Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men

Filippo Maria Nimbi, PhD, PsyD,1,2 Francesca Tripodi, PsyD,2 Roberta Rossi, PsyD,2 and Chiara Simonelli, AP, PsyD1,2

ABSTRACT

Background: The literature lacks studies of the male sex drive. Most existing studies have focused on hypoactive
sexual desire disorder in coupled heterosexual men, highlighting some of the main related biological, psycho-
logical, and social factors.
Aim: To evaluate the role of selected psychological and social variables affecting male sexual desire such as quality
of life, sexual function, distress, satisfaction, psychological symptoms, emotions, alexithymia, couple adjustment,
sexism, cognitive schemas activated in a sexual context, sexual dysfunctional beliefs, and different classes of
cognitions triggered during sexual activity about failure anticipation, erection concerns, age- and body-related
thoughts, erotic fantasies, and negative attitudes toward sexuality.
Methods: A wide self-administered survey used snowball sampling to reach 298 heterosexual Italian men (age ¼
32.66 ± 11.52 years) from the general population.
Outcomes: 13 questionnaires exploring psychological and social elements involved in sexual response were
administrated: International Index of Erectile Function, Short Form 36 for Quality of Life, Beck Depression
InventoryeII, Symptom Check Liste90eRevised, Toronto Alexithymia Scale, Premature Ejaculation Severity
Index, Sexual Distress Scale, Sexual Satisfaction Scale, Dyadic Adjustment Scale, Ambivalent Sexism Inventory,
Sexual Modes Questionnaire, Sexual Dysfunctional Belief Questionnaire, and Questionnaire of Cognitive
Schema Activation in Sexual Context.
Results: Results showed lack of erotic thoughts (b ¼ 0.328), fear (b ¼ 0.259) and desire to have a baby
(b ¼ 0.259) as the main predictors of the level of sexual desire in this group. Energy-fatigue, depression,
premature ejaculation severity, sexual distress, compatibility, subjective sexual response, and sexual conservatism
had a weaker effect on sexual desire. Sexual functioning (13.80%), emotional response (12.70%), dysfunctional
sexual beliefs (12.10%), and negative automatic thoughts (12.00%) had more variable effects on sexual drive.
Clinical Translation: Analyzed variables could represent important factors that should be considered in the
assessment of desire concerns and discussed in therapy.
Strengths and Limitations: The strength of this study is the analysis of novel psychological and social factors
on male sexual desire. Recruitment and sample size do not allow generalization of the results, but some crucial
points for future research and clinical practice are discussed.
Conclusion: Our findings showed that male sexual desire could be affected by many psychological and social
elements. Other factors remain to be explored, in their direct and interactive effects, aiming to better explain male
sexual desire functioning. Nimbi FM, Tripodi F, Rossi R, Simonelli C. Expanding the Analysis of
Psychosocial Factors of Sexual Desire in Men. J Sex Med 2017;XX:XXXeXXX.
Copyright
2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Key Words: Desire; Sexual Behavior; Sexual Response; Sexuality; Sex Drive; Biopsychosocial Approach

INTRODUCTION
Sexual desire is frequently attributed to a subjective status
(with psychological, physiologic, affective, and cognitive com-
Received April 26, 2017. Accepted November 29, 2017.
1
ponents) to motivate and initiate human sexual behavior. Desire
Department of Dynamic and Clinical Psychology, Sapienza University of
Rome, Rome, Italy;
is considered to be triggered by internal and/or external stim-
2
Institute of Clinical Sexology, Rome, Italy
uli.1e3 Levine4e6 highlighted 3 biopsychosocial elements of
desire: drive (a biological aspect including the anatomy and
Copyright ª 2017, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved. physiology of the neuroendocrine system), motivation (a psy-
https://doi.org/10.1016/j.jsxm.2017.11.227 chological part including mental states, relational issues, and

J Sex Med 2017;-:1e15 1

2 Nimbi et al
social context), and wish (a cultural element considering ideals,
values, and rules for the expression of sexuality). More recently,
desire has been closely associated with arousal, being described as
“the predisposition to subjectively respond to sexual stimuli with
feelings of sexual excitement.”7,8 The classification of male sexual
dysfunctions in the Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition is based on Kaplan’s linear model,9,10 in
which desire is described as a distinct phase preceding arousal and
activating a sexual “chain reaction” response. Criticisms of this
model state that it does not contemplate that male desire can be
responsive and influenced by psychosocial factors such as sexual
experiences.11e14 The Fourth International Consultation on
Sexual Medicine (ICSM)15 strongly emphasized that hypoactive
sexual desire disorder should be kept separate from arousal dys-
functions. Moreover, considering expert opinions and clinical
principles, the ICSM gave a unisex definition of sexual interest-
desire disorder as “persistent or recurrent deficiency or absence of
sexual or erotic thoughts or fantasies and desire for sexual ac-
tivity,” showing how it is similar in men and women, with some
etiologic and prevalence peculiarities. Future research should
focus on supporting this definition and elucidating etiologies and
prevalence and other characteristics.
The literature lacks studies on the male sex drive. Most
existing studies have focused on hypoactive sexual desire disor-
der, mainly in coupled heterosexual men.7,16e21 Fewer studies
have investigated high-level sexual desire in different
populations.17,22e24
The biopsychosocial model recognizes a complex interaction
among internal cognitive processes, neurophysiologic mecha-
nisms, and affective components in sexual desire.13,25 Few
studies have attempted to describe these relations with rudi-
mentary models.26,27 However, the current understanding of the
specific factors influencing the nature of sexual desire in men is
incomplete and remains to be explored.
Early studies identified hormonal factors that act as physiologic
predictors of sex drive.28e36 Recent guidelines37 indicate that
several hormones modulate or promote human sexual behavior,
including drive and arousal. Although the literature corroborates
the crucial role of testosterone and prolactin on desire,38,39 results
for other hormones are less clear. Hypothalamic neurohormones
such as oxytocin and a-melanocyteestimulating hormones are
currently under active research for therapeutic purposes. Hor-
monal treatment can improve libido in hypogonadal and
hyperprolactinemic men. Other evidence has shown that
androgen deprivation therapy, which can be used as curative or
palliative treatment in advanced prostate cancer, lowers libido.40
Age and presence of organic disease have a negative effect on
overall sexual response.41e43 It is clear that biological factors play
a central role in sexuality, but they are not enough to explain the
human sexual response. In addition, it is very difficult to isolate
the weight of physical components from their natural interaction
with the psychosocial system.2,16 For these reasons, an increasing
importance of cognitive, emotional, relational, and sociocultural
variables has been recognized.44
Among psychological factors, specific mood states can pro-
mote or inhibit sexual desire. Depression and anxiety have been
mostly associated with low levels of desire.16,45e47 However,
some studies have found an increase in the level of sexual desire
in association with altered mood tone.23,48e51 Therefore, the
mechanisms underlying the relation among anxiety, depression,
and sexual interest remain unclear and not necessarily linear.48
Regarding emotional management, studies have reported
conflicting results. Portuguese researchers have emphasized the
centrality of emotions in the male sexual response.52e54 None-
theless, negative emotions related to sexual experience (eg,
sadness, anger, and disillusionment) do not seem to have played a
decisive role in male desire.2 Sexual dysfunctions have been
associated with a lack of positive affect rather than the presence of
more negative emotions specific to sexual activity.55 Alexithymia
has been found to have an important impact on male sexuality,
principally on arousal and orgasmic phases. A few studies have
found a minor connection with hypoactive sexual desire disorder,
despite the finding that alexithymia could decrease the ability to
daydream and describe erotic thoughts.56e59
Distress and satisfaction about sexual activity are recognized as
central elements of sexual functioning.26,60,61 Positive and
negative experiences have a direct effect on sexual behavior.
Moreover, the presence of other sexual dysfunctions could have a
negative effect on interest and overall sexual function.
The association with relational factors also is not clearly
defined: sexual interest in men appears to be independent of
couple dynamics, especially relational conflict.62 In addition, the
desire for tenderness and closeness with a partner seems to
decrease with the length of a relationship, although sexual desire
does not decrease.63 The same trend was confirmed by Murray
and Milhausen64 in a study in which relationship duration was
associated with a decrease of sexual activity only in women.
Carvalheira et al16 reported conflicting results: men who were
married and cohabitating longer than 5 years, with higher edu-
cation, work stress, and couple conflicts, presented lower levels of
desire. More than relationship duration, dyadic satisfaction could
have a role in determining sexual interest.65 Ridley et al66 re-
ported that positive feelings such as trust, intimacy, and good
communication can increase sexual desire.
The impact of cultural factors has been less studied: myths
related to male sexual performance and sexual scripts (eg, hostile
and benevolent sexism) have been examined primarily in relation
to other sexual problems such as erectile dysfunction.53,67e73
The most representative factor of low desire in men seems to
be the “lack of erotic thoughts” during sexual activity.2,52,74
Rigid thoughts about virility and a focus on erection and sex-
ual performance foster an unrealistic expectation of male sexu-
ality. Studies have shown that cognitive factors (beliefs related to
J Sex Med 2017;-:1e15
Psychosocial Factors of Male Sexual Desire 3

