caused by a past trauma, or because the person has not met someone who has made them feel a sexual attraction. As a whole, asexuality is often asserted to be associated with immaturity, that the person has not grown to like sex, or that they are incapable of forming relationships with people. But many people who are asexual are interested in developing relationships just those that are not sexual ones; many people can love a best friend, and not have a sexual relationship with them, for asexual people, that is just the basis of all of their relationships.
Asexuality & Medical Science
The science of asexuality study is barely a decade old, which means we truly have a rudimentary understanding of asexual individuals currently, from a research perspective. Various theories in medicine and psychology have been proposed to explain how asexuality should best be technically classified; including earlier beliefs that it is rooted in psychiatric disease, a paraphilia, or is an extreme variant of hypoactive sexual desire or sex aversion disorder. Asexuality is easily misunderstood or confused with medical or mood diagnosis for people who have an aversion to sex.
Medical studies that have compared asexual and sexual individuals have found no evidence that levels of inherent depression, lack of emotions, or social desirability differed between the two groups. Studies have found higher rates of social withdrawal and modest support for higher rates of Asperger’s disorder, both of which are characterized by difficulties in social interactions, and a recent study did reveal elevated rates of depression and anxiety associated with asexuality.
However, most studies have surmised that mood disorders found in asexuality people are more likely related to the consequences of being a sexually marginalized group, and not a contributing factor to being asexual. No study has found evidence to directly support the contention that asexuality may be an expression of a psychiatric illness.(1) Just because asexuality is rare doesn’t mean it is a disease.
Another classification attempt has been to include asexuality in the container of paraphilias which is defined as atypical sexual attractions, but this is inherently nonsensical as paraphilic tendencies often engage in some human sexual contact — whether in the context of their paraphilia or independent of it — whereas asexual individuals deny attraction toward anyone.
From a clinical perspective, it can be challenging at first to differentiate asexuality from low libido or sex aversion disorder. Hypoactive sexual desire disorder is characterized by a problematic disinterest in sexual activity, whereas sex aversion is denoted by disgust, fear, and revulsion, in addition to lack of desire in consensual relationships involving genital contact.
Sex aversion is often correlated with a past history of sexual trauma such as rape, incest, or other abuse. The symptoms of sexual aversion disorder can range from mild to severe. Mild symptoms of sex aversion can include lack of interest and mild disgust, which can mirror some asexual people’s perspective on sex.
Severe symptoms of sex aversion do differ from asexuality, and can include panic attacks with all the symptoms of such an attack, including dizziness, shortness of breath, intense fear, and rapid heartbeat even when just in proximity to someone they think has sexual interests in them.
People suffering from sexual aversion disorder often go out of their way to avoid situations that could end in sexual contact through any means they can think of, including going to bed at different times from a partner, spending extra time at work, or trying to make themselves less sexually attractive.
The key diagnostic criteria to both hypoactive sexual desire disorder as well as sex aversion, and what distinguishes them from asexuality, is the person experiences distress from their sexual disinterest or the sexual experience. Asexuals maintain that their lack of sexual interest and attraction evokes no inherent sexual distress for them personally, although it may result in distress in a relationship. Therefore the origin of distress with sexual disinterest is important to understand, but often difficult to ascertain.
A common joke is that pizza is a lot like sex, and when it’s good, it’s really good, and when it’s bad, it’s still pretty good. To try and elucidate the genuine truth for disinterest in sexual activity, I will often ask to a person who states they never want to have sex again “Is it true that you never want to have sex again, or that you never want to have BAD sex again?” For a person with low libido, the distinction is they do not want sex to be painful or unpleasant, but they often have experienced fulfilling sex in the past, they very much desire the return of amazing sex in their life, or wish to experience extraordinary sex for the first time.
A low libido person has often eaten bad pizza too often, and has stopped feeling it is even worth having anymore, but very much would love to eat an artisan pizza with thin crust on a summer evening alongside a glass of chilled white wine on a waterfront deck with a loved one. The asexual person never wanted pizza to begin with, never liked it hot or cold packed for lunch leftovers the next day, it was never tasty baked from frozen at home or straight out of a fire oven at a pizza parlor; they are simply not interested in pizza, in any state, so to speak.
