Management of hypoactive sexual desire disorder in women in the gynecological setting

 

 Permissions and Reprints

Key-points

• Hypoactive Sexual Desire Disorder (HSDD) is the most prevalent sexual dysfunction among women.

• Psychological, biological, behavioral, relational and environmental factors are the main causes of HSDD and should be assessed during HSDD investigation.

• Gynecologists should assess women's sexual problems during routine gynecological consultations.

• Sexual education is the start point of managing HSDD, secondary to psychological, biological, behavioral, relational and environmental factors.

• The multidisciplinary teamwork approach achieves the best results to deal with HSDD.

The National Specialty Commission for Sexology of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.

Publication History

Article published online:
28 June 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• References

• 1 ICD-11 for Mortality and Morbidity Statistics [Internet]. 2020 [cited 2020 Aug 3]. Available from: https://icd.who.int/browse11/l-m/en
  PubMedGoogle Scholar
• 2 McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD. et al. Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016; 13 (02) 144-152 DOI: 10.1016/j.jsxm.2015.12.034.
  CrossrefPubMedGoogle Scholar
• 3 McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health. 2018; 18 (01) 108 DOI: 10.1186/s12905-018-0602-4.
  CrossrefPubMedGoogle Scholar
• 4 Yazdani M, Mahmoodi Z, Azin SA, Qorbani M. The effect of counseling based on sexual self-concept via social networks on smartphone in infertile women: a randomized controlled trial. Int J Community Based Nurs Midwifery. 2019; 7 (03) 231-240 DOI: 10.30476/IJCBNM.2019.44998.
  CrossrefPubMedGoogle Scholar
• 5 Bitzer J, Platano G, Tschudin S, Alder J. Sexual counseling for women in the context of physical diseases: a teaching model for physicians. J Sex Med. 2007; 4 (01) 29-37 DOI: 10.1111/j.17436109.2006.00395.x.
  CrossrefPubMedGoogle Scholar
• 6 Lara LAS, Coelho Neto MA, Martins WP, Ferriani RA, Navarro PA. Assessment of sexual function in infertile women in a gynecological care setting. J Sex Med. 2016; 13 (06) 938-944 DOI: 10.1016/j.jsxm.2016.04.065.
  CrossrefPubMedGoogle Scholar
• 7 Lara LAS, Scalco SCP, Troncon JK, Lopes GP. A model for the management of female sexual dysfunctions. Rev Bras Ginecol Obstet. 2017; 39 (04) 184-194 DOI: 10.1055/s-0037-1601435.
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Di Francesco S, Caruso M, Robuffo I, Militello A, Toniato E. The impact of metabolic syndrome and its components on female sexual dysfunction: a narrative mini-review. Curr Urol. 2019; 12 (02) 57-63 DOI: 10.1159/000489420.
  CrossrefPubMedGoogle Scholar
• 9 Otunctemur A, Dursun M, Ozbek E, Sahin S, Besiroglu H, Koklu I. et al. Effect of metabolic syndrome on sexual function in pre- and postmenopausal women. J Sex Marital Ther. 2015; 41 (04) 440-449 DOI: 10.1080/0092623X.2014.918068.
  CrossrefPubMedGoogle Scholar
• 10 Nascimento ER, Maia ACO, Nardi AE, Silva AC. Sexual dysfunction in arterial hypertension women: the role of depression and anxiety. J Affective Disord. 2015; 181: 96-100 DOI: 10.1016/j.jad.2015.03.050.
  CrossrefPubMedGoogle Scholar