restrictive attitudes toward sexuality, erection myths, and erotic Table 1. Sociodemographic characteristics of group (N ¼ 298
thoughts) could be the best predictors of sexual desire.2,27 heterosexual men)
Following the lead of some relevant studies in the field, the Marital status, n (%)
main objective of this study was to analyze the effect of several Unmarried 219 (73.5)
factors (psychological, emotional, sexual function, relational, and Married 61 (20.5)
cultural) that the literature has highlighted as connected with Divorced 13 (4.4)
sexual desire in men. In this study, we included dimensions such Not answered 5 (1.7)
as quality of life (QoL), psychopathologic symptoms, emotions Relationship status, n (%)
Single 101 (33.9)
endorsed during sexual activity, alexithymia, sexual function,
Non-cohabiting couple 104 (34.9)
distress, satisfaction, quality of dyadic relationship (if any),
Cohabiting couple 88 (29.5)
sexism, automatic thoughts and cognitive schemas during sexual
Not answered 5 (1.7)
activity, dysfunctional beliefs, and adherence to stereotypes about
Children, n (%)
sexuality. The final objective was to identify the main predictors No 231 (77.5)
of male sexual interest to lay the foundation for the construction Yes 58 (19.5)
of a new model of sexual desire in men that is more represen- Not answered 9 (3.0)
tative of the complexity of human sexuality. In line with the Desire to have a baby, n (%)
available literature, we hypothesized the following associations No 226 (75.8)
with lower levels of sexual desire: worse QoL, greater presence of Yes 63 (21.1)
psychological symptoms, greater endorsement of negative emo- Not answered 9 (3.0)
tions during sexual activity, higher level of alexithymia, more Education level, n (%)
sexual distress declared, lack of sexual satisfaction, worse sexual Middle school 15 (5.0)
functioning, lower levels of dyadic adjustment, higher level of High school 115 (38.6)
sexism, higher presence of dysfunctional beliefs, automatic At least degree 159 (53.4)
thoughts, and cognitive schemas. Not answered 9 (3.0)
Employment status, n (%)
Employed 159 (53.4)
METHODS Unemployed 17 (5.6)
Student 103 (34.6)
Participants and Procedures Retired 10 (3.4)
Using a snowball recruitment from a convenience population, Not answered 9 (3.0)
we reached 407 men enrolled directly by researchers at Sapienza Sexual problems in past 6 mo, n (%)
University, at the Policlinic Umberto I of Rome, and at the None declared 189 (63.4)
Institute of Clinical Sexology of Rome. The research was 1 declared 100 (33.6)
advertised on the internet and social networks to reach more Not answered 9 (3.0)
participants. Depending on their preference, subjects completed
a paper form (28ss; 9.69%) or a web survey (270ss; 90.31%;
relationship status as unmarried and coupled (with 1 third of the
offered on computer, smartphone, and tablet on the Google
total sample being single, 1 third being coupled and cohabitating,
Docs platform). We chose to use these 2 forms of assessment to
and 1 third being coupled and not cohabitating); most men
reach a wider variety of men, especially those who were less
neither had children nor desired children at the time of the survey.
familiar and confident with technology. Participants did not
They had a medium to high education level and most were
receive any remuneration for taking part in this study and all
employed. In accordance with recent epidemiologic data,75 in our
provided written informed consent of participation. The ques-
study population 3 of 10 reported at least 1 sexual problem in the
tionnaires administered were completely anonymous.
past 6 months (mean duration ¼ 48.37 ± 74.27 months) and
The inclusion criteria were age at least 18 years and being reported a “moderate to high” level of sexual desire (as declared on
prevalently heterosexual (the 1st 2 points were measured using a item 12 of the International Index of Erectile Function [IIEF]).
7-point Kinsey scale). After applying those criteria, we selected a Compared with Italian sociodemographic statistics,76 the group
group of 298 men eligible for the study. The institutional ethics seemed to be quite representative of the Italian male population,
committee of the Department of Dynamics and Clinical Psy- even if the sampling size and methods do not allow them to be
chology, Sapienza University of Rome provided approval to carry considered a “representative” group. To reach a wider variance in
out the research on January 21, 2015. Data were collected from data,77 we analyzed men with and without sexual problems
March 2015 to July 2016. together to yield more realistic results in the following hierarchical
The sociodemographic characteristics of the group are presented regression analyses. Moreover, we assessed some specific ques-
in Table 1. The mean age of the participants was 32.66 ± 11.52 tionnaires on sexual functioning and related distress to evaluate the
years (range ¼ 18e72 years). Most men reported their direct effect of sexual complaints on sexual desire.

