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Question: “I am a 20-year-old male, healthy and active. However, I do not have any desire whatsoever to have sex. I am in a long-term relationship where we used to be very sexually active but recently, I cringe at the thought of sexual activity. I struggle to unpack what is going on and when we discuss this together, I dissociate strongly and lose my ability to put my emotions into words. I tend to get angry and have to fight a strong urge to shut down the dialog. I feel so much shame and guilt about this as I know she has needs, needs I cannot fulfill right now with my genuine emotional experience. I see the danger of pretending and attempting to meet her needs while ignoring mine, as I know doing things out of sense of obligation or guilt will lead our relationship into ruins. I am certain this a psychological problem as I don’t show any of the classic signs (other than reduced sex drive) of lowered testosterone and I am not having issues “getting up” for the occasion. It seems like this is all stemming from my head. I would love Stefan’s help getting to the bottom of this as this is such a difficult topic for me to explore on my own, with friends or with my girlfriend. How can I overcome some of this mental blocks that are preventing me from having a fulfilling sex life as this is such an important aspect of successful long term relationship? More generally, what is a healthy mindset to approach a problem like this without beating myself up, as this only seems to make things worse?”

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