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Sexual Desire Disorders: Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

In the DSM-IV-TR, there was a single disorder that was simply called "Hypoactive Sexual Desire Disorder." It could be applied to men or women. Hypoactive means low sexual desire. As discussed, men and women experience sexual desire at different levels. To recognize this, the DSM-5 now offers 2 disorders - Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder. Each has its own criteria that must be met for a diagnosis to be made.

Female Sexual Interest/Arousal Disorder

The symptoms of this condition include:

Lack of, or significantly reduced, sexual interest/arousal with at least 3 of the following present for a minimum of 6 months:

  • Absent/reduced interest in sexual activity
  • Absent/reduced sexual/erotic thoughts or fantasies
  • No/reduced initiation of sexual activity, and typically unreceptive to a partner's attempts to initiate
  • Absent/reduced sexual excitement/pleasure during sexual activity in 75-100% of sexual encounters
  • Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (written, verbal or visual)
  • Absent/reduced genital or nongenital sensations during sexual activity in 75-100% of sexual encounters

The symptoms must also cause significant stress in the female's life.

Symptoms cannot be happening due to a nonsexual mental disorder, because of severe relationship distress (for example, partner violence), and cannot be the result of another medical disorder or medication (prescription or drug of abuse).

The clinician should specify whether the condition is:

  • Lifelong - the problems have been present since the person became sexually active
  • Acquired - the problems began after a period of relatively normal sexual function

It should also be noted whether it is:

  • Generalized - not limited to certain types of stimulation, situations or partners.
  • Situational - only happens with certain types of stimulation, situations or partners.

Finally, the condition can be mild, moderate or severe depending on the level of stress over the symptoms that are happening.

Male Hypoactive Sexual Desire Disorder

The criteria for this condition include:

  • Persistent or recurring reduced or absent sexual/erotic thoughts or fantasies and desire for sexual activity. This judgment is made by the clinician after taking into account factors that affect sexual functioning, such as age, general factors, and sociocultural factors of the man's life.
  • The symptoms must have been present for at least 6 months.
  • They must also cause significant stress in the man's life.
  • Symptoms cannot be happening due to a nonsexual mental disorder, because of severe relationship distress (for example, partner violence), and cannot be the result of another medical disorder or medication (prescription or drug of abuse).

The clinician should specify whether the condition is:

  • Lifelong - the problems have been present since the person became sexually active
  • Acquired - the problems began after a period of relatively normal sexual function

It should also be noted whether it is:

  • Generalized - not limited to certain types of stimulation, situations or partners.
  • Situational - only happens with certain types of stimulation, situations or partners.

Finally, the condition can be mild, moderate or severe depending on the level of stress over the symptoms that are happening.

Causes & Risk Factors of Sexual Desire Disorders

There are many risk factors and causes associated with Sexual Desire Disorders. If we consider sexual health and function from a comprehensive perspective, it is not surprising that mental health disorders, and physical troubles, can cause sexual dysfunction.

In terms of mental illness, an actual symptom of depression is loss of interest in activities that were previously enjoyed, one of which can be sex. Additionally, anxiety can also impact sexual function. Certainly, relationship troubles can also take its toll on sexual desire.

There are also physical factors that can influence sexual desire. As mentioned earlier, menopause (women) and andropause (men) can significantly impact sexual function. This happens because the natural aging process results in decreasing hormonal levels of estrogen and testosterone. These two hormones play a key role in sexual desire. Certain medical procedures such as removal of the prostate, pelvic radiation (interventions in cancer treatment may result in permanent sexual impairment), and procedures associated with the spinal cord can also impact sexual desire. Additionally, low sexual desire can be a side effect of many medications. It is important that you discuss side effects and concerns you have regarding any medication you are taking with your doctor.

Treatment Options for Sexual Desire Disorders

Individuals experiencing low sexual desire may benefit from psychotherapy and/or hormone replacement therapy (HRT). Women may benefit from oral contraceptive treatment that may include increasing one or more female sex hormones (estrogen and progesterone). This can happen via medications or so-called natural replacement (primarily through plant-based estrogens). Treatment may include oral medications that are swallowed, or skin patches, creams, or suppositories where medication is absorbed directly into the bloodstream through the skin. Estrogen therapy may improve low interest and/or arousal disorders. Low estrogen levels may lead to poor sleep, dislike of sensual touching, and lack of well-being, which can all impact sexuality. Where vaginal dryness is a concern, estrogen may also be delivered via cream or suppository directly to the vaginal area. However, the North American Menopause Society concludes, "HRT is not recommended as the sole treatment of sexual function, including decreased libido." (North American Menopause Society, 2008).

Even more controversial is the use of testosterone replacement therapy. Because testosterone is a necessary component of the sex drive, men and women may benefit from this treatment. However, testosterone products are not government approved for use by women in the United States or Canada. Therefore, if a woman's doctor recommends testosterone for low sex drive, the medication must be specially created.

Recently, mindfulness techniques have also been found to be helpful in the treatment of low sexual desire. Mindfulness involves being aware of the present moment and comes from Buddhist meditation. It has been brought to Western health care by Jon Kabat Zinn and many others. It has been used to treat many psychological disorders, including depression, anxiety, and borderline personality disorder. It has also been used with chronic physical pain. Most of us go through life not living in the present moment. We go back and forth between thinking in the future (worrying about what we need to get done, planning what to do next) and living in the past (thinking about what happened yesterday). Because of this, we often miss out on what is going on right now. While multitasking can be helpful in certain situations, it is important to be present during sexual activities. Research has indicated that practicing mindfulness can improve sexual desire levels (Brotto, Krychman, & Jacobson, 2008).