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Conditions: HSDD

Understanding HSDD

Did you know that hypoactive sexual desire disorder (HSDD) affects about 1 in 10 women? 

It’s the most common of female sexual dysfunctions, but it’s underdiagnosed and undertreated.  Many practitioners aren’t sure of how to approach it with their patients.  Some clinicians feel uncomfortable discussing sex.  Others feel that they don’t have the expertise to handle HSDD complaints or that discussing sexual health will take up too much time during the office visit.

However, sexual health is important to overall general health.  And because HSDD can have medical and psychological implications, it’s best to keep it in mind when assessing your female patients or clients.

What is HSDD?

HSDD is a decrease or absence of sexual desire that causes a woman personal distress.  The “personal distress” aspect is critical.  Sexual desire varies from woman to woman. What might seem “normal” for one may not be “normal” for another.  If a woman is not bothered by her level of desire, then she probably does not have HSDD.   

HSDD is classified as generalized or situational.  In generalized cases, a woman lacks desire in most sexual circumstances.  When HSDD is situational, it only happens at certain times. 

HSDD can also be classified as acquired or lifelong.  Acquired HSDD happens after a woman has had normal functioning for some time.   

There are many possible causes for HSDD.  Common physical ones include diabetes, high blood pressure, and coronary artery disease. Certain medications, such as antidepressants, can affect sex drive.  And hormonal changes from pregnancy or menopause can play a role.

Psychological issues like stress, anxiety, depression, low self-esteem, and sexual abuse are other causes.  A woman might also lose her desire for sex if there are problems with her partner or relationship. 

Often, there is a combination of causes at work.  For example, a new mother might lose interest in sex because of hormonal changes and because she’s exhausted from caring for a newborn baby. 

HSDD can lead to, or worsen, poor self-esteem, anxiety, and problems with relationships. 

Patient/Provider Communication

Why is HSDD underdiagnosed and undertreated?

The problem may be communication – or lack of it.  Many healthcare providers don’t bring up the subject of sex.  It’s awkward sometimes.  There are cultural taboos.  Taking a sexual history may not be part of the everyday routine.  Some providers are afraid of offending their patients.  Or they might not feel confident in their abilities to handle sexual health issues.

Unfortunately, female patients are often just as – or even more – reluctant to bring up the subject.  Many women are brought up to believe that “nice girls” aren’t supposed to want to have sex or that their sexual needs aren’t important.  Some believe, or fear, that it’s all in their heads.

Also, many women simply don’t know about HSDD and that it’s a treatable condition.  A recent survey conducted by the Society for Women’s Health Research showed that women were 7 times more familiar with erectile dysfunction in men (ED) than with HSDD.  66% of the women surveyed knew about ED, but only 9% knew about HSDD. 

But remember, you and your patient are a team.  Your goal is to improve overall health and addressing sexual health concerns, when appropriate, is part of that goal.

So how can you approach the topic?

Establish rapport with your patient.  Help her understand the importance of sexual health and that it’s okay to discuss sexual matters.

For diagnosing HSDD, the Decreased Sexual Desire Screener (DSDS) is a helpful tool.  The DSDS is a five-point questionnaire that a woman can easily fill out during her office visit (click here to see the questions).  Provided instructions guide the practitioner in clarifying and evaluating the patient’s answers to determine if she does have HSDD.

After diagnosis, you can decide what next steps might be appropriate for your patient.  She may need to be screened for certain illnesses, have her hormone levels checked, or have medications changed.

She may also need a referral to a specialist, such as a sex therapist or counselor, to help her work through any psychological or relationship issues.

Learning More

You may not have received much sexual health training during your professional education.  But we encourage you to learn more about sexual health – and about HSDD in particular.  Find out what professional development opportunities are available for your clinical setting.  Read more about discussing sexual health with patients.  Talk to your colleagues about how they approach HSDD with patients and what strategies they use to discuss, diagnose, and treat it. 

Working together, healthcare providers can improve sexual health communication and get help for their patients with HSDD.

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