Dear Dr. Queen,

Is it possible for a guy, when he gains weight, to be so upset about it that he stops wanting to have sex? This is the case with my boyfriend, or so he says. How common is this among men? He has gained this extra weight for the first time, and he is definitely having a hard time with it, but I don't get how if I still find him attractive, he can't just forget about how he looks for long enough to have sex! Can you help?
-- Slim

Dear Slim,

We expect this kind of response from body-image-conscious women -- at least, we're not very surprised by it -- but the dirty little secret of men today is that many of them are just as focused on, and worried about, their looks as the gals have traditionally been. This means that when a guy isn't in the trim, he can harbor doubts about his attractiveness to the point that he withdraws emotionally or sexually; if he's single, he might withdraw socially to the point that he doesn't try to meet possible partners. I don't know that anyone has researched how common this is, but male body focus is definitely on the upswing: witness the gym craze and such male body modifications as ab and pec implants, not to mention my least favorite body mod of all, penis "enhancement" surgery.

Gay male culture has dealt with this body image thing in a creative way: plenty of men find big men erotic (this is the basis of the "bear" subculture that's sprung up within the ranks of the hyper-toned). There's bear porn, sex ads from horny "chubby chasers," and clubs to join where big boys find ardent admirers. None of this exists in such well-developed form among straight folk, although if you look, you will find plenty of hetero men fetishizing large women. It stands to reason that some women like big boys too, but porn for them is in awfully short supply. Cruising the Internet may lead you to chat rooms where this is a hot topic, but it's not like you can just go outside and readily access such a subculture.

And none of this may impress your boyfriend anyway. Particularly if his weight gain is recent, he is still dealing with the change in his body and his image of himself. A poor body image is quite an anti-aphrodisiac, so his withdrawing sexually is no great surprise. However, if there is any chance at all that his weight gain results not from a suddenly sedentary lifestyle with plenty of cake and ice cream in the diet, but from other less obvious physiological processes, your boyfriend should go get a thorough physical and mention weight gain and libido loss as presenting issues. There are health problems that can manifest this way, and furthermore, a sudden loss of libido is a classic sign that a serious disease process may be underway. No amount of "I-love-my-body-just-the-way-it-is" introspection and affirmation will restore his sex drive if something internal is affecting it.

Libido downswings and weight gain may also be associated with the onset of depression. So if his physical looks good, there is still the question of his emotional state. Beware of anti-depressant drugs, some are surely lifesavers for the people who need them, but many of them affect libido and erectile capabilities. If your boyfriend is diagnosed with depression and prescribed a drug regimen to deal with it, have him tell his doctor that he wants to try the anti-depressant with the fewest sexual side effects. If the doc doesn't know much about this, your partner can read up on the meds in question on the Internet or in the nearest medical library. (He should also consider another doctor, since not caring about depressed peoples' sex lives isn't a sign of a very aware and compassionate clinician.)

Finally, I assume you are reassuring him that you still find him sexy -- keep this up, as it may eventually sink in. You might also offer to support him in any healthy diet or exercise regimen he chooses -- take walks every day, for instance -- to help him get in better shape. Whether or not this makes him lose weight is almost irrelevant, because libido loss is also associated with the sedentary lifestyle that fosters weight gain.