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Hypoactive Sexual Desire Disorder

Sometimes you want sex, sometimes you don’t. That’s normal. Every woman has her own level of what is considered “normal” based on their own experiences and biological drive. But when a woman has a low libido or low sexual desire and is bothered by this lack of interest in sex, she may have a condition called hypoactive sexual desire disorder (HSDD).

HSDD is defined as the absence of sexual fantasies and thoughts, and/or desire for or receptivity to, sexual activity that causes the personal distress or difficulties in her relationship. This distress is an important component. After all, some women with what is considered a low libido may not have any distress or problems with a partner as a result.

While prevalence rates vary, The Society for Women’s Health Research estimates that about one in ten women have HSDD, making it one of the most common female sexual difficulties.

What causes HSDD?

There are many potential causes, both physical and psychological.

  • There are a number of physical conditions associated with HSDD, including breast cancer, diabetes, depression, urinary incontinence, thyroid problems, and multiple sclerosis, among others.
  • An imbalance of neurotransmitters (chemicals) in the brain may be the cause, as the chemicals that can cause (or inhibit) sexual desire and excitement may be out of balance.
  • Diminished libido may be a side effect of certain medications, including medications used to treat depression, anxiety and high blood pressure, as well as some medications to treat pain.
  • Relationship issues may play a role for some women. If there is conflict or a lack of trust in a relationship, women may lose interest in sex with that partner as a result. (Although it should be noted that a woman may experience HSDD and not be in a relationship).
  • Some psychological conditions may be associated with the development of HSDD, including depression, anxiety and low self-esteem.

Can HSDD be treated?

HSDD is treatable and can be manageable, so the first step if you are concerned about a lack of interest in sex is to talk to a healthcare provider to see what options are available. The provider may ask a series of questions called the Decreased Sexual Desire Screener (DSDS) to help diagnose HSDD. The first four questions are:

  1. In the past, was your level of sexual desire/interest good and satisfying to you?
  2. Has there been a decrease in your level of sexual desire/interest?
  3. Are you bothered by your decreased level of sexual desire/interest?
  4. Would you like your level of sexual desire/interest to increase?

If a woman answers ‘no’ to any of these questions, she likely will not be diagnosed with HSDD. If she answers ‘yes’ to these, she will also be asked about other factors that may be contributing to her low desire, including physical and mental health conditions, recent childbirth, her relationship with her partner, her level of stress and fatigue, and other issues.

Treatment may include sex therapy or counseling, alone or with a woman’s partner, to address any mental health or relationship issues that may be present. Medications may be evaluated as contributing factors, and underlying medical conditions may be addressed.

For women who have not yet gone through menopause, there is a single FDA-approved treatment for HSDD called flibanserin. This drug works on neurotransmitters, or chemicals, in the brain that are related to sexual excitement. When these chemicals in the brain are out of balance, the result can be a diminished level of sexual interest and desire. Flibansarin, taken as a once-daily pill helps to keep these chemicals in balance.

Find a Healthcare Provider

There is help for HSDD. You can use the search tool below to look for providers who specialize in women’s sexual health difficulties, including HSDD. Enter your zip code in the search box to find the closest provider to you, as well as telemedicine options.

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      A Three-Part Conversation with Dr. Pepper Schwartz on Female Sexual Difficulties

      Dr. Pepper SchwartzFemale sexual difficulties are more common than you think and impact couples inside and outside the bedroom. When sex isn’t easy how do you even begin this conversation with your partner or, for that matter, your healthcare provider? Sociologist, sexologist and relationship expert Dr. Pepper Schwartz joins our Sex+Health podcast for a three-part discussion on the range of female sexual difficulties and offers practical advice and resources for women (and their partners). You’re not alone!

      Episode One: How do female sexual difficulties (FSD) affect relationships in and out of the bedroom?

      Episode Two: Concerned your partner is no longer in the mood? It may be more than you think.

      Episode Three: Diving deeper into the most common female sexual difficulty (FSD), Hypoactive Sexual Desire Disorder (HSDD), and the other types of FSD that may be affecting your relationship.

