What issues you should cover

Define reduced sexual desire—The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), defines hypoactive sexual desire as a deficiency or absence of sexual desire or fantasy causing personal distress, interpersonal difficulty, or both. Explore exactly what she means by never being in the mood. Does she initiate sex? What kind of sexual contact is she having (or not)?

Causes—These can be psychological (most cases) or physical, although they often overlap. Relationship problems (unexpressed negative feelings about the partner, extramarital affairs), motivational problems (fear of loss of femininity, loss of reproductive potential), cognitive problems (low self image and self esteem), family problems (“empty nest” syndrome), and life stresses (retirement, financial worries) are common associations. Physical causes can be systemic (anaemia, …