CNS Drugs

, Volume 16, Issue 11, pp 745–753 | Cite as

Female Hypoactive Sexual Desire Disorder

Epidemiology Diagnosis and Treatment
Therapy In Practice

Abstract

Female hypoactive sexual desire disorder (HSDD) may occur in up to one-third of adult women in the US. The essential feature of female HSDD is a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty.

The evaluation of female HSDD generally requires careful and thoughtful consideration of the patient and the multitude of factors that impact on the various components of adult female sexual desire. Several female reproductive life experiences may uniquely affect sexual desire. These events include menstrual cycles, hormonal contraceptives, postpartum states and lactation, oophorectomy and hysterectomy, and perimenopausal and postmenopausal states. Sexual dysfunctions in women have strong positive associations with low feelings of physical and emotional satisfaction and low feelings of happiness. Thus, female HSDD can greatly impact on quality of life.

In this article, treatment options are discussed with special attention to significant reproductive life events that may impact on sexual desire in adult women. Depending on the particular phase of reproductive life that a woman is experiencing, different recommendations are made. Various options in the treatment of HSDD in women include lifestyle changes, treatment of coexisting medical or psychiatric disorders, switching or discontinuing medications that could impact on sexual desire, hormone therapy and marital therapy. Clinical trials are presently underway to assess medications that may potentially benefit female patients with HSDD.

Notes

Acknowledgements

No funding was used to assist in the preparation of this manuscript. The author is a speaker for and has received research grants from GlaxoSmithKline, Pfizer and Solvay.