      FDA Approves First Drug to Treat Low Sexual Desire in Women

      The American Sexual Health Association strongly supports the Food and Drug Administration’s (FDA) decision to empower women and their healthcare providers by approving Flibanserin, the first drug to treat low sexual desire in females.

      Hypoactive sexual desire disorder (HSDD, also known as low sexual desire) is the most commonly reported type of sexual dysfunction in women. Until today’s FDA decision there were no medical treatments available for the condition, leaving many women and medical professionals frustrated and puzzled at the lack of options. Speaking on the impact HSDD, Deborah Arrindell says “What I’ve heard from women is despair, anxiety, loss of confidence, loss of self worth, troubled relationships, and families in crisis. Women deserve to have desire, arousal, even pleasure. Clearly the FDA heard these women and today’s decision provides long overdue relief.”

      That’s not to say that Flibanserin is a proverbial magic pill. ASHA CEO Lynn Barclay believes it’s really about choices: “There is seldom a one-size-fits-all answer to the many challenges real people face in achieving and maintaining sexual health and satisfying sex lives. We believe BOTH men and women as well as their healthcare providers should have choices in addressing sexual dysfunction. We also believe that women—and men—can be trusted to decide for themselves about using an FDA-approved and health care provider-prescribed treatment option.”

      Barclay adds that sexual health should not be seen as separate from our overall health, as each impacts the other. She says “This is about a woman’s wellbeing, her quality of life.” She notes that a woman’s sexual health affects her partner, too. “You’ve heard the saying “If mama ain’t happy, ain’t nobody happy”? Well, as grammatically imperfect as that may be, it makes a good point. Let’s make sure mamas, aunts, sisters, and women just like me everywhere have a complete menu of choices. We deserve it, we are worth it, and in the end we’ll all be better for it.”

      One Step Closer: FDA Panel Recommends Approval for Drug to Treat Women’s Low Sexual Desire

      flibanserinOn June 4, 2015, an FDA advisory committee recommended approval of flibanserin, a drug to treat low sexual desire (known as hypoactive sexual desire disorder or HSDD) in women. The committee did make its approval contingent of steps being made to make women aware of the potential side effects of the drug, including low blood pressure, fainting, nausea and dizziness.

      The final decision on the drug will be made by the full FDA in August. While recommendations of advisory committees aren’t binding, the FDA frequently follows their guidance. If approved, flibanserin, manufactured by Sprout Pharmacueticals, would become the first medication on the market to treat HSDD in women.

      ASHA’s President and CEO, Lynn Barclay, spoke at the advisory committee meeting. A full transcript of her remarks are below.

      Good afternoon. I’m Lynn Barclay, the President of the American Sexual Health Association.

      Our organization was founded more than 100 years ago. In that century of working in sexual health, it’s been apparent from the early days that there is seldom a one-size-fits-all answer to the many challenges real people face in achieving and maintaining sexual health and satisfying sex lives. What works well for one may not be nearly enough for another, so the best approach is often an array of solutions that are as diverse as the populations we serve.

      We firmly believe this to be the case with women just like me who are struggling with issues of sexual desire. Let’s face it, this is a complex issue! Sexual desire is an interesting brew of mind and body, with a dash of society and a pinch of interpersonal issues tossed in. For some women these matters are best addressed with a bottle of champagne, a romantic stroll on the beach, or good therapy. Other women need something else, maybe a combination of things. What makes me sad, worried, and to be honest annoyed is that there are NO medical options available for women for whom biological factors are at play. Not….one. This for a condition the FDA itself recognizes as a top unmet medical need in the U.S.

      Our organization believes sexual health should not be seen as separate from our overall health; each impacts the other. Sexual health is, in our view, not a privilege but a right. We believe BOTH men and women as well as their healthcare providers should have choices in addressing sexual dysfunction. We also believe that women – and men- can be trusted to decide for themselves about using an FDA-approved and health care provider-prescribed treatment option.

      We applaud you for this focus on women’s sexual health, which really, is a focus on women’s health. This is about a woman’s well-being, her quality of life. And you better believe it affects her partner, too. You’ve heard the saying “If mama ain’t happy, ain’t nobody happy”? Well, as grammatically imperfect as that may be, it makes a good point. Let’s make sure mamas, grandmas, aunts, sisters, and women just like me everywhere have a complete menu of choices. We deserve it, we are worth it, and in the end we’ll all be better for it.

