Hypoactive
Sexual Desire Disorder (HSDD) is 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.
It is not directly caused by substance use (medication or drug
of abuse) or by a general medical condition.
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 crutial.
Sex therapy
may not be the best referral in some circumstances, especially
if the relationship between the sufferer and partner has frequent
have angry disagreements. 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. Many couples will
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.
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