What is Hypoactive Sexual Desire Disorder in Women?
Hypoactive sexual desire disorder (HSDD) is a condition often misdiagnosed and not properly treated, affecting many women. Social and cultural barriers, feelings of shame, and limited knowledge among healthcare providers contribute to people not being diagnosed or receiving sufficient treatment. HSDD was defined in 1980, in a guide used by mental health professionals, often referred to as DSM-III. This guide clarified that HSDD involves a persistent lack of sexual desire or fantasies, which leads to significant distress or difficulty in interpersonal relationships. In the context of HSDD, distress is mainly related to not having sexual desire or experiences.
If someone has a sexual desire disorder but does not experience distress, it is classified as female sexual arousal disorder (FSAD). This condition is characterized by decreased sensation, enjoyment, or excitement during sexual activity. Because there is a connection between sexual desire, interest, and physical arousal, both FSAD and HSDD have been reclassified as female sexual interest/arousal disorder (FSIAD) in a more recent edition of the guide, the DSM-5.
HSDD, as described in DSM-IV, has been widely studied. The results of these studies form the basis of our current understanding of sexual desire disorders and how to manage them. The occurrence of HSDD varies from 7.4% in women over 65 to as high as 12.3% among women between 45 and 64. However, with new advances in early diagnosis and management methods, there is now potential for better treatment options. This provides hope for women who were previously reluctant to seek help.
What Causes Hypoactive Sexual Desire Disorder in Women?
A woman’s sexuality is determined by a complex mix of physical, mental, biological, chemical, hormonal, medical, and social factors. Things like age, whether or not a woman has gone through menopause, cultural pressures, stress, difficult relationships, health conditions, side effects of medications, and physical factors can all play a part in a woman’s sexual desire. One particular condition that can affect sexual desire is Hypoactive Sexual Desire Disorder (HSDD), where a woman has low or no interest in sex. Things like personal situations, ethnicity, and culture can also influence sexual disorders. It’s been found that single women and Black women are reported to experience HSDD less than married women and White women.
Psychological factors and the relationship with a sexual partner can also significantly influence a woman’s sexual desire. Female circumcision, also known as Female Genital Mutilation (FGM), also plays a role. It’s a common practice in certain countries and cultures. Research has shown that women who have undergone FGM are more likely to experience reduced sexual desire, decreased sexual satisfaction, decreased sexual arousal with or without stimulation, and painful experiences during sex. Female sexual dysfunction and HSDD are much more common in women who have undergone FGM than those who haven’t.
Sex hormones like progesterone, testosterone, and estrogen also have an impact on a woman’s sexual desire. These hormones affect various parts of the brain and interact with neurotransmitters, which are chemical messengers in the brain. Some neurotransmitters are responsible for excitement and desire, primarily controlled by dopamine and norepinephrine (noradrenalin), which enhance sexual excitement, desire, arousal, and orgasm. Similarly, some neurotransmitters inhibit sexual desire and enjoyment, primarily through serotonin. Too much serotonin, or a decrease in metabolizing it, could result in the loss of sexual desire. Medicines like selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels, might cause symptoms like those seen in HSDD. Conditions and medications that increase serotonin or decrease dopamine levels have been linked to HSDD.
Risk Factors and Frequency for Hypoactive Sexual Desire Disorder in Women
HSDD, or Hypoactive Sexual Desire Disorder, is the most frequently reported sexual dysfunction in women. However, its exact prevalence was hard to measure in the past because there wasn’t a standard definition for it. In recent times, studies have been able to get a more accurate measure of its prevalence thanks to a standardized definition in the DSM-IV, which includes the important factor of distress.
The Pharmacogenomics in Depression Study (PRESIDE) found that HSDD prevalence varies with age. It affects 7.4% of women that are 65 years and older, 12.3% of women between 45 and 64, and 8.9% of younger women between 18 and 44 years old. Of all age groups, nearly 38.7% reportedly have sexual desire disorder, with or without distress. To ensure accurate diagnosis, the study used a Female Sexual Distress Scale (FSDS) score of 15 or above to identify patients with HSDD and distress.
The Women’s International Study of Health and Sexuality (WISHeS) showed varying prevalence across different locations. In Europe, the prevalence ranged between 6 and 16%. In North America, it ranged between 9 and 26%. Even though low libido tends to increase with age, distress related to low libido decreases, making HSDD more common in middle-aged women rather than older or younger women. Menopause, whether natural or surgically induced, greatly increases the incidence of HSDD.
- HSDD is also more common in obese women, smokers, those currently depressed, and those with lower education levels or undergoing hormone replacement therapy.
- HSDD is also linked to low self-esteem, dissatisfaction with sexual partners, emotional distress, back pain, fatigue, memory issues, and relationship difficulties.
Signs and Symptoms of Hypoactive Sexual Desire Disorder in Women
If a person has Hypoactive Sexual Desire Disorder (HSDD), a doctor has to carefully evaluate them. This involves looking into their medical history and performing a physical exam. The aim is to find out the cause of the issue and how long it has been a problem. This information can help the doctor develop an effective plan for their patient.
