What Is Hypoactive Sexual Desire Disorder?
Hypoactive sexual desire disorder (HSDD) presents as persistently low sexual desires, negligible sexual fantasies, and a general lack of interest in sexual activity. The condition results in active distress and interpersonal difficulty. It is one of two sexual desire disorders (the other being sexual aversion disorder).
Who Is Affected by Hypoactive Sexual Desire Disorder?
HSDD affects both sexes, although the condition is more prevalent in women - women are two times more likely to experience sexual desire disorders than men; around 35 % - 40 % of women experience HSDD, as opposed to about 5 % to 25 % in men.
How Is Hypoactive Sexual Desire Disorder Classified?
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Primary or Lifelong Hypoactive Sexual Desire Disorder: Primary or lifelong HSDD refers to a lifelong lack of sexual interest in the individual. It may manifest as low libido, limited thoughts of sex before first sexual contact, and disinterest with reduced sexual desire right from the first sexual experience.
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Secondary or Acquired Hypoactive Sexual Desire Disorder: Secondary or acquired HSDD refers to sexual disinterest developed after a period of regular sexual functioning and desire.
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Generalized Hypoactive Sexual Desire Disorder: In generalized HSDD, sexual desire is absent in all sexual circumstances, regardless of the partner, the situation, or the type of sexual activity.
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Situational Hypoactive Sexual Desire Disorder: Situational HSDD is specific to situations and people. It may be noted as occurring only in response to a particular sexual partner or aspect of sexual activity or during moments of stress.
What Causes Hypoactive Sexual Desire Disorder?
Hypoactive sexual desire disorder is attributed chiefly to causes other than medications (from a diagnostic perspective). However, clinically, various reasons may be responsible, including the use of certain medications.
Male Hypoactive Sexual Desire Disorder:
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Hormonal Causes: Deficient androgen (male sex hormone), excess prolactin (a hormone secreted by the pituitary gland, involved in male reproduction and health).
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Systemic Illnesses.
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Medications: Selective serotonin reuptake inhibitors (SSRIs), antihypertensives (medicines for high blood pressure), anticonvulsant medication, and cancer chemotherapy drugs.
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Psychological Conditions: Depression, low self-esteem, emotional or sexual dysfunction, body image issues.
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Emotional Issues: Relationship issues, family problems.
Female Hypoactive Sexual Desire Disorder:
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Chemical Imbalance: An imbalance of neurotransmitters in the brain can inhibit libido (desire for sexual activity).
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Systemic Illnesses: Breast cancer, multiple sclerosis, diabetes, thyroid dysfunction.
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Medications: Antidepressants, antihypertensives, and pain medications.
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Psychological Conditions: Anxiety, depression, low self-esteem, and body image issues.
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Emotional Issues: Relationship issues, family problems.
What Are the Signs and Symptoms of Hypoactive Sexual Desire Disorder?
The diagnosis of hypoactive sexual desire disorder rests on the signs and symptoms that include:
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Reduced motivation to engage in any form of sexual activity that may be due to:
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Diminished spontaneous sexual desire (sexual fantasies and thoughts).
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Diminished stimulated sexual desire (in response to erotic stimulation).
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Reduced capacity for the maintenance of sexual desire.
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General lack of interest in sexual activity.
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Behavioral changes related to lack of motivation:
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Failure to initiate sexual activity.
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Engaging in sexual intercourse to maintain peace in the relationship or due to fear of partner betrayal and loss.
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Avoidance of sexually charged atmospheres and situations.
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Emotional distress as a consequence of reduced sexual capacity, which is manifested as:
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Feelings of low self-esteem.
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Feelings of incompetence.
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Guilt.
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Fear.
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Worry.
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Depression.
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Sadness.
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Confusion.
The key to diagnosing hypoactive sexual desire disorder lies in certain pre-requisites in tandem with the signs and symptoms:
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The affected person must show signs of distress at their reduced ability to feel sexual desire. Lack of distress may be seen in premenopausal or older women - this cannot be categorized as hypoactive sexual desire disorder.
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The patient should have been able to participate in healthy sexual activity before developing symptoms of HSDD. Individuals who have a lifelong history of HSDD would be diagnosed and treated on that basis, as opposed to those who have recently acquired it.
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On average, the reduced libido and interest in sexual activity should have been noted consistently for the previous three months. This is important because occasional instances of reduced sexual desire for a shorter period of time are inconsistent with a diagnosis of HSDD. They may be isolated cases that are not indicative of a disorder.