J Sex Med 2017;-:1e15

4 Nimbi et al

Table 2. Mean ± SD of questionnaire total scores for each test research as an outcome for medical and psychological treatments.
(N ¼ 298) The SF-36 is composed of 9 scales: physical functioning, role
Variable (total score) Mean ± SD (minemax) functioning-physical, role functioning-emotional, energy-fatigue,
emotional well-being, social functioning, pain, general health,
ASI 27.12 ± 6.68 (7.00e41.50) and health change. Higher scores indicate better QoL. In this
BDI-II 9.39 ± 7.80 (0.00e44.00)
study, Cronbach a values ranged from 0.73 (pain) to 0.86
DAS 103.15 ± 16.55 (48.00e133.00)
(physical functioning).
IIEF 52.41 ± 18.99 (7.00e75.00)
PESI 27.44 ± 19.56 (1.00e86.00) The Beck Depression InventoryeII (BDI-II)81 is an effective
QCSASC 42.95 ± 17.65 (26.00e104.00) measure of depressive symptoms evidenced by its widespread use
SCL-90-R GSI 0.59 ± 0.49 (0.00e2.62) in clinical practice and research. The BDI-II represents an
SDBQ 71.68 ± 16.24 (38.00e124.00) improvement over the 1st version across all aspects including
SDS-M 12.66 ± 11.95 (0.00e48.00) content, external, and psychometric validity. In this study, the
SF-36 68.75 ± 18.35 (10.00e100.00) Cronbach a value was 0.89.
SMQ total emotion 14.09 ± 6.89 (0.00e29.00)
The State-Trait Anxiety Inventory Form Y (STAI-Y)82 is a 40-
SMQ total sexual response 3.14 ± 1.06 (0.00e5.00)
item questionnaire pertaining to anxiety symptoms and has good
SMQ total thoughts 49.59 ± 13.92 (28.00e101.00)
levels of reliability and validity. Anxiety can occur as a reaction to
SSS-M 13.25 ± 5.20 (6.00e25.00)
STAI-Y state 40.86 ± 11.64 (20.00e75.00)
stressful situations or can be associated with psychological dis-
STAI-Y trait 42.05 ± 11.24 (20.00e74.00) orders. The STAI-Y measures state and trait anxiety and is used
TAS-20 44.10 ± 11.92 (21.00e79.00) in making diagnoses in clinical settings and in research. Higher
scores suggest higher levels of anxiety. In this study, Cronbach a
ASI ¼ Ambivalent Sexism Inventory; BDI-II ¼ Beck Depression
InventoryeII; DAS ¼ Dyadic Adjustment Scale; IIEF ¼ International Index of
values ranged from 0.75 (trait anxiety) to 0.76 (state anxiety).
Erectile Function; max ¼ maximum; min ¼ minimum; PESI ¼ Premature The Symptom Check Liste90eRevised (SCL-90-R)83,84 is a
Ejaculation Severity Index; QCSASC ¼ Questionnaire of Cognitive Schema commonly used checklist measuring the severity of self-reported
Activation in Sexual Context for Men; SCL-90-R GSI ¼ Symptom Check
Liste90eRevised Global Severity Index; SDBQ ¼ Sexual Dysfunctional psychopathologic symptoms on a 5-point Likert scale ranging
Belief Questionnaire; SDS-M ¼ Sexual Distress Scale for Males; from “not at all” to “extremely.” The SCL-90-R includes 9
SF-36 ¼ Short Form 36 for Quality of Life; SMQ ¼ Sexual Modes Ques- subscales exploring the previous 7 days: somatization, obsession
tionnaire; SSS-M ¼ Sexual Satisfaction Scale for Males; STAI-Y ¼ State- and compulsion, interpersonal sensitivity, depression, anxiety,
Trait Anxiety Inventory Form Y; TAS-20 ¼ Toronto Alexithymia Scalee20.
hostility, phobic anxiety, paranoid ideation, and psychoticism. It
is used in clinical practices as a general screening of the psy-
Measures chological state of the patient and has been adopted in psycho-
A wide protocol composed of 14 self-report questionnaires therapy as an outcome measure. In this study, Cronbach a values
exploring different psychosocial factors was administered. Means, ranged from 0.77 (psychoticism) to 0.91 (depression).
SDs, and range scores are presented in Table 2. The Toronto Alexithymia Scalee20 (TAS-20)85e87 measures
A sociodemographic questionnaire was created to collect a general dimension of alexithymia with 3 main factors (difficulty
general information such as age, sexual orientation (measured identifying feelings, difficulty describing feelings, and externally
with 7-step Kinsey scale), relationship and marital status, edu- oriented thinking). The TAS-20 demonstrated adequate internal
cation level, employment status, children, and presence and and test-retest reliability. In this study, Cronbach a values ranged
duration of sexual difficulties. from 0.77 (difficulty describing feelings) to 0.82 (externally
The IIEF78 is a widely used multidimensional 15-item in- oriented thinking).
strument for the evaluation of male sexual function. A general The Premature Ejaculation Severity Index88 is a 10-item
index of sexual function and 5 specific dimensions can be questionnaire exploring the general experience of premature
calculated: erectile function, orgasmic function, sexual desire, ejaculation (PE) on multidimensional perception: intravaginal
satisfaction with intercourse, and overall satisfaction. Higher ejaculation latency time, personal distress, sexual satisfaction,
scores indicate better sexual functioning. Psychometric studies comorbidities with other sexual dysfunctions, ejaculatory control,
reported good reliability, validity, and the ability to discriminate partner’s concern, and impact of symptoms on QoL. Items are
between clinical and non-clinical subjects. In this study, the summed to a single main dimension indicating the severity of the
sexual desire scale was used as a dependent variable to assess the condition. In this study, the Cronbach a value was 0.86.
level of male sexual desire. In this study, Cronbach a values The Sexual Distress Scale for Males (SDS-M)89 is a 12-item
ranged from 0.83 (sexual desire) to 0.94 (overall satisfaction). questionnaire to assess personal distress related to sexuality
The Short Form 36 for Quality of Life (SF-36)79,80 is a with 1 main score. It was previously used in combination with
36-item instrument of generic, coherent, and easily administered the Female Sexual Function Index for women. Test-retest reli-
QoL measures. The SF-36 is widely used in clinical practice and ability and internal consistency coefficients were acceptable. The

