Hypoactive sexual desire disorder (HSDD) is defined as a persistent or recurring deficiency of sexual fantasies, thoughts, and/or receptivity to sexual activity, which causes personal distress. Review of 10 studies conducted between 1978 and 1999 of women in the general population, ages 18 – 75 years suggests the estimated prevalence of HSDD to be 11 – 20% increasing by 2-3% per decade. This prevalence rate is supported in a large general population representative sample (>30,000 responders to 50,000 surveys) using a validated questionnaire to assess low libido (the Changes in Sexual Functioning Questionnaire), and distress (the Female Sexual Distress Scale). Confounding factors in the diagnosis of HSDD include concurrent major depressive disorder (MDD) with related features of onset with hormonal changes associated with reproductive-life events, financial dependency, greater number of children, history of sexual harassment, and co-morbid diabetes mellitus. The greatest dilemma in differentiating between HSDD and MDD appears to be related to women responsive to antidepressant therapy with a serotonin reuptake inhibitor, but with associated sexual dysfunction/diminished desire. Surveys of primary care physicians and specialists reveal low comfort and knowledge about diagnosis and treatment of HSDD. As a result, providers rarely initiate discussions with patients about sexual functioning, and sexual disorders go undiagnosed. Evaluation should include assessment of all phases of the sexual response cycle with emphasis on nature, duration, and intensity of the change in sexual desire, level of personal distress, quality of the relationship, sexual history, and notation of medical and psychiatric diagnoses and treatments with targeted physical examination and laboratory studies. Current treatment options are limited; further research is needed.
Conflict of Interest: Grants: Biosante Pharmaceuticals, Inc.; Boehringer-Ingelheim; Bristolmyerssquibb; Eli Lilly And Company; Forest Pharmaceuticals; Glaxosmithkline; Neuronetics; Pfizer, Inc.; Sanofi-Aventis; Wyeth Advisory Board/Consultant: Boehringer-Ingelheim; Bristolmyerssquibb; Eli Lilly And Company; Fabre-Kramer Pharmaceuticals; Glaxosmithkline; Novartis Pharmaceuticals; Pfizer, Inc; Vela Pharmaceuticals; Wyeth Speaker’S Bureau/Honorarium: Eli Lilly; Glaxosmithkline; Pfizer, Inc.; Wyeth
Financial Support/Funding: Boehringer-Ingelheim
Sydney Australia, April 2007
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