      Sex+Health Podcast

      ASHA’s Sex+Health podcast covers all aspects of sexual health. Featuring interviews with medical professionals and experts in the field of sexuality, Sex+Health aims to offer information and resources to with the goal of helping people take charge of their sexual health and understand its importance to overall well being. Listen to episodes here or subscribe on iTunes.

      Big Changes! New HPV Vaccine Protocols and Update to Cervical Cancer Screening Guidelines

      February 6,2019
      Since our last update on HPV and cervical cancer some big changes have occurred: HPV vaccination has been approved for use with males and females through age 45 and updated cervical cancer screening guidelines now include an option for HPV primary testing (translation: an HPV test done alone without a Pap as a co-test).  In this episode Ina Park, MD, breaks all of this down and peeks at a future where we might actually be able to discuss the elimination of cervical cancer. Dr. Park is an associate professor at the University of California, San Francisco School of Medicine, Department of Family and Community Medicine.

       

      Herpes Diagnosis and Management: A Two-Part Conversation with Terri Warren, ANP

      In this two-part episode, Terri Warren, ANP—nurse, author, and owner of Westover Heights Clinic in Portland, Oregon that specializes in the genital herpes infection—explains the tests that can provide an accurate genital herpes diagnosis and how they work and clarifies that a physical exam alone should never be the final diagnosis for anyone, for many reasons. She also discusses the importance of knowing herpes type and offers helpful insight into how to put a herpes infection into proper perspective.

      Sexual Pleasure beyond the Big “O”

      A conversation with sexuality and relationship expert Dr. Logan Levkoff
      March 9, 2018
      In this episode we chat with Dr. Logan Levkoff on the value of pleasure not only in a relationship but as part of our overall well-being. Whether alone or with a partner, sexual pleasure is good for you! Listen in as Dr. Levkoff dishes on everything from not only having more sex but better sex, and why sexual pleasure doesn’t need to involve a partner!

      Chronic Pelvic Pain in Women

      February 23,2018
      Beyond the physical discomfort they experience, women with chronic pelvic pain often have to navigate choppy waters emotionally and in their relationships. Dr. Karen Tang with the Gynecology Specialists of Philadelphia practice joins us to talk about the many possible causes of chronic pelvic pain and approaches to treatment. She offers practical advice not only for women but their partners, too. Visit http://philadelphiagyn.com/ for patient education resources including videos with Dr. Tang.

       

      Treat Me Right: The Continued Evolution of Therapies for Cervical Cancer

      January 26, 2018
      The development of new treatment options for cervical cancer has been frustratingly slow but Dr. Kathleen Moore of the University of Oklahoma’s Stephenson Cancer Center says that may finally be changing. In this episode we chat about current therapies for cervical cancer, take a glimpse into the pipeline to see what’s being developed and finish with a discussion on the crucial role of clinical trials in expanding our treatment arsenal.

      Proposed Changes to Cervical Cancer Screening Guidelines

      December 28, 2017
      The U.S. Preventive Services Task Force (USPSTF) has published a draft of updated cervical cancer screening guidelines and some big changes are proposed. For insight on why check-ups for cervical cancer continue to change and move away from the traditional annual Pap, in this episode, we chat with Mark H. Einstein, MD, MS, Professor and Chair of OB/GYN and Women’s Health at Rutgers New Jersey Medical School.

      A Three-Part Conversation with Dr. Pepper Schwartz on Female Sexual Difficulties

      December 27, 2017
      Female sexual difficulties are more common than you think and impact couples inside and outside the bedroom. When sex isn’t easy how do you even begin this conversation with your partner or, for that matter, your healthcare provider? Sociologist, sexologist and relationship expert Dr. Pepper Schwartz joins our Sex+Health podcast for a three-part discussion on the range of female sexual difficulties and offers practical advice and resources for women (and their partners). You’re not alone! NOTE: the findmyspark.com website mentioned in these episodes is currently unavailable so for information on females sexual difficulties visit ASHA’s pages on women’s health. We also offer a patient education resource ASHA developed in collaboration with WebMD Education, Painful Sex? Getting Your Groove Back During Menopause.

