Hypoactive Sexual Desire Disorder
Is described as a deficiency or absence of sexual fantasies
and desire for sexual activity. This is considered a disorder if it causes distress for
the patient or problems in the patient's relationships. It must be determined that this is
not the result of another psychological disorder which is the primary problem. If the
sexual partner of a patient with suspected hypoactive sexual desire disorder feels that
this is a problem within the relationship, that concern should be sufficient for the
individual to seek psychological consultation.
Desire for and fantasy
about sexual activity are chronically or recurrently deficient or absent. The
clinician judges this on the basis of the patient's age and other
life circumstances that may affect
sexual functioning.
This behavior causes
marked distress or interpersonal problems.
Except for another
Sexual Dysfunction, no other Axis I disorder explains it better.
It is not directly caused
by substance use (medication or drug of abuse) or by a general medical
condition.
Type Codes for the Sexual Dysfunctions
* Specify 1 of:
Due to Psychological Factors or
Due to Combined Psychological Factors and a General Medical Condition
* Specify 1 of:
Lifelong (it occurs throughout the patient's active sexual life) or
Acquired (there has been a time when the patient did not have this sexual dysfunction)
* Specify 1 of:
Generalized (the disorder occurs with all partners and in all situations) or
Situational
Associated Features:
Physical illnesses when they
produce fatigue, pain
Hormone deficiencies may occasionally be implicated.
Stress
Insomnia or inadequate amounts of sleep, resulting in fatigue.
Pain with intercourse, for women
Erection problems
Retarded Ejaculation,
Differential Diagnosis
Some disorders have similar or even the same symptoms. The clinician, therefore, in
his/her diagnostic attempt has to differentiate against the following disorders which need
to be ruled out to establish a precise diagnosis.
Depression
Cause:
This disorder can be present in adolescents
and can persist throughout a person's life. Many times, however, the lowered sexual desire
occurs during adulthood, often times following a period of stress. Interestingly, patients with a general dislike of sexual activity
(hypoactive desire or aversion), at least with their current partner, can effectively use
an injury to justify avoidance of sexual contact.
Treatment:
Treatment of HSDD will depend in some part on the
duration of the problem and its causes. If it is the result of attitudes and experiences
of a long-standing nature, changing how patients think and feel about the problem and
their sexuality is critical.
Counseling and Psychotherapy [ See Therapy Section
]:
Sex therapy may not be the best referral in some
circumstances such as the patient with HSDD who tells you that she and her partner
frequently have angry disagreements is not a good candidate for sex therapy until the
arguing is resolved in marital or couples counseling. Some couples just aren’t
sexually attracted to each other, leading to HSDD in one or both. They find it difficult
to tell each other about the lack of attraction. In all of these cases, referral to a
psychotherapist for couples counseling is the treatment of choice. Treatment must be individualized to the factors that may be
inhibiting sexual interest. Often, there may be several such factors. Some couples will
need relationship enhancement work or marital therapy prior to focusing directly on
enhancing sexual activity. Declining sex is sometimes one of the few areas where someone
who feels dominated in most other areas of a marriage may still exert control. Some
couples will need to be taught skills in conflict resolution and be helped to work through
differences in nonsexual areas. Communication training in talking on a feeling level,
showing empathic understanding, resolving differences in a manner that reflects
sensitivity and respect for the feelings of both parties, learning how to express anger
constructively, and reserving time for couple activities, affection and talking all tend
to encourage sexual desire. Many couples will also need direct focus on the sexual
relationship wherein through education and couple assignments they expand the variety and
time devoted to sexual activity. Some couples will also need to focus on how they may
sexually approach their partner in more interesting and desirable ways, and in how to more
gently and tactfully decline a sexual invitation. When problems with sexual arousal or
performance are factors in decreasing libido, these sexual dysfunctions will need to be
directly addressed.
Pharmacotherapy [ See
Psychopharmacology Section ] :
Testosterone supplementation for men
Coding Notes
Although I have picked Female Sexual Arousal Disorder as
the example, the following notes apply to many of the Sexual Disorders discussed below:
A patient who has a general medical condition (diabetes
mellitus) that partly, but not completely, accounts for a problem with arousal would be
diagnosed:
Axis I 302.72 Female Sexual
Arousal Disorder, Due to Combined Factors
Axis III 250.01 Insulin-dependent Diabetes Mellitus
A patient who uses drugs and who has arousal problems due
partly, but not solely, to the direct effects of drug use, would be diagnosed (other
specifiers would also apply):
Axis I 302.72 Female Sexual
Arousal Disorder, Due to Combined Factors
Patients whose arousal problems are due solely to a
combination of substance use (such as heroin intoxication) and a general medical condition
(such as diabetes mellitus) should be given two Axis I diagnoses:
625.8 Other Female Sexual
Dysfunction Due to Diabetes Mellitus
292.89 Heroin-Induced Sexual Dysfunction, With Impaired Arousal,
With Onset During
Intoxication
Of course, you would have to supply the appropriate Axis I
and Axis III codes for each of the above examples.
See Also
Our Sexual Dysfunction Links Page.
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