Clinical Management of Hypoactive Sexual Desire Disorder

Sheryl Kingsberg, PhD, IF; Stephanie Faubion, MD, FACP, NCMP, IF


Menopause. 2019;26(2):217-219. 

In This Article

Prevalence and Etiology

Estimates of prevalence indicate that 7.4% to 12.3% of women meet the criteria for HSDD (low sexual desire with distress), with the highest prevalence in women in midlife (45-64 y) and beyond.[4]

The etiology of female sexual dysfunction is often multifactorial, and evaluation and treatment of HSDD should take biological (eg, hormone status, medical conditions, medications), psychological (eg, depression, anxiety, stress, substance abuse, history of sexual abuse, or trauma), interpersonal (eg, relationship quality, partner sexual function), and cultural (eg, sexual norms, religious values) factors into account.[5] The woman's history should be evaluated using a biopsychosocial approach for possible contributors to low sexual desire.

Although a number of factors may contribute to the development of HSDD, women with HSDD have different patterns of brain activation. Low sexual desire results from hypofunctional excitation, hyperfunctional inhibition, or a combination of the two.[6] Sexual desire is thought to be regulated by neuromodulators (neurotransmitters and hormones) of both excitatory pathways (eg, dopamine, norepinephrine, melanocortins, oxytocin) and inhibitory pathways (eg, serotonin, opioids, endocannabinoids).[7]