Hypoactive Sexual Desire Disorder – I’m Not In the Mood

Hypoactive Sexual Desire DisorderHypoactive Sexual Desire Disorder (HSDD) is by far the most frequent problem occurring in female sexual dysfunctions. It is generally characterized by persistent or recurrent absence of sexual fantasies or desires.In other words, the woman is rarely in the mood for any form of sexual activity. She neither initiates sex nor seek sexual stimulation. This condition is also referred to as inhibited sexual desire, low sexual desire, impaired sexual interest, and low libido, among others.People with this condition neither masturbate nor do they engage in sexual fantasy or thoughts and they avoid sexual activity as long as they possibly can. This is a commonly diagnosed disorder and it has been estimated that more than 20% of women between the ages of 18 and 59 years experience decreased sexual desire.There are basically four subtypes of HSDD. In essence, HSDD can be:
  1. Acquired – HSDD started after a period of normal sexual functioning
  2. Life-long – the woman has always had no/low sexual desire
  3. Global – she has a general lack of sexual desire
  4. Situational – she still has sexual desires, but lacks sexual desire for her current partner
Consequently, HSDD may be a primary condition in which she has never felt much sexual desire or interest. Also, it might have occurred secondarily where she formerly had sexual desire, but no longer has interest.

Sexual Desire Disorders

The DSM-IV-TR category of Sexual and Gender Disorders is divided into three parts, one of which is Sexual Dysfunctions. One of the groups of sexual dysfunctions is “Sexual Desire Disorders” (SDD) of which there are two kinds: (a) hypoactive sexual desire disorder (HSDD) and (b) sexual aversion disorder (SAD). The former is the subject matter of this article.

Sexual Aversion Disorder (SAD)

Sexual Aversion Disorder (SAD)
Sexual aversion disorder, a fear of sex and a compelling desire to avoid sexual contact, is a relatively rare problem and it is often the result of sexual abuse or trauma. This difficulty is also known as sexual phobia and sexual panic disorder.Sexual aversion disorder may vary from a moderate dislike and anxiety about sex to the extremes of panic, disgust, and revulsion. Even the thought of these sexual behaviors may trigger a negative emotional reaction. Most often such fears result from sexual trauma, such as rape or incest.Although both low sexual desire and sexual aversion serve as a means of avoiding or fleeing sex, they represent two different types of self-protection provided by the mind. When a woman has low sexual desire due to past trauma, sexual cues produce no response. Her unconscious mind seeks protection by not responding to anything that could reactivate the buried pain.In cases of sexual aversion, rather than experiencing no response to sexual cues, she experiences strong, negative emotions. Feelings of disgust prompt the woman to avoid sex, which is an unconscious means of trying to avoid a recurrence of the earlier trauma.Similar to low sexual desire, sexual aversion may first occur right after the trauma, or may come about later in life, even after a period of safe or pleasant sex.Therefore, hypoactive sexual desire disorder isn’t the same as having difficulty getting aroused or experiencing orgasm. In fact, even though she may lack sexual desire, she can still get turned on and even orgasm when she’s sexually active.HSDD isn’t the same thing as being afraid of, or disgusted by sex. With hypoactive sexual desire disorder, it’s not that she finds sex scary, bad, or distasteful; she simply has no interest in it. She doesn’t seek it, doesn’t fantasize about it, and wouldn’t miss it if sex disappeared from her life altogether.

Causes of Hypoactive Sexual Desire Disorder

Hypoactive sexual desire disorder may occur in a woman at any age. It may be present in adolescence and can persist throughout a woman’s life. However, HSDD often occurs during a woman’s adulthood, often times following a period of stress. The source of hypoactive sexual desire disorder may be multi-factorial illness, medications, and psychological issues.


HSDD in women is more common as a result of menopause. Reduced estrogen to postmenopausal levels can lead to dryness of the vagina making sex painful which reduces motivation. The gradual decline of the hormones estrogen, progesterone and testosterone together serve to decrease drive.

Physical Problems

Physical ailments such as diabetes, heart diseases, vaginal yeast and urinary tract infections, neurological disorders, pelvic surgery, chronic liver disease and kidney diseases can all lead decreased or low sexual desire.

Psychological Problems

Psychological causes such as stress from work and family, relationship communication problems, anxiety, depression, and previous traumatic sexual experiences can also contribute to the development of this disorder.

Physical abuse

A lifelong or primary HSDD where a woman has never felt any sexual desire not exhibited interest in sex could be as a possible result of incest, sexual abuse or rape.

Repressive Cultures/Belief Systems

Certain repressive family attitudes towards sex which are often enhanced by rigid religious trainings can force individuals to think of sex as an immoral activity.

Unpleasant Initial Sexual Experience

Initial failed attempts at sexual intercourse or pains from first sexual experiences could also lead to HSDD.

Insufficient Sexual Hormone Levels

Low levels of testosterone may cause HSDD in males and females. However, while some argue that increasing testosterone levels even in those without low levels may also serve to increase sex drive; others are of the opinion that HSDD in males and females rarely results from insufficient levels of the male sex hormone, testosterone.

Relationship Boredom

A woman experiencing stagnation or boredom in a relationship can develop an acquired HSDD.

Medication Side Effects

The usage of antidepressants for depression, antihypertensive medication, and oral birth control pills may interfere with sex drive, arousal, and orgasm leading to the development of HSDD.

Sexual Function Impairment

Impairment of sexual functions such as vaginismus (an involuntary contraction or spasm of the pelvic floor muscles and outer third of the vagina resulting from an unconscious desire to prevent vaginal penetration thus making it impossible or very painful) can develop into HSDD. This may be due to incompatibility in sexual interest between the sexual partners. This can also occur in the presence of a sexually demanding partner.


Dyspareunia or painful intercourse due to surgery, injury or infection may also cause HSDD. Also inadequate lubrication at the time of penetration from insufficient foreplay can also cause painful intercourse.General symptoms of HSDD in patients include infrequent and eventual absence of sexual activity; less enjoyment of sexual activities than she used to; avoidance of sex; and have fewer or no erotic dreams and sexual fantasies. In a selective and focused HSDD, there might be zero interest in having sex with their partners but have normal or increased real/fantasized sexual desires toward other men.

Treatment options for Hypoactive Sexual Desire Disorder

Hypoactive Sexual Desire Disorder - Treatment
Treat of HSDD is typically directed at removing or alleviating the underlying cause e.g. relationship misunderstanding, depression, and other sexual dysfunction (especially arousal or orgasm difficulties). When the problems causing HSDD arise from issues with sexual arousal or performance, then these dysfunctions will need to be directly addressed.It is acknowledged that majority of HSDD cases are situational in nature arising from dissatisfaction and loss of interest in the sexual partner. Thus there will be need for treatment to be within the context of the relationship itself and as such, it is common for both partners to be involved in therapy.The use of antidepressants like Prozac and Paxil of which women are major consumers, has been known to be a major cause of decrease in libido in as much as 60 percent of patients. Where possible, it is advisable to switch to a lower dosage or to one that has less of a sexual side effect, like Celexa, Effexor, or Wellbutrin.On the pharmaceutical side, testosterone supplementation in individuals with testosterone levels below the normal range (20 nanograms per deciliter) seems to be the treatment of choice. Although testosterone has not been approved for the treatment of HSDD by the FDA, studies have shown that several women who have used the testosterone patch have reported significant increase in the frequency of sexual activity and satisfying desire.However, it should be noted that there is very limited data on the effectiveness of various forms of medication and therapy for female HSDD.
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