Disorders of Sexual Desire and Arousal
Section snippets
Prevalence
It is difficult to estimate the prevalence of desire disorders. Laumann and colleagues [1] reported on a national probability sample of 1749 women aged 18 to 59 years. Of these, 43% reported a sexual dysfunction. Among the 2400 midlife multiethnic women (Hispanic, white non-Hispanic, African American, Chinese, and Japanese) in six United States cities who completed baseline questionnaires in the prospective Study of Women's Health across the Nation, 40% reported that they never or infrequently
Masters and Johnson
Masters and Johnson advanced our knowledge of human sexuality. Masters was the first to describe a physiologic model for the sexual response cycle. His original model did not include a desire phase because he did not consider desire disorders to be sexual dysfunctions; he used the term dysfunction to describe “an altered state of physiologic responsivity.” Rather, he considered inhibited sexual desire and sexual aversion to be nondysfunctional diagnostic categories.
Biphasic model
Masters separated sexual
Hypoactive desire disorder, sexual aversion, and female sexual arousal disorder
Patients often present with the complaint, “I just don't have any interest in sex.” Successful therapy for these patients depends on an accurate diagnosis. Unfortunately, there is no consensus on diagnostic definitions. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (Text Revision) definitions of desire and arousal disorders are shown in Box 1. The international multidisciplinary group gathered by the American Foundation for Urologic Disease definitions are shown in Box 2
Domestic violence
Women who are in a violent relationship have high rates of sexual dysfunction including desire disorders. Chapman [46] found that 61% of women who suffered from domestic violence had sexual dysfunctions. Schei and Bakketeig [47] found an association between sexual problems and domestic violence as well. All women who present with complaints of decreased desire should be screened for domestic violence.
Depression
Depression is strongly associated with decreased desire [27], [48]. The relationships between depression, marital distress, and sexual dysfunction are complex. The relationships between sexual dysfunctions, depression and antidepressants are discussed in detail elsewhere in this issue. Women who present with complaints of decreased desire should be screened for depression.
Substance abuse
Substance abuse is associated with decreased desire. Abuse of alcohol, narcotics, marijuana, and cocaine has been associated with decreased desire. The associations of substance abuse and sexual dysfunctions are discussed in detail elsewhere in this issue. A patient who presents with decreased desire should be screened for substance abuse.
Androgen deficiency
Androgen deficiency is covered in detail elsewhere in this issue.
History
A complaint of decreased desire may be overt or may be uncovered in a review of systems. A complete sexual history is described elsewhere in this issue. A general medical history should be taken, with emphasis on uncovering chronic illness such as those described above. A menstrual history may uncover thyroid disorders or hyperprolactinemia. A complete list of medications including over-the-counter and herbal preparations should be obtained. The patient should be screened for domestic violence,
Therapeutic approaches
Therapy for desire phase disorders is difficult. There is minimal data on the effectiveness of different therapeutic approaches [49]. Masters and Johnson reported a success rate of over 90% for sexual aversion using sensate focus therapy [39]. They reported that low libido required an intensive psychotherapeutic approach. Kaplan stated that only a small proportion of patients who have inhibited sexual desire responded to brief sex therapy. Therapy must be directed toward the etiology of the
Cognitive behavioral therapy
Cognitive behavioral therapy focuses on the role of thinking in how we feel and act. The theory is that thinking causes patients to feel and act the way they do. Therapy is directed to replacing negative thoughts with thoughts that lead to more desirable feelings and behaviors. In this paradigm, decreased sexual desire is caused by negative thoughts about sex or the partner. Replacing these thoughts with positive ones leads to a change in behavior and feelings. Trudel and colleagues [50]
Intensive sex therapy
Intensive sex therapy involves sensate focus exercises as an educational tool. Intensive sex therapy has been reported to be effective in sexual aversion and arousal disorders, but less so in HSDD.
Pharmacologic therapy
A variety of pharmacologic approaches have been advocated. The US Food and Drug Administration has not approved any drugs for treatment of HSDD or female sexual arousal disorder. Prescription drugs and herbal and alternative therapies are discussed in detail elsewehere in this issue.