J Sex Med 2017;-:1e15

Psychosocial Factors of Male Sexual Desire
scale showed a discriminant ability distinguishing between
dysfunctional and functional subjects. For this study, it was
translated to Italian, adapted for the male population, and used
in combination with the IIEF. The Cronbach a value for this
measure was 0.96.
The Sexual Satisfaction Scale for Males (SSS-M)90 is a 30-item
measure of sexual satisfaction composed of 5 factors: content-
ment, communication, compatibility, relational, and personal
concern. It displayed good psychometric properties and
discriminative capability between clinical and non-clinical sub-
jects. For this study, it was translated to Italian and adapted for
the male population. The Cronbach a value ranged from 0.84
(communication) to 0.95 (relational concern).
The Dyadic Adjustment Scale (DAS)91 is a 32-item scale
designed to assess dyadic adjustment quality according to 4 di-
mensions in coupled subjects: dyadic consensus, dyadic satis-
faction, dyadic cohesion, and dyadic affection. The questionnaire
showed good internal consistency and construct validity. In this
study, Cronbach a values ranged from 0.79 (dyadic affection) to
0.89 (dyadic consensus).
The Ambivalent Sexism Inventory92 is a 22-item measure
designed to assess sexist attitudes toward women using a 6-point
Likert scale from 0 (“strongly disagree”) to 5 (strongly agree”).
Total sexism score and 2 subscale scores (hostile and benevolent
sexism) can be calculated. In this study, Cronbach a values
ranged from 0.78 (benevolent sexism) to 0.83 (hostile sexism).
The Sexual Modes Questionnaire (SMQ)54 is a 30-item
measure to assess the connection of automatic thoughts, emo-
tions, and sexual responses in a sexual context. The male version
is composed of 5 dimensions: failure anticipation thoughts,
erection concern thoughts, age and body related thoughts,
negative thoughts toward sex, and lack of erotic thoughts.
Emotions endorsement and the level of subjective sexual
response to thoughts can be calculated. Higher scores correspond
to more negative thoughts, higher endorsements, and sexual
response. Test-retest reliability and internal consistency were
supported by psychometric studies. The SMQ can discriminate
dysfunctional from functional men. In this study, Cronbach a
values ranged from 0.79 (negative thoughts toward sex) to 0.87
(erection concern thoughts).
The Sexual Dysfunctional Belief Questionnaire (SDBQ) is a 73
40-item measure that evaluates 6 classes of beliefs about sexuality:
sexual conservatism, female sexual power, “macho” beliefs, beliefs
about women’s sexual satisfaction, restricted attitudes toward
sexual activity, and sex as an abuse of men’s power. Answers range
on a 5-point Likert scale from 1 (“completely disagree”) to 5
(“completely agree”). Higher scores indicate more dysfunctional
sexual beliefs. Good coefficients of test-retest reliability and in-
ternal consistency were shown. The SBDQ can discriminate
dysfunctional from functional men. In this study, Cronbach a
values ranged from 0.77 (restricted attitudes toward sexual activity)
to 0.90 (beliefs about women’s sexual satisfaction).
J Sex Med 2017;-:1e15
5
The Questionnaire of Cognitive Schema Activation in Sexual
Context for Men (QCSASC)93 assesses the activation of 28 self-
schemas usually associated with psychological problems after
the presentation of 4 events of sexual dysfunctions. 5
dimensions emerged: undesirability-rejection, incompetence, self-
depreciation, difference-loneliness, and helpless. The QCSASC
showed good internal consistency, test-retest reliability, convergent
validity, and incremental validity. It can discriminate between
clinical and non-clinical groups. In this study, Cronbach a values
for this measure ranged from 0.84 (difference-loneliness) to 0.93
(undesirability-rejection).
RESULTS
Data Analysis
Hierarchical multiple regression analyses (enter method) were
performed for each class of factors (QoL, psychopathologic
symptoms, emotions, alexithymia, sexual functioning, sexual
satisfaction, sexual distress, dyadic adjustment, sexism, negative
automatic thoughts, dysfunctional sexual beliefs, and cognitive
schemas) to identify the main predictors of sexual desire within
each class (Table 3). We wanted to control the effect of some
sociodemographic variables such as age, relationship status
(coded as coupled or not coupled), desire to have a baby, edu-
cation level, having or not having a sexual problem in the past 6
months, and the duration of symptoms. These variables entered
the 1st steps of all hierarchical regressions as covariates. To
prevent type I error, significance level was based on the
Bonferroni-corrected a value in each regression. A final hierar-
chical multiple regression analysis, including the previous sig-
nificant variables and covariates, was performed to find the best
predictors of male sexual desire (Table 4). A Pearson correlation
matrix (Table 5) was built between the variables entered in the
final regression model to observe and discuss associations be-
tween predictors. Moreover, Figure 1 shows the relation of the
percentage of the variance explained by different models (class of
predictors). All statistical analyses were performed using SPSS
22.0 (SPSS Inc, Chicago, IL, USA).
Sociodemographic Variables
Age, relationship status, desire to have a baby, education level,
sexual problems, and duration of sexual problems were evaluated
with a multiple regression using level of sexual desire (IIEF) as
the dependent variable (step 1). A significant model emerged
(F6,292 ¼ 2.663; P < .05; R2 ¼ 0.061) with the emerging
predictor “desire to have a baby” indicating that men who desired
children at the time of the survey reported significantly lower
levels of sexual desire. This model was used as a 1st step (cova-
riates) for all subsequent hierarchical multiple regressions.
QoL was evaluated using level of sexual desire (IIEF) as the
dependent variable and sociodemographic variables as covariates
(step 2.1). A significant model emerged (F13,244 ¼ 2.818; P <
.01; DR2 ¼ 0.083). The predictor “energy-fatigue” was
 6
Table 3. Predictors of male sexual desire—hierarchical multiple regressions (enter method)
Step 1: sociodemographic predictors Step 2.1: quality of life Step 2.3: emotional Step 2.4: alexithymia
(covariates) predictors Step 2.2: psychopathologic predictors response predictors predictors

B SE b B SE b B SE b B SE b B SE b
Age 0.018 0.011 0.121 0.014 0.011 0.095 0.017 0.012 0.117 0.012 0.012 0.085 0.017 0.011 0.116
Relationship 0.275 0.156 0.128 0.143 0.161 0.067 0.127 0.170 0.059 0.310 0.170 0.140 0.226 0.157 0.105
status
Desire to have 0.696 0.276 0.161* 0.715 0.283 0.164 0.708 0.298 0.160 0.766 0.309 0.169 0.670 0.278 0.155
a baby
Education level 0.302 0.183 0.103 0.180 0.187 0.061 0.306 0.204 0.105 0.341 0.198 0.113 0.236 0.185 0.081
Sexual problems 0.303 0.245 0.082 0.184 0.256 0.050 0.245 0.273 0.066 0.017 0.294 0.004 0.283 0.251 0.077
Duration of sexual 0.215 0.209 0.067 0.131 0.214 0.041 0.342 0.227 0.106 0.229 0.222 0.071 0.233 0.209 0.073
problems
*Bonferroni-corrected a (P < 0.008) physical 0.006 0.011 0.045 depression (BDI-II) 0.039 0.025 0.173 worry 0.207 0.973 0.019 difficulty 0.024 0.025 0.073
functioning identifying
feelings
role functioning 0.011 0.005 0.176 state-anxiety (STAI-Y1) 0.009 0.017 0.059 sadness 20.416 10.559 0.111 difficulty 0.010 0.027 0.027
physical describing
feelings
emotional 0.004 0.006 0.048 trait-anxiety (STAI-Y2) 0.014 0.019 0.093 disillusion 10.960 10.289 0.123 externally 0.035 0.026 0.096
well-being oriented
thinking
role functioning 0.003 0.004 0.071 somatization 0.171 0.327 0.052 fear 4.724 1.345 0.279* *Bonferroni-corrected a
emotional (SCL-90-R) (P < 0.006)
energy-fatigue 0.036 0.012 0.320* obsessive-compulsive 0.185 0.352 0.069 guilt 0.160 2.414 0.004
(SCL-90-R)
social 0.009 0.009 0.090 interpersonal 0.003 0.367 0.001 shame 3.056 1.893 0.122
functioning sensitivity (SCL-90-R)
pain 0.014 0.008 0.157 depression (SCL-90-R) 10.046 0.419 0.391* anger 1.816 1.601 0.085
*Bonferroni-corrected anxiety (SCL-90-R) 0.421 0.431 0.130 hurt 0.194 4.873 0.003
a (P < 0.004)
hostility (SCL-90-R) 0.352 0.290 0.124 pleasure 0.286 0.943 0.029
phobic anxiety (SCL-90-R) 0.058 0.410 0.014 satisfaction 0.569 10.065 0.048
paranoid ideation (SCL-90-R) 0.278 0.259 0.112 *Bonferroni-corrected a (P < 0.004)
psychoticism (SCL-90-R) 0.142 0.472 0.041
*Bonferroni-corrected a
(P < 0.003)

