Hypoactive sexual desire disorder (HSDD) is a type of sexual dysfunction characterized by a persistent or recurrent lack of sexual desire or interest in sexual activity, which causes distress or interpersonal difficulties. HSDD can occur in both men and women and can have various causes, including physical, psychological, or a combination of both.
In women, HSDD is often associated with hormonal imbalances, such as low levels of testosterone or estrogen. It can also be caused by medications, such as antidepressants, or psychological factors, such as depression, anxiety, or relationship issues.
In men, HSDD can be caused by low testosterone levels, certain medications, such as antidepressants or blood pressure medications, or psychological factors, such as stress or relationship issues.
Treatment for HSDD may involve addressing underlying medical or psychological issues, as well as counseling, sex therapy, or medication. Testosterone therapy may also be an option for some individuals with HSDD, but it should only be used under the supervision of a healthcare provider, as it can have potential risks and side effects.
In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), Hypoactive Sexual Desire Disorder (HSDD) was reclassified and merged into a broader diagnosis for women called Female Sexual Interest/Arousal Disorder (FSIAD). This change was made to reflect the clinical reality that, in many women, sexual desire and arousal are often intertwined and difficult to separate.
Diagnostic Criteria for FSIAD (formerly HSDD) — DSM-5
A woman must experience at least three of the following for a minimum of 6 months, and the condition must cause clinically significant distress:
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Absent/reduced interest in sexual activity
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Absent/reduced sexual/erotic thoughts or fantasies
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No/reduced initiation of sexual activity and typically unreceptive to a partner’s attempts
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Absent/reduced sexual excitement/pleasure during sexual activity in almost all (75–100%) encounters
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Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
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Absent/reduced genital or non-genital sensations during sexual activity in almost all (75–100%) encounters
For Men:
Male Hypoactive Sexual Desire Disorder (MHSDD) remains a separate diagnosis in the DSM-5, with the following criteria:
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Persistently or recurrently deficient (or absent) sexual thoughts or fantasies and desire for sexual activity.
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The low sexual desire must cause marked distress or interpersonal difficulty.
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Not better explained by a nonsexual mental disorder, medical condition, or effects of a substance or medication.
Important Notes:
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The DSM-5 emphasizes distress as a key component. Low sexual desire is not considered a disorder unless it causes significant emotional or relational distress.
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The change also reflects a more nuanced understanding of sexual functioning, especially in women, integrating both psychological and physiological components.
Risk Factors
Several risk factors can increase the likelihood of developing hypoactive sexual desire disorder (HSDD). Some of these risk factors include:
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Age: HSDD is more common in older individuals, especially women.
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Hormonal imbalances: Hormonal changes, such as those that occur during menopause in women, can increase the risk of HSDD.
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Medical conditions: Chronic illnesses, such as diabetes, heart disease, or cancer, can contribute to HSDD.
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Medications: Certain medications, such as antidepressants, blood pressure medications, or hormonal contraceptives, can cause HSDD.
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Psychological factors: Stress, anxiety, depression, and relationship issues can all contribute to HSDD.
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Substance abuse: Alcohol and drug abuse can interfere with sexual function and increase the risk of HSDD.
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Cultural and societal factors: Societal and cultural norms and expectations surrounding sexuality and gender can also contribute to HSDD.
Treatment
The treatment of hypoactive sexual desire disorder (HSDD) depends on the underlying cause of the condition. Treatment options may include:
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Counseling or psychotherapy: Counseling can help identify and address psychological factors that may be contributing to HSDD, such as relationship issues, stress, or anxiety.
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Medications: Some medications, such as bupropion or flibanserin, may be prescribed to treat HSDD. Testosterone therapy may also be an option for some individuals with HSDD.
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Lifestyle changes: Making lifestyle changes, such as reducing stress, improving communication in relationships, or incorporating regular exercise into your routine, can also help improve sexual function.
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Treatment of underlying medical conditions: If HSDD is related to an underlying medical condition, such as diabetes or depression, treating the condition may help improve sexual function.
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Sex therapy: Sex therapy involves working with a therapist to address sexual concerns and develop strategies for improving sexual function and communication in relationships.
It’s important to talk to your healthcare provider if you’re experiencing a lack of sexual desire or interest. They can help determine the underlying cause of the condition and recommend appropriate treatment options.