Sexual desire and the loss of it take many different and distinct forms. It is potentially influenced by a myriad of physiological, psychological, and psychosocial factors, all of which may, in turn, carry their own complex history. Both interculturally and intrapsychically, the subjective experience of desire is framed and mediated by expectations. These expectations are inculcated by prevailing social value systems, familial codes of behavior, peer and partner pressure, previous experience, and many other contributing forces. People tend to place heavy reliance on personal norms, and hence, sexual confidence is easily disrupted by the kinds of change and adaptation necessitated by illness, surgery, or significant life events such as bereavement, divorce, pregnancy, and childbirth.

Social change in the 20th century has been rapid and, in terms of women to a greater degree and men to a lesser degree, has led to the confusion resulting from conflicting demands and the inequities and consequent resentments associated with sexual double standards. For many women, changes in work and child-care patterns have resulted in a multiple burden of tasks and responsibilities. Moreover, it was only 60 years ago that women were incarcerated in asylums for displaying sexual need and pleasure. Changes in expectations held by and about women have come a very long way in a short space of time. Sexual behavior is “scripted” in that it is a “role” that is learned and subsequently acted out within a social context. Different social and cultural contexts may have widely varying scripts. “Sexuality,” therefore, refers not just to engagement in sexual activity, but also to all the attitudes, value systems, and behaviors that might be seen to have some sexual significance in our society.

Sexual interaction is characterized by a degree of suspicion and doubt as to the intentions and interpretations of the other, and such problems are heightened by different sexual vocabularies and expectations. The strain on communication that results from the effort of managing this disparity frequently exacerbates relationship difficulties, contributing to a negative spiral that further reduces the level of sexual desire experienced by one or both partners. Discrepant communication strategies and emphases have the capacity to foster and feed resentment, leading to a general breakdown in communication, with sex as a notable casualty.