Hypoactive Sexual Desire Disorder

There have been reports of women stating a low sexual desire from at least 1972.

Here are some stats from recent studies:

Berman et al (2003)
• Sample:4,000 women with sexual dysfunction
• 40% reported not seeking help
• 54% of those would have liked to seek help

National Health & Social Life Survey (1999)
• 43% of American women suffer from sexual dysfunction
• 1/3 say they lack sexual interest
• About ¼ to not experience orgasm
• About 20% report lubrication difficulties
• About 20% find sex not pleasurable

It is also known that women are unlikely to discuss sexual dysfunction or dissatisfaction with their physician.

In 1977, low sexual desire was labeled as a specific disorder. However, only 10% of women ages 18-45 meet the criteria for a desire disorder diagnosis. That means that you are probably one of the many that has only a few hurdles to increasing your libido! And even if you do have HSDD, there are still many forms of treatment.

As a clinician, this is the diagnosis criteria that I would use.

Hypoactive Sexual Desire Disorder (HSDD)

A. Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person's life.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong Type
Acquired Type
Specify type:
Generalized Type
Situational Type
Specify:
Due to Psychological Factors
Due to Combined Factors

Assessment

Here is a rough outline of what I’d do and ask about:
1. Clarify the problem (e.g. details, history, past attempts at treatment)
2. Determine onset (gradual, acute, lifelong)
3. Determine context for the complaints (generalized or situational)
4. List all sexual symptoms
5. Go over typical sexual response cycle
6. Consider partner reaction to the sexual dysfunction (level of conflict, stress)
7. Assess couple motivation for treatment
8. Medical, psychiatric and surgical history

Each of these would impact how to treat the sexual dysfunction. I like to match the type of treatment with the cause. For example, if you’re taking Paxil or Zoloft I’d explain that about 70% of the patients on those medications have sexual side effects. I’d suggest you look into alternative medications. If you think it’s psychosocial, I’d suggest counseling, talking to partner etc. I almost always suggest Sensate Focus for clients presenting with sexual concerns.

Here are some possible treatments:

Physical

• Adjust or change medications that have sexual side effects. Look up the side effects of current medications.
• Treat thyroid problems or other hormonal conditions. You can usually have your doctor order blood work to test this.
• Optimize treatment for depression or anxiety. Make sure you’re following through on your doctors recommendations. Also, I recommend reading Feeling Good and When Panic Attacks.
• Try strategies recommended by your doctor to help with pelvic pain or other pain problems
• Estrogen, Progesterone or Androgen Therapy
• Tibolone, Provestra, Hersolution or Vigorelle (Not FDA approved). *In a small study, women taking the drug experienced an increase in vaginal lubrication, arousal and sexual desire.
• Strengthen pelvic muscles by doing Kegal Exercises
• Have a healthy lifestyle by eating well, exercising, getting enough rest etc.
• Estrogen vaginal cream
• Switch medications to something less likely to affect hormones (e.g. lots of birth controls impact libido depending on amounts of hormones)

Psychological

• Seek Counseling. Look for somebody that says they have experience working with sexual issues. Even better, look for somebody who has treated sexual issues relationally (with couples as well as individuals). The best sex therapy occurs when both partners are involved. *Cognitive Behavioral Therapy has resulted in 75% of women significantly improving with 65% remaining improved at 1-year follow-up. (Basson et al., 2005)
• Talk to your partner. Let them know how you’re feeling and have intimate, connecting conversations.
• Sensate focus, which is similar to systematic desensitization, often found in therapies that treat anxiety, is shown to have about a 50% success rate following treatment. (Basson et al., 2005) This means that it is still effective even after finishing therapy and sensate focus exercises; it has lasting effects.

Happy Valentine's Day! And a WINNER!

Happy Valentine's Day, Loves! Did you know this is my favorite holiday? Oh really?... How'd you know? I'm so glad we could do a little Valentine's Day Giveaway today and am so pleased to announce the winner. Including the anonymous email entries I received, there were a whopping 132 entries! We may just have to do this again sometime :)

The winner was an anonymous email entry and has asked that I keep her name private. I have contacted her via email so check your inboxes :)

In case you missed it, here's what she's won:

A pretty in pink Siri by Lelo. Babeland.com offers the Siri in pink and purple. Lelo designs high-end toys in discrete packaging. The unoffensive design puts to rest any discomfort or hesitation that a first time toy user may feel. Many of the reviewers on Babeland.com's site have named the Siri as their favorite accessory. It's rechargeable, sleek, quiet, and cute.

