One-third of adult women in the United States may experience female hypoactive sexual desire disorder (HSDD)

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One-third of adult women in the United States may experience female hypoactive sexual desire disorder (HSDD).  HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty.

Several female reproductive life experiences may uniquely affect sexual desire. These events include menstrual cycles, hormonal contraceptives, postpartum states and lactation, oophorectomy and hysterectomy, and perimenopausal and postmenopausal states (Warnock, 2002).  Notably, HSDD shares some similarity with depression, as its etiology can be explained using a biopsychosocial model that includes biological, psychological, and sociocultural factors, as well as interpersonal influences (Kingsberg, 2020).  Thus, female HSDD can greatly impact the quality of life. 

HSDD is well established as a valid and treatable clinical diagnosis. Even for those inexperienced in treating sexual problems, there are simple and validated screening tools such as the Decreased Sexual Desire Screener that can help identify HSDD and a need for further evaluation and treatment.  Despite the current consensus in the literature that HSDD can manifest at any age in a woman’s life, it is documented that during menopause, up to 40% of women experience reduced sexual libido (AlAwlagi, Amor & Hammadeh, 2017). 

DSM 5 Criteria

1. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
   1. Absent/reduced interest in sexual activity.
   2. Absent/reduced sexual/erotic thoughts or fantasies.
   3. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate.
   4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
   5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
   6. Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (approximately 75%–100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
2. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.
3. The symptoms in Criterion A cause clinically significant distress in the individual.
4. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether:

• Lifelong: The disturbance has been present since the individual became sexually active.
• Acquired: The disturbance began after a period of relatively normal sexual function.

Specify whether:

• Generalized: Not limited to certain types of stimulation, situations, or partners.
• Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current severity:

• Mild: Evidence of mild distress over the symptoms in Criterion A.
• Moderate: Evidence of moderate distress over the symptoms in Criterion A.
• Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.

Despite the stigma, this issue has gained attention in the medical field.  In addition, several pharmacologic agents have been designed to target HSDD and are in various stages of clinical trials. However, the field continues to face some hurdles including a lack of information, confusion over medications and management, and the discomfort associated with addressing the subject of sexuality (AlAwlaqi, Amor & Hammadeh, 2017).