Four Ways to Not Want Sex: Asexuality, Low Desire, Medication, and Aversion

• Four distinct things present identically at intake as I don't want sex: asexuality (an orientation), low desire meeting disorder criteria, medication-induced dysfunction, and trauma-related aversion.
• The distress criterion does most of the diagnostic work — and it is the criterion most often applied wrong, because externally sourced distress gets counted as internal.
• The DSM's desire disorders are not meant to be diagnosed in someone who identifies as asexual. That exclusion is frequently unknown or ignored.
• Trajectory separates most of these faster than symptom description: lifelong and stable, versus a change with a start date.
• Aversion and absence are different. Aversion is a response to something; absence is the lack of a response.
• These are not mutually exclusive. An ace person can also be on an SSRI and also have a trauma history.

She is thirty-four, partnered for six years, and she came in because her partner asked her to. That is the first thing she says.

The account is straightforward. She does not want sex. She did not particularly want it before this relationship either. She can identify no period in her life when she did. She is not distressed by this in isolation — she describes her own experience as fine, uncomplicated, unremarkable to her. What distresses her is the six years of conversations, the sense that she is withholding something, the phrase fair to me which has come up more than once.

Her intake form, filled out in the waiting room, says: low libido.

Four different formulations fit the sentence on that form. Only one of them fits her.

This vignette is a composite. It does not describe any individual client.

Get this one wrong and you do not merely fail to help. You actively supply the wrong frame to a person's most intimate relationship — and frames of this kind get repeated at home for years. A clinician who writes hypoactive sexual desire in a chart for an asexual client has handed one partner a medical justification for a grievance. That does damage no subsequent affirmation undoes.

The four possibilities:

Prevalence estimates run from roughly 0.4% to 1% of the general population. Little or no sexual attraction, spanning the spectrum from asexual through gray-asexual and demisexual — AVEN's overview of the gray area is the clearest plain-language map of that middle ground. It is not a dysfunction, not a symptom, and not a decision — the review literature is consistent that asexuality is neither a sexual dysfunction nor a paraphilia. It is a description of who a person is attracted to — in this case, no one, or rarely, or only under specific conditions.

Markers: Lifelong and stable. No start date. The person typically reports that the absence is unremarkable to them — this is the crucial phrase. Distress, where present, is nearly always relational or social in origin: a partner's disappointment, family expectation, the sense of being broken that comes from a culture that has no category for you. Sexual functioning is frequently intact; many ace people masturbate, experience physical arousal, and have no difficulty with the mechanics. Attraction is the thing that is absent, not function (Prause & Graham, 2007; Brotto et al., 2010; Yule, Brotto & Gorzalka, 2015).

Worth knowing: Hinderliter (2013) sets out the conceptual distinction between asexuality and hypoactive sexual desire disorder directly, and is the single most useful reference if you are asked to justify the distinction. The DSM's desire disorders also carry an explicit exclusion — the diagnosis is not to be made if the person identifies as asexual. This is in the manual: a lifelong lack of sexual desire better explained by self-identification as asexual is not to be diagnosed as female sexual interest/arousal disorder, with parallel language for male hypoactive sexual desire disorder (DSM-5, pp. 434, 490). It is also routinely unknown to clinicians who nonetheless diagnose from it. The asymmetry this creates — no DSM diagnosis takes same-sex desire as its primary symptom, but two take low desire — is the subject of Flanagan & Roughley's Why is absent/low sexual desire a mental disorder (except when patients identify as asexual)? (2023). [Confirm DSM-5-TR page numbers; the cited pagination is DSM-5.]

Genuinely low desire, causing genuine personal distress, in someone for whom this represents a departure.

Markers: There is usually a start date, or at least a period of contrast — a time when desire was present and now is not. The distress is intrinsic: the person misses it, experiences the loss as a loss, and would want it back independent of anyone else's opinion. This is the single sharpest discriminator between this and asexuality, and it requires a specific question: if your partner were entirely at peace with never having sex again, would this still bother you? An ace person says no, usually with relief. A person with genuine low desire says yes — they want the wanting back.

