Low sex drive? What is hypoactive sexual desire disorder?

It is estimated that 1 in 3 women experience some loss of sex drive during their lifetime. It’s important to remember that this problem is not uncommon, so you are not alone in feeling this way. But it’s often not discussed which can cause distress and a loss of intimacy in relationships.

Hypoactive sexual desire disorder (HSDD) is defined as a continued lack of interest in sexual activities and sexual fantasies, resulting in personal distress. To be given this diagnosis, this lack of interest must have been present for 6 months. 

In the past, this categorisation has incorporated both male and female loss of libido, however these were separated in the fifth addition of the ‘psychiatrists’ bible’, Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The conditions are now widely known as female sexual interest/arousal disorder and male hypoactive sexual desire disorder (MHSDD).

As both the male and female variants of this disorder are characterised by low sex drive, for the purpose and ease of this article we will refer to both under their original umbrella term of HSDD. 

Causes of hypoactive sexual desire disorder

Changing levels of sexual desire are natural, however when this reduced desire is prolonged there may be a variety of causes. It is important to remember that sexual desire can be influenced by wide ranging factors, anything from your health to past experiences and current relationship status. 

Some of the key factors that can contribute to HSDD are:

• Relationship/communication breakdown
• Pain during sex
• Inability to orgasm
• Sexual dysfunctions – e.g erectile dysfunction (ED)
• Low self-esteem
• Medical conditions – arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.
• Depression, anxiety, stress and fatigue
• Changes to hormone levels – e.g. during the menopause, hormonal contraception, during pregnancy or post giving birth
• Medications – some antidepressants
• Surgery – this can affect your perception of your body and lower self-esteem
• History of abuse
• Drinking too much alcohol

Hypoactive sexual desire disorder in men

While the differences in the conditions experienced by men and women are subtle the symptoms are slightly different, and in men these are traditionally characterised by reduced/absent sexual thoughts or fantasies and reduced/absent desire for sexual activity. 

It is perhaps worth mentioning here that it is less common for men to present with HSDD, than it is for women, just 14.4% of men in a 2014 study claimed to have lowered libido for at least 2 months, as opposed to the two thirds of women earlier mentioned. The most frequent sexual problem men are likely to seek help for is ED. This may be because this is actually the most widespread problem, or could be in fact a result of societal norms suggesting men always desire sex. This may make it hard for men to talk about their low libido with their GP or sexual partner.. 

Hypoactive sexual desire disorder in women

To be diagnosed as having HSDD or female sexual interest/arousal disorder, you would need to experience the following symptoms for at least six months:

• Absent/reduced desire for sexual activity
• Less frequent/absent sexual thoughts or fantasies
• Little to no initiation of sexual activity
• Reduced or no sexual excitement or pleasure when having sex
• Little to no arousal when partner engages in sexual activity
• Absent/reduced genital sensations during sexual activity

Hypoactive sexual desire disorder treatment

Treatment for HSDD may involve psychotherapy, medication or a combination of the two. Counselling or sex therapy, either alone or with your partner may help to address relationship or mental health issues that might be contributing to a low libido.

For women, if the cause of HSDD is reduced levels of oestrogen and/or testosterone, hormone replacement therapy (HRT)  may be able to help you manage your sex drive. Some GPs have argued that women should be prescribed testosterone on the NHS to help boost their sex drive. Currently all licensed testosterone medications are designed for men, so would have to be prescribed ‘off label’ if they were to be given to women. In the US a new drug, Flibanserin (addyi™), has been approved to treat low sexual desire in women pre-menopause, however it has not been approved in the UK. 

If the cause of HSDD in men is identified as sexual problems such as ED or premature ejaculation (PE), there are a variety of treatments and medications that can be made accessible. Treatments such as Viagra have been shown to be effective in improving ED in up to two thirds of men.

If you think you might have HSDD or low libido, don’t worry the condition can be managed and you’re not alone. First thing’s first, you should try and speak to your partner, followed by a healthcare professional. They should then be able to speak to you about options for treatment. 

References

https://www.independent.co.uk/life-style/health-and-families/health-news/low-sex-drive-loss-desire-women-libido-testosterone-nhs-doctor-hormone-menopause-a7351481.html
https://www.mayoclinicproceedings.org/article/S0025-6196(16)30596-1/fulltext
https://www.psychiatry.org/psychiatrists/practice/dsm
https://www.psychologytoday.com/gb/conditions/sexual-desire-disorder
https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/symptoms-causes
https://labs.la.utexas.edu/mestonlab/hypoactive-sexual-desire-disorder/
http://www.ashasexualhealth.org/hypoactive-sexual-desire-disorder/
https://www.nhs.uk/medicines/sildenafil-viagra/