Asexuality in Men and Women: Causes, Signs, and Treatment Options

Asexuality is generally understood as a persistent lack of sexual attraction to others or a very low interest in sexual activity that is not perceived as a problem by the individual. It is not a "phase," not a random pause in intimacy, or the result of a bad experience, but a stable characteristic that can persist for many years. Researchers are increasingly considering asexuality as a distinct sexual orientation or a normal variant within the sexuality spectrum.

It's important to distinguish asexuality from abstinence and celibacy. Abstinence and celibacy are behaviors associated with a conscious decision not to engage in sexual activity for personal, cultural, or religious reasons. An asexual person may or may not be sexually active, but the key difference is that there is a fundamental lack of sexual desire, not just the actual fulfillment of that desire. Therefore, "no sex" and "no sexual desire" are not the same thing.

Asexual people often refer to themselves as "ace" and speak of the "ace community." Within this community, a wide spectrum of identities is identified: from people who almost never experience sexual desire to those who experience it rarely or only under certain emotional conditions. This diversity of experiences explains why a clear and unified definition of asexuality does not exist, even in the scientific literature. [3]

Asexuality does not preclude romantic feelings. A person can experience strong emotional attachment, fall in love, form partnerships, start a family and have children, and still not experience sexual attraction. To describe this, separate terms for romantic orientation are introduced: for example, heteroromantic, homoromantic, bi-, or pansexual romantic orientations in the absence of sexual desire. [4]

In practice, asexuality in men and women is described using similar terms: "no desire for sex," "feeling like there's no sexual attraction," "interest in relationships, but not in sex." Gender differences relate more to the frequency of self-diagnosis and stigma than to the experience of lack of attraction itself. Some studies note a slightly higher proportion of women among people who identify as asexual, but the data range is wide, and the results depend on the sample and survey methodology.

Table 1. How asexuality differs from abstinence and “low libido”

State	What's happening in reality	Key feature
Asexuality	Persistent lack of sexual desire	This usually doesn't bother a person.
Voluntary abstinence	The desire exists, but the person does not consciously realize it.	Behavioral choice
Celibacy	Abstinence for religious or ideological reasons	Conscious installation
"Low libido" of a temporary nature	Desire is weakened due to stress, illness, medications	May recover after the cause is eliminated

Asexuality and medical diagnoses: not to be confused with sexual desire disorders

In psychiatry and sexology, there are diagnoses associated with a lack of sexual interest, such as hypoactive sexual desire disorder in men and interest and arousal disorder in women. These conditions describe individuals who experience significant distress due to decreased sexual desire and perceive it as a problem. To be diagnosed, not only low desire is required, but also a duration of symptoms of at least six months and the presence of significant experiences and interpersonal difficulties.

Recent versions of diagnostic guidelines specifically emphasize that if a person self-identifies as asexual and does not experience distress due to a lack of sexual desire, then a diagnosis of sexual desire disorder is not made. This approach was influenced by research and activism within the asexual community, which sought to distinguish between orientation and medical dysfunction. [8]

Comparative studies show that asexual people generally report lower levels of sexual desire and fewer sexual experiences than patients with hypoactive sexual desire disorder. Furthermore, asexual people typically report lower levels of distress and fewer complaints related specifically to lack of desire, whereas this is the central complaint of patients with desire disorder. [9]

Another difference relates to the motivation for seeking help. People with sexual desire disorder often seek help from a doctor or psychotherapist themselves, as they find it difficult to cope with their decreased sexual interest. Asexual people typically do not view their lack of desire as a medical condition and seek help only when accompanied by anxiety, depression, conflict with a partner, or social pressure. [10]

Thus, the key criterion for distinction is the presence or absence of suffering and the desire to "correct" the situation. Asexuality is viewed as a normal variant on the sexuality spectrum, while sexual desire disorders are clinical conditions in which a person specifically requires help, not recognition of their sexual orientation. Confusion between these concepts is fraught with either unnecessary medication "correction" of sexual orientation or, conversely, missed treatment where the person is truly suffering. [11]

Table 2. Asexuality and sexual desire disorders: key differences

Sign	Asexuality	Hypoactive sexual desire disorder
Sexual attraction	Consistently low or absent	Reduced compared to the previous level
A person's attitude to a situation	More often neutral or accepting	Expressed distress and dissatisfaction
Duration	Often from adolescence, for many years	Can occur at any stage of life
Reason for visiting a doctor	More often due to social pressure or related problems	Because of the loss of desire itself
Medical assessment	Orientation option	Sexual dysfunction requiring analysis

[12]

Prevalence of asexuality: What's known about the numbers?

