What Is HSDD?
Hypoactive sexual desire disorder (HSDD) has been a topic of hot debate for many years. You may have heard it being referred to as sexual aversion, inhibited sexual desire, or more colloquially as "frigidity". It was estimated that one in 10 premenopausal women suffer from HSDD in the United States, making it the most common sexual dysfunction in women.
The term HSDD was first introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to describe the lack or absence of sexual desire. The International Society for Sexual Medicine describes HSDD as a chronic loss of interest in sex that causes distress to the affected person.
Note that it is not unusual for a woman’s sexual desire to fluctuate from time to time, and that some people identify as being asexual (lack of sexual attraction to anyone). Losing your sex drive is not enough to get a diagnosis. Personal distress is a critical criterion. Patients must be experiencing it for at least six months.
Sexual Desire vs Arousal
Sexual interest and sexual arousal were believed to be separate, though linked, processes in both men and women. Sexual interest is an individual’s desire to engage in sexual activity while arousal is the body’s response to sexual excitement.
In women, arousal is characterized by vaginal vasocongestion (increased blood flow), vaginal lubrication and swelling of external genitals.
However, the recent DSM update combined female sexual arousal and interest problems as a single disorder; the panel argued that one cannot reliably differentiate between the two processes.
Causes of HSDD
The exact cause of low sexual desire has not been clearly established, quite likely due to the enigmatic concept of desire where physiological, psychological, and behavioral variables are at play.
Scholars and researchers reached a consensus that the condition is multifactorial. Both physical and psychological factors can trigger HSDD.
- Many illnesses such as diabetes, multiple sclerosis, arthritis, cancer, heart disease, and other vascular and neurological problems may lead to arousal problems
- Hormone levels may cause low sexual desire
- Certain medications may affect sexual arousal and impair vaginal lubrication
- In some cases, societal norms about female sexuality can lead to long-term feelings of guilt associated with sexual interest
- A person with a history of sexual abuse or trauma may develop HSDD
- Psychological problems like anxiety and depression are associated with low sexual interest
- Relationship problems such as lack of trust or infidelity can fuel low libido
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HSDD: A Controversial Diagnosis
HSDD may cause psychological and emotional distress that can be debilitating. Unlike the DSM approach, experts in women’s health try to put more emphasis on understanding the causes of a woman’s sexual dissatisfaction and on trying to prevent them. Some authors believe that many sexual problems are not dysfunctions that should be fixed with medications.
However, recent advancements in the medical field put HSDD medications on the market. Flibanserin, the first drug to be approved for HSDD, was designed based on the theory that loss of sexual desire is caused by an imbalance in brain chemicals.
One study revealed that when HSDD subjects were shown segments of an erotic video, their brain scans showed altered activity in the brain locations responsible for sexual response compared to women without HSDD. One of the brain regions that play a role in stimulating pelvic organs is deactivated in women with HSDD, which leads to the "absence of vaginal vasocongestion and lubrication and decreased sexual behavior in general".
Sexual desire cannot be quantified. There is no universal description of what is normal. It is normal to not be "in the mood" from time to time. Sex drive varies between everyone. You may be less interested in sex than your partner or other women of your age.
Here are some of the symptoms of HSDD:
- Persistently low sex drive
- Limited levels to a total lack of interest in sex
- Having no sexual fantasies
- Inability to feel pleasure when the genitals are stimulated
- Feeling frustrated about lack of sexual activity
Treatment may include counseling or sex therapy, either alone or with your partner, to check for mental health and relationship issues that are contributing to the problem. If your condition is caused by certain medications you are currently taking, your provider can suggest alternative medicines to help resolve the sexual problem.
A variety of medical disorders impact sexual function, causing decreased desire and arousal, and impaired orgasm. Your doctor will try to eliminate the presence of these diseases (e.g., thyroid disease, depression, diabetes, androgen and estrogen deficiency) to reach a diagnosis and design the right treatment plan.
There are two FDA-approved medications for HSDD in premenopausal women. One treatment is in tablet form, and is taken once a day at bedtime; the other is a self-administered shot used as needed, at least 45 minutes before sexual activity.
Sex is a natural biological need. There’s no reason to be embarrassed when discussing your sexual issues. Find a doctor you can trust and feel comfortable with so you can learn about the types of treatment that can help.
- Obstetrics and Gynecology (Sexual problems and distress in United States women: prevalence and correlates)
- The Journal of Sexual Medicine (A Study of Trends Observed in Self-Identified ‘Asexual’ People)
- Journal of Sex and Marital Therapy (Beyond Dysfunction: A New View of Women's Sexual Problems)
- Standford News (Quick Study: Sex, women and the brain)
- Sexual Medicine Reviews (How the Emotional Motor System Controls the Pelvic Organs)
- Sexual Medicine Society of America (Conditions: HSDD)
- Psychiatry Edgmont (Sexual Desire Disorders)
- Mayo Clinic (Hypoactive Sexual Desire Disorder)
- International Society for Sexual Medicine (What is hypoactive sexual desire disorder (HSDD) in women? What causes it?)