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Hypoactive sexual desire disorder: definition and description.

Hypoactive sexual desire disorder (HSDD) is the diagnostic label given to the most common sexual dysfunction in women of all ages. It has been a recognized condition in the medical and psychological literature for 40 years. (1)

In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), (2) HSDD is defined as persistently or recurrently deficient or absent sexual fantasies and desire for sexual activity that cause marked distress or interpersonal difficulty. Loss of desire should not be better accounted for by another psychiatric disorder, drug, or other medical condition or by the normal fluctuation in a relationship over time or life circumstance. Furthermore, although HSDD can lead to difficulties in intimate relationships, low desire that results from a relationship conflict is not considered HSDD.

In DSM-5, (3) HSDD and female sexual arousal disorders are combined into a single entity, female sexual interest/arousal disorder (FSIAD), derived primarily from Basson's sexual response model, which suggests sexual response is not always a linear process, the distinction between desire and arousal may be artificial, and normal desire has a responsive component. (4-5) Replacing D5M-IV language with FSIAD in DSM-5 does not complicate diagnosis in clinical practice and does not obliterate HSDD as a condition. The only essential change required to establish a diagnosis specific to loss of desire is time since symptom onset, which DSM-5 designates as 6 months to avoid overdiagnosis of transient symptoms. Furthermore, an expert panel at the October 2014 FDA scientific workshop on FSIAD agreed that HSDD still exists as a condition. (6) International Classification of Diseases, Tenth Revision (ICD-10) diagnostic coding continues to include HSDD (F52.0). (7)

Office visits should include a brief assessment of sexual function. The Decreased Sexual Desire Screener, a tool specifically developed for use by health care providers, does not require experience in sexual medicine. (8) This self-administered 5-question survey can help identify acquired HSDD in premenopausal and postmenopausal women. The first 4 questions are "In the past, was your level of sexual desire or interest good and satisfying to you?" "Has there been a decrease in your level of sexual desire or interest?" "Are you bothered by your decreased level of sexual desire or interest?"and "Would you like your level of sexual desire or interest to increase?" For a woman who answers yes to these questions, a fifth question helps identify potential causes of or factors that contribute to HSDD. Assessing a patient's perceptions of a problem and its timeline and context may assist in isolating etiologies and may serve as a basis for treatment considerations. (9)

A thorough sexual history and/or physical examination is needed to uncover physiologic and anatomical factors in sexual complaints. There are no standard laboratory tests or imaging studies required for the initial evaluation of a patient with normal examination findings. The examination also provides an opportunity to educate the patient on anatomy and female sexual function. Many medical and psychiatric conditions as well as prescription and over-the-counter medications can affect sexual function, and these should be assessed during the evaluation. (10)


(1.) Kaplan HS. Hypoactive sexual desire. J Sex Marital Ther. 1977;3(1):3-9.

(2.) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Arlington, VA: American Psychiatric Association; 2000.

(3.) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

(4.) Basson R. Human sex-response cycles. J Sex Marital Ther. 2001;27(1):33-43.

(5.) Binik YM, Brotto LA, Graham CA, Segraves RT. Response of the DSM-V Sexual Dysfunctions subworkgroup to commentaries published in JSM. J Sex Med. 2010;7(7):2382-2387.

(6.) US Food and Drug Administration. Scientific Workshop on Female Sexual Interest/Arousal Disorder. ents/UCM419992.pdf. Published October 28,2014. Accessed August 2, 2016.

(7.) 2016 ICD-10-CM Code F52.0: hypoactive sexual desire disorder. http://www Accessed August 2, 2016.

(8.) Clayton AH, Goldfischer ER, Goldstein I, Derogatis L, Lewis-D'Agostino DJ, Pyke R. Validation of the Decreased Sexual Desire Screener (DSDS): a brief diagnostic instrument for generalized acquired female hypoactive sexual desire disorder (HSDD) J Sex Med. 2009;6(3):730-738.

(9.) Kingsberg S, Althof SE. Evaluation and treatment of female sexual disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(suppl 1):S33-S43.

(10.) Kingsberg SA, Rezaee RL. Hypoactive sexual desire in women. Menopause. 2013;20(12):1284-1300.

Sheryl A. Kingsberg, PhD

Case Western Reserve University School of Medicine

Cleveland, Ohio
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Author:Kingsberg, Sheryl A.
Publication:OBG Management
Date:Oct 1, 2016
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