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Sexual Desire Disorders: Hypoactive Sexual Desire Disorder

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

Hypoactive Sexual Desire simply translated is, low sexual desire. The DSM-IV-TR defines this disorder as consisting of an absence of sexual fantasies and desire for sexual activity. It is very important that factors such as age and context should be taken into consideration when making this diagnosis. Additionally, it may be worthwhile to note that not all clinicians and researchers agree with the DSM-IV-TRs definition of Hypoactive Sexual Desire Disorder. As previously mentioned, sexual dysfunctions are defined as disruptions in the sexual response cycle. This implies that the sexual response cycle is linear: 1) First, one must experience desire, 2) Second, one must seek out sexual stimulation and become aroused, and 3) Lastly, one must reach orgasm. Because Hypoactive Sexual Desire Disorder is extremely common among women (about 1 out of every 3 women experience low sexual desire) the way in which this disorder is understood has been questioned. It has been proposed that the female sexual response cycle is quite different than the male sexual response cycle in that it is not linear (Basson, 2005). Many women report they are not interested in sex and that they simply do not feel like engaging in sexual activity. However, when sought out by their partner, they become aroused and willing to engage in sexual activity. Thus, a woman may not experience desire but with appropriate stimulation she may become aroused, and in turn experiences desire. Essentially, it appears that the female sexual response cycle does not always begin with sexual desire (i.e., thoughts and fantasies about sex).

While men experience low sexual desire less frequently than women, this may be in part related to how the male manifests low sexual desire. If one attempts sexual activity sans desire, the arousal process may be impacted; thus, oftentimes men who are experiencing low sexual desire will also report erectile difficulties. At times it may be difficult to distinguish between low sexual desire and erectile dysfunction. Similarly, performance anxiety can impact desire. If a person is feeling anxious and stressed out about engaging in sexual activity this may impact the level of desire they have to engage in such activities.

Hypoactive Sexual Desire Disorder: Causes & Risk Factors
There are many risk factors and causes associated with Hypoactive Sexual Desire Disorder. If we consider sexual health and function from a holistic perspective, it is not surprising that mental health disorders, and physical ailments, can cause sexual dysfunction. In terms of mental illness, an actual symptom of depression is loss of interest in activities that were previously enjoyed, one of which can be sex. Additionally, anxiety can also impact sexual function. Certainly, marital discord or relationship disharmony, can also take its toll on sexual desire.

Beyond psychological factors, there are a number of physical factors that can influence sexual desire. As mentioned earlier, menopause (women) and andropause (men) can significantly impact sexual function because the natural aging process results in decreasing hormonal levels of estrogen and testosterone. These two hormones play a key role in sexual desire. Certain medical procedures such as removal of the prostate, pelvic radiation (interventions in oncology may result in permanent sexual impairment), and procedures associated with the spinal cord can also impact sexual desire. Additionally, low sexual desire can be a side effect of an assortment of medications. It is important that you discuss side effects and concerns you have regarding any medication you are taking with your physician.

Hypoactive Sexual Desire Disorder-Treatment Options
In terms of treatment options, individuals experiencing low sexual desire may benefit from psychotherapy and/or hormone replacement therapy (HRT). Women may benefit from oral contraceptive treatment that may include increasing one or more female sex hormones (estrogen and progesterone) via pharmacologic replacement or so-called natural replacement (primarily through plant-based estrogens). Treatment may include oral compounds that are swallowed, or subcutaneous patches, creams, or suppositories where medication is absorbed directly into the bloodstream through the skin. Estrogen therapy may improve low interest and/or arousal disorders as low estrogen levels may lead to poor sleep, dislike of sensual touching, and lack of well-being all of which can impact sexuality. Where vaginal dryness is a concern, estrogen may also be delivered via cream or suppository directly to the vaginal area. However, the North American Menopause Society concludes, "HRT is not recommended as the sole treatment of sexual function, including decreased libido." (North American Menopause Society, 2008).

Even more controversial is the use of exogenous androgens (testosterone). Because testosterone is a necessary component of the sex drive, men and women may benefit from testosterone replacement therapy. However, testosterone products are not government approved for use by women in the United States or Canada. Therefore, if a woman's healthcare practitioner recommends testosterone for low sex drive, the medication must be specially compounded.

Recently, mindfulness techniques have also been found to be helpful in the treatment of low sexual desire. Mindfulness can be described as present-moment awareness and comes from Buddhist meditation. It has been brought to Western health care by Jon Kabat Zinnn and has been used to treat many psychological disorders (i.e., Depression, Anxiety, and Borderline Personality Disorder) as well as chronic physical pain. The majority of us go through life not living in the present moment. We go back and forth between thinking in the future (worrying about what we need to get done, planning what we have to do next) and living in the past (thinking about what happened yesterday). Because of this, we often miss out on what is going on right now. While multitasking can be helpful in certain situations, it is important to be present during sexual activities. Research has indicated that practicing mindfulness can actually improve sexual desire levels (Brotto, Krychman, & Jacobson, 2008).