What Is a Sexual Response Cycle and Why Is It Important for Hypoactive Sexual Desire Disorder?
The sexual response cycle is a progression of physical and emotional changes that occur during sexual activity. It occurs in four phases:
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Excitement: Motivated by sexual desire and arousal - displays increased heart rate, muscle tension, and blood flow, resulting in swollen or erect genitals.
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Plateau: Intensification of the changes occurring during the excitement phase.
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Orgasm: The shortest phase, characterized by involuntary muscle contractions, the release of sexual tension, and ultimately, sexual fulfillment.
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Resolution: The body returns to normal functioning again, and partners may experience emotional intimacy.
The sexual response cycle guides how sexual dysfunction and sexual desire disorders, including HSDD, are understood, diagnosed, and treated. Given the different physical and emotional changes accompanying the sexual response cycle, it is easier to identify the stage at which sexual dysfunction occurs and determine what underlying component or driving factor needs to be looked into.
How Is Hypoactive Sexual Desire Disorder Treated?
Treatment of hypoactive sexual desire disorder should focus on treating the cause, as well as the component that distresses the affected individual most. Often, these factors are one and the same.
Common aspects of treatment are:
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Psychosocial.
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Biological.
Treatment options may include:
Psychotherapy:
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Cognitive and Motivational: Psychotherapy is used for cognitive and motivational issues - it addresses negative thoughts, behaviors, and reactions to sexual activity and attempts to convert these into positive reinforcements and responses.
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Cognitive Behavioral Therapy (CBT): CBT addresses negative thoughts or behaviors that infringe upon sexual activities and distract from the focus on sexual pleasure and desire. It also tries to change sexual behavior by placing the onus on sexual pleasure and achieving it through any form of sexual activity rather than altogether avoiding sex.
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Mindfulness: Mindfulness is equivalent to awareness. It focuses on staying in the here and now and being in touch with one’s feelings and emotions. This would help with staying present in the moment when sexual activity is taking place and understanding female sexuality and how thoughts and behaviors can influence sexual interest and patterns.
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Sensate Focus: Sensate focus therapy is directed at couples, where progressive touching in an undemanding fashion leads to reduced anxiety about being touched or sexually stimulated. Initially, the touching does not involve genital areas, but genital touching may be included, culminating in sexual intercourse as it progresses.
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Sex Therapy: A sex therapist can help get to the root of psychologically-motivated factors for HSDD, engage couples in sex exercises, and provide counseling where necessary.
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Counseling: Counseling will enable physicians and therapists to validate sexual concerns and provide tailored solutions.
Drug Therapy:
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Flibanserin: Flibanserin is a non-hormonal, FDA-approved drug for generalized acquired HSDD that increases sexual desire, decreases distress, and improves sexual satisfaction.
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Bupropion: While Bupropion is commonly used as an antidepressant and in smoking cessation, it has seen some success in treating HSDD by improving sexual function.
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Buspirone: Buspirone is an approved drug for anxiety - however, it has also achieved positive outcomes with HSDD. Reduction in medically-induced sexual dysfunction has been noted with the use of Buspirone.
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Testosterone: Testosterone therapy has proven effective in both men and women suffering from HSDD. It may be provided as a transdermal patch that releases testosterone, which is absorbed by the skin and into the bloodstream. The therapy has been shown to improve the quality of sexual events and sexual desire.
Can Hypoactive Sexual Desire Disorder Be Treated At Home?
Hypoactive sexual desire disorder usually occurs due to a reasonable underlying factor that may require psychotherapy or drug administration. Attempting to “fix” the problem alone may only worsen the situation and increase feelings of guilt and frustration. Consulting a sex therapist or physician is recommended if HSDD symptoms accompanied by extreme distress are cropping up.
How Can Partners Help?
Partners, like the patients, may also be suffering from guilt, worry, and feelings of inadequacy. It is important that they also refrain from attempting to fix the patient or place blame on themselves or their partner. Providing support and understanding that the disorder is not necessarily because of a lack of love is necessary to maintain a happy relationship and achieve better outcomes from treatment.
Conclusion:
The distress that accompanies disorders of sexual desire is valid and understandable. Reaching out to a supportive therapist, being accepting of oneself, and remaining patient and optimistic will lead to more satisfying sexual outcomes.