References

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  2. 2.
    Goldstein I. Female sexual arousal disorder: new insights. Int J Impot Res 2000; 12Suppl. 4: 152S–7SCrossRefGoogle Scholar
  3. 3.
    Graziottin A. The biological basis of female sexuality. Int Clin Psychopharmacol 1998 Jul 13; 13Suppl.6: 1S5–22SGoogle Scholar
  4. 4.
    Redmond GP. Hormones and sexual function. Int J Fertil Womens Med 1999 Jun–Aug; 44(4): 193–7PubMedGoogle Scholar
  5. 5.
    Sarrel PM, Whitehead MI. Sex and menopause: defining the issues. Maturitas 1985 Sep; 7(3): 217–24PubMedCrossRefGoogle Scholar
  6. 6.
    Sarrel PM. Sexuality and menopause. Obstet Gynecol 1990 Apr; 75Suppl.4: 26S–30SPubMedGoogle Scholar
  7. 7.
    Stahl SM. Essential psychopharmacology: neuroscientific basis and practical applications. 2nd ed. Cambridge: Cambridge University Press, 2000Google Scholar
  8. 8.
    Crenshaw TL, Goldberg JP. Sexual pharmacology: drugs that affect sexual function. New York: W.W. Norton and Company, 1996Google Scholar
  9. 9.
    Canale D, Pistoia S. Libido and hormones. CNS Spectrums 2000 Aug; 5(8): 21–3PubMedGoogle Scholar
  10. 10.
    Waxenberg SE, Finkbiner JA, Drellick ND, et al. The role of hormones in human behavior, 2: changes in sexual behavior in relation to vaginal smears of breast cancer patients after oophorectomy and adrenalectomy. Psychosom Med 1960; 22: 435–9PubMedGoogle Scholar
  11. 11.
    Rako S. The hormone of desire: the truth about sexuality, menopause and testosterone. New York: Harmony Books, 1996Google Scholar
  12. 12.
    Basson R. The female sexual response: a different model. J Sex Marital Ther 2000 Jan–Mar; 26(1): 51–65PubMedCrossRefGoogle Scholar
  13. 13.
    Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–44PubMedCrossRefGoogle Scholar
  14. 14.
    DeCherney AH. Hormone receptors and sexuality in the human female. J Womens Health Gend Based Med 2000; 9(1): S9–13PubMedCrossRefGoogle Scholar
  15. 15.
    Sherwin BB, Gelfand MM, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Psychosom Med 1985 Jul–Aug; 47(4): 339–51PubMedGoogle Scholar
  16. 16.
    Sherwin BB. Changes in sexual behavior as a function of plasma sex steroid levels in post-menopausal women. Maturitas 1985 Sep; 7(3): 225–33PubMedCrossRefGoogle Scholar
  17. 17.
    Shifren JL, Braunstein GD, Simon JA, et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med 2000 Sep 7; 343(10): 682–8PubMedCrossRefGoogle Scholar
  18. 18.
    Clayton AH, Clavet GJ, McGarvey EL, et al. Assessment of sexual functioning during the menstrual cycle. J Sex Marital Ther 1999 Oct–Dec; 25(4): 281–91PubMedCrossRefGoogle Scholar
  19. 19.
    Gitlin MJ. Effects of depression and antidepressants on sexual functioning. Bull Menninger Clin 1995 Spring; 59(2): 232–48PubMedGoogle Scholar
  20. 20.
    Warnock JK, Blake CF. Psychiatric aspects of hormonal contraception. In: Clayton AH, Kornstein SG, editors. Women’s textbook of mental health. New York: Guilford Press, 2002: 114–31Google Scholar
  21. 21.
    Graham CA, Sherwin BB. The relationship between mood and sexuality in women using oral contraceptive as a treatment for premenstrual symptoms. Psychoneuroendocrinology 1993; 18(4): 273–81PubMedCrossRefGoogle Scholar
  22. 22.
    Graham CA, Ramos R, Bancroft J, et al. The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods. Contraception 1995 Dec; 52(6): 363–9PubMedCrossRefGoogle Scholar
  23. 23.
    Slap GB. Oral contraceptives and depression: impact, prevalence and cause. J Adolesc Health Care 1981 Sep; 2(1): 53–64PubMedCrossRefGoogle Scholar
  24. 24.
    Bancroft J, Sherwin BB, Alexander GM, et al. Oral contraceptives, androgens, and the sexuality of young women. II: the role of androgens. Arch Sex Behav 1991 Apr; 20(2): 121–35Google Scholar
  25. 25.
    Coenen CM, Thomas CM, Borm GF, et al. Changes in androgens during treatment with four low-dose contraceptives. Contraception 1996 Mar; 53(3): 171–6PubMedCrossRefGoogle Scholar
  26. 26.
    Hendrick V, Altshuler LL, Suri R. Hormonal changes in the postpartum and implications for postpartum depression. Psychosomatics 1998 Mar–Apr; 39(2): 93–101PubMedCrossRefGoogle Scholar
  27. 27.
    Pfaus JG, Everitt BJ. The psychopharmacology of sexual behaviour. In: Bloom FE, Kupfer D, editors. Psychopharmacology. New York: Raven Press, 1995: 743–58Google Scholar
  28. 28.
    American College of Obstetricians and Gynecologists. Issues in women’s health. Washington, DC: Office of Public Information, 1992Google Scholar
  29. 29.
    Heiman JR, Meston CM. Evaluating sexual dysfunction in women. Clin Obstet Gynaecol 1997 Sep; 40(3): 616–29CrossRefGoogle Scholar
  30. 30.
    Warnock JK. Hormonal aspects of sexual function in women: treatment advantages with hormone replacement therapy. Primary Psychiatry 2001; 8(4): 60–4Google Scholar
  31. 31.
    Davis SR. Androgen treatment in women. Med J Aust 1999; 170(11): 545–9PubMedGoogle Scholar
  32. 32.
    Fava M, Rankin MA, Alpert JE, et al. An open trial of oral sildenafil in antidepressant-induced sexual dysfunction. Psychother Psychosom 1998; 67(6): 328–31PubMedCrossRefGoogle Scholar
  33. 33.
    Nurnberg HG, Lauriello J, Hensley PL, et al. Sildenafil for iatrogenic serotonergic antidepressant medication-induced sexual dysfunction in 4 patients. J Clin Psychiatry 1999 Jan; 60(1): 33–5PubMedCrossRefGoogle Scholar
  34. 34.
    Salerian AJ, Deibler WE, Vittone BJ, et al. Sildenafil for psychotropic-induced sexual dysfunction in 31 women and 61 men. J Sex Marital Ther 2000 Apr–Jun; 26(2): 133–40PubMedCrossRefGoogle Scholar
  35. 35.
    Segraves RT, Croft H, Kavoussi R, et al. Bupropion sustained release (SR) for the treatment of hypoactive sexual desire disorder (HSDD) in nondepressed women. J Sex Marital Ther 2001; 27(3): 303–16PubMedCrossRefGoogle Scholar
  36. 36.
    Clayton AH, McGarvey EL, Warnock JK, et al. Bupropion as a treatment for SSRI-induced sexual dysfunction. Female Sexual Functioning Forum; 2000 Oct 26–29; Boston (MA)Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.University of Oklahoma Health Sciences Center — TulsaTulsaUSA

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