Step 2.5: sexual functioning Step 2.6: premature Step 2.7: sexual satisfaction Step 2.8: sexual distress Step 2.9: dyadic adjustment
predictors ejaculation severity predictor predictors predictor predictors

B SE b B SE b B SE b B SE b B SE b
Age 0.004 0.010 0.028 0.016 0.011 0.107 0.036 0.013 0.253 0.020 0.011 0.134 0.021 0.015 0.147
J Sex Med 2017;-:1e15

Relationship status 0.103 0.159 0.048 0.290 0.158 0.133 0.017 0.231 0.007 0.253 0.156 0.117 — — —
Desire to have a baby 0.758 0.257 0.175* 0.642 0.281 0.147 0.868 0.316 0.207 0.692 0.274 0.160 1.171 0.369 0.276*
Education level 0.209 0.174 0.071 0.347 0.188 0.115 0.339 0.202 0.121 0.304 0.184 0.102 0.215 0.219 0.078
Sexual problems 0.088 0.240 0.024 0.023 0.268 0.006 0.188 0.340 0.051 0.043 0.287 0.012 0.153 0.324 07.042

Nimbi et al
Duration of sexual 0.122 0.199 0.038 0.262 0.213 0.081 0.540 0.248 0.163 0.282 0.210 0.088 0.467 0.280 0.139
problems

(continued)
J Sex Med 2017;-:1e15

Psychosocial Factors of Male Sexual Desire

Table 3. Continued
Step 2.5: sexual functioning Step 2.6: premature Step 2.7: sexual satisfaction Step 2.8: sexual distress Step 2.9: dyadic adjustment
predictors ejaculation severity predictor predictors predictor predictors

B SE b B SE b B SE b B SE b B SE b
Erectile function 0.042 0.022 0.225 premature 0.020 0.006 0.214* contentment 0.026 0.036 0.082 sexual 0.025 0.011 0.168* dyadic 0.031 0.020 0.171
ejaculation distress consensus
severity
Orgasmic function 0.098 0.039 0.186 *Bonferroni-corrected a (P < 0.007) communication 0.138 0.065 0.398 *Bonferroni-corrected a (P < 0.007) dyadic 0.037 0.040 0.083
satisfaction
Intercourse 0.033 0.045 0.093 compatibility 0.315 0.111 0.505* dyadic cohesion 0.063 0.043 0.162
satisfaction
General satisfaction 0.032 0.058 0.048 relationship concern 0.234 0.093 0.377 affectionate 0.079 0.102 0.088
expression
*Bonferroni-corrected personal concern 0.117 0.062 0.253 *Bonferroni correct
a (P < 0.005) alpha p < 0.005
*Bonferroni-corrected a (P < 0.005)

Step 2.14: cognitive

Step 2.11: negative automatic Step 2.12: subjective sexual Step 2.13: dysfunctional sexual schemas activated during
Step 2.10: sexism predictors thoughts predictors response predictor beliefs predictors sexual activity predictors

B SE b B SE b B SE b B SE b B SE b
Age 0.032 0.012 0.212 0.012 0.012 0.085 0.016 0.011 0.111 0.011 0.011 0.077 0.022 0.012 0.151
Relationship status 0.363 0.181 0.164 0.195 0.169 0.088 0.291 0.172 0.131 0.314 0.162 0.143 0.332 0.172 0.150
Desire to have a baby 0.919 0.339 0.187 0.679 0.294 0.150 0.691 0.304 0.152 0.661 0.286 0.148 0.837 0.298 0.186*
Education level 0.349 0.219 0.120 0.146 0.194 0.048 0.328 0.197 0.108 0.174 0.194 0.058 0.281 0.200 0.094
Sexual problems 0.381 0.294 0.091 0.061 0.300 0.016 0.128 0.270 0.033 0.478 0.247 0.127 0.198 0.291 0.052
Duration of sexual 0.226 0.218 0.074 0.320 0.216 0.099 0.199 0.218 0.061 0.172 0.215 0.053 0.300 0.223 0.092
problems
Hostile sexism 0.010 0.015 0.045 failure anticipation 0.018 0.0370.047 subjective 0.381 0.113 0.222* sexual 0.143 0.036 0.305* undesirability- 0.064 0.041 0.207
thoughts sexual conservatism rejection
response
Benevolent sexism 0.020 0.016 0.094 erection concern 0.031 0.028 0.099 *Bonferroni- female sexual 0.056 0.029 0.156 incompetence 0.087 0.041 0.310
thoughts corrected power
a (P < 0.007)
*Bonferroni-corrected a (P < 0.006) age- and body-related 0.046 0.058 0.065 “macho” belief 0.012 0.033 0.032 self- 0.191 0.094 0.212
thoughts depreciation
negative thoughts 0.003 0.047 0.005 beliefs about 0.075 0.041 0.188 difference- 0.054 0.087 0.072
toward sex women’s loneliness
satisfaction
lack of erotic thoughts 0.208 0.041 0.339* restrictive attitude 0.096 0.063 0.120 helpless 0.103 0.079 0.179
toward sex
*Bonferroni-corrected a (P < 0.005) sex as an abuse 0.284 0.105 0.225 *Bonferroni-
of men’s power corrected
a (P < 0.005)
*Bonferroni-corrected a (P < 0.004)

BDI-II ¼ Beck Depression InventoryeII; SCL-90-R ¼ SCL-90-R ¼ Symptom Check Liste90eRevised; SE ¼ standard error; STAI-Y1 ¼ State Anxiety Inventory; STAI-Y2 ¼ State Anxiety Inventory.

