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


Diagnosing low sexual desire with associated distress is challenging because women often fail to discuss these issues with their healthcare providers (HCPs). A woman's HCP can initiate the general discussion and assessment of sexual health concerns and HSDD by explaining that sexual health is an important aspect of overall health and that assessment of sexual function is a routine part of good medical care. An initial assessment can be accomplished quickly during an office visit with a few brief questions: "Many of my patients have sexual concerns at midlife—what concerns do you have?" or "How do you feel about your current level of desire and your ability to get aroused or to orgasm?" To facilitate open discussion, offer patient-friendly materials in the waiting and examination rooms, include questions about sexual health topics on intake forms, and train staff to be comfortable with sexual topics.

In addition, consider using a screening questionnaire to identify a diagnosis of HSDD. The Decreased Sexual Desire Screener (DSDS) consists of five questions and is available online.[8] Although screening for HSDD is easily performed as part of an office visit, if problems are identified, a follow-up visit may be encouraged to address sexual concerns and to provide office-based counseling or medication management.[5]

Overlap of female sexual disorders is common: HSDD impairs sexual arousal that impairs orgasm or may lead to sexual pain (eg, attempting penetration without adequate lubrication because she is not interested or aroused). Likewise, by reducing associated dryness/pain, treating the genitourinary syndrome of menopause (GSM) can increase desire. A complete assessment/history can help delineate the primary problem, establish the diagnosis, and assist in developing an approach to individualize treatment.