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  Hypoactive Sexual Desire Disorder
 
Author: Peter J. Fagan, Ph.D. Last modified: October 13, 2001
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • Across seven community samples prevalence ranges from < 1% to 7% (Simons & Carey, 2001).
  • U.S. population study of men 18 – 59 years reported 16% experienced problems of low desire during previous 12 months (Laumann et al. 1999)

  RISK FACTORS

  • Age – decrease in bioavailable testosterone as man ages. In one study of men < 70 years, 26% prevalence of hypoactive sexual desire(Panser et al., 1995)
  • Medical illness – any chronic systemic disease that causes chronic fatigue, low testosterone, or poor body image: MS, pituitary adenoma, alcoholism, breast or genital surgery, s/p MI,HIV
  • Medication effect – carbamazepine, SSRIs, Beta-blockers, digoxin, disulfiram, lithium, narcotics, verapamil
  • May be long-term effect of major depression even after all depressive symptoms have abated

  SIGNS AND SYMPTOMS

  • Absent or deficient sexual fantasies or the desire for sexual activity which one would expect for an individual of patient’s age, gender and life circumstances. (APA, 1994)
  • Sexual activity with partner may occur at a normal frequency (to satisfy partner) and be satisfactory to the individual in terms of orgasmic pleasure

  DIFFERENTIAL DIAGNOSIS

  • Hypogonadism – refer to section on hypogodanism by A. Dobs
  • Depression – clinician should assess general mood and whether there is a generalized anhedonia as initial screen; if positive for low mood or anhedonia, complete full mental status examination
  • Relationship conflict – especially if the reported hypoactive sexual desire is situational, i.e. limited to a specific partner
  • Another sexual dysfunction in man or partner is primary - can lead to secondary hypoactive sexual desire disorder

  LABORATORY FINDINGS

  • None available for psychogenic hypoactive sexual desire.
  • Clinician should obtain patient’s report of present and past levels of sexual fantasy, sexual behaviors including frequency of solitary and partnered orgasm.
  • Interview of partner provides fuller view of complaint and of status of relationship.
 
TREATMENT
TREAT UNDERLYING MEDICAL OR PSYCHIATRIC CONDITION
  • Treat patient medically to attain maximum level of health given the limitations of age, chronic illness or post-surgical status
  • Avoid, if possible, medications which are known to further decrease sexual desire
  • Assist patient to accept limits of sexual desire that accompany the maximum health gain
TREAT PRIMARY SEXUAL DYSFUNCTION
  • If another sexual dysfunction is primary, e.g. erectile disorder, treat that disorder first. (see sections of specific disorders)
COUPLE THERAPY
  • Indicated for those couples whose relationship is marked by discrepancy in levels of sexual desire or whose interpersonal relations are conflicted.
  • Refer to clinician that is skilled in the practice of relational or marital therapy.
INDIVIDUAL PSYCHOTHERAPY
  • Indicated for those individuals whose sexual desire is inhibited by factors such as restrictive sexual attitudes, sexual trauma, avoidant or compulsive personality traits, or negative self-image.
  • Refer to psychotherapist who is skilled in treating issues that may inhibit sexual desire.
 
IMPORTANT POINTS/RECOMMENDATIONS
  • With hypoactive sexual desire, as with all sexual dysfunction, to make sure as possible that there is no medical condition that is causal before attempting to treat the condition as psychogenic.
  • If the hypoactive sexual desire is found to be biogenic, there may be psychological and relational issues to be addressed by the clinician.
 
REFERENCES
  1. American Psychiatric Association ;  Diagnostic and Statistical Manual of Mental Disorders ;  Washington, DC: American Psychiatric Association, 1994.

  2. Laumann EO, Paik A, Rosen RC ;  Sexual dysfunction in the United States ;  JAMA 2001; 281:537-544.

  3. Panser LA, Rhodes A, Girman CJ, Guess HA, Chute CG, Osterling JE et al. ;  Sexual function of men ages 40 to 79 years: The Olmsted County Sutudy of Urinary Symptoms and Health Status among Men ;  J Am Geriatr Soc 1995; 43:1107-1111.

  4. Simons JS, Carey MP ;  Prevalence of sexual dysfunctions: results from a decade of research. ;  Arch Sex Behav 2001; 30(2):177-219

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