Hypoactive sexual desire disorder (HSDD) is one of the most common presenting problems in the practice of sex and couple therapy. It is estimated that approximately 30%-40% of women are affected by low or absent sexual desire.
DEFINITION OF HYPOACTIVE SEXUAL DESIRE DISORDER
Hypoactive Sexual Desire Disorder is the absence of sexual fantasies, thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal interpersonal distress.
Causes of biopsychosocial factors: often a combination of factors such as the individual’s feelings and beliefs about sexual intimacy, relationship issues, and, in some cases, family-of-origin difficulties and traumas.
3 Criteria for Diagnosis:
- Lack of sexual fantasy and desire to engage in sexual activity. This absence of fantasy and desire must produce marked personal or interpersonal distress.
- The distress can affect both partners. Sometimes the distress is more pronounced in the individual who would like to feel desire but cannot experience it. In other cases, the distress affects both partners, particularly if there is a distinct discrepancy in sexual appetite resulting in frustration or disappointment.
- The disorder is not met as a result of a major psychiatric or medical condition or the result of substance abuse.
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There are 5 major risk factors to consider:
- Biological Factors:
- Hormonal status
- Physical health
- Psychological Factors:
- Low self-esteem
- Low testosterone
- Low body-image
- Fear of intimacy
- Feelings of rejection
- Sexual and/or physical abuse
- Negative Cognitive distortions
- Sexual orientation conflicts
- Obsessive-compulsive disorder
- Grief and Loss
- The Couple’s Relationship:
- Low interest in the relationship
- Diminished Sexual attraction
- Relationship/marital distress
- Power struggles
- Poor communication skills
- Illness and/or disability
- Partner sexual dysfunction
- Lack of sex script
- Intimacy issues
- The Family of Origin:
- Family of origin difficulties
- Individual/couples religious values and beliefs towards sex and/or sexual intimacy
- Cultural attitudes towards sex and/or sexual intimacy
- Medical Factors:
- Recreational drugs
Often a medical physician is a necessary part of treatment. Endocrine disorders, chronic illness, or long-term medication use can be the cause of low sexual desire. It is important to have a consultation with your GP to rule out any medical conditions and prior to stopping, decreasing dosage or changing any of your medications.
- The iatrogenic effects of many commonly used prescription medications can be another factor in HSDD Treatment strategies for overcoming the sexual side effects of medications include waiting to see if the symptoms remit, lowering the dose, substituting another antidepressant, adding a supplementary medicine to act as an antidote, or discontinuing the medication for brief periods. Remember it is important firstly to discuss these areas with your medical physician. A qualified sex therapist will work with your GP or specialist to monitor any physical or emotional changes.
- Estrogens replacement therapy has been shown to correlate positively with sexual activity, enjoyment and fantasies. The mechanism of estrogens effect on desire may be indirect and occurs through improvement in urogenital atrophy, vasomotor symptoms and menopausal mood disorders (depression).
Testosterone is recognized as an important component of the sexual appetite as it promotes sexual desire, curiosity, fantasy, interest, and behaviour. However long-term use is limited by possible side effects, including cardiovascular and liver dysfunction. Clinical evaluation and applications are limited and no guidelines for testosterone replacement therapy for women with disorders of desire and no consensus of “normal” or “therapeutic” levels of testosterone therapy exits.
Most therapists treating HSDD are not physicians, yet they must assess for physical conditions that could cause or contribute to the lack of desire. A qualified clinical sexologist must work collaboratively with psychiatrists, urologists and gynecologists and must be familiar with the role of testosterone in sexual desire and the medical conditions that could create deficiencies of this and other hormones. Additionally, chronic medical conditions, normative physiological changes, and iatrogenic effects medications can contribute to HSDD.
The fundamental goal of treatment is to restore sexual desire to the intimate relationship; however, other objectives can be accomplished in the process. A lack of sexual desire can be tied to other elements of the couple’s relationship, specifically those that diminish the sexual experience such as anger, resentment, or poor communication. Sexual Health & Relationships WA provided experience in relationship/marriage counselling, sex therapy and general concerns around anxiety/depression, grief and loss and poor communication skills and conflict resolution.
Sex therapy and couples counseling for low sexual desire or miss matched libidos may include some of the following:
Intersystemic model – deals with the interfacing of three general areas:
- Each partner’s biological and psychosocial dynamics
- The couple’s relationship
- Factors learned within the families of origin and expressed in the present
Congnitive Behaioural Therapy (CBT)
Enhancing communication skills
Addressing fears, conflict and anger
Promoting sexual intimacy
Behavioural homework exercises
Raelene Stokes at Sexual Health & Relationships WA is a highly trained clinical counsellor of sexual health, providing a confidential counselling service, specialised in sexual health and relationship issues. Raelene offers counselling and support for women and men with hypoactive sexual desire disorder and their partners.
If you wish to make an appointment or would like further information, please contact Raelene at: firstname.lastname@example.org.