Female Sexual Health

Hypoactive Sexual Desire Disorder (HSDD)

Hypoactive sexual desire disorder is defined as a "persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts, and/or desire for or receptivity to sexual activity, which causes personal distress".

Studies investigating the prevalence of a lack of sexual desire among women have yielded a wide range of results depending on how the problem is defined. In general, however, it appears that a large number of women report a lack of sexual desire, suggesting that HSDD is the most common sexual dysfunction among women. In a national study of Canadian women aged 18 to 44, 39% reported that "My sexual desire is often much lower than I would like it to be".

Married women were significantly more likely than unmarried women to report diminished desire (53% vs. 21%). A U.S. population-based study of women aged 18 to 59 found that approximately 30% reported lacking interest in sex.

A study of postmenopausal women found that 46% had HSDD. As is the case with many other sexual dysfunctions, a relatively low level of sexual desire should only be considered a sexual dysfunction requiring treatment if it causes distress to the patient. Nevertheless, low sexual desire is the most common sexual problem presented to primary care physicians.

In most cases, HSDD results from either psychological/emotional factors and/or is secondary to physiological problems such as hormonal deficiencies and medical or surgical procedures. It is rare to have a single etiology and the cause is usually multifactorial particularly when the problem has been established for some time. For example, a woman who is experiencing prolonged emotional distress due to conflict with her primary relationship partner may find that her overall desire for sexual activity is reduced.

Prolonged stress due to work-related issues and/or the burdens of child rearing can have similar effects on levels of sexual desire. Sexual assault or sexual abuse as well as low self-esteem or poor body image can also play a role in low desire. A wide variety of psychiatric conditions including depression, anxiety disorders, post traumatic stress disorder, and eating disorders have also been found to be associated with low desire.

In addition, disruptions to the hormonal milieu resulting from natural menopause, surgically or medically induced menopause, or endocrine disorders can result in reduced sexual desire. The precise role that hormones play in influencing female sexual desire is unclear. For women with pronounced HSDD, particularly those who have passed through menopause, assessment of hormone levels can be instructive in determining etiology.

It is clear that commonly prescribed antidepressant medication can have a negative impact of levels of sexual desire among women. Tricyclic antidepressants, monoamine oxidase inhibitors, lithium, and some antipsychotics are among the medications reported to result in reduced sexual interest.

In sum, primary and generalized HSDD tend to be related to traumatic sexuality related events occurring early in life or a highly sex negative upbringing. Acquired and situational HSDD tends to be related to environmental, hormonal, medical or relationship factors. Unfortunately HSDD is the most difficult problem to treat in the sexual disorders. All treatments have a high failure rate and a high recurrence rate even if treatment is initially successful. Most HSDD will require some component of couples counselling.

Medications Associated with HSDD
Type Description
Psychoactive Antipsychotics, Barbiturates, Benzodiazapines, Selective serotonin reuptake inhibitors, Lithium, Tricylic antidepressants.
Cardiovascular/Antihypertensive Antilipid medications, Beta blockers, Clondine (Catapres), Digoxin, Spironolactone (Aldactone).
Hormonal GnRh agonists, oral contraceptives
Other Histamine H2-receptor blockers and promotility agents, Indomethacin (Indocin), Ketaconazole (Nizoral), Phenytoin sodium (Dilantin).
Female Sexual Health