The first major estimates of the prevalence of asexuality emerged in the early 2000s, based on the British National Survey of Sexual Behavior. At that time, approximately 1% of adults responded that they had "never experienced sexual attraction to anyone." Revised data and subsequent waves of research have yielded an estimate of approximately 0.5%, but figures vary in other countries. [13]

More recent surveys and polls indicate that the actual proportion of people identifying as asexual or close to it may range from 1% to 4% of the population, depending on the wording of the questions, the age of the respondents, and the cultural context. In Japan, for example, a national study found approximately 0.8-0.9% of people explicitly identifying as asexual. [14]

Interestingly, historically, there was also a category of people without sexual activity in classic sexuality scales. In addition to gradations from hetero- to homosexuality, the Kinsey scale included an additional category for people without sexual contact or response. Today, it's clear that a lack of behavior doesn't always coincide with a lack of attraction, but the very fact that such a category was identified demonstrates that the phenomenon of low sexual interest had been noted before.

Gender differences have been noted across studies. In some samples, women are more likely to hold an asexual identity, while in others, there is virtually no difference. Results are strongly influenced by age, the social desirability of responses, and awareness of the term "asexuality." Young people tend to use the label "ace" more often than older generations, even if their subjective experiences are similar.

Surveys in recent years have emphasized that the visibility of the asexual community and the number of people openly using this identity are growing. This is due to the availability of information, online communities, and activism, and not necessarily to an actual increase in the proportion of asexual people. More importantly for practical medicine, doctors and psychologists are increasingly encountering patients who come with a pre-existing identity and expect respect for it. [17]

Table 3. Estimates of the prevalence of asexuality in different studies

Country or source	Estimating the proportion of asexual people	Comments
UK National Survey	About 0.5-1% of adults	A classic source of early estimates
Selected studies in Europe and New Zealand	1-3%	Depends on the wording of the questions
An overview of the asexual spectrum	1-4%	Gray and demisexual identities are included
Literature Review 2020-2022	Increasing visibility, stable rare orientation	The methodology is being clarified

[18]

Causes and factors in the development of asexuality

To date, no single, confirmed "biological cause" for asexuality has been found. The current scientific position is closer to the idea that asexuality is a variant of human sexuality, shaped by a complex set of biological, psychological, and social factors. Research examines hormonal, neurobiological, psychosocial, and cultural aspects, but none of them can explain the phenomenon in most people. [19]

Some studies have attempted to link asexuality to differences in sex hormone levels or neurotransmitters that influence the reward and arousal systems. However, there is no convincing evidence of systematically reduced levels of testosterone or other hormones specifically in asexual people. In most cases, endocrine levels are within normal limits, and attempts to explain asexuality solely through hormones are considered overly simplistic. [20]

Psychological theories focus on attachment experiences, personal history, and potential traumatic events, but there is no universal model here either. While some asexual people report negative sexual experiences or long-term anxiety, the same story is also shared by people with typical sexual desire. Major reviews emphasize that attempts to "reduce" asexuality to trauma or anxiety disorder stigmatize people and are inconsistent with the data. [21]

It is hypothesized that cultural scripts and expectations regarding sex influence the formation of asexual identity. In societies where sexuality is hyper-emphasized in advertising and media, people with low sexual interest find it easier to recognize their own difference and accept the label "asexual." Online communities and activism provide language and support that enable people to understand their identity not as a defect, but as a variant of the norm. [22]

Ultimately, research agrees that asexuality cannot be reduced to simple explanations such as "low hormonal levels," "negative experiences," or "a fashion trend." Rather, it is a stable feature of the structure of attractions, like other orientations, which is experienced and understood differently by people. For practitioners, it is more important not to look for a "culprit," but to assess whether a person is suffering, whether they need help, and how to support them in connecting with themselves and their partners. [23]

