Sexual Desire Disorder

Sexual desire disorder is a psychiatric condition marked by a lack of desire for sexual activity over a prolonged period.

Definition

In the DSM-5, Sexual Desire Disorder has been broken down into two separate conditions: Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder. Both of these refer to a low level of sexual interest resulting in a failure to initiate or respond to sexual intimacy. Neither of these conditions can be diagnosed if the main problem is a "desire discrepancy" in which one partner desires more sexual activity than the other; rather, the conditions are diagnosed when symptoms have been present for a minimum of six months and cause clinically significant distress in the individual. 

A diagnosis of sexual desire disorder in men and women refers to a lack of, or significantly reduced, sexual interest or desire for sexual activity. This can include an absence of sexual thoughts or fantasies, reduced or absent pleasure during sexual activity, and absent or reduced interest in internal or external erotic cues. 

Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder can both be diagnosed as generalized, meaning they may be a general attitude toward any potential partner or situation. These conditions can also be diagnosed as being situational, meaning symptoms are only present with certain types of stimulation, situations, or partners. Female Sexual Interest/Arousal Disorder was known as Sexual Arousal Disorder in previous versions of the DSM, although this diagnosis has been replaced by gender-specific conditions in the DSM-5. 

The prevalence of Female Sexual Interest/Arousal Disorder is unknown, although some older women report less distress about experiencing low sexual desire than younger women. In men, it is estimated that 6 percent of younger men (ages 18-24) and 41 percent of older men (ages 66-74) have some problems with sexual desire. Only 1.8 percent of men ages 16-44, however, experience persistent problems lasting more than six months.

Symptoms

Symptoms for Female Sexual Interest/Arousal Disorder include the following:

  • Absent or reduced interest in sexual activity
  • Absent or reduced sexual thoughts or fantasies
  • Reduced or no initiation of sexual activity
  • Absent or reduced sexual excitement or pleasure during most sexual activity
  • Absent or reduced sexual interest or arousal in response to internal or external cues, such as a partner's attempts to initiate sexual activity
  • Absent or reduced genital or nonessential sensations during sexual activity

To meet criteria for Female Sexual Interest/Arousal Disorder, the symptoms must be present for at least six months and cause significant distress to the individual. 

Symptoms for Male Hypoactive Sexual Desire Disorder include the following:

  • Reduced or absent sexual thoughts or fantasies
  • Reduced or absent desire for sexual activity

Similar to Female Sexual Interest/Arousal Disorder, the symptoms must also be present for at least six months and cause significant distress to the individual. 

Both of these conditions can be diagnosed as a lifelong problem or an acquired problem that presented itself after a period of normal sexual activity. 

Causes

Changes in sexual desire are natural over time, and may come and go depending on personal events or partner-related issues. When the lack of interest in sexual activity lasts longer than six months and causes distress, however, the criteria for a sexual desire disorder may be met. 

Some risk factors for developing a sexual desire disorder include:

  • Negative attitudes about sexuality
  • Relationship difficulties (poor communication, abuse)
  • Partner sexual functioning 
  • Childhood stressors
  • Medical conditions (diabetes mellitus, thyroid dysfunction)
  • Endocrine disorders (hyperprolactinemia) 
  • Erectile dysfunction
  • History of emotional or physical abuse
  • Other psychiatric diagnosis (depression, anxiety)
  • Medication side effects
  • Stressors (job loss, bereavement) 
  • Alcohol use

Treatments

Treatment for a sexual desire disorder may include psychotherapy and medication. In 2015, the FDA approved a medication called Addyi (flibanserin) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Research is currently underway to evaluate the effectiveness of this medication.

Treatment must be individualized—some couples will need relationship or marital therapy prior to focusing directly on enhancing sexual activity.

Of course, many couples may need to focus on the sexual relationship itself, and through education and assignments they can expand the variety and time devoted to sexual activity.

When problems with sexual arousal or performance are factors, these sexual dysfunctions will need to be addressed.

Prevention

One helpful way to prevent issues with sexual desire is setting aside time for nonsexual intimacy. Couples who reserve time for one-on-one talking are more likely to experience sexual desire. Also, reserving time before exhaustion sets in will encourage closeness and sexual desire. Couples might mentally separate sex and affection, so that neither one is afraid to be affectionate daily.

Reading books or taking courses in couples communication or massage may also encourage feelings of closeness. For some couples, reading novels or viewing movies with romantic or sexual content may also serve to encourage sexual desire.

Low sexual desire may be a barometer of the emotional health of the relationship. In the case of a loving relationship, low sexual desire may cause a partner to repeatedly feel hurt and rejected, leading to eventual feelings of resentment and promoting eventual emotional distance.

Sex is something that, for most couples, either bonds their relationship or creates a wedge that gradually drives them apart. When one partner is significantly less interested in sex than their companion, professional help is recommended before the relationship becomes strained.

References

  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised
  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • National Institutes of Health - National Library of Medicine
  • Jaspers, L., Feys, F., Bramer, W. M., Franco, O. H., Leusink, P., & Laan, E. T. (2016). Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: A systematic review and meta-analysis. JAMA internal medicine, 176(4), 453-462.

Last reviewed 03/06/2018