      Episode One: How do female sexual difficulties (FSD) affect relationships in and out of the bedroom?

      Episode Two: Concerned your partner is no longer in the mood? It may be more than you think.

      Episode Three: Diving deeper into the most common female sexual difficulty (FSD), Hypoactive Sexual Desire Disorder (HSDD), and the other types of FSD that may be affecting your relationship.

      Gynecological Health Awareness Month

      September 8, 2017
      It’s Gynecological Cancer Awareness Month—time to talk about cancers that affect more than 89,000 women in the US each year. Mamta Singhvi, MD, a radiation oncologist and ASHA board member, discusses various ways gynecologic cancers are treated, what to expect during and following treatment and issues around prevention and early detection.

      World Sexual Health Day

      September 8, 2017
      In this episode, Dr. Eli Coleman, director of the Program in Human Sexuality at the University of Minnesota and a former member of ASHA’s board of directors, talks about developing a broader view of sexual health that goes beyond merely having sex with another person.

      Men’s Health Month 2017

      July 17, 2017
      We ruminate on men and sexual health in this episode with Dr. Abe Morgentaler of Men’s Health Boston and ASHA’s vice president for strategic partnerships Kay Phillips. Both offer their insights and we highlight the tools and resources ASHA offers for men (and organizations serving them).

      Talking to Girls and Young Women about S-E-X

      May 15, 2017
      “[Girls] have told by society that sex is great but that’s not their experience. They don’t know how to talk about that disconnect, there’s a certain amount of shame that shuts down their voice….for me, sexual empowerment for girls is helping them to find a voice in their sexual relationships.”

      In a compelling TED Talk video, nurse practitioner Jane Epstein makes the case that our efforts are sadly lacking with it comes to talking to teen girls and young women. In this episode of ASHA’s podcast we delve deeper into the topic with Ms. Epstein on not only what to say when talking to young females about sex, but how to help them speak up for themselves.

      Jane Epstein is a Yale graduate and a clinician who sees teenagers at a high school-based health clinic where, as part of comprehensive health care, she provides sexual health care including contraception services to teens.

      HPV “Miracle Cures”

      January 4, 2017
      We’re frequently asked about websites touting unlicensed, off-the-grid vaccines and supplements that claim to cure HPV and related diseases. In this episode, H. Hunter Handsfield, MD, Professor Emeritus of Medicine, University of Washington Center for AIDS and STD, breaks down the more common HPV “miracle cures” and also answers the most common questions about legitimate, approved HPV vaccines.

      Men’s Sexual Health

      September 28, 2016
      There are many misconceptions around men, sex, sexuality, and just what men want from relationships. Guys are seen as always turned on, selfish in the bedroom, and not all that interested in their partner once the carnal tango ends. Is that fair?

      To find out we chatted with men’s sexual health expert Dr. Abraham Morgentaler, an associate clinical professor at Harvard Medical School, the director and founder of Men’s Health Boston, and a member of ASHA’s board of directors. He’s also the author of The Truth About Men and Sex: Intimate Secrets from the Doctor’s Office.

      More episodes:

      Menopause

      Menopause is a normal, natural event—not a disease.

      Technically, you don’t actually “hit” menopause until it’s been one year since your final menstrual period. In the United States, that happens about age 51, on average. As women move beyond their childbearing years they may experience many physical and emotional changes.

      Despite negative stereotypes, as well as some actual difficulties women can face during this time, many women report that once they’ve reached menopause they feel more confidant, stronger, and energized than they did before. At this period in their lives, many women have fewer child-rearing responsibilities and can use this time to take care of themselves. Women no longer have to worry about getting pregnant when having sex, potentially allowing for less stress and more enjoyment during sex.

      Menopause isn’t a one-size-fits-all event, though. It affects each woman differently. Some women reach natural menopause with little to no trouble; others may experience symptoms that can hamper their lives. And when menopause starts suddenly as a result of surgery, chemotherapy, or radiation, the adjustment can be tough. Fortunately, menopause is better understood and more openly discussed than ever before. And better treatment options are available when needed.

