Hypoactive Sexual Desire Disorder (HSDD)

Last edited 04/2020 and last reviewed 10/2021

Hypoactive sexual desire disorder (HSDD) is defined as a persistent or recurrent deficiency (or absence) of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty not related to a medical or psychiatric condition or the use of a substance or medication (1,2)

Epidemiology:

• HSDD is common in women but is often unaddressed or undertreated (3)
• large population-based studies have shown that approximately 36% to 39% of women report low sexual desire, with 8% to 10% meeting the primary diagnostic criteria for HSDD (low desire and associated distress) (4,5)
• in women, low sexual desire generally increases with age, whereas related distress decreases, resulting in a fairly steady prevalence of HSDD across the adult lifespan (6,7)
• HSDD is present in 8.9% of women ages 18 to 44, 12.3% ages 45 to 64, and 7.4% over 65 (7)
• HSDD is associated with lower health-related quality of life; lower general happiness and satisfaction with partners; and more frequent negative emotional states (7)
• HSDD is underdetected and undertreated. Less than half of patients with sexual problems seek help from or initiate discussions with physicians (7)

When evaluating loss or absence of sexual desire, the clinician also should take into account the context of the person’s life (eg, severe relationship problems) (1,2)

Notes:

• Hypoactive Sexual Desire Disorder (HSDD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (DSM-IV-TR) as persistent deficient sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty
• in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), HSDD has been subsumed by Female Sexual Interest/Arousal Disorder (7)

Reference:

• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text rev.Washington, DC: American Psychiatric Association; 2000.
• Goldstein I, Kim NN, Clayton AH, et al. Hypoactive sexual desire disorder: International Society for the Study of Women’s Sexual Health (ISSWSH) expert consensus panel
  review. Mayo Clin Proc 2017;92:114-128.
• Parish S, Hahn SR. Hypoactive sexual desire disorder: a review of epidemiology, biopsychology, diagnosis, and treatment. Sex Med Rev 2016;4:103-120.
• Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008;112:970-978.
• West SL, D’Aloisio AA, Agans RP, et al. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med 2008;168:1441-1449.
• Hayes RD, Dennerstein L, Bennett CM, et al. Relationship between hypoactive sexual desire disorder and aging. Fertil Steril 2007;87:107-112.
• Parish SJ, Hahn SR. Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment.Sex Med Rev. 2016 Apr;4(2):103-120.