The first thing a doctor needs to figure out is what the main problem is. This could be anything from having no desire for sex, problems getting aroused, dryness in the vagina, not reacting strongly to foreplay, discomfort during sex, or difficulties reaching an orgasm. It’s important to thoroughly understand a person’s medical history. This is a critical part of diagnosing HSDD. A step-by-step process is needed when evaluating a patient for HSDD.
- Determine the primary sexual problem
- Look into arousal difficulties
- Investigate about vaginal dryness
- Check for insufficient response to foreplay
- Ask about discomfort during sexual activity
- Address challenges in achieving orgasm
- Gather and document a comprehensive medical history
Testing for Hypoactive Sexual Desire Disorder in Women
Women who struggle with HSDD, a condition that lowers sexual desire, can seek help in a variety of healthcare settings such as primary care offices, emergency departments, women’s clinics, mental health clinics, and sexual health clinics. However, many women might not talk about their problems due to embarrassment or fear. Therefore, healthcare professionals must recognise that some symptoms may be subtle or ignored. Unfortunately, some healthcare professionals might not have the knowledge, comfort, or time to effectively help patients with sexual desire or function concerns.
If doctors think that another underlying health condition might be causing HSDD, they could suggest tests such as complete blood count, thyroid stimulation hormone level, vitamin D level, and prolactin level. Physical examinations may also be needed. However, despite these tests, many healthcare professionals express low confidence in diagnosing HSDD, often feeling inadequately equipped to diagnose and treat sexual disorders.
To diagnose HSDD, taking a thorough patient’s history is crucial. Important factors include lack of interest in sex, difficulty with sexual arousal, vaginal dryness, difficulties responding to foreplay, pain during sex, and problems reaching orgasm. It’s important to note that not every woman with these symptoms has HSDD, and it is also possible to have more than one sexual disorder.
HSDD is diagnosed when a patient shows distress or concerns about their relationships on top of their sexual disorder symptoms. However, sexual symptoms without distress might suggest the presence of other sexual desire disorders other than HSDD.
Different tools, like questionnaires, are used to measure and screen for HSDD. One of such tools is the Female Sexual Function Index (FSFI) that gauges scores in six areas: desire, lubrication, arousal, orgasm, satisfaction, and pain. For each domain, there’s a scale from 1 to 5 with a score equal or less than 26.55 indicative of sexual dysfunction. Another tool is the Decreased Sexual Desire Screener (DSDS) which helps diagnose generalized acquired HSDD.
According to the DSM-5 medical classification system, for an HSDD diagnosis, symptoms should last at least 6 months. They also emphasize that a women’s reduced or lack of interest in sexual activity might be influenced by emotional, psychological, cognitive, and interpersonal factors. Women do not always engage in sexual activities strictly because of sexual desire. There can be other reasons such as feeling obligated to satisfy their partner’s needs, wanting an emotional connection or to exchange for nonsexual favors.
Medical, sociological, and psychological factors can be the root cause of HSDD or Female Sexual Interest/Arousal Disorder (FSIAD). For example, female circumcision or genital mutilation, trauma, and recent or previous abuse might affect sexual functionality. Heart disease, liver conditions, thyroid issues, neurological problems, and cancer are other factors that might contribute to developing sexual desires disorders. It’s also important for healthcare professionals to take into account any current and previous medication usage.
Treatment Options for Hypoactive Sexual Desire Disorder in Women
There are a variety of treatment options available for managing Hypoactive Sexual Desire Disorder (HSDD), including both non-drug related and drug-related interventions.
Treatment often starts with counseling and therapy. The process begins with educating patients about sexuality, emotions, the science behind the body’s reactions, and the right lifestyle choices to improve sexual desire and experience. This method of counseling is called psychosexual counseling and it can include various forms of therapy like cognitive behavioral therapy, mindfulness meditation, body awareness education, and relationship counseling.
Cognitive behavioral therapy is an advanced therapy that helps patients understand their thoughts and behaviours and is often used for deeper exploration. It’s been found to be very effective in managing sexual disorders, including HSDD. The goal is to change ineffective ways of thinking which helps to improve emotional well-being and change problematic behaviors.
There are a few FDA-approved medications for treating HSDD. One is Flibanserin, which helps by decreasing certain chemicals and increasing others in the brain that affect sexual desire. It was approved by the FDA in August 2015 for women before menopause.
In June 2019, the FDA approved Bremelanotide, another drug used to treat HSDD, specifically in premenopausal women. Bremelanotide works by stimulating a receptor in the brain that affects arousal, motivation, and sexual appetite. It should be used cautiously in women with heart disease concerns and its usage should be well-monitored.
Additionally, some non-FDA approved treatments or what’s known as “off-label” treatments are sometimes used for HSDD. These include bupropion and testosterone. Bupropion is a type of antidepressant that also increases certain chemicals in the brain that control sexuality and thus, can be beneficial in managing HSDD.
Testosterone is a hormone that’s been found effective for menopausal women with sexual desire dysfunction. The treatment plan for testosterone is often tailored to individual patients’ symptoms while trying to keep the side effects to a minimum. However, there’s mixed opinion on the use of testosterone in premenopausal women.