Self-reported sexual attraction is at the heart of sexual orientation, regardless of one’s sexual behavior proclivities. Many asexual people engage in sexual activity to appease someone else, but this doesn’t change that they are asexual. Because the self-reports of asexual individuals center around their lack of subjective attraction to anyone, the existing medical science evidence leans in favor of asexuality being considered as a unique sexual orientation.
Unfortunately for some people who are asexual the trauma of discrimination, or being coerced into sexual activity in order to be “normal,” which is a deeply unsatisfying or harmful experience for them, can fuse into having sexual aversion traits over time.
Cognitive behavioral sex therapy strategies to reduce anxiety or panic with sexual activity can be helpful; however, support to explore a true asexual identity is ultimately most indicated. A marriage where one person is asexual but their partner is not and expects a lifelong sexual relationship is typically an area of enormous distress & conflict for both people in the relationship, and this conflict is what prompts most asexual people to seek professional help from a sexuality expert.
An asexual person who has a lifestyle and relationships congruent with being asexual can live happy, content lives, and they do not typically present with any clinical concerns of being asexual. Clinical management of asexuality almost always is provoked by partners or family members who are telling them “there is something wrong with you — go to a doctor and figure it out.”
In these circumstances it is important to explore and rule out any endocrine or other known contributions to sexual dysfunction, such as thyroid problems, menopause, medication sexual side effects, or pituitary tumors.
Women who are asexual attempting to engage in sex against their preference, but to appease a partner can develop pain with intercourse due to lack of arousal and lubrication, which can commonly lead to pelvic floor muscle tensions disorders that can be greatly improved with pelvic floor physical therapy.
Asexual men trying to force themselves into sexual activity at someone else’s preference can be unable to develop or sustain an erection, or report inability to ejaculate or orgasm, particularly in partner sex.
Medical investigation to assure that there are no hormonal, prostatic, or cardiovascular contributions to these sexual complaints, is often prudent in a clinical environment to be thorough and assure a medical etiology is not contributing to their sexual disinterest or impaired function.
It is not uncommon for an asexual person to wish for medical work-ups to confirm that they are in fact in good health as they explore their sexual identity. Yet in contrast, a recent small study found that many asexual people are however often just as physically capable of erections or vaginal lubrication as anyone else, implying that the mechanics work, there just isn’t any interest in using them.(2)
To be clear, asexuality itself is not a medical condition, and medical work-ups will be entirely normal if sexual disinterest is originating from one’s true sexual orientation. A sexual medicine approach to treating a person who is determined to identify as asexual, is discussing treatment options to support associated depression or anxiety if present, but primarily is aimed to garner a support system for them to feel empowered and supported in their true identity, and create relationships and a lifestyle that are congruent with their own personal sexual orientation truth.
After several years of an often difficult journey of embracing his asexuality, “Jason” explained to me that he finally felt at peace, being able to accept himself, and felt free from so many pressures he felt to conform to relationships as others expected him to in the past but which never felt right to him.
He found a community of other people who shared his values, and had joined a dating site for asexual people who were seeking same minded relationships. He joked that on a recent date, the only thing awkward was determining which person would sleep on the couch since neither were interested in sharing the same bed. He insisted as the gentlemen that she take his bed, and both were delighted to have a restful night sleep after a great date together, without any pressure to engage in sex that neither of them wanted to have.
Additional Asexuality Resources
- Asexuality and Visibility Education Network
- Asexual Explorations
- Love From the Asexual Underground (blog)
- Asexualitic (community for asexuals)
1. Brotto, L., Yule, M., & Gorzalka, B. (2014). Asexuality: An Extreme Variant of Sexual Desire Disorder? The Journal of Sexual Medicine J Sex Med,646-660.
2. Bogaert, A. (2015, April 21). Asexuality: What It Is and Why It Matters. Retrieved August 13,2015