Common contributors worth screening: thyroid, testosterone, anemia, chronic pain, sleep debt, depression, perimenopause, postpartum, chronic stress, relationship conflict. A desire complaint without a medical review is an incomplete assessment.

Predominantly SSRIs and SNRIs, though hormonal contraceptives, antipsychotics, beta blockers, finasteride, and others contribute.

Markers: Onset tracks the medication. This is the whole tell, and it requires an actual timeline rather than an impression — when did the prescription start, when did the change begin, was there a dose adjustment. The presentation is often characterized by blunting rather than absence: genital numbness, delayed or absent orgasm, muted arousal, and frequently a flattening of emotional intensity generally, not only sexual.

Two things that get missed. First, people rarely volunteer this, both because the connection is not obvious and because raising it feels like threatening a medication that is otherwise helping. Ask directly. Second, post-SSRI sexual dysfunction — persistence after discontinuation — is a recognized phenomenon and clients who have found it online are frequently told they are imagining it. They may not be.

Do not advise anyone to stop or change a psychiatric medication. That conversation belongs with the prescriber, and abrupt SSRI discontinuation carries real risk.

A protective response, sometimes to specific sexual trauma, sometimes to a broader history of coercion, boundary violation, or a purity-culture upbringing that framed desire itself as dangerous.

Markers: This is the one that presents as aversion rather than absence, and the distinction is the key to the whole differential. Aversion is a response — there is something being responded to. It shows up as dread, panic, nausea, dissociation, freezing, hypervigilance during intimacy, or the specific pattern of being fine until a particular cue. Absence has no charge to it. There is nothing to flinch from.

Aversion is also frequently contextual in a way that asexuality is not: fine alone, not fine partnered; fine with one partner, not another; fine until a specific act. And dissociation during sex is close to diagnostic for this branch — it does not belong to any of the other three.

• Has this always been the case, or did it change? Lifelong points to orientation. A start date points to the other three.
• If your partner were completely content never having sex again, would you still want this to be different? The single highest-yield question in the whole differential.
• Is it that you don't want it, or that you don't want it to happen to you? Absence versus aversion.
• What medications are you taking, and when did each start? Then map the timeline explicitly against the symptom onset.
• Does your body still work the way it used to? Function intact with attraction absent points to asexuality. Function altered points to medication or a medical contributor.
• Whose idea was it that you come in? Not a throwaway. The answer reframes everything about where the distress lives.

A structured option. The Asexuality Identification Scale (AIS-12) (Yule, Brotto & Gorzalka, 2015) is the only validated instrument for this construct. Twelve items, scored 1–5, range 12–60. A cutoff of 40 captured 93% of self-identified asexual participants, while 95% of sexual participants fell below it. Its value here is that it measures the construct independent of self-identification, which makes it useful in exactly the case where a client is unsure.

Two limits that matter for this differential. The original validation did not include gray-asexual, demisexual, or questioning participants — the populations most likely to be in this differential. And it was normed on largely cisgender samples, which constrains its use with gender-diverse clients. Treat it as one structured input alongside the timeline and the distress question, never as an arbiter.

Every desire disorder requires clinically significant distress. In principle this protects ace people from diagnosis. In practice it does the opposite, because clinicians count distress without asking where it came from.

Brotto, Yule and Gorzalka (2015) examined precisely this question — whether asexuality is best understood as an extreme variant of a desire disorder — and found that asexuality is generally not accompanied by significant distress about the lack of attraction itself. Distress, where it appears, has a source. An asexual person in a relationship with an allosexual partner who is unhappy will, reliably, be distressed. They may be miserable. They may describe guilt, inadequacy, fear of the relationship ending, and a sense that something is wrong with them. Score that as clinically significant distress and the criterion is met — and the diagnosis follows.

