Sexuality is an essential component of a full and healthy life. However, at one time or another, sexual problems plague more than 40 percent of women in the U.S. Among the sexual issues women experience, the #1 problem reported is low sexual desire. When that’s compounded by distress — which nearly a fourth of women say they have because of their low libido — you have the hallmarks of hypoactive sexual desire disorder (HSDD). This is a problem that can wreak havoc on an intimate relationship.
HSDD is a condition in which a woman experiences distress and/or relationship difficulties because she is lacking sexual desire, which means she has few or no sexual thoughts, fantasies or sexual desires. The episodes can be intermittent or sustained over a long period of time. HSDD isn’t just “not being in the mood” every once in a while. The diagnosis of HSDD is confirmed after a physician, psychologist, or other trained healthcare professional determines that the HSDD isn’t the result of a medication or underlying medical condition.
Although it is fairly common, HSDD is underdiagnosed and undertreated, a situation that is likely the result of physicians feeling ill-equipped to treat it. Not only do some lack the formal training to treat sexual disorders in women, they also rarely ask women about their sex lives or lack thereof. This lack of discussion is compounded by the fact that physicians do not have the appropriate tools to treat female sexual dysfunction. Currently, there are no drugs available in the United States for treating women with low sexual desire. How can doctors feel motivated to even start a conversation, when they feel like they don’t have the resources to address the problem or treatment options to offer women?
Without a solution, doctors rely heavily on behavioral therapy to address psychological issues and may often direct women to over the counter products such as lubricants and arousal gels, which can help heighten sensation during sex. Many also try using vibrators, massage oils and nutritional or herbal supplements to increase arousal or try “new things” in the bedroom to break up an otherwise boring sexual routine. However, none of these actually stimulate sexual thoughts or fantasies; they may enhance the sexual experience itself, but “if your head’s not in it,” satisfaction can be reduced. So, it’s necessary for the healthcare professional to look at other causes of low desire.
Understanding HSDD is not always straightforward. It can be a complicated condition that affects a wide range of women. Age is not directly correlated with HSDD, nor is menstrual status, as it can affect both pre- and post-menopausal women. However, psychological and social issues are possibilities. Studies suggest that women with HSDD over-focus on their sexual response to stimulation, which may lead to poor overall response. Other problems may include past negative experiences, low self-esteem, concerns about pregnancy or sexually transmitted diseases, and, of major significance, the quality of her relationship with her partner. These issues may require referral to an appropriate health professional for psychological counseling.
Another major factor contributing to HSDD is the delicate balance of pathways in the brain that regulate sexual desire. An imbalance between the stimulating signals and the inhibiting signals is likely one of the causes of HSDD. These imbalances may result from excessive inhibition, insufficient excitation, or a combination of the two. While treatments targeting a specific component of this imbalance have shown some positive effects, side effects and mixed efficacy have caused the FDA to reject all “single pathway” treatments reviewed so far. There is, in fact, no FDA approved therapy for HSDD. The complicating factor may be that restoring the brain’s natural balance may require a more comprehensive approach, in effect, “re-tuning” a woman’s brain sexual chemistry. Indeed, new products that target multiple pathways have shown promise in clinical studies, with one such product currently under review by the FDA.
While no one modality or treatment is likely to solve all sexual problems in every woman, the array of options is increasing. Near-term prospects of treatments that can address and balance the underlying problem of brain chemistry will add an important new approach to treating HSDD, which could truly enrich women’s lives — and their intimate relationships.
James A. Simon is a clinical professor, George Washington University and medical director, Women’s Health & Research Consultants. He can be reached at his self-titled site, James A. Simon.