7
8 Nimbi et al

Table 4. Main predictors of male sexual desire

Model 1: sociodemographic (covariates) Model 2: main predictors of male sexual desire

Predictors B SE b B SE b

Age 0.018 0.011 0.121 0.016 0.013 0.113

Relationship status 0.275 0.156 0.128 0.030 0.235 0.012
Desire of having a baby 0.696 0.276 0.161* 10.133 0.326 0.259*
Education level 0.302 0.183 0.103 0.292 0.234 0.093
Sexual problems 0.303 0.245 0.082 0.213 0.354 0.055
Duration of sexual problems 0.215 0.209 0.067 0.437 0.256 0.132
Energy-fatigue (SF-36) 0.002 0.011 0.016
Depression (SCL-90-R) 0.070 0.294 0.024
Fear (SMQ) 3.941 1.310 .259*
Premature ejaculation severity (PESI) 0.002 0.009 0.021
Compatibility (SSS) 0.069 0.048 0.108
Sexual distress (SDS-M) 0.010 0.017 0.063
Lack of erotic thoughts (SMQ) 0.217 0.059 0.328*
Subjective sexual response (SMQ) 0.086 0.144 0.051
Sexual conservatism (SBDQ) 0.031 0.038 0.070
R2 0.061 0.281
DR2 0.061 0.220
F for DR2 3.216† 9.312‡
PESI ¼ Premature Ejaculation Severity Index; SCL-90-R ¼ Symptom Check Liste90eRevised; SDBQ ¼ Sexual Dysfunctional Belief Questionnaire; SDS-
M ¼ Sexual Distress Scale for Males; SF-36 ¼ Short Form 36 for Quality of Life; SMQ ¼ Sexual Modes Questionnaire; SSS ¼ Sexual Satisfaction Scale.
*Bonferroni-corrected a level (P < .004).
†
P < .05; ‡P < .001.

significant, indicating that a higher perceived energy level was
associated with a higher level of sexual desire.
Psychopathologic symptoms were evaluated using level of
sexual desire (IIEF) as the dependent variable and sociodemo-
graphic variables as covariates (step 2.2). A significant model
emerged (F18,241 ¼ 1.713; P < .05; DR2 ¼ 0.064). The pre-
dictor “depression” from the SCL-90-R was the single significant
association, indicating that a greater presence of depressive
symptoms was associated with a lower level of sexual desire.
Emotional responses were evaluated using level of sexual desire
(IIEF) as the dependent variable and sociodemographic variables
as covariates (step 2.3). A significant model emerged (F16,246 ¼
3.125; P < .001; DR2 ¼ 0.127). “Fear” was the only significant
predictor, indicating that a higher endorsement of this emotion
in sexual context was associated with a lower level of sexual
desire.
Alexithymia was evaluated using level of sexual desire (IIEF) as
the dependent variable and sociodemographic variables as cova-
riates (step 2.4). A significant model emerged (F9,252 ¼ 2.473; P
< .05; DR2 ¼ 0.024), but no factor was significant.
Sexual functioning was evaluated using level of sexual desire
(IIEF) as the dependent variable and sociodemographic variables
as covariates (step 2.5). A significant model emerged (F10,254 ¼
6.039; P < .001; DR2 ¼ 0.138), but only the covariate “desire to
have a baby” emerged as a significant factor.
PE severity was evaluated using level of sexual desire (IIEF) as
the dependent variable and sociodemographic variables as
covariates (step 2.6). A significant model emerged (F7,245 ¼
3.747; P < .01; DR2 ¼ 0.037). The predictor “PE severity” was
significant, indicating that a higher level of severity was associated
with a lower level of sexual desire.
Sexual satisfaction was evaluated using level of sexual desire
(IIEF) as the dependent variable and sociodemographic variables
as covariates (step 2.7). A significant model emerged (F11,239 ¼
3.881; P < .001; DR2 ¼ 0.052). The predictor “compatibility”
was significant, indicating that a higher level of sexual compati-
bility was associated with a higher level of sexual desire.
Sexual distress was evaluated using level of sexual desire (IIEF)
as the dependent variable and sociodemographic variables as
covariates (step 2.8). A significant model emerged (F7,253 ¼
3.048; P < .01; DR2 ¼ 0.019). The predictor “sexual distress”
was significant, indicating that a higher level of perceived sexual
distress was associated with a lower level of sexual desire.
Dyadic adjustment was evaluated using level of sexual desire
(IIEF) as the dependent variable and sociodemographic variables
as covariates (step 2.9). Only subjects in a relationship were
considered for this analysis (n ¼ 192). A significant model
emerged (F9,179 ¼ 3.121; P < .01; DR2 ¼ 0.026), but only the
covariate “desire to have a baby” emerged as a significant factor.
Sexism was evaluated using level of sexual desire (IIEF) as the
dependent variable and sociodemographic variables as covariates
(step 2.10). A significant model emerged (F8,201 ¼ 2.834; P <
.01; DR2 ¼ 0.011), but no factor was significant.

J Sex Med 2017;-:1e15

Psychosocial Factors of Male Sexual Desire 9

Negative automatic thoughts were evaluated using level of

IIEF ¼ International Index of Erectile Function; PESI ¼ Premature Ejaculation Severity Index; SCL-90-R ¼ Symptom Check Liste90eRevised; SDBQ ¼ Sexual Dysfunctional Belief Questionnaire; SDS-M ¼
16

0.037 0.296‡ 0.086 

sexual desire (IIEF) as the dependent variable and sociodemo-
graphic variables as covariates (step 2.11). A significant model
emerged (F11,226 ¼ 4.450; P < .001; DR2 ¼ 0.120). The pre-
15

0.139 0.355‡ 0.504‡ —

dictor “lack of erotic thoughts” was significant, indicating that a
lower presence of erotic thoughts was associated with a lower
14

0.245† 0.387‡ —
level of sexual desire.
Subjective sexual response was evaluated using level of sexual
desire (IIEF) as the dependent variable and sociodemographic
13

0.215† —
variables as covariates (step 2.12). A significant model emerged

0.115
(F7,226 ¼ 3.927; P < .001; DR2 ¼ 0.046). The predictor
“subjective sexual response” was significant, indicating that a
12

—
0.293‡ 0.422‡ 0.044 0.600‡
0.060 0.206†

0.189† 0.234‡ 0.202† 0.284‡

0.227† 0.238‡ 0.087 0.368‡

0.002 0.247‡ 0.196†

higher level of sexual activation during sexual automatic thoughts
was associated with a higher level of sexual desire.
0.180† 0.257‡ 0.242‡ —
11

Sexual Distress Scale for Males; SF-36 ¼ Short Form 36 for Quality of Life; SMQ ¼ Sexual Modes Questionnaire; SSS ¼ Sexual Satisfaction Scale.
Dysfunctional sexual beliefs were evaluated using level of
sexual desire (IIEF) as the dependent variable and sociodemo-
graphic variables as covariates (step 2.13). A significant model
10

0.108 —

emerged (F11,237 ¼ 3.029; P < .01; DR2 ¼ 0.121). The pre-

0.154* 0.123

dictor “sexual conservatism” was significant, indicating that a

0.605‡ —

higher presence of conservative beliefs about sexuality was asso-

9

0.144*

ciated with a lower level of sexual desire.

