2.19.2011

Hypoactive Sexual Desire Disorder

There have been reports of women stating a low sexual desire from at least 1972.

Here are some stats from recent studies:

Berman et al (2003)
• Sample:4,000 women with sexual dysfunction
• 40% reported not seeking help
• 54% of those would have liked to seek help

National Health & Social Life Survey (1999)
• 43% of American women suffer from sexual dysfunction
• 1/3 say they lack sexual interest
• About ¼ to not experience orgasm
• About 20% report lubrication difficulties
• About 20% find sex not pleasurable

It is also known that women are unlikely to discuss sexual dysfunction or dissatisfaction with their physician.

In 1977, low sexual desire was labeled as a specific disorder. However, only 10% of women ages 18-45 meet the criteria for a desire disorder diagnosis. That means that you are probably one of the many that has only a few hurdles to increasing your libido! And even if you do have HSDD, there are still many forms of treatment.

As a clinician, this is the diagnosis criteria that I would use.

Hypoactive Sexual Desire Disorder (HSDD)
A. Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person's life.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:
Lifelong Type
Acquired Type
Specify type:
Generalized Type
Situational Type
Specify:
Due to Psychological Factors
Due to Combined Factors

Assessment

Here is a rough outline of what I’d do and ask about:
1. Clarify the problem (e.g. details, history, past attempts at treatment)
2. Determine onset (gradual, acute, lifelong)
3. Determine context for the complaints (generalized or situational)
4. List all sexual symptoms
5. Go over typical sexual response cycle
6. Consider partner reaction to the sexual dysfunction (level of conflict, stress)
7. Assess couple motivation for treatment
8. Medical, psychiatric and surgical history

Each of these would impact how to treat the sexual dysfunction. I like to match the type of treatment with the cause. For example, if you’re taking Paxil or Zoloft I’d explain that about 70% of the patients on those medications have sexual side effects. I’d suggest you look into alternative medications. If you think it’s psychosocial, I’d suggest counseling, talking to partner etc. I almost always suggest Sensate Focus for clients presenting with sexual concerns.

Here are some possible treatments:

Physical
  • Adjust or change medications that have sexual side effects. Look up the side effects of current medications.
  • Treat thyroid problems or other hormonal conditions. You can usually have your doctor order blood work to test this.
  • Optimize treatment for depression or anxiety. Make sure you’re following through on your doctors recommendations. Also, I recommend reading Feeling Good and When Panic Attacks.
  • Try strategies recommended by your doctor to help with pelvic pain or other pain problems
  • Estrogen, Progesterone or Androgen Therapy
  • Tibolone, Provestra, Hersolution or Vigorelle (Not FDA approved). *In a small study, women taking the drug experienced an increase in vaginal lubrication, arousal and sexual desire.
  • Strengthen pelvic muscles by doing Kegal Exercises
  • Have a healthy lifestyle by eating well, exercising, getting enough rest etc.
  • Estrogen vaginal cream
  • Switch medications to something less likely to affect hormones (e.g. lots of birth controls impact libido depending on amounts of hormones)
Psychological
  • Seek Counseling. Look for somebody that says they have experience working with sexual issues. Even better, look for somebody who has treated sexual issues relationally (with couples as well as individuals). The best sex therapy occurs when both partners are involved. *Cognitive Behavioral Therapy has resulted in 75% of women significantly improving with 65% remaining improved at 1-year follow-up. (Basson et al., 2005)
  • Talk to your partner. Let them know how you’re feeling and have intimate, connecting conversations.
  • Sensate focus, which is similar to systematic desensitization, often found in therapies that treat anxiety, is shown to have about a 50% success rate following treatment. (Basson et al., 2005) This means that it is still effective even after finishing therapy and sensate focus exercises; it has lasting effects.



8 comments:

  1. Your posts are so helpful. Thank you!

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  2. This is such a great post. So many women just don't know what they CAN do about it. I'm sure this will help many take proactive steps. Awesome!

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  3. I'm in the opposite boat where my husband desires sex much less than I do. Believe me, it's no picnic being on the receiving end of that "no, not tonight." He has taken steps to increase his sex drive but results are yet to be seen. Ladies, may I gently remind you to be grateful that your husband desires to be with YOU while I remind ladies like me to be grateful that we have our husbands' love.

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  4. Hey Gwen,

    How do you feel about writing a post about the 'sex-less marriage' phenomenon? I think marriages with little to no sex are likely a result of the above mentioned condition.

    I think women would benefit from a post about male psychology in terms of sex. Men in sex-less marriages are affection starved, generally blame themselves for what is often a medical or psychological condition their wife is experiencing, and they must decide to stay for the sake of the kids or jump ship. They tend to stay and suffer for decades!

    Yes, there is the side discussion asking the questions of whether the man dates his wife/treats her like a princess. Also, it is assumed the man has made attempts to communicate how he feels to his wife. What about a marriage where the wife feels no sexual desire, has replaced the children as the objects of her affection rather than her husband, and isn't willing to do anything to help increase her acknowledged lack of sexual desire?

    What does a loving man do in this circumstance? These are issues I never considered when I was dating or a newly wed.

    ReplyDelete
  5. Love. Love. Love. Thanks so much for sharing. Your blogs my new fave.
    Please visit mine at www.fashboulevard.blogspot.com

    ReplyDelete
  6. Alyssa- I have a hard time orgasming and especially during intercourse. What would you recommend I do to be able to learn how to orgasm more consistently and to orgasm during intercourse? I don't feel pain or discomfort during intercourse.

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  7. Anon 8:57

    Most women don't easily orgasm during intercourse. If you are having a hard time having an orgasm, I would ask you, "do you know what feels best for you, in order for you to orgasm"? Do you, or have you ever, masturbated? For some women, it takes some solo time figuring out what feels best for you, what types of touch, soft, hard, slow, fast, penitration while stimulating the clitorus (or not), etc...

    For many women, being on top during intercourse is the best position for reaching orgasm. This position gives you the most control of the angle of penitration, and gives you the ability to grind and put pressure on the clitorus.

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  8. Though this subject can be extremely touchy for many folks, my opinion is that there has to be a middle or typical floor that we all can uncover. I do appreciate that you've further relevant and intelligent commentary appropriate here while. Thank you!

    ReplyDelete

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