Sexual dysfunction: What’s love got to do with it?

At any particular moment, we may know what we mean by “I love you” and why we are saying it. We may not be willing, however, to have our motives, meanings, and emotions fully known by the listener. In fact, the motive for saying “I love you” is often to obscure the view:

• Lover A: I love you.
  
• Lover B: Why do you love me?
  
• Lover A: I don’t know, I just do.
  

Clinically, a patient saying, “I love my partner” can mean, “I don’t want to examine this further now:”

• Doctor: Why do you put up with this behavior from your spouse?
  
• Patient: Because I love him.
  
• Doctor: What does that mean?
  
• Patient: I don’t know.
  

Table 1

What is the meaning of ‘I love you’? Love is…

A transient emotion
An ambition
An arrangement
An attachment
A moral commitment
A mental struggle
A force of nature
An illusion
A stop sign

Table 2

Love as ambition: 7 ideals for loving relationships

Mutual respect
Behavioral reliability
Enjoyment of one another
Sexual fidelity
Psychological intimacy
Sexual pleasure
A comfortable balance of individuality and couplehood
Source: Reference 4

What is sexual desire?

Sexual desire—at any given moment—is the sum of biological, psychological, interpersonal, and cultural forces that incline us toward and away from sexual behavior.⁶ Understanding desire can help you:

• ask patients insightful questions about their relationship concerns
  
• formulate a hypothesis to explain how drive, motivation, and values contribute to a patient’s sexual dysfunction.
  

Drive. Science shows with certainty that desire’s biological component has a basis in anatomy and neuroendocrine physiology. Factors that account for different endowments in the strength of desire over time for any person have not been clarified, however, and neither have the immediate precursors to feeling spontaneously “horny.”

Motivation is the degree of willingness an individual has to enter into sexual behavior with a particular partner at a moment in time. Sexual motivation is a psychological force that is influenced by:

• affective states, such as joy or sorrow
  
• interpersonal states, such as mutual affection, disagreement, or disrespect
  
• relationship stage, such as short or long duration
  
• cognitive states, such as moral disapproval.⁷
  

Values. A person’s sexual desire and behaviors are shaped by families, schools, religions, politics, regional influences, history, and economic forces. These cultural influences begin in childhood and can be remodeled as individuals are exposed to new ideas as they mature.

Values serve an evaluative function as our minds screen personal sexual behaviors with two questions:

• Is the behavior normal or abnormal?
  
• Is it morally acceptable or unacceptable?
  

Values are forces beyond the biological or psychological details of the person’s life. When orthodox religious injunctions against sex envelop a culture, for instance, its followers are likely to suffer in their sexual function without knowing why. Old-fashioned ideas—such as, “Nice women do not enjoy sex”—can inhibit desire long after they are cognitively outgrown.

In talking with Mrs. C, for example, you learn that her family reinforced the religious prohibition against extramarital sexual expression. “When I was a teenager, my father told me not to come home if I got pregnant before I was married,” she relates.

Values augment or diminish desire by affecting our willingness to engage in sexual behaviors. Values are camouflaged as motivation; Mrs. C may not realize that values she acquired at home early in life continue to influence her and may contribute to her lack of desire for nonreproductive sex.

Related resources

• Regan PC: Love relationships. In: Muscarella F (ed). Psychological perspectives on human sexuality. New York: John Wiley & Sons; 2000:232-82.
  
• Aron A, Fisher H, Mashek DJ. Reward, motivation, and emotion systems associated with early stage intense romantic love. J Neurophysiology 2005;94:327-37.
  

Acknowledgment

Singer Tina Turner recorded “What’s Love Got To Do With It?” in 1984.