0.053

Cognitive schemas activated during sexual activity were eval-

—
8

uated using level of sexual desire (IIEF) as the dependent variable

0.005

0.085

0.053
0.187

0.124
0.136
0.132

0.174

0.153

and sociodemographic variables as covariates (step 2.14). A sig-

nificant model emerged (F11,237 ¼ 3.029; P < .01; DR2 ¼
—
7

0.062), but only the covariate “desire to have a baby” emerged as

0.205†
0.544‡
0.424‡
0.279‡

0.026
0.166*
0.095
0.170*
0.177†
Table 5. Pearson correlation between level of sexual desire and sociodemographic variables

0.147

significant factor.
—
6

0.244‡
0.088
0.049

0.005
0.054
0.027

0.027

Main Predictors of Male Sexual Desire

0.010

0.010
0.109

0.131*

According to the final aim of evaluating the best predictors of

—
5

male sexual desire, we conducted a hierarchical multiple

0.068

0.058
0.003
0.042
0.215‡
0.037

0.173†
0.051

0.013
0.104
0.189

0.121

regression using level of sexual desire (IIEF) as the dependent

variable with sociodemographic variables as covariates (step 1)
—
4

0.200†

and using as predictors the factors found as significantly asso-

0.088
0.180†

0.040
0.046
0.199†

0.065
0.205

0.156*

0.072
0.013
0.131*

0.120

ciated with sexual desire in the previous analyses (energy-fatigue,

—

depression, fear, premature ejaculation severity, compatibility,

3

0.208†
0.460‡

0.286‡

0.090

sexual distress, lack of erotic thoughts, subjective sexual

0.089

0.089
0.160*
0.186†
0.070
0.120*

0.059
0.331†

0.043
0.011

response, and sexual conservatism; Table 4). The analysis pro-

—
2

duced a significant general model that explained 28.1% of the

0.230‡
0.265‡

0.263‡
0.339‡
0.222‡
0.088

0.020
0.168†
0.169†
0.093

variance in sexual desire (F15,179 ¼ 9.514, P < .001, R2 ¼

0.022

0.179†
0.157*

0.001
0.122

0.281). The main predictors were lack of erotic thoughts, fear,

—
1

and desire to have a baby.

11. Premature ejaculation severity (PESI)

15. Subjective sexual response (SMQ)

DISCUSSION
14. Lack of erotic thoughts (SMQ)

16. Sexual conservatism (SBDQ)

7. Duration of sexual problems

The aim of this study was to investigate the role of selected

13. Sexual distress (SDS-M)

*P < .05; †P < .01; ‡P < .001.

1. Sexual desire level (IIEF)

4. Desire of having a baby

9. Depression (SCL-90-R)

psychological and social factors on male sexual desire. Working

8. Energy-fatigue (SF-36)

12. Compatibility (SSS)

from the foundation laid by the studies of Carvalho and

3. Relationship status

Nobre,2,27 we increased the number of factors analyzed (such as

6. Sexual problems
5. Education level

QoL, alexithymia, sexism, sexual function, distress, and satis-

10. Fear (SMQ)

faction) to have a more detailed view of male sexual interest. The

Variable

data showed a complex situation in which many predictors were

2. Age

not significantly associated with the level of sexual desire in men

or, at least, explained a very small amount of the variance (R2).