      Painful Sex? Getting Your Groove Back During Menopause

      ASHA, in partnership with WebMD Education, has created a program to help women learn more about taking charge of their sexual health during menopause. In this program, you and your partner can learn about changes during menopause that may lead to vaginal dryness and painful sex; ways to get relief with over-the-counter or prescription medicines; and how to talk with your doctor about your concerns. You’ll also hear from a patient who shares her story.

      Why Menopause Happens

      A woman is born with a finite number of eggs, which are stored in the ovaries. The ovaries also produce the hormones estrogen and progesterone, which regulate menstruation and ovulation. Menopause occurs when the ovaries no longer produce an egg every month and menstruation stops.

      Menopause is normalMenopause, when it occurs after the age of 40, is considered “natural” and is a normal part of aging. But some women can experience menopause early, either as a result of a surgical intervention, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that occurs before the age of 40, regardless of the cause, is called premature menopause.

      Natural menopause happens gradually. The ovaries don’t abruptly stop; they slow down. The transition to menopause is called perimenopause. During perimenopause, it’s still possible to get pregnant—a woman’s childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still functioning and she still may ovulate, though not necessarily on a monthly basis.

      What to Expect

      Here are some potential benefits of menopause:

      • Less stress about getting pregnant
      • More time for intimacy with a partner
      • Chance to reflect on priorities in life
      • Increased sexual pleasure and closeness with partner

      While many women take advantage of this time of transition to make positive changes in their lives, some symptoms can be inconvenient or difficult to deal with. The signs and symptoms of menopause, which can vary in intensity from woman to woman, often appear long before the one-year anniversary of your final period. Symptoms may include:

      • Irregular periods
      • Decreased fertility
      • Vaginal dryness
      • Hot flashes
      • Sleep disturbances
      • Mood swings
      • Increased abdominal fat
      • Thinning hair
      • Loss of breast fullness
      When to See a Healthcare Provider

      It’s important to see your healthcare provider during the years leading up to menopause (perimenopause) and the years after menopause for preventive health care as well as care of medical conditions that may occur with aging. If you’ve skipped a period but aren’t sure you’ve started menopause, you may want to see your healthcare provider to determine whether you’re pregnant. He or she may take a medical history, do a pelvic examination and, if appropriate, order a pregnancy test.

      Always seek medical advice if you have bleeding from your vagina after menopause.

      Alternative Medicine

      Many approaches have been promoted as aids in managing the symptoms of menopause, but there is very little scientific evidence to back up the claims. Be sure to consult your healthcare provider before taking any herbal treatments or dietary supplements for signs and symptoms of menopause. Herbal products can interfere or interact with other medications you may be taking.

      Sexual Health after Menopause

      What are some concerns about sexual health after menopause? For one, less estrogen can lead to vaginal dryness, which may make intercourse uncomfortable or painful. Try using a water-soluble lubricant during sex, or applying a vaginal moisturizer every few days. Vaginal moisturizers are applied regularly, not just before sex, and get absorbed into the skin.

      Libido may also change, for better or worse, but many factors besides menopause—including stress, medications, depression, poor sleep, and relationship problems—affect sex drive. Talk to your healthcare provider if sex problems occur—don’t settle for a so-so sex life. And remember, sexually transmitted infections (STIs) don’t end with menopause; safer sex still counts.

      FAQs about Menopause

      Does menopause lower sex drive in all women?
      No. In fact, some postmenopausal women report an increase in sex drive. This may be due to decreased anxiety associated with a fear of pregnancy. In addition, many postmenopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners. However, if you’re having concerns, take a look at this video for some reassurance and information about sexual difficulties women may face.
      How does menopause affect sex drive?
      The loss of estrogen following menopause can lead to changes in a woman’s sexual drive and functioning. Perimenopausal and postmenopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking—which can result in decreased interest in sex. Women who have a very low sex drive may be diagnosed hypoactive sexual desire disorder, or HSDD. Until recently, there weren’t medical treatments available for women’s low sexual desire. However, an FDA advisory committee recently approved the drug Addyi to treat