Erections are about blood engorging the penis. Dr Ezio Baraldi, president of the SA Sexual Health Association (SASHA), explains: "Diabetics often face ED. This is brought about by the changes induced in the penis by high blood pressure, high cholesterol and high glucose. Additionally, some of the medicines used to treat these conditions can themselves cause ED. Diabetics normally don't lack a desire for sex, but their ability to perform is reduced."

Dr Nevon Ramsunder, managing director of Men's Clinic International, lists the following common physical factors that can lead to the early demise of his sex life (and therefore yours): fatigue, anatomical problems and disorders, chronic illness and nerve damage.

Regarding a sudden disinterest in sex, Dr Ramsunder says: "This could occur in men with hormonal imbalances. Men do occasionally experience such problems."

Get the groove back
One should never sit on uncertainty, so a doctor's appointment is in order if odd symptoms are experienced. It's important to rule out underlying medical causes for his inability to rise to the occasion.

After a night of heavy drinking, the only thing one wants to do in bed is sleep. The more so for men who're alcoholic, and whose long-term affair with the bottle rates far above a desire for sex. As Shakespeare says of alcohol in Macbeth: "...it provokes and unprovokes; it provokes the desire, but it takes away the performance..."

"Alcohol inhibits the inhibitory neurons and the individual acts more spontaneously," explains Dr Baraldi. "It therefore increases desire – at least initially – and after drinking, a man is likely to want sex more. But alcohol also reduces the ability to perform sexually and so may lead to ED."

Stop the cycle of sexless nights
If his drinking's getting out of hand, look up the nearest branch of Alcoholics Anonymous. Drug abuse, too, can cause sexual problems. For help, visit the SA National Council on Alcoholism and Drug Dependence (Sanca).

Bringing home the bacon is never a straightforward matter and when his workload piles up too high, sex often slides into second, third or no place. Says Johannesburg psychiatrist and sexologist, Dr Bernard Levinson: "Tension and being burnt out at work can reduce sex drive. Stress is probably the major cause of loss of desire in all the males I see."

Dr Ramsunder lists common emotional causes of ED as anxiety, depression, anger and sexual ignorance. And Dr Levinson adds: "Being overweight, taking pills for blood pressure, tranquillisers or anti-depressants can all reduce sexual desire and performance too. A person may be depressed and not actually be aware of this subterranean, secret blanket that's slowly fallen over their soul. The psychiatrist picks it up and the patient's always amazed. It's a major cause of loss of desire."

De-stressing
Says Cape Town-based sexologist Marlene Wasserman (Dr Eve): "It's painful to a woman's heart and ego when a man's not interested in sex. We're socialised to believe all men want sex all the time. So when he turns out to be just a person who doesn't always feel horny, we feel personally rejected – and indignant! And if your man's never had much libido, it will only get worse as the relationship progresses. An honest conversation is required, or else you'll wear out your vibrator and start looking around for another man."

When he has a sexual dysfunction
Sexual dysfunction can be defined as a variety of problems from arousal to desire and fear of intimacy. Psychosocial variables like upbringing and belief affect how each individual expresses their sexuality.

Dr Baraldi explains: "There are three stages in the sexual response cycle: desire, arousal and orgasm. In men, impotence is an arousal disorder: the individual fails to achieve and/or maintain an erection sufficient for a satisfactory sexual experience.

"Lack of interest in sex is a desire disorder. Lack of sexual desire in general and lack of desire in masturbation are further divided into two categories: firstly, long-standing disorders, which are normally related to deep-seated psychological issues, often arising out of childhood problems. And, secondly, new disorders, which are often caused by physical problems."

"Performance anxiety is a common problem in men with both short- and long-term erection failures," says Dr Ramsunder. "In most cases, the fear of failure results in them shying away from sex altogether."

Solutions
In treating sexual dysfunction, a Patients' Fact Sheet produced by the US Society for Reproductive Medicine advises: "...Factors such as marital stability and communication, sexual history, mood disorders or emotional problems and a history of sexual abuse must be assessed."

Says Dr Ramsunder: "From my experience, all forms of sexual dysfunction have an effect on the sex life of both parties. It's essential to establish the underlying reason for a man having a low sex drive. Due to the magnitude of different approaches and treatment options now available for the treatment of ED, without a proper physical medical examination and some knowledge of the circumstances surrounding the problem, no recommendations or treatment options can be suggested."

Trouble in paradise is bound to arise, even in the best of pairings. If a couple has other problems in their relationship – disagreements about money, child-rearing or domestic roles – the resentment may creep into the bedroom, and sex may creep out. This may herald the beginning of the end, unless a plan of action is devised.

Then there's sheer monotony, which can also kill desire and, consequently, performance. When a man can predict every move his partner's going to make, or when intercourse is relegated to the same time-slot (every Tuesday and Saturday, straight after the late TV news and always in the bedroom!), the prospect of intercourse is often less than thrilling.

Says Dr Baraldi: "One form of desire disorder is a lack of interest in sex with a particular partner, while maintaining desire for sex with other partners or masturbation. This is normally caused by problems in the relationship between the two parties."

So what can you do if your bedroom's become a bored-room? Dr Baraldi says it's crucial to address the relationship problems which have led to the sexual stagnation – either through honest communication, professional counselling, self-help books and weekends away together or apart.

So much for sexological explanations for your man's lack of desire. But what if he suffers from none of the symptoms listed by the learned, and still keeps putting you off? It's only natural to start suspecting he's taken out third party insurance. You have grounds for real concern if any of the following describe his behaviour: