Overview
Hypoactive sexual desire disorder (HSDD) refers to person’s chronic or ongoing lack of interest in sex, to the point of personal or relationship distress. HSDD affects both men and women, however it is most common in women. According to some studies, 22% of women and 5% of men experience HSDD continuously. The Mayo Clinic notes that as many as 40% of women will be diagnosed with HSDD at some point in their lives, making it the most common female sexual dysfunction.
It is normal to experience a loss of interest in sex from time to time. Libido can fluctuate throughout life. It might be high when feeling good, confident, or excited, but decrease when feeling insecure, struggling with low self-esteem, or increased life stress. Maturational hormonal changes can also impact desire in both men (i.e. aging, Low Testosterone) and women (i.e. pregnancy, menopause).
HSDD can be frustrating for the person experiencing the decrease in desire, as well as their partner, but it's a treatable condition. Even though it might take some time to discover what is causing it, with treatment, a satisfying sex life can return.
Symptoms
Symptoms of HSDD include a decrease in or lack of sexual thoughts, interest in initiating sexual activity, and receptivity to a partner’s advances of sexual activity. These symptoms are persistent, lasting longer than 6 months, and cause personal distress and/or problems in romantic relationships. The important distinction with HSDD is that it causes personal or relational distress. Some people experience lower sexual desire than other people, but if a person isn’t bothered by their lack of sexual desire, then it is not a problem and would not be considered HSDD. HSDD differs from Asexuality in that it is a lack of desire, not a lack of attraction.
Causes
HSDD is a complicated disorder with a number of possible causes. Sometimes, several underlying conditions contribute to HSDD all at once. There can be physical causes, hormonal fluctuations, and psychological causes.
Physical/Biological Causes
Many illnesses such as diabetes, cancer, arthritis, and cardiovascular disease, can weaken a person’s sex drive. Similarly, many medications, like those taken for depression or high blood pressure can decrease libido.
Women may experience lower sex drive during menopause or pregnancy, when levels of estrogen and testosterone – a hormone that boosts libido – fall substantially. Men may experience Low Testosterone due to aging or illness, causing decreased sexual desire.
Psychological and Emotional Causes
A number of psychological and emotional factors can affect a person’s sex drive. Anxiety, depression, poor self-esteem, history of abuse, and/or general stress all can take a toll on someone’s interest in sexual activity.
Relationship problems can also be a factor. Low sex drive might result if partners don’t communicate well, haven’t unresolved conflict, have experienced mistrust, or have had an unsatisfying sex life for a length of time.
Diagnosis
HSDD is a decrease or absence of sexual desire that causes personal distress. The personal distress is critical to diagnosis. Sexual desire varies from person to person. What might seem “normal” for one person may not be “normal” for another. If a person is not bothered by their level of desire, then they probably do not have HSDD.
HSDD has different classifications. HSDD is classified as generalized or situational. In generalized cases, a woman lacks desire in most sexual circumstances. When HSDD is situational, it only happens at certain times (e.g., high stress, after childbirth, conflict with a partner). HSDD can also be classified as acquired or lifelong. Acquired HSDD happens after a person has had normal functioning for some time, then experiences a decline. Lifelong HSDD has no known start, as the person has always experienced a lack of interest in sexual activity.
The main symptom of HSDD is a lack of interest in sex. But because everyone is different, there is no official threshold or diagnostic test that tells whether a person has HSDD or not. Rather, diagnosis depends on how distressed a person is about their low sex drive and whether it is causing any other problems. If a person expresses concerns about low libido, doctors will usually try to pinpoint any underlying causes. They often start by looking for related physical causes and do a complete medical workup, including a medical history, screening tests, and physical exam.
Unfortunately, HSDD is underdiagnosed and undertreated. Many healthcare providers do not bring up the subject of sex. Some providers are afraid of offending their patients, or they might not feel confident in their abilities to handle sexual health issues. Also, people simply do not know about HSDD and that it’s a treatable condition.
Treatment
There are many ways to treat HSDD. Just as a combination of factors can cause the disorder, a combination of treatments can be beneficial.
Lifestyle Changes
Lifestyle changes may be needed to combat low libido. Stress management, self-care, diet, and exercise can help address certain causes of HSDD, including fatigue, body image concerns, life stress, and weight gain.
Counseling
Counseling (e.g. Sex therapy) can help treat the psychological causes of HSDD. Specialists use talk therapy to treat psychological conditions or relationship concerns that may be impacting a person’s desire for sexual activity.
Hormonal Therapies
Estrogen therapy can be helpful in treating HSDD for some women. Estrogen is a sex hormone that affects libido, among other functions. This type of therapy, called systemic estrogen therapy, helps the brain make its needed chemical connections to increase desire.
Testosterone is hormone that affects the sex drives of both men and women (see Low Testosterone section for more information on the impact of low testosterone levels in men). Testosterone therapy is currently not FDA approved for women in the United States. Studies have shown women may experience side effects like extra hair growth or hair loss, acne, liver problems, and enlargement of the clitoris from testosterone therapy.
Medications
When experiencing HSDD, it is important to keep in mind medications that are known for decreasing libido (e.g., hormonal birth controls and antidepressants), as well as medication options for increasing sexual desire (hormone therapies, flibanserin, and bremelanotide). Talk to your healthcare provider about medication options for managing HSDD symptoms.
Condition overview written by Claire Postl, MA, LPCC