Summary
Desire and arousal disorders are very common. These disorders can cause significant distress to a patient. A successful approach depends on an accurate diagnosis, which is dependent on history. Laboratory evaluation is usually not helpful, whereas psychosexual therapy is helpful in many cases. Although there is some evidence that drug therapy is helpful in some cases, no drug has been approved for the treatment of these disorders.
References (50)
- et al.
Hypoactive sexual desire disorder in menopausal women: a survey of Western European women
J Sex Med
(2006) - et al.
Prevalence of female sexual dysfunction symptoms and its relationship to quality of life: a Japanese female cohort study
Urology
(2005) - et al.
Epidemiology/risk factors of sexual dysfunction
J Sex Med
(2004) - et al.
Sexual dysfunctions: relationship to childhood sexual abuse and early family experiences in a nonclinical sample
Child Abuse Negl
(1995) - et al.
Sexual dysfunction in women with hyperprolactinemia: a pilot study report
J Urol
(2005) - et al.
Sexual behavior and steroid levels among gynecologically mature premenopausal women
Fertil Steril
(1986) - et al.
Sexuality, hormones and the menopausal transition
Maturitas
(1997) - et al.
The relative effects of hormones and relationship factors on sexual function of women through the natural menopausal transition
Fertil Steril
(2005) - et al.
Decreased sexual interest and its relationship to body build in postmenopausal women
Maturitas
(1996) - et al.
Low sexual desire in women: the role of reproductive hormones
Horm Behav
(1989)
Women's sexual function improves when partners are administered vardenafil for erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled trial
J Sex Med
Sexual dysfunction in the United States: prevalence and predictors
JAMA
Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women's Health Across the Nation (SWAN)
Menopause
Sexual activity and function in middle-aged and older women
Obstet Gynecol
Distress about sex: a national survey of women in heterosexual relationships
Arch Sex Behav
Predictors of sexual functioning in ovarian cancer patients
J Clin Oncol
Sexual dysfunction in women with type 1 diabetes: a controlled study
Diabetes Care
Low sexual desire in midlife and older women: personality factors, psychosocial development, present sexuality
Menopause
Women's health in midlife: the influence of the menopause, social factors and health in earlier life
Br J Obstet Gynaecol
Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS)
Menopause
On categorization and quantification of women's sexual dysfunctions: an epidemiological approach
Int J Impot Res
Female sexual dysfunction in a healthy Austrian cohort: prevalence and risk factors
Eur Urol
Prevalence of sexual dysfunction in women: results of a survey study of 329 women in an outpatient gynecological clinic
J Sex Marital Ther
Inhibited sexual desire in women
Arch Sex Behav
Sexual dysfunctions in men and women: significance of a dysfunctional family climate and sexual abuse
Psychother Psychosom Med Psychol
Cited by (10)
Do women with endometriosis have to worry about sex?
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Overall it seems that chronic illnesses may be associated with decreased sexual desire [32]. Moreover, women with dyspareunia often develop Hypoactive Sexual Desire Disorder (HSDD) or arousal disorder because pain is both a potent inhibitor of the sexual response cycle and a potent modifier of behaviour [32]. They have lower frequency of intercourse and lower levels of desire and arousal [33].
Hypoactive sexual desire disorder: comparison of two questionnaires (the brief profile of female sexual function and the health and female sexual dysfunction in primary care) in women with hysterectomy plus bilateral oophorectomy versus normal women
2010, Clinica e Investigacion en Ginecologia y ObstetriciaSexuality: A Quality-of-Life Issue for Cancer Survivors
2008, Seminars in Oncology NursingCitation Excerpt :Decreased desire and arousal are common in individuals suffering from depression.4,21,32 Emotional distress, especially anxiety, negatively influences sexual desire.29 Body image is a key aspect of sexuality and encompasses an individual's feelings and attitudes toward their body.18,65
Management of hypoactive sexual desire dysfunction at a specialized service in women’s sexual health
2024, Journal of Sex and Marital TherapySexual function in women undergoing surgery for deep infiltrating endometriosis: A comparison with healthy women
2015, Journal of Family Planning and Reproductive Health CareSexuality in Endometriosis
2012, Endometriosis: Science and Practice