Table 4. Groups of factors discussed in the context of asexuality

Group of factors	Examples	Degree of proof
Biological	Neurotransmitters, features of the response of reward systems	Discussed, no single confirmed model
Hormonal	Testosterone and estrogen levels	Typically within normal limits for most
Psychological	Attachment experience, personal beliefs	Important to experience, but don't explain everything
Social and cultural	Norms of society, media, online community	Affect self-identification and visibility

[24]

How asexuality manifests itself: the spectrum, romance, and relationship scenarios

Asexuality manifests itself primarily in subjective experience. A person may notice that they have never felt the desire to have sex with anyone, that erotic scenes evoke curiosity or indifference, but not an internal impulse to act. A physical response, such as genital arousal, may be present, but it is not experienced as a "desire for sex" in the traditional sense. [25]

Within the asexual spectrum, several identities are distinguished. Gray asexuals describe rare and weak bursts of sexual desire, while demisexuals say sexual desire emerges only after forming a deep emotional connection. This spectrum helps people find more precise words for their experiences and better explain them to potential partners. [26]

Romantic orientations among asexual people also vary. Some identify as heteroromantic, homoromantic, bisexual, or pansexual romantically, meaning they experience infatuation and affection, but without a sexual dimension. Others call themselves aromantic, meaning they experience virtually no romantic attraction to anyone, although this does not preclude close friendships. [27]

The lives of asexual people vary widely. Some form long-term relationships with people of similar sexuality, others choose relationships in which sex is present for the sake of the partner but not an internal need, and some prefer to live alone or in atypical family settings. The presence or absence of sex in itself doesn't make such relationships better or worse; voluntariness and mutual consent remain key. [28]

It's important to remember that asexuality doesn't preclude masturbation, erotic fantasies, or an interest in physical intimacy. Some asexuals use sexual activity as a means of relaxation or satisfying a partner, while others prefer to avoid sex entirely. All of this falls within the spectrum of asexual experience and doesn't negate the fundamental characteristic—the lack of sustained attraction to other people. [29]

Table 5. Asexual spectrum variants and sample experiences

Identity	Brief description of the experience	Possible relationship scenarios
Asexuality	Persistent lack of sexual desire	Partnerships without sex or with rare sex
Gray asexuality	Rare, weak episodes of desire	Occasional sex, frequent indifference
Demisexuality	Desire comes after a deep connection	Sexuality only in trusting relationships
Aromanticism	There is virtually no romantic attraction.	Friendships, single life

[30]

Asexuality, mental health, and relationships

Research shows that asexual people are more likely to experience anxiety, depressive symptoms, and feelings of social isolation than heterosexual and homosexual respondents. However, it is important to emphasize that this is not a "mental illness of asexuality," but rather the consequences of stigma, misunderstanding, and environmental pressure that imposes the idea of "normality" on an active sexual life. [31]

Some asexual people describe feeling "broken" or "abnormal" in adolescence and early adulthood, especially when surrounded by conversations about sex and romantic relationships. Lack of awareness of asexuality as an orientation increases anxiety and can lead to attempts to "remake oneself" through sexual coercion, which only increases psychological distress. [32]

In relationships with partners, the main sources of difficulty are different levels of sexual interest and expectations. A partner with a typical level of attraction may perceive abstinence from sex as rejection, while an asexual person may feel pressured and guilty. Openly discussing sexual orientation, seeking compromises, and, if necessary, working with a family counselor can help build stable relationships without violence and hidden resentment. [33]

Some asexual people face discrimination and misunderstanding even within sexual minority communities. Research shows that asexuals are sometimes perceived as "cold" or "inferior" compared to other sexual minorities. This reinforces feelings of loneliness and the need for their own support networks.