While it’s not highly suggested, oral and intramuscular testosterone are sometimes used. Their effectiveness, though, is inconsistent due to variances in dosage. On the other hand, transdermal testosterone (through the skin) is preferred for women. It’s available in the form of patches, gel, cream, or spray.
Patients who begin treatment with testosterone therapy should get their lipid levels and liver function checked periodically. Side effects can include changes in skin, voice, hair growth, and effects on lipid profile. Conversely, it can also provide some protective effects against breast cancer development.
Lastly, while Flibanserin is approved for premenopausal women, it has also been used effectively in postmenopausal women to improve sexual desire and decrease distress. Common side effects can include tiredness, dizziness, headaches, and nausea.
What else can Hypoactive Sexual Desire Disorder in Women be?
HSDD, which stands for Hypoactive Sexual Desire Disorder, is a condition that can be confused with many other conditions due to its large range of symptoms. One such condition is Low Sexual Desire (LSD) disorder, which shares many similar traits with HSDD. However, whereas LSD doesn’t need to be accompanied by distress, with HSDD it’s a critical part for diagnosis. Other mental health conditions, such as depression, obsessive-compulsive disorder, and personality disorders, can also imitate HSDD.
Some medications might cause side effects that resemble HSDD. Drugs, like selective serotonin receptor inhibitors (SSRIs), tricyclic antidepressants (TCAs), first-generation antipsychotics, and monoamine oxidase inhibitors (MAOIs), could simulate HSDD. If patients on these medications develop symptoms similar to HSDD, doctors might adjust the dosage or swap the medication to alleviate the symptoms without needing specific HSDD treatment. Certain blood pressure medications, like beta-blockers and calcium channel blockers, also have the potential to cause symptoms that give the impression of HSDD.
Notable too is that several health conditions like hyperprolactinemia, diabetes, connective tissue disorders, and liver disease might bring about symptoms that mimic HSDD. Other issues, such as sexual trauma, physical injury, and substance abuse or dependence, can also act like HSDD. Dysfunctions due to difficulties with sexual arousal, orgasm, or painful sex might be mistaken for HSDD, but dissimilar treatments may be needed to address these particular dysfunctions.
What to expect with Hypoactive Sexual Desire Disorder in Women
HSDD, or Hypoactive Sexual Desire Disorder, in women can have different outcomes depending on several things such as its root causes, personal traits, and how effective the treatment is. While the overall outcome can change from person to person, many people see improvements in their sexual desire and overall sense of wellness when the disorder is accurately identified and treated.
If you’re experiencing HSDD, it’s really important for you to get help from healthcare providers who can give recommendations for treatment that are tailor-made for you and provide you with ongoing support.
The outlook for people with HSDD can often be quite good if the disorder is identified early on and treated properly. However, there can be challenges along the way. These can include delays in diagnosis, which might be due to things like patients unwilling to seek help, healthcare professionals not considering the possibility of HSDD in women who come for help with different, but potentially related issues, and doubt in the ability of healthcare providers to both identify and adequately treat HSDD.
Possible Complications When Diagnosed with Hypoactive Sexual Desire Disorder in Women
: If Hypoactive Sexual Desire Disorder (HSDD) isn’t recognized and treated quickly, it can lead to a decrease in quality of life, self-esteem, and overall happiness. It may also lead to emotional distress and dissatisfaction in various aspects of life. This disorder can bring about both physical and emotional problems, affecting a person’s well-being, relations with others, and satisfaction with life. Potential issues related to HSDD include problems in relationships, reduced intimacy, and a negative self-perception.
Importantly, people with sexual disorders, including HSDD, are at a much higher risk of suffering from depression.
- Decreased quality of life
- Lower self-esteem
- Reduced happiness and satisfaction
- Emotional distress
- Dissatisfaction in life
- Relationship issues
- Decreased intimacy
- Negative self-image
- Increased risk of depression
Therefore, it’s vital for people suffering from HSDD to reach out to healthcare professionals. These professionals can provide a thorough evaluation, suggest suitable treatment options, and help manage any related issues. Honest communication with partners and seeking therapy or joining support groups can also be beneficial. Handling the challenges related to HSDD in such ways can greatly improve overall well-being and satisfaction in relationships.
Preventing Hypoactive Sexual Desire Disorder in Women
The main approach to managing and preventing Hypoactive Sexual Desire Disorder (HSDD) – a condition marked by low sexual desire, is to target the root cause of the issue and emphasize sexual health and well-being. It’s important to educate people about the value of maintaining a healthy sexual life, effective communication, and emotional closeness within their relationships, as these can prevent HSDD from developing.
Encouraging open conversations about sexual concerns, eliminating the shame or embarrassment surrounding sexual matters, and providing access to extensive sexual health education can empower people to seek help early if they experience signs of HSDD. Additionally, creating an understanding and supportive environment in medical settings can help detect and treat at-risk individuals in a timely manner.
Last but not least, by addressing changeable risk factors, promoting positive views on sexuality, and ensuring people have access to the right resources and support, attempts to deter and prevent can be crucial in decreasing the occurrence and influence of HSDD on people and their relationships.
