Sunday, February 26, 2012

Low Sexual Desire in Women: Is it "HSDD"?

Hypoactive Sexual Desire Disorder (HSDD) is a term used to describe a decrease in sexual desire in women.  How do you know if you have HSDD?

First of all, the diagnosis is a term describing sexual dysfunction.  There is a lack or complete absence of sexual fantasies, and a lack of desire for sexual activity.  The diagnosis comes from a clinician, not the patient.  No 'partner' is required to make the diagnosis.

Requirements include that the patient has distress or relationship problems.  It has to be a perceived problem.

The topic of female sexuality is of paramount interest for not only 'the female', but for all females. By default, it is also a topic of mental health, quality of life, Family Matters, Marital Relationships, procreation, and aging through menopause. There is one main fact that seems to stand out amongst all: #1) women are reluctant to volunteer information on sexual dysfunction, and #2) doctors are reluctant to ask women about sexual dysfunction.

Think of females and their sexual health. Now think of female sexual disorders. What is the most common female sexual disorder? It is Low Desire, with Laumann et al  estimating a stunning prevalence of 30% (1) in a 1999 study done in the United States of America.

In an earlier blog, we mentioned Masters and Johnson as being one of the first to describe a female model of the sexual response. Their paramount study was done in 1966 (2). It categorized, in a linear fashion, four stages of the sexual response: Excitement, Plateau, Orgasm, and Resolution. In 1977, Kaplan added Sexual Desire to this scenario (3).

Today's nonlinear description by Basson takes into account: physosocial and psychocultural matters, relationship satisfaction, emotional intimacy, and sexual stimuli (4).

The American Psychiatric Association classifies female sexual dysfunction into these categories:
Desire, Arousal, Orgasm, or Pain. We aim to focus on Desire, specifically Low Sexual Desire. But before we leave this item, we retain the stance that another reclassification is perhaps under way. Brotto suggests that Desire and Arousal be more of a 'combined' issue of Sexual Interest/Arousal Disorder (5).

To get to our final point here, what is low sexual desire? Both the WHO and the DSM-IV have similar descriptions for Hypoactive Sexual Desire Disorder, or HSDD. It is a recurrent or persistent absence or deficiency of sexual fantasies and desire for sexual activity, causing marked distress or interpersonal difficulty (6, 7).

So, it can be that:

(A) Decreased Sexual Desire  + (B) Problems  ~  HSDD.

(A) = No sexual fantasies, recurrent lack of sexual fantasies, no sexual desire, and/or recurrent lack of sexual desire;

(B) = Personal Problems/Distress, or Relationship Problems

How big is this problem? In the 2006 Women's International Study of Health and Sexuality ((WISHeS), HDSS was determined across the USA, Canada, Germany, Italy, and France.

In America, the prevalence of HSDD ranged from 9% to 26% (8).
In Europe, the prevalence of HSDD was from 6 to 16% (9).
Age and menopause mattered.

While many of the studies on female sexual dysfunction were done by telephone interview, this is to suggest that such anonymity is the result of ongoing female discomfort in talking face-to-face with her health care provider(s). So if a personal relationship or marriage is encountering difficulties due to 'mismatching' of sexual drive, low libido, chronic illness, or other matters having to do with sex, what is the doctor to do? First, let us provide encouragement that the patient needs to feel comfortable telling her doctor about sexual issues.

And if you are a female with low libido or a partner whose sex drive far succeeds yours, and this is causing you marriage or relationship problems, perhaps you do not know that you could have a diagnosis of HSDD. Talk to your doctor about it.

Let's open the door to some frank discussion.

It is time.

Medical Disclaimer: Nothing in this content is meant to advise, diagnose, treat, or cure any medical condition whatsoever. Please speak to your health care professional for medical advice. 
Full Disclosure: Dr. Margaret Aranda Ferrante is an Institute Physician with Cenegenics Medical Institute, specializing in Age Management Medicine.

(1) Laumann  EO, Paik A, and Rosen RC. Sexual dysfunction in the United States. Prevalence and Predictors. JAMA Vol 281(6), pp 537 - 544; 1999.
(2) Masters WH and Johnson VE. Human Sexual Response. Little, Brown & Co.; Boston, MA. USA (1866).
(3) Kaplan HS. Hypoactive Sexual Desire. J. Sex Marital Ther: Vol 3 (1), pp 3 - 9; 1977.
(4) Basson R. Using a Different Model for Female Sexual Response to Address Women's Problematic Low Sexual Desire. J. Sex Marital Ther: Vol 27(5); pp 395 - 403; 2001.
(5) Brotto LA. The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in women. Arch. Sex Behav. Vol 39(2), pp 221 - 239; 2010.
(6) World Health Organization. International Statistical Calculation of Diseases and Related Health Problems, 10th Revision. World Health Organization, Geneva, Switzerland; 1992.
(7) Basson R, Leiblum S, Brotto L, et al. Definitions of Women's Sexual Dysfunctions Reconsidered: Advocating Expansion and Revision. J Psychosom. Obstet. Gynaecol Vol 24(4), pp 221 - 229; 2003.
(8) Leiblum SR, et al. Hypoactive Sexual Desire Disorder in Postmenopausal Women. US Results from the Women's International Study of Health and Sexuality (WISHeS).  Menopause Vol 13(1), pp 46 - 56; 2006.
(9) Dennerstein L, et al. Hypoactive Sexual Desire Disorder in Menopausal Women: A Survey of Western European Women. J. Sex. Med. Vol 3(2), pp 212 - 222; 2006.


  1. What are women saying?

    (1) They don't think that sex is that important;
    (2) They wish they knew what it was all about;
    (3) Masturbation occurs;
    (4) The fear of getting pregnant interferes with sexual pleasure;
    (5) They want to experience orgasm during intercourse.

    ...AND.... we can confirm that women do not like to volunteer information about decreased sexual desire (i.e. few Comments)...

    ...BUT....we can also confirm that this is a 'red hot' topic that women really care about.

  2. Special Note: The Fear of Getting Pregnant needs to be added to future studies of Women's sexual desire.


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