At the same time, many asexual people experience a high quality of life, especially if they have found a language to describe their identity and a supportive environment. Conscious acceptance of one's orientation and the refusal to pathologize one's condition are associated with lower levels of depression and greater life satisfaction, even if sexual activity is completely absent. [35]

Table 6. Potential difficulties and resources for asexual people

Region	Possible difficulties	Important resources
Mental health	Anxiety, depression, feeling of being "abnormal"	Information about asexuality, therapy if needed
Relationship	Conflicts due to different levels of desire	Open dialogue, agreements, couples therapy
Social life	Stigma, misunderstanding, pressure to “be like everyone else”	Support communities, online resources, activism

[36]

Asexuality in adolescents and young adults

Adolescence and early adulthood are a period when most people first experience sexual interest, experimentation, and identity development. For those who don't experience sexual attraction, this stage can be accompanied by a particularly strong sense of difference from their peers. Young people see their friends falling in love, talking about sex, and trying out relationships, while they have no such desire. [37]

At the same time, adolescents and young adults generally experience more variable and unstable sexual interest. For some young people, a temporary lack of interest may be due to developmental factors, stress, cultural restrictions, or religious beliefs, and may not necessarily indicate asexuality as a stable orientation. Therefore, experts emphasize the importance of a cautious approach, avoiding labels and pressure to "make a decision once and for all." [38]

Studies of college and high school students show that a significant proportion of young people have no sexual experience until late adolescence and even after age 18, but this is not always due to a lack of sexual desire. When assessing asexuality, it's not so much the presence of experience that matters, but the persistence of the lack of desire and the individual's attitude toward this characteristic.

Mental health risks in young people are primarily associated with a combination of internal misunderstanding and external pressure. If a teenager or young adult is constantly told that "there is no life without sex," there is a high risk of developing a sense of inferiority, especially in the absence of positive asexual role models. The task of parents, teachers, and doctors is to provide a broader picture of normalcy and avoid shaming. [40]

An important aspect is the ability to safely discuss your concerns with a specialist. A qualified sexologist or clinical psychologist can help differentiate a temporary decline in interest from a stable orientation, explain the difference between asexuality and sexual desire disorders, and, if necessary, assess the presence of anxiety, depression, or other conditions that require treatment. [41]

Table 7. What to look for in adolescents and young adults

Sign	Possible meaning
Persistent lack of sexual desire over several years	It may be a sign of asexual orientation.
Temporary loss of interest due to stress or illness	Often a reversible condition
Strong feelings of being "different from others"	A reason for support and, if necessary, consultation
Pressure from partners or peers	Risk of trauma and boundary violation

[42]

Self-diagnosis, tests, and when it makes sense to consult a specialist

There are numerous questionnaires and "asexuality tests" available online that ask questions about a person's desire for sex, their attitude toward erotic topics, and whether a lack of desire bothers them. These tools can help people reflect on their experiences, but they are not an official diagnosis. No professional guidelines provide a formal "diagnosis of asexuality" in the traditional medical sense. [43]

The main criterion for self-definition is internal consistency. If a person notices a lack of sexual desire over a long period of time and feels that the label "asexual" helps them better understand themselves and communicate with others, that's enough. The asexual community emphasizes that everyone has the right to use or not use this term, as long as it helps and doesn't hinder. [44]

Consulting a doctor or psychotherapist is advisable if a lack of sexual desire is accompanied by distress, anxiety, depressive symptoms, somatic complaints, or relationship conflicts. A specialist can help rule out endocrine and other medical causes of decreased desire, assess mental health, and discuss whether the condition is related to sexual orientation or reversible factors.

It's important to discuss expectations for the consultation in advance. If a person isn't seeking "asexuality treatment" but support in self-acceptance or resolving conflicts with a partner, this should be clearly stated. An ethical specialist respects the patient's self-determination and won't push the goal of "making you sexually active" if the person doesn't want it and doesn't consider it necessary. [46]

More broadly, awareness of asexuality is important not only for asexual people themselves, but also for their partners, families, and doctors. Understanding that lack of sexual desire can be a normal and persistent characteristic reduces the risk of stigma, misguided medicalization, and traumatic attempts at "fixing" that do more harm than good. [47]

Table 8. When tests and consultation may be helpful

Situation	What can help?
A man doubts whether he is asexual	Discussion in supportive communities, reading materials, gentle self-tests
Lack of sexual desire causes anxiety or distress	Consultation with a sexologist or psychotherapist
Conflict with a partner due to different levels of attraction	Family or couples therapy, joint information
Questions about hormonal status or physical health	Doctor's appointment, basic examinations as indicated

[48]