Hypoactive sexual desire disorder (HSDD) is considered as a sexual dysfunction
and is characterized as a lack or absence of sexual fantasies and desire for
sexual activity, as judged by a clinician. For this to be regarded as a
disorder, it must cause marked distress or interpersonal difficulties and not be
better accounted for by another mental disorder, a drug (legal or illegal), or
some other medical condition.
Medical Causes of HSDD
Obviously, lifestyle factors also influence the desire for sex. A single
working mom who is overwhelmed by family needs may feel too exhausted to relax,
kick back and fantasize about sex — let alone engage in it! However, sometimes a
medical condition is the underlying cause of low libido, including:
- Medication Use: Many commonly prescribed drugs, such as
antihypertensives, antidepressants and birth control pills, interfere with
sex drive, arousal and orgasm by affecting the balance of sexual hormones
and the transmission of chemical messengers. For instance, antidepressants
known as selective serotonin reuptake inhibitors combat depression by
increasing the production of serotonin in the brain. Unfortunately,
serotonin dampens sexual desire.
- Menopause: The onset of menopause, either surgical or natural, is
characterized by a gradual decline of the hormones estrogen, progesterone
and testosterone. Reduced testosterone levels, in particular, say the
Bermans, can lead to a "sudden or gradual" decline in libido. Ironically,
the conventional hormone replacement regimen of estrogen and progesterone
given to relieve menopausal symptoms can make matters worse, because
estrogen increases a protein (called steroid hormone-binding globulin) in
the blood that binds to testosterone, causing it to become less available to
- Depression: A common symptom of depression is diminished sex drive,
which, in turn, can exacerbate depression. Studies indicate that 12 percent
of all women will experience clinical depression at some point in their
lives. As mentioned, one of the side effects of the popular antidepressants
Prozac, Paxil and Zoloft is loss of libido. Dysthymia is a lower-grade form
of depression that is not easily diagnosed because you can function with it,
note the Bermans. A woman with dysthymia may feel isolated and overwhelmed
and withdraw from sex and social activities.
Low sexual desire alone is not equivalent to HSDD because of the requirement
in HSDD that the low sexual desire causes marked distress and interpersonal
difficulty and because of the requirement that the low desire is not better
accounted for by another disorder in the DSM or by a general medical problem. It
is therefore difficult to say exactly what causes HSDD. It is easier to
describe, instead, some of the causes of low sexual desire.
In men, though there are theoretically more types of HSDD/low sexual desire,
typically men are only diagnosed with one of three subtypes.
- Lifelong/generalized: The man has little or no desire for sexual
stimulation (with a partner or alone) and never has.
- Acquired/situational: The man was previously sexually interested in his
present partner but now lacks sexual interest in them but has desire for
sexual stimulation (i.e. alone or with someone other than his present
- Acquired/generalized: The man previously had sexual interest in his
present partner, but lacks interest in sexual activity, partnered or