• 11 Polland AR, Davis M, Zeymo A, Iglesia CB. Association between comorbidities and female sexual dysfunction: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Int Urogynecol J. 2019; 30 (03) 377-383 DOI: 10.1007/s00192-018-3739-7.
  CrossrefPubMedGoogle Scholar
• 12 Nappi RE, Cucinella L. Advances in pharmacotherapy for treating female sexual dysfunction. Expert Opin Pharmacother 2015; 16 (06) 875-887 DOI: 10.1517/14656566.2015.1020791.
  CrossrefPubMedGoogle Scholar
• 13 Dèttore D, Pucciarelli M, Santarnecchi E. Anxiety and female sexual functioning: an empirical study. J Sex Marital Ther. 2013; 39 (03) 216-240 DOI: 10.1080/0092623X.2011.606879.
  CrossrefPubMedGoogle Scholar
• 14 Mitchell KR, Mercer CH, Ploubidis GB, Jones KG, Datta J, Field N. et al. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet 2013; 382 (9907): 1817-1829 DOI: 10.1016/S0140-6736(13)62366-1.
  CrossrefPubMedGoogle Scholar
• 15 Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. Women's Health (Lond) 2018; 14: 1745506518762664 DOI: 10.1177/1745506518762664.
  CrossrefPubMedGoogle Scholar
• 16 Düring SW, Nielsen MØ, Bak N, Glenthøj BY, Ebdrup BH. Sexual dysfunction and hyperprolactinemia in schizophrenia before and after six weeks of D2/3 receptor blockade - An exploratory study. Psychiatry Res. 2019; 274: 58-65 DOI: 10.1016/j.psychres.2019.02.017.
  CrossrefPubMedGoogle Scholar
• 17 Montejo AL, Montejo L, Baldwin DS. The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management. World Psychiatry 2018; 17 (01) 3-11 DOI: 10.1002/wps.20509.
  CrossrefPubMedGoogle Scholar
• 18 Allen K, Baban A, Munjiza J, Pappa S. Management of antipsychotic-related sexual dysfunction: systematic review. J Sex Med. 2019; 16 (12) 1978-1987 DOI: 10.1016/j.jsxm.2019.08.022.
  CrossrefPubMedGoogle Scholar
• 19 Rappek NAM, Sidi H, Kumar J, Kamarazaman S, Das S, Masiran R. et al. Serotonin Selective Reuptake Inhibitors (SSRIs) and Female Sexual Dysfunction (FSD): hypothesis on its association and options of treatment. Curr Drug Targets 2018; 19 (12) 1352-1358 DOI: 10.2174/1389450117666161227142947.
  CrossrefPubMedGoogle Scholar
• 20 Sidi H, Asmidar D, Hod R, Jaafar NRN, Guan NC. Hypoactive sexual desire among depressed female patients treated with selective serotonin reuptake inhibitors: a comparison between escitalopram and fluoxetine. Int J Psychiatry Clin Pract. 2012; 16 (01) 41-47 DOI: 10.3109/13651501.2011.617457.
  CrossrefPubMedGoogle Scholar
• 21 Clayton AH, Croft HA, Handiwala L. Antidepressants and sexual dysfunction: mechanisms and clinical implications. Postgrad Med. 2014; 126 (02) 91-99 DOI: 10.3810/pgm.2014.03.2744.
  CrossrefPubMedGoogle Scholar
• 22 Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P. et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological treatments. Can J Psychiatry 2016; 61 (09) 540-560 DOI: 10.1177/0706743716659417.
  CrossrefPubMedGoogle Scholar
• 23 Atmaca M. Selective serotonin reuptake inhibitor-induced sexual dysfunction: current management perspectives. Neuropsychiatr Dis Treat 2020; 16: 1043-1050 DOI: 10.2147/NDT.S185757.
  CrossrefPubMedGoogle Scholar
• 24 Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B. et al. Combined oral contraceptives and sexual function in women-a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2016; 101 (11) 4046-4053 DOI: 10.1210/jc.2016-2032.
  CrossrefPubMedGoogle Scholar
• 25 Boozalis A, Tutlam NT, Chrisman Robbins C, Peipert JF. Sexual desire and hormonal contraception. Obstet Gynecol. 2016; 127 (03) 563-572 DOI: 10.1097/AOG.0000000000001286.
  CrossrefPubMedGoogle Scholar
• 26 Sanders SA, Graham CA, Bass JL, Bancroft J. A prospective study of the effects of oral contraceptives on sexuality and wellbeing and their relationship to discontinuation. Contraception 2001; 64 (01) 51-58 DOI: 10.1016/s0010-7824(01)00218-9.
  CrossrefPubMedGoogle Scholar
• 27 Kingsberg SA, Woodard T. Female sexual dysfunction: focus on low desire. Obstet Gynecol. 2015; 125 (02) 477-486 DOI: 10.1097/AOG.0000000000000620.
  CrossrefPubMedGoogle Scholar
• 28 Ben Thabet J, Charfeddine F, Charfi N, Baati I, Zouari L, Zouari N. et al. [Sexuality of Tunisian women: involvement of religion and culture]. Encephale 2015; 41 (02) 144-150 DOI: 10.1016/j.encep.2013.10.006. French
  CrossrefPubMedGoogle Scholar
• 29 Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, Graham C. et al. Ethical and sociocultural aspects of sexual function and dysfunction in both sexes. J Sex Med. 2016; 13 (04) 591-606 DOI: 10.1016/j.jsxm.2016.01.021.
  CrossrefPubMedGoogle Scholar
• 30 Kingsberg SA, Althof S, Simon JA, Bradford A, Bitzer J, Carvalho J. et al. Female sexual dysfunction-medical and psychological treatments, Committee 14. J Sex Med. 2017; 14 (12) 1463-1491 DOI: 10.1016/j.jsxm.2017.05.018.
  CrossrefPubMedGoogle Scholar
• 31 Kellogg Spadt S, Rosenbaum TY, Dweck A, Millheiser L, Pillai-Friedman S, Krychman M. Sexual health and religion: a primer for the sexual health clinician (CME). J Sex Med. 2014; 11 (07) 1607-1618 DOI: 10.1111/jsm.12593.
  CrossrefPubMedGoogle Scholar
• 32 Mark KP, Lasslo JA. Maintaining sexual desire in long-term relationships: a systematic review and conceptual model. J Sex Res. 2018; 55 (4-5): 563-581 DOI: 10.1080/00224499.2018.1437592.
  CrossrefPubMedGoogle Scholar
• 33 Zhang J, Li F, Li H, Zhang Z, Yang B, Li H. Clinical features of and couple's attitudes towards premature ejaculation: a multicenter cross-sectional study. Aging Male 15.07.2019; DOI: 10.1080/13685538.2019.1640194. [ahead of print].
  CrossrefPubMedGoogle Scholar
• 34 Rosen NO, Dubé JP, Corsini-Munt S, Muise A. Partners experience consequences, too: a comparison of the sexual, relational, and psychological adjustment of women with sexual interest/arousal disorder and their partners to control couples. J Sex Med. 2019; 16 (01) 83-95 DOI: 10.1016/j.jsxm.2018.10.018.
  CrossrefPubMedGoogle Scholar
• 35 Byers ES. Beyond the birds and the bees and was it good for you?: thirty years of research on sexual communication. Can Psychol/Psychol Can. 2011; 52 (01) 20-28 DOI: 10.1037/a0022048.
  CrossrefPubMedGoogle Scholar
• 36 Marieke D, Joana C, Giovanni C, Erika L, Patricia P, Yacov R. et al. Sexual desire discrepancy: a position statement of the European Society for Sexual Medicine. Sex Med. 2020; 8 (02) 121-31 DOI: 10.1016/j.esxm.2020.02.008.
  CrossrefPubMedGoogle Scholar
• 37 Haseli A, Shariati M, Nazari AM, Keramat A, Emamian MH. Infidelity and its associated factors: a systematic review. J Sex Med. 2019; 16 (08) 1155-1169 DOI: 10.1016/j.jsxm.2019.04.011.
  CrossrefPubMedGoogle Scholar
• 38 Fincham FD, May RW. Infidelity in romantic relationships. Curr Opin Psychol. 2017; 13: 70-74 DOI: 10.1016/j.copsyc.2016.03.008.
  CrossrefPubMedGoogle Scholar
• 39 Hawks L, Woolhandler S, Himmelstein DU, Bor DH, Gaffney A, McCormick D. Association between forced sexual initiation and health outcomes among US women. JAMA Intern Med. 16.09.2019; e193500 DOI: 10.1001/jamainternmed.2019.3500. [ahead of print.
  CrossrefPubMedGoogle Scholar
• 40 Thornton K, Chervenak J, Neal-Perry G. Menopause and sexuality. Endocrinol Metab Clin North Am. 2015; 44 (03) 649-61 DOI: 10.1016/j.ecl.2015.05.009.
  CrossrefPubMedGoogle Scholar
• 41 Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause 2013; 20 (09) 888-902 DOI: 10.1097/ GME.0b013e3182a122c2.
  CrossrefPubMedGoogle Scholar
• 42 Pitsouni E, Grigoriadis T, Falagas ME, Salvatore S, Athanasiou S. Laser therapy for the genitourinary syndrome of menopause. A systematic review and meta-analysis. Maturitas 2017; 103: 78-88 DOI: 10.1016/j.maturitas.2017.06.029.
  CrossrefPubMedGoogle Scholar
• 43 Clayton AH, Goldstein I, Kim NN, Althof SE, Faubion SS, Faught BM. et al. The International society for the study of women's sexual health process of care for management of hypoactive sexual desire disorder in women. Mayo Clin Proc. 2018; 93 (04) 467-487 DOI: 10.1016/j.mayocp.2017.11.002.
  CrossrefPubMedGoogle Scholar
• 44 Nastri CO, Lara LA, Ferriani RA, Rosa-E-Silva ACJS, Figueiredo JBP, Martins WP. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2013; (06) CD009672 DOI: 10.1002/14651858.CD009672.pub2.
  CrossrefPubMedGoogle Scholar
• 45 Aribi L, Ben Houidi A, Masmoudi R, Chaabane K, Guermazi M, Amami O. [Female sexuality during pregnancy and postpartum: a study of 80 Tunisian women]. Tunis Med. 2012; 90 (12) 873-877 French.
  PubMedGoogle Scholar
• 46 Kračun I, Tul N, Blickstein I, Velikonja VG. Quantitative and qualitative assessment of maternal sexuality during pregnancy. J Perinat Med. 2019; 47 (03) 335-340 DOI: 10.1515/jpm-2018-0206.
  CrossrefPubMedGoogle Scholar
• 47 Woolhouse H, McDonald E, Brown S. Women's experiences of sex and intimacy after childbirth: making the adjustment to motherhood. J Psychosom Obstet Gynaecol. 2012; 33 (04) 185-190 DOI: 10.3109/0167482X.2012.720314.
  CrossrefPubMedGoogle Scholar
• 48 Fuchs A, Czech I, Sikora J, Fuchs P, Lorek M, Skrzypulec-Plinta V. et al. Sexual functioning in pregnant women. Int J Environ Res Public Health 2019; 16 (21) 4216 DOI: 10.3390/ijerph16214216.
  CrossrefPubMedGoogle Scholar
• 49 Fuentealba-Torres M, Cartagena-Ramos D, Fronteira I, Lara LA, Arroyo LH, Arcoverde MAM. et al. What are the prevalence and factors associated with sexual dysfunction in breastfeeding women? A Brazilian cross-sectional analytical study. BMJ Open 2019; 9 (04) e025833 DOI: 10.1136/bmjopen-2018-025833.
  CrossrefPubMedGoogle Scholar
• 50 Kainu JP, Halmesmäki E, Korttila KT, Sarvela PJ. Persistent pain after cesarean delivery and vaginal delivery: a prospective cohort study. Anesth Analg. 2016; 123 (06) 1535-1545 DOI: 10.1213/ANE.0000000000001619.
  CrossrefPubMedGoogle Scholar
• 51 Banaei M, Torkzahrani S, Ozgoli G, Azad M, Mahmoudikohani F, Pormehr-Yabandeh A. Addressing the sexual function of women during first six month after delivery: aquasiexperimental study. Mater Sociomed. 2018; 30 (02) 136-140 DOI: 10.5455/msm.2018.30.136-140.
  CrossrefPubMedGoogle Scholar