Hypoactive sexual desire disorder (HSDD) is the leading sexual
complaint by women and is characterized by diminished or complete absence of
libido. It is found to occur in at least 20% of women in the US.
HSDD is an aversion to sex, a sexual apathy and sexual anorexia with inhabited sexual desire. In simple
terms, it can be defined as an extreme aversion to sex and absence of and avoidance
of all genital sexual contact with a sexual partner.
In extreme cases, the patient finds sex repulsive, revolting and distasteful so much so that phobic and panic
responses are exhibited. Hypoactive sexual desire disorder may either be
oriented against a single partner in particular, or it may be a lack of sexual
interest in anyone in general.
Low sexual desire is often associated with aging. It is estimated that 10% of women age 49 or younger have
low desire, 22% of women age 50 to 65 and 47% of women age 66 to 74 report low
Often HSDD is the result of either physical or emotional trauma. In general, a woman's sex drive is guided
by a complex system of signals between her brain, ovaries and other
reproductive sexual organs. It is a healthy brain, more than a healthy body
that dictates desire for sex. Often a disruption in this complex interaction
between brain and body may cause decreased interest in sex.
- Decreased sex drive or less interest in sex may occur
in a woman at any age. But this sexual dysfunction is more common during
and after menopause has ended. Several physical and psychological factors
cause sexual dysfunction. These include:
- Physical ailments such as diabetes, vaginal yeast
infections, urinary tract infections, heart disease, neurological
disorders, pelvic surgery, chronic liver disease, chronic kidney disease,
menopause, alcoholism, smoking, drug abuse, breast feeding, and recovery
- Psychological causes such as stress from work and
family, anxiety, marital discord, unresolved sexual orientation,
depression and previous traumatic sexual experiences.
- In some HSDD may be a primary condition and the
patient must have never felt any sexual desire or exhibited interest in
sex. This may be due to sexual trauma such as incest, sexual abuse or
rape. Sometimes repressive family attitude and rigid religious training
may be the cause for this primary HSDD condition.
- Whereas in some patients sexual desire might have
occurred formerly but it no longer has interest. Initial attempts at
sexual intercourse might have resulted in pain or sexual failure and hence
- Insufficient levels of sexual hormone, testosterone
can cause HSDD in males and females.
- Boredom in relationship with a sexual partner results
in acquired HSDD.
- Depression, use of psychoactive or antihypertensive
medications may contribute to this problem. Studies indicate that at least
12% of women experience clinical depression at some point of time in their
lives. One of the side effects of popular anti depressants is loss of
libido. She may feel isolated and overwhelmed and withdraw from sexual
- HSDD may result from impairment of sexual function
such as vaginismus on the part of female. Vaginismus is a voluntary
contraction or spasm of the lower vaginal muscles resulting from an
unconscious desire to prevent vaginal penetration. This may be due to
incompatibility in sexual interest between the sexual partners. This can
also occur in the presence of a sexually demanding partner.
- Dyspareunia or painful intercourse is another common
deterrent to genital sexual activity in women. This is caused by
vaginismus or local urogenital trauma or inflammatory conditions such as
hymenal tears, labial lacerations, urethral bruising, or inflammatory
conditions of the labial or vaginal glands.
- Delayed sexual maturation may be a potential cause of
HSDD. In girls, this is characterized by lack of breast enlargement by age
thirteen or by a period greater than five years between the beginning of
breast growth and onset of menstruation.
Signs and symptoms of HSDD
There is an inability to attain
or maintain adequate vaginal lubrication and swelling response. Intercourse is
painful and involuntary contraction of vaginal muscles, vaginismus occurs.
There is delay or absence or orgasm. She avoids having sex and she ignores her
own personal hygiene to avoid having sex. She has fewer erotic dreams and
HSDD and menopause
During and after menopause, the
estrogen level is remarkably reduced in women. This leads to dryness of the
vagina which makes sex painful. This in turn leads to reduced motivation in
sexual intercourse. The decrease in drive is due to the gradual decline in the
hormones estrogen, progesterone and testosterone.
Although this disorder is
prevalent in women in all reproductive stages, it is seen that younger,
surgically postmenopausal women are at greater risk. Prevalence in naturally
postmenopausal women is 9% and in surgically postmenopausal younger women is
Treatment of HSDD
Treatment of HSDD is related to
its cause. If the reason for the problem is medical, then necessary therapy and
cure is affected. For instance, if the cause is diabetes, improvement in
diabetes control should be aimed.
In case of insufficient
testosterone, diagnostic tests are done and supplemental replacement therapy is
aimed. Testosterone level less than 20 ng/dl in females indicates need for
supplemental replacement therapy.
Low dosage testosterone treatment option is well supported by
several researchers and doctors although it has not been approved by FDA. There
has been enormous success in treating low-libido patients with supplemental
testosterone. Several women who have used the testosterone patch have reported
significant increase in the frequency of sexual activity and satisfying desire.
A study reveals that women in the testosterone group had a 52% meaningful
benefit when compared to other treatment options.
Other treatment methodologies include
anti depressants, hormone replacement therapy, androgen therapy, herbal
remedies, psychotherapy and marriage counseling.
The prognosis is reasonably good,
for instance, in case of treatment of a prolactin secreting pituitary tumor;
whereas in case of certain genetic defects such as Turner's syndrome and
Klinefelter's syndrome there can be no attainment of sexual function even after
But as such, there is no approved
pharmacological treatment for HSDD. Even psychotherapy has proved to be only
minimally effective. If the underlying cause for HSDD is interpersonal in
nature, therapy for couples should help as support and understanding of the
sexual partner is essential.
It can be observed that majority
of HSDD cases are situational in nature arising out of dissatisfaction and loss
of interest in the sexual partner. Although significant assistance can be
rendered to couples with marital discord, most of the times there is poor
response to such therapy. More often than not, the marriage breaks, and the
partner opts to find a new sexual partner after divorce.
Side effects of treatment for HSDD
Possible side effects of treatments for HSDD include sleep disorders, headaches, irritability, and
sexual dysfunction in women using antidepressants. Vaginal bleeding, tenderness
of breast, weight gain, abdominal bloating can be observed in women using
hormone replacement therapy. Acne, greasy skin, excessive hair and elevated
cholesterol using androgen therapy are normally observed.
Prevention of HSDD
In women sexual dysfunction is often linked to menopause and its side effects such as depression, she could
well see a healthcare professional before HSDD can become a serious problem.
Early treatment and management should help minimize her problems.
But a thorough understanding and support from the
sexual partner is essential for successful treatment of HSDD. In fact there are
therapists who would recommend abstinence from genital sex for a period of time
and concentrate instead on non-genital sex for effective treatment of HSDD.
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