Here's what they say about the Siri on Babelands website:

Shake hands with Siri, and you may never need to meet another clit vibe again. A beveled shape for targeted clit vibration, six pulsation and speed options (controlled by an intelligent microprocessor, no less!), intuitive controls, and Lelo's quality construction and materials make for a perfect storm of pleasure. And as with all Lelo vibrators, Siri is rechargeable and nearly silent, so you can enjoy it anytime, anywhere. Cup it easily in the palm of your hand, and the rest will come as easy as Sunday morning. Comes with a one-year warranty against breakage or defects.

I hope you all have a fabulous Valentine's Day! Thank you again for participating in the giveaway and for all of your kind words.

xoxo,

Gwen

Sensate Focus Follow Up

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I'm curious to hear how The Sensate Focus Challenge went.

What went well? What didn't?

Did you and your partner learn anything new?

Were there difficulties? Why do you think?

Did you like it? Did it benefit your relationship?

Any tips or advice you'd give others doing this challenge?

As always, feel free to ask questions or make suggestions for future posts.

Valentine's Day Giveaway!

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Military Marriages

Dear Gwen,

First let me say I ADORE your blog. My question is what is your advice for us military wives? My husband is often gone and it is very hard on the relationship. Even when he comes home it takes a lot of time to slowly get back into the swing of things and get used to eachother again. Any ideas or tips on keeping the romance going for us gals' who's hubby is gone often?

-A Military Wife

{photo credit}

First of all, thank you so much for your kind words. And more importantly, thank you for your family's sacrifice. Military families are my heroes.

I'm not sure what protocol is for the military communication, but here is one solution I thought of for you. I assume you are able to send letters to one another.

Try writing an erotic letter to your husband. Don't hold back. Tell him what turns you on and describe your fantasies in detail. It doesn't have to be wild or crazy, but it certainly can if you'd like. The letter can be as simple as describing a past sexual encounter with him. Encourage him to have an orgasm. Though you are miles or seas apart, you will be connected. Tell him to write you back quickly because you are anxious to enjoy the same experience.

Your focus will remain on each other and you will feel as though you still know each other sexually.

Let me know if you try this, how it works out for you. Was his response positive?

Valentine's Day Wish, Simply Livly

Is this hint too bold for you, dear husband? Isn't this necklace from Simply Livly gorgeous?!

Sensate Focus: Levels 4 & 5

*To clarify, Level 4 is just penetration without any movement and stimulation afterward. Level 5 includes movement and continued stimulation, but stopping before orgasm. I posted both levels because I realize for some moving between these levels will happen quickly. Those who have difficulties with lubrication, tenseness, vaginismus, erectile dysfunction or other issues should move gradually between these levels.

Level 4: Penis inserted in Vagina

Check in with your partner regarding each other’s level of comfort with Level 3. Talk to each other. Did you learn anything new? What was it like to give feedback to your partner and tell them what your preferences were with how they touched you? What was it like to tune in to your partner’s body language and sense what they wanted? Is it safe to talk about touch? Are you anxious while discussing these exercises with your partner? What was it like to include genital touch without expecting intercourse? Once you have discussed your experience and both express comfort, you are ready for Level 4.

Level 4 of sensate focus includes all previous levels and now he may insert his penis into your vagina. Some of you may feel like it is extremely difficult to do this without working to orgasm or fully having intercourse. Slowing it down helps you each tune into the experience. This step is particularly important for women who are having trouble staying aroused after insertion or having trouble lubricating and for men having erectile dysfunction or premature ejaculation.

Which areas are more sensitive than others? Do you find you are aroused with some kinds of touch but not others? Do you find certain positions are more comfortable or stimulating? Do you find yourself tensing at any point? When? Is it easy for you to stay relaxed? Is there a certain order of touch that you prefer (foreplay) that you find more enjoyable? What happens if you do kegal exercises while his penis is inserted? Find out what you like and don’t like and help your partner to understand. The relationship has to be safe for this to be effective. Be open, honest and loving.

