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.