But that distress is not evidence of a disorder. It is evidence of an incompatibility, plus a culture that has assigned the incompatibility to one side of it. The question is not is this person distressed. It is would this person be distressed in the absence of external pressure? For genuine low desire, yes. For asexuality, almost never.

These co-occur constantly. An ace person can be on an SSRI. A trauma survivor can also be demisexual. A person with genuine hypoactive desire can have a partner who is additionally being unreasonable about it. Presenting four clean categories is a teaching device; real clients arrive as combinations, and the useful move is usually to identify which strand is doing the most work right now rather than to pick a winner.

Lifelong is harder to establish than it sounds. Someone whose desire ended at fourteen after an experience they have not disclosed will report it as lifelong in good faith. Absence of a remembered start date is weaker evidence than it appears, particularly early in a therapeutic relationship, and particularly before disclosure.

I have leaned hard on the "would you still care" question, and it has limits. A person who has spent twenty years absorbing the idea that not wanting sex makes them defective may not be able to locate an answer independent of that. Someone deeply enmeshed in a partner's distress may genuinely not know which feelings are theirs. It is the best single question I know. It is not a test, and it can take months rather than one session.

Identity can also be protective. Occasionally a person adopts an ace label because it is a more bearable account than a trauma they are not ready to approach. This happens. It is also used as a pretext for dismissing ace clients wholesale, which is far more common and far more damaging. The workable stance: believe the person, keep the door open, and let them decide if and when to walk through it.

On this site

• Lexicon — hover definitions for every term used here
• Topic Index — all articles by subject
• Neurodivergence self-assessment
• Resources

Validated instrument

• Asexuality Identification Scale (AIS-12) — Yule, Brotto & Gorzalka (2015), Psychological Assessment, 27, 148–160. Full text hosted by the Brotto Lab, UBC. Not diagnostic; not validated on gray-ace, demisexual, or gender-diverse samples.

Key references

• Hinderliter (2013). How is asexuality different from hypoactive sexual desire disorder?
• Brotto, Yule & Gorzalka (2015). Asexuality: An Extreme Variant of Sexual Desire Disorder?
• Brotto & Yule (2017). Asexuality: Sexual Orientation, Paraphilia, Sexual Dysfunction, or None of the Above?
• Bogaert (2004). Asexuality: prevalence and associated factors in a national probability sample

Community and education

• AVEN — What is asexuality?
• AVEN — General FAQ
• AVEN — The Gray Area
• AVEN — Romantic Orientations
• AVEN — Asexual Perspectives — first-person accounts
• AVEN Forums

• Hinderliter, A. (2013). How is asexuality different from hypoactive sexual desire disorder?
• Brotto, L. A., & Yule, M. (2017). Asexuality: Sexual Orientation, Paraphilia, Sexual Dysfunction, or None of the Above?
• Brotto, L. A., Yule, M., & Gorzalka, B. B. (2015). Asexuality: An Extreme Variant of Sexual Desire Disorder?
• Prause, N., & Graham, C. A. (2007). Asexuality: Classification and Characterization.
• Yule, M. A., Brotto, L. A., & Gorzalka, B. B. (2015). A Validated Measure of No Sexual Attraction: The Asexuality Identification Scale.
• Catri, F. (2021). Defining Asexuality as a Sexual Identity: Lack/Little Sexual Attraction, Desire, Interest and Fantasies.
• Van Houdenhove, E., T'Sjoen, G., & Enzlin, P. (2013). Asexuality: Few Facts, Many Questions.
• Bogaert, A. F. (2006). Toward a Conceptual Understanding of Asexuality.
• Chasin, C. J. D. (2011). Theoretical issues in the study of asexuality.

Content on this site is for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. Nothing here creates a therapist–client relationship. If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room.

Well wishes. 🙏

Mx. Love C. Dialogos, LMFT · Buddhist Chaplain Licensed Marriage and Family Therapist · AAMFT Clinical Fellow & Approved Supervisor Love Psychotherapy, LLC

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