Hypoactive sexual desire disorder: what you need to know

If your libido disappears, there are steps you can take to regain sexual desire

It’s completely normal to go through phases of being less interested in sex. During the menopause, tiredness, stress, life and bodily changes like weight gain, night sweats or aches and pains can put even the most physical relationships under strain.

But there is a key difference between ‘not tonight’ and ‘no, never’. When that disinterest becomes more than a phase and a permanent state of being, then you may have Hypoactive Sexual Desire Disorder (HSDD). This is deemed to be a total lack of interest, lasting for more than six months, that has consequences on your relationship and/or self-esteem.

Other signs of HSDD include no interest in any type of sexual activity, no sexual thoughts or fantasies, no interest in initiating sex, and difficulty getting pleasure from it, including masturbation.

Who gets HSDD?

HSDD is the most common female sexual dysfunction. One review paper found HSDD is present in about 8.9% of women aged 18-44, 12.3% of 45-64 year olds, and 7.4% in women over 65 [1].

While this shows HSDD peaks during the menopausal years, a lack of libido doesn’t have to be an inevitable consequence of getting older.

How is HSDD diagnosed?

There’s no one test for HSDD but the International Society for the Study of Women’s Sexual Health has issued guidelines for its diagnosis and management so it is well worth speaking to a healthcare professional [2]. Explain how your low sex drive is impacting you and any relationships you have. They will want to explore the root cause, which can often be a combination of factors. You will be asked some questions when a diagnosis of HSDD is being considered, including:

1. In the past, was your level of sexual desire or interest good and satisfying to you?

2. Has there been a decrease in your level of sexual desire or interest?

3. Are you bothered by your decreased level of sexual desire or interest?

4. Would you like your level of sexual desire or interest to increase?

5. What are the factors that you feel contribute to your current decrease in sexual desire or interest: a. An operation, depression, injuries, or other medical condition

b. Medications, drugs, or alcohol you are currently taking

c. Pregnancy, recent childbirth, or menopausal symptoms

d. Other sexual issues you may be having (pain, decreased arousal, or orgasm)

e. Your partner’s sexual problems

f. Dissatisfaction with your relationship or partner

g. Stress or fatigue

How is HSDD treated?

Treatment will depend on the cause and your preferences, and will likely take a well-rounded approach.

You might look to make some changes to relieve stress and improve intimacy, such as exercising regularly to boost self-esteem, taking part in activities you both find relaxing, planning times for connection and intimacy, and sexual experimentation (this could include different positions, places, role play or sex toys). Specialist counselling for yourself, or as a couple, can help.

You might look to avoid substances like tobacco and alcohol, which can reduce sexual desire and performance, or change medications you might be on that are lowering your libido. Sometime medications are suggested to boost your libido.

If sex is uncomfortable, vaginal oestrogen can help relieve symptoms. Finally, systemic transdermal testosterone (through a gel or cream) is recommended for women with HSDD who do not have any modifiable factors or contributory conditions, such as relationship or mental-health problems.

RELATED: the importance of testosterone

References

Parish, S. J., Hahn, S. R. (2016), ‘Hypoactive sexual desire disorder: A review of epidemiology, biopsychology, diagnosis, and treatment’, Sex Medicine Reviews, 4 (2) pp. 103–20. doi: 10.1016 / j.sxmr.2015.11.009
ISSWSH Process of Care for Management of Hypoactive Sexual Desire Disorder in Women