J Sex Med 2017;-:1e15

10
Figure 1. Percentage of variance explained (DR2) for each regression model having sociodemographic variables as covariates.
When considering sociodemographic variables, only the desire
to have a baby was negatively associated with the level of sexual
desire. The presence of conflictual issues regarding paternity
should be better investigated: from a clinical point of view, a
rational willingness for paternity could be associated with un-
conscious fears about changes in lifestyle, new responsibilities,
loss of independence, and couple intimacy—all factors that can
negatively affect desire level. The association between the current
desire to have a baby and a lower level of sexual drive also could
be explained by a shift in the purpose of physical intimacy from
pleasure to reproduction. This important change in sexual
motivation could directly affect sexual interest. Moreover, studies
on infertility have highlighted how, when sex is planned and
implemented mainly for reproduction, men report a decrease of
desire and satisfaction.94e96 In contrast with the current litera-
ture, in our study, neither age nor relationship status was asso-
ciated with level of sexual desire. This was perhaps due to the
overall youthfulness of our sample. In our data, the presence of
sexual problems (whether short or long term) was not directly
associated with level of sexual desire. When distress about the
sexual problem was present, there was an association with
changes in level of desire. People with sexual difficulties but low
distress about those problems did not report changes in desire
levels, leading to a conclusion that lack of sexual distress97 could
play a mediating effect on sexual symptoms.
When considering QoL, the main predictor of sexual interest
was energy-fatigue, which explains how the personal feeling of
being active, dynamic, and energetic is related to higher sexual
drive. The positive association between healthy sexual functioning
and energetic aspects of QoL is well established in the literature
and it confirms the protective role of sexuality in daily life.98e100
Nimbi et al
When considering psychological symptoms, the main predic-
tor associated with low level of sexual desire was depression. Our
findings are in line with those of other studies that have found a
direct relation among depressive symptoms, low sexual desire,
and lower energy levels.16,50,51,101e103 Low energy and fatigue
are parameters of depression states, as recognized in the literature
and clinical practice. It is not surprising that these variables
showed high correlations with low sexual desire in our group.
However, when these variables were included in the final
regression, they did not show a strong effect on desire and did
not explain a relevant amount of the variance. The precise roles
of depression and anxiety remain a matter of debate48: there is
the need to further explore this aspect while searching for
mediator variables or non-linear associations with sexual interest
(given that depression and anxiety can be associated with high
and low levels of desire).
When considering alexithymia, no significant factor emerged.
Our findings suggest that difficulty in processing emotions does
not directly affect the ability to erotically fantasize. However, the
association is strong with other male sexual problems such as
erectile dysfunction and PE.57e59 For emotions triggered by
sexual thoughts, we also found, in line with Ansong and Pun-
waney36 and Carvalho and Nobre,104,105 a significant effect of
fear on sexual desire and a significant model explaining 12.70%
of the variance. Sexual desire in men appears to be strongly
influenced by emotions, as in women, even if with some gender
peculiarities.104,105 Men grow up dealing with strong stereotypic
messages about machismo and virility based mainly on “perfor-
mance issues.”106,107 Men could be afraid of showing their
sensitivity and weakness, and this fear could lead to lower interest
in being involved in sexual situations.
J Sex Med 2017;-:1e15
Psychosocial Factors of Male Sexual Desire
Sexual functioning showed a significant model explaining
13.8% of the variance. Many studies have reported that general
sexual function has an impact on sexual desire, more in women
than in men.16,99,100,108,109 This aspect has been well explained
by the idea of circularity in sexual response.110 In our data, no
single significant factor emerged by IIEF subscales, but PE
severity (a measure of symptom severity and distress) had a sig-
nificant predictive role in sexual desire. In this case, men who
complained about severe PE reported lower desire. To better
understand these results, we should examine them in association
with distress and satisfaction. Our data showed a significantly
small role played by distress and sexual satisfaction (small per-
centage of the explained variance). In the correlation matrix,
sexual distress is associated with having sexual problems and PE;
satisfaction seems to be more related to cognitive aspects of
sexuality than to functioning. Recent studies have highlighted
how distress negatively influences sexual desire more than arousal
and orgasm.26,60,61,111 Low sexual self-confidence seems to have
an important negative impact on interest.97,111 Moreover, pre-
vious research has highlighted how men are more focused on
sexual performance and their partner’s pleasure than on personal
sexual satisfaction.52,72,112 These elements seem to suggest that
personal satisfaction is less important to men than distress or
sexual functioning in affecting sexual drive.
When considering dyadic adjustment, no significant factors
emerged. The literature describes relationship as a controversial
factor in sexual interest: some research has focused on length of
relationship63,64 and others have focused on couple satisfac-
tion16,65,66 as predictors of sexual desire. Other studies have re-
ported that male desire is less affected by dyadic conflicts than
female desire.62 Reflecting on the most current literature and the
data in our study, it seems that relationship does not have a direct
effect on the level of sexual desire, which could be influenced by
other submerged factors.
When considering cultural aspects such as sexism, no signifi-
cant factors emerged. This is the 1st study that has addressed
whether sexism is associated with sexual desire in men, and
unexpectedly, based on our clinical experience and on research in
women,113 it did not show any direct effect on interest. Cultural
aspects are very important in desire and sexual functioning,114
but stereotypes regarding gender roles and male attitudes about
women could have a stronger effect on couple dynamics than on
sexual response.113,115,116
Findings regarding negative automatic thoughts, dysfunctional
beliefs, and cognitive schemas activated in sexual contexts indi-
cated that the lack of erotic thoughts, sexual conservatism, and
subjective sexual response triggered by automatic thoughts on
sexuality were significant predictors of sexual desire explaining a
significant portion of the variance. As 1st described by Carvalho
and Nobre,2,27 cognitive facets are closely connected with the
level of desire and, in general, with sexual function. Moreover,
the importance of attentional focus during sexual activity is clear:
distracting thoughts are involved in generating and maintaining
J Sex Med 2017;-:1e15
11
psychogenic erection problems2,117 and could have a central role
in the interest process. Men might shift attention from erotic
fantasies or sensation to performance and partner satisfaction,
overshadowing their own sexual pleasure and subsequently losing
the power to trigger a sexual response.8,118,119
The final multiple regression analysis showed lack of erotic
thoughts, fear, and the desire to have a baby as the main pre-
dictors of male sexual desire. The general model showed a
moderate effect size accounting for 22.0% of the variance in
sexual interest.77 Energy-fatigue, depression, PE severity,
compatibility, sexual distress, subjective sexual response, and
sexual conservatism showed weaker effects. In accord with the
biopsychosocial approach to sexuality, psychological and social
factors are confirmed as having an important role in modulating
sexual desire levels. These results seem to suggest that sexual
functioning and cognitive and emotional factors have a primary
role in the process of male sexual interest. The most relevant
sexual desire factors for explaining the variance are sexual func-
tioning (13.80%), emotional response (12.70%), negative
automatic thoughts (12.10%), and dysfunctional sexual beliefs
(12.00%). Other classes of factors seem to be comparatively of
lower importance.
Findings from this study should be interpreted with caution
because of some limitations. (i) Because of a lack of financial
resources, we could not analyze the role of physiologic variables
such as hormone levels on sexual desire. This did not allow us to
consider an important aspect of the determinants of male sexual
desire. The examination of physiologic factors should be
implemented in future studies in addition to psychological and
social variables. (ii) The protocol was composed of self-report
questionnaires, some of which were translated scales (SDS,
SSS, SMQ, SBDQ, and QCSASC) that have yet to be validated
for the Italian language. Nevertheless, the SDS and SSS were
administered in association with other validated measures (such
as IIEF and DAS) to control for the lack of validity of other
measures. The SMQ, SBDQ, and QCSASC are validated and
recognized measures of cognitive and cultural aspects in many
countries, but they pose some interpretational problems: some
subscales presented are not clear or easy to understand for re-
searchers and subjects (eg, sexual response, restrictive attitude
toward sex, and female sexual power). Deepening the analysis of
desire predictors with validated versions of these tools will be of
significant help for future studies.
In addition, snowball sampling was used for ease of reaching
study volunteers and having more case variety; however, it leads
to concerns regarding the generalization of the results. Our
group, although demonstrating good variability, is not repre-
sentative of the entire Italian male population and could better
describe the cohort of young adults. To limit this bias, socio-
demographic variables were considered as covariates in all ana-
lyses. Moreover, the choice of paper and online versions needs
further discussion: on the 1 hand, this allowed us to reach some
older men who are less familiar and confident with technology;
12
on the other hand, assessing the same protocol in 2 ways could
influence the results, although the number of completed paper
questionnaires was limited (<10%).
Despite these limitations, the present study contributes to the
current knowledge on the variables associated with male sexual
desire. An open question remains: in which way are these newly
identified factors associated with level of desire? At the current
state of the literature, it is hard to establish whether they are
influenced by or influence sexual interest. Based only on data, it
is not possible to determine a precise direction of the effects,
because the associations tested with regressions are linear and
bidirectional. Nevertheless, referring to the biopsychosocial
model, the factors raised could have a very important role in
clinical work, indicating areas in which a clinician should focus
attention when dealing with desire problems. During the
assessment phase, clinicians should explore fantasies, emotions,
sexual distress, satisfaction, depression symptoms, energy, pa-
ternity desire, stereotypes, and sexual beliefs and analyze the
predisposing, precipitating, maintaining, contextual, and pro-
tective role of each factor. In sexual therapy, specialists should
include clinical tools to identify and explore sexual fantasies,
reflecting on the erotic imagery and stimulating critical thinking
and discussion about sexuality. Counteracting dysfunctional
sexual beliefs with sexual education could improve the con-
sciousness of self-attitudes and limitations on sexuality. More-
over, analyzing the influence of other sexual problems (such as
erectile dysfunction and PE) on desire and attending to perceived
distress are essential for the therapy process. Our findings show
that male sexual desire could be affected by many psychological
and social elements, but other factors remain to be explored, in
their direct and interactive effects, aiming to better explain desire
functioning.
Corresponding Author: Filippo Maria Nimbi, PhD, PsyD, c/o
Institute of Clinical Sexology, Via Savoia 78, Rome 00198, Italy.
Tel: 393405006643; E-mail: filipponimbi@hotmail.it
Conflicts of Interest: The authors report no conflicts of interest.
Funding: None.
STATEMENT OF AUTHORSHIP
Category 1
(a) Conception and Design
Filippo Maria Nimbi; Francesca Tripodi; Roberta Rossi; Chiara
Simonelli
(b) Acquisition of Data
Filippo Maria Nimbi; Francesca Tripodi; Roberta Rossi
(c) Analysis and Interpretation of Data
Filippo Maria Nimbi; Francesca Tripodi
Category 2
(a) Drafting the Article
Filippo Maria Nimbi
Nimbi et al
(b) Revising It for Intellectual Content
Francesca Tripodi; Roberta Rossi; Chiara Simonelli
Category 3
(a) Final Approval of the Completed Article
Chiara Simonelli
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