Double-standard, double-trouble.

A man in his late 50’s goes to see a therapist for stress. After sitting through a few sessions, he finally musters up the guts to tell her what’s really bothering him. “So, I’ve noticed that since I turned 50, my libido has slowly disappeared.” The therapist, whether trained in sexual dysfunction or not, will probably ask if he’s ever spoken to his doctor about it and had a blood workup. After all, it is common for men hitting middle age to notice a decline in their sexual dysfunction; the constant commercials these days for male sexual dysfunction treatments is a testament to that.

Odds are the, therapist will not say, “has your wife gained weight and become less attractive to you?” Or, “are you two not communicating well?” Or, “perhaps you were molested when you were younger…do you have memories of that?” Don’t get me wrong; emotional and relationship functioning may play a role on physical functioning, and a man’s sexual dysfunction may have contributing factors beyond his age. But what’s fascinating is the comparison to how this same vignette would play out if the client at hand was a woman.

If a woman in her late 50’s told her therapist that she noticed a decline in her libido since turning 50, odds are the next few questions would not include asking whether she had spoken to her doctor about it and looked for a second opinion, if necessary. The focus would probably go right to the relationship, to whether she feels attracted to her partner, how they are connecting, if she’s had sexual trauma. Many patients have shared with me that they had this experience. But men and women are different, you might argue, and they relate sexually in different ways. True. But to say that male sexual dysfunction is ALL physical and female sexual dysfunction is ALL mental is a dangerous oversimplification.

Fortunately, medicine and mental health have become more collaborative and studies have reflected increased efficacy in treatment that addresses holistic functioning. Hopefully, this trend will translate into more education around sexual dysfunction for both genders and ultimately, increased utilization of appropriate treatment for all those who suffer.

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