Tuesday, October 23, 2012

Understanding Low Sexual Desire in Women

by Margaret Aranda, MD, PhD

Hypoactive Sexual Desire Disorder (HSDD) is a term used to describe a decrease in sexual desire in women.  How do you know if your woman has HSDD?  How many women fake orgasm or pretend to enjoy sex with their husbands, when post-menopausal symptoms of vaginal dryness may be "knife-blade", painfully sharp?  Every menopausal woman deserves a work-up to determine hormonal causes as a primary cause of sexual dysfunction, decreased quality of life, or psychosocial satisfaction.

First of all, HSDD is a term describing sexual dysfunction.  There is a lack or complete absence of sexual fantasies, and a lack of desire for sexual activity.  The diagnosis comes from a clinician, not the patient.  No 'partner' is required to make the diagnosis.

Requirements include that the patient has distress or relationship problems.  It has to be a perceived problem.

The topic of female sexuality is of paramount interest for not only 'the female', but for you men. By default, it is also a topic of mental health, quality of life, Family Matters, Marital Relationships, procreation, and aging through menopause.

Men are affected by any decrease in libido that their partner has, no matter the cause.  It is important to discuss the topic openly, as this could provide relief of the situation.  There is one main fact that seems to stand out amongst all: #1) women are reluctant to volunteer information on sexual dysfunction, and #2) doctors are reluctant to ask women about sexual dysfunction.

Think of females and their sexual health. Now think of female sexual disorders. What is the most common female sexual disorder? It is Low Desire, with Laumann et al  estimating a stunning prevalence of 30% (1) in a 1999 study done in the United States of America.

Masters and Johnson were the first to describe a female model of the sexual response. Their paramount study was done in 1966 (2). It categorized, in a linear fashion, four stages of the sexual response: Excitement, Plateau, Orgasm, and Resolution. In 1977, Kaplan added Sexual Desire to this scenario (3).

Today's nonlinear description by Basson takes into account: psychosocial and psychocultural matters, relationship satisfaction, emotional intimacy, and sexual stimuli (4).

The American Psychiatric Association classifies female sexual dysfunction into these categories:
Desire, Arousal, Orgasm, or Pain. We aim to focus on Desire, specifically Low Sexual Desire. But before we leave this item, we retain the stance that another reclassification is perhaps under way. Brotto suggests that Desire and Arousal be more of a 'combined' issue of Sexual Interest/Arousal Disorder (5).

To get to our final point here, what is low sexual desire? Both the World Health Organization and the DSM-IV (the Psychiatrist's book of diagnoses) have similar descriptions for Hypoactive Sexual Desire Disorder, or HSDD. It is a recurrent or persistent absence or deficiency of sexual fantasies and desire for sexual activity, causing marked distress or interpersonal difficulty (6, 7).

So, it can be that:

(A) Decreased Sexual Desire  + (B) Problems  ~  HSDD.

(A) = No sexual fantasies, recurrent lack of sexual fantasies, no sexual desire, and/or recurrent lack of sexual desire;

(B) = Personal Problems/Distress, or Relationship Problems

How big is this problem? In the 2006 Women's International Study of Health and Sexuality (WISHeS), HDSS was determined across the USA, Canada, Germany, Italy, and France.

In America, the prevalence of HSDD ranged from 9% to 26% (8).
In Europe, the prevalence of HSDD was from 6 to 16% (9).

Age and menopause mattered.

While many of the studies on female sexual dysfunction were done by telephone interview, this is to suggest that such anonymity is the result of ongoing female discomfort in talking face-to-face with her health care provider(s). So if a personal relationship or marriage is encountering difficulties due to 'mismatching' of sexual drive, low libido, chronic illness, or other matters having to do with sex, what is the husband or man to do? First, let us provide encouragement that the patient needs to feel comfortable telling her partner about sexual issues.  Then, it is good to disclose these problems to her doctor.

And if your female partner has a low libido or you are a partner whose sex drive far succeeds hers, and this is causing you marriage or relationship problems, perhaps you do not know that she could have a diagnosis of HSDD. Talk to her doctor about it.  Go to the appointment with her.

Possible treatment?  Possibilities include diet, exercise, and hormones (e.g., testosterone, estrogen, progesterone, thyroid hormone) as initial, corrective treatment.  

Let's open the door to some frank discussion.

It is time.

Medical Disclaimer: Nothing in this content is meant to advise, diagnose, treat, or cure any medical condition whatsoever. Please speak to your health care professional for medical advice. 
Full Disclosure: Dr. Margaret Aranda Ferrante was an Institute Physician with Cenegenics Medical Institute, specializing in Age Management Medicine. 

(1) Laumann  EO, Paik A, and Rosen RC. Sexual dysfunction in the United States. Prevalence and Predictors. JAMA Vol 281(6), pp 537 - 544; 1999.
(2) Masters WH and Johnson VE. Human Sexual Response. Little, Brown & Co.; Boston, MA. USA (1866).
(3) Kaplan HS. Hypoactive Sexual Desire. J. Sex Marital Ther: Vol 3 (1), pp 3 - 9; 1977.
(4) Basson R. Using a Different Model for Female Sexual Response to Address Women's Problematic Low Sexual Desire. J. Sex Marital Ther: Vol 27(5); pp 395 - 403; 2001.
(5) Brotto LA. The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in women. Arch. Sex Behav. Vol 39(2), pp 221 - 239; 2010.
(6) World Health Organization. International Statistical Calculation of Diseases and Related Health Problems, 10th Revision. World Health Organization, Geneva, Switzerland; 1992.
(7) Basson R, Leiblum S, Brotto L, et al. Definitions of Women's Sexual Dysfunctions Reconsidered: Advocating Expansion and Revision. J Psychosom. Obstet. Gynaecol Vol 24(4), pp 221 - 229; 2003.
(8) Leiblum SR, et al. Hypoactive Sexual Desire Disorder in Postmenopausal Women. US Results from the Women's International Study of Health and Sexuality (WISHeS).  Menopause Vol 13(1), pp 46 - 56; 2006.
(9) Dennerstein L, et al. Hypoactive Sexual Desire Disorder in Menopausal Women: A Survey of Western European Women. J. Sex. Med. Vol 3(2), pp 212 - 222; 2006.

Medical Disclaimer: Nothing on this website is meant to diagnose, treat, or practice medicine. You must be seen in person by a physician for appropriate and individual medical treatment. If you have an emergency, call 9-1-1 in the USA.

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Full Disclosure: Margaret A. Ferrante, M.D.  is an Institute Physician with Cenegenics Medical Institute.  She receives no monetary compensation for hosting this website you are on, which is independent and not affiliated with Cenegenics. The information presented is for education and awareness.  Dr. Ferrante currently sees patients out of the Cenegenics office in Beverly Hills, CA. 
To book an appointment for a free Consultation, please email her at: mferrante@cenegenics.com

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