Hypoactive Sexual Desire Disorder in Women

Psychological and Physiological Causes of Low Sex Drive

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The loss of libido can be a disheartening experience for women, eliciting feelings of frustration and guilt for a condition which may have no obvious explanation. It can greatly diminish a woman's sense of self-worth and undermine not only her sexual relationship but her non-sexual ones, as well.

It is believed that as many as one in 10 women are affected by a condition known as hypoactive sexual desire disorder (HSDD).

It is one in which the loss of libido is often accompanied by certain physiological changes, including a marked increase in certain hormones (such as dopamine) and a corresponding decrease in others (such as serotonin).

HSDD is fast undergoing a transformation in the way that it is being approached by the medical community. It is no longer considered just a psychological disorder but one in which a person's health, culture, and social interactions play an integral part.

Conflicts in Definition

According to an expert panel at the International Society for the Study of Women's Sexual Health (ISSWSH), HSDD is characterized by the loss of spontaneous sexual desire, the inability to respond to sexual cues, and the inability to maintain interest during sex spanning the course of at least six months.

For its part, the American Psychiatric Association (APA) has offered a far narrower definition in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In the latest version, the APA has abandoned the term HSDD and replaced it with female sexual interest/arousal disorder (FSIAD), a decision that has been widely criticized for its lack of empirical evidence and non-specific criteria for inclusion.

These inconsistencies have cast an even larger shadow of doubt over a subject for which millions of women continue to suffer, often in silence.

Prevalence of HSDD

A survey conducted by researchers at the University of Chicago in 2015 aimed to identify the causes and types of sexual dysfunction in a cohort of women between the ages of 18 and 59. What they found was that certain sexual disorders occurred among all women irrespective of age or ethnicity.

Chief among them was the fact that 33.4 percent of the women surveyed reported symptoms consistent with HSDD. These larger-than-expected numbers suggest that HSDD may be a far bigger problem than previously imagined.

Moreover, the survey appeared to confirm what many had long suspected: that HSDD is linked to not only the psychological status of a woman but her physiological status, as well.

Psychological Components of HSDD

While it is clear that a woman's psychological state can contribute to HSDD, it is often a chicken-and-egg situation. Are the emotional stresses triggering the low libido, or is the low libido manifesting with feelings of stress and anxiety? Today, most scientists believe that it is little of both, further blurring the line between the actual cause and effect.

What most experts do agree is that HSDD is closely linked to certain psychosocial factors that impact both a woman's self-image and her relationship to sex.

When experiencing the loss of libido, a woman will often describe feelings of frustration, hopelessness, anger, poor self-esteem, and loss of femininity while concurrently expressing dissatisfaction with her sex life, partner, or marriage.

Age is also a factor. While aging itself doesn't inherently play a part, a woman's cultural reference to age can. One study conducted by the University of Melbourne in Australia reported that American women were far more to experience HSDD as they got older compared to a matched set European women (19 percent versus 13 percent, respectively). This suggests that social and cultural stress can contribute as much to the risk of HSDD as one's own psychological vulnerabilities.

Physiological Causes of HSDD

In terms of medical causes, there is a clear association between the lack of sexual desire and a woman's general health. Conditions like thyroid disease and certain autoimmune disorders, for example, are closely linked to HSDD. In cases like these, any malfunction in hormonal/immune regulation can significantly affect the excitatory sexual systems of the brain. Moreover, the medications used to treat these disorders can interfere with the various neurotransmitters that modulate sexual desire.

The effect is more than just theoretical. Positron emission tomography (PET) scans of the brain were able to show this in a 2016 study from the University of Queensland in Australia. In their research, the investigators found that women with HSDD who were shown erotic videos had weaker activation of the right side of the brain (which performs tasks related to creativity and imagination) and less deactivation in the left side (which oversees logics and reason). This effect was not only consistent but had a characteristic "signature" among the women tested.

While this should not suggest that HSDD is a condition purely defined by hormones and neurotransmitters, it does illustrate how a treatment plan focused solely on the psychological aspects of low libido may come up short.

Diagnosis and Treating HSDD

In order to effectively treat HSDD, a doctor would need to conduct an extensive evaluation of all possible causes, both biological and psychological. For this reason, the treatment plan can vary dramatically from one woman to the next.

Typically speaking, the doctor will treat the most distressing aspects of the condition first while exploring any co-existing condition or drug treatment that may be directly or indirectly contributing.

If psychotherapy is indicated, the woman would likely to be referred to a sex therapist who would be better able to determine the appropriate course of treatment, either conducted alone or with her partner.

Sources:

Hayes, R.; Dennerstein, L.; Bennett, C. et al. "Relationship between hypoactive sexual desire disorder and aging." Fertil Steril. 2007; 87(1):107-12. DOI: 10.1016/j.fertnstert.2006.05.071.

Holstege, G. "How the emotional motor system controls the pelvic organs." Sex Med Rev. 2016; 4(4):303-28. DOI: 10.1016/j.sxmr.2016.04.002.

Goldstein, I.; Kim, N.; Clayton, A. et al. "Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review." Mayo Clin Pro. 2017; 92(1):114-28. DOI: 10.1016/j.mayocp.2016.09.018.

McCabe, M.; Sharplip. I.; Balon, A. et al. "Definitions of sexual dysfunctions in women and men: A consensus statement from the Fourth International Consultation on Sexual Medicine 2015." J Sex Med. 2016; 13(2):135-43. DOI: 10.1016/j.jsxm.2015.12.019.

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