Level 5: Intercourse excluding Orgasm

Check in with your partner regarding each other’s level of comfort with Level 4. Talk to each other. Did you learn anything new? What was it like to give feedback to your partner and tell them what your preferences were with how they touched you? What was it like to tune in to your partner’s body language and sense what they wanted? Is it safe to talk about touch? Are you anxious while discussing these exercises with your partner? What was it like to insert penis without expecting intercourse? Did you find you were more relaxed? Once you have discussed your experience and both express comfort, you are ready for Level 5.

Level 5 of sensate focus includes all previous levels and now intercourse without orgasm. This may be really difficult. The goal is to help you both learn what is stimulating. Slowing it down helps you each tune into the experience.

Which areas are more sensitive than others? Are certain speeds more stimulating? Do you find you are aroused with some kinds of touch but not others? Do you find certain positions are more comfortable or stimulating? Do you find yourself tensing at any point? When? Is it easy for you to stay relaxed? Is there a certain order of touch that you prefer (foreplay) that you find more enjoyable? What happens if he uses his hand to stimulate your clitoris while having intercourse? What happens if you do kegal exercises while his penis is inserted? Find out what you like and don’t like and help your partner to understand. The relationship has to be safe for this to be effective. Be open, honest and loving.

Possible Modifications (Bonus Points):
Don't talk to each other. Cue in to each other's body language to see what each partner enjoys.
Turn out the lights or close your eyes.
Engage other senses. Light a candle. Face each other. Wear perfume. Leave the lights on.
Focus on one body area each day.
Spend an hour giving each other massages
Tell your partner what you like in their touch.
Grab his/her hand and guide them instead of just telling them.

How's it going? Are the conversations awkward or relaxed?

Ask the Audience: Sensate Focus

A few women are having trouble convincing their men to try the sensate focus challenge with them.

Have any of you talked your partners into trying sensate focus with you? What's worked?

Sensate Focus Challenge: Level 3

A few have asked for tips to improve their sex drive. Try sensate focus for a bit and I'll do a follow up post to answer this question more in detail. Sensate focus generally has a 75% success rate for increasing desire so give it a try.

Level 3: Nondemand Touch Including Breasts and Genitals

Check in with your partner regarding each other’s level of comfort with Level 2. Talk to each other. Did you learn anything new? What was it like to give feedback to your partner and tell them what your preferences were with how they touched you? What was it like to tune in to your partner’s body language and sense what they wanted? What was it like to have gentle touch without expecting intercourse? Is it safe to talk about touch? Are you anxious while discussing these exercises with your partner? Once you have discussed your experience and both express comfort, you are ready for Level 3.

Level 3 of sensate focus includes more nondemand touching and caressing except now you may include breasts and genitals. Which areas are more sensitive than others? Do you find you are aroused with some kinds of touch but not others? Do you like oral or manual stimulation more? Do you find yourself tensing at any point? When? Is it easy for you to stay relaxed? Is it okay for your partner to just directly touch genitals or do you prefer touch in other ares first? You have a few choices here. You could explore by stimulating close to orgasm to figure out what is arousing for your partner. (If you want to veer a bit, you could stimulate to orgasm. If you’re experiencing any anxiety or nervousness or tenseness then do not include orgasm. Remember, orgasm is not the goal. These exercises are to increase sensitivity and intimacy.) Find out what you like and don’t like and help your partner to understand. The relationship has to be safe for this to be effective. Be open, honest and loving.

Possible Modifications (Bonus Points):
Don't talk to each other. Cue in to each other's body language to see what each partner enjoys.
Turn out the lights or close your eyes.
Engage other senses. Light a candle. Face each other. Wear perfume. Leave the lights on.
Focus on one body area each day.
Spend an hour giving each other massages
Tell your partner what you like in their touch.
Grab his/her hand and guide them instead of just telling them.

How's it going? Do you find that you are having a hard time staying tuned in? Is it difficult to do nondemand touch without intercourse?