Hypoactive sexual desire disorder (HSDD) is the leading sexual complaint by women and is characterized by diminished or complete absence of libido. It is found to occur in at least 20% of women in the US.
HSDD is an aversion to sex, a sexual apathy and sexual anorexia with inhabited sexual desire. In simple terms, it can be defined as an extreme aversion to sex and absence of and avoidance of all genital sexual contact with a sexual partner.
In extreme cases, the patient finds sex repulsive, revolting and distasteful so much so that phobic and panic responses are exhibited. Hypoactive sexual desire disorder may either be oriented against a single partner in particular, or it may be a lack of sexual interest in anyone in general.
Low sexual desire is often associated with aging. It is estimated that 10% of women age 49 or younger have low desire, 22% of women age 50 to 65 and 47% of women age 66 to 74 report low desire.
Why HSDD?
Often HSDD is the result of either physical or emotional trauma. In general, a woman's sex drive is guided by a complex system of signals between her brain, ovaries and other reproductive sexual organs. It is a healthy brain, more than a healthy body that dictates desire for sex. Often a disruption in this complex interaction between brain and body may cause decreased interest in sex.
- Decreased sex drive or less interest in sex may occur in a woman at any age. But this sexual dysfunction is more common during and after menopause has ended. Several physical and psychological factors cause sexual dysfunction. These include:
- Physical ailments such as diabetes, vaginal yeast infections, urinary tract infections, heart disease, neurological disorders, pelvic surgery, chronic liver disease, chronic kidney disease, menopause, alcoholism, smoking, drug abuse, breast feeding, and recovery after childbirth.
- Psychological causes such as stress from work and family, anxiety, marital discord, unresolved sexual orientation, depression and previous traumatic sexual experiences.
- Physical ailments such as diabetes, vaginal yeast infections, urinary tract infections, heart disease, neurological disorders, pelvic surgery, chronic liver disease, chronic kidney disease, menopause, alcoholism, smoking, drug abuse, breast feeding, and recovery after childbirth.
- In some HSDD may be a primary condition and the patient must have never felt any sexual desire or exhibited interest in sex. This may be due to sexual trauma such as incest, sexual abuse or rape. Sometimes repressive family attitude and rigid religious training may be the cause for this primary HSDD condition.
- Whereas in some patients sexual desire might have occurred formerly but it no longer has interest. Initial attempts at sexual intercourse might have resulted in pain or sexual failure and hence this condition.
- Insufficient levels of sexual hormone, testosterone can cause HSDD in males and females.
- Boredom in relationship with a sexual partner results in acquired HSDD.
- Depression, use of psychoactive or antihypertensive medications may contribute to this problem. Studies indicate that at least 12% of women experience clinical depression at some point of time in their lives. One of the side effects of popular anti depressants is loss of libido. She may feel isolated and overwhelmed and withdraw from sexual activities.
- HSDD may result from impairment of sexual function such as vaginismus on the part of female. Vaginismus is a voluntary contraction or spasm of the lower vaginal muscles resulting from an unconscious desire to prevent vaginal penetration. This may be due to incompatibility in sexual interest between the sexual partners. This can also occur in the presence of a sexually demanding partner.
- Dyspareunia or painful intercourse is another common deterrent to genital sexual activity in women. This is caused by vaginismus or local urogenital trauma or inflammatory conditions such as hymenal tears, labial lacerations, urethral bruising, or inflammatory conditions of the labial or vaginal glands.
- Delayed sexual maturation may be a potential cause of HSDD. In girls, this is characterized by lack of breast enlargement by age thirteen or by a period greater than five years between the beginning of breast growth and onset of menstruation.
Signs and symptoms of HSDD
There is an inability to attain or maintain adequate vaginal lubrication and swelling response. Intercourse is painful and involuntary contraction of vaginal muscles, vaginismus occurs. There is delay or absence or orgasm. She avoids having sex and she ignores her own personal hygiene to avoid having sex. She has fewer erotic dreams and sexual fantasies.
HSDD and menopause
During and after menopause, the estrogen level is remarkably reduced in women. This leads to dryness of the vagina which makes sex painful. This in turn leads to reduced motivation in sexual intercourse. The decrease in drive is due to the gradual decline in the hormones estrogen, progesterone and testosterone.
Although this disorder is prevalent in women in all reproductive stages, it is seen that younger, surgically postmenopausal women are at greater risk. Prevalence in naturally postmenopausal women is 9% and in surgically postmenopausal younger women is 26%.
Treatment of HSDD
Treatment of HSDD is related to its cause. If the reason for the problem is medical, then necessary therapy and cure is affected. For instance, if the cause is diabetes, improvement in diabetes control should be aimed.
In case of insufficient testosterone, diagnostic tests are done and supplemental replacement therapy is aimed. Testosterone level less than 20 ng/dl in females indicates need for supplemental replacement therapy.
Low dosage testosterone treatment option is well supported by several researchers and doctors although it has not been approved by FDA. There has been enormous success in treating low-libido patients with supplemental testosterone. Several women who have used the testosterone patch have reported significant increase in the frequency of sexual activity and satisfying desire. A study reveals that women in the testosterone group had a 52% meaningful benefit when compared to other treatment options.
Other treatment methodologies include anti depressants, hormone replacement therapy, androgen therapy, herbal remedies, psychotherapy and marriage counseling.
The prognosis is reasonably good, for instance, in case of treatment of a prolactin secreting pituitary tumor; whereas in case of certain genetic defects such as Turner's syndrome and Klinefelter's syndrome there can be no attainment of sexual function even after treatment modalities.
But as such, there is no approved pharmacological treatment for HSDD. Even psychotherapy has proved to be only minimally effective. If the underlying cause for HSDD is interpersonal in nature, therapy for couples should help as support and understanding of the sexual partner is essential.
It can be observed that majority of HSDD cases are situational in nature arising out of dissatisfaction and loss of interest in the sexual partner. Although significant assistance can be rendered to couples with marital discord, most of the times there is poor response to such therapy. More often than not, the marriage breaks, and the partner opts to find a new sexual partner after divorce.
Side effects of treatment for HSDD
Possible side effects of treatments for HSDD include sleep disorders, headaches, irritability, and sexual dysfunction in women using antidepressants. Vaginal bleeding, tenderness of breast, weight gain, abdominal bloating can be observed in women using hormone replacement therapy. Acne, greasy skin, excessive hair and elevated cholesterol using androgen therapy are normally observed.
Prevention of HSDD
In women sexual dysfunction is often linked to menopause and its side effects such as depression, she could well see a healthcare professional before HSDD can become a serious problem. Early treatment and management should help minimize her problems.
But a thorough understanding and support from the sexual partner is essential for successful treatment of HSDD. In fact there are therapists who would recommend abstinence from genital sex for a period of time and concentrate instead on non-genital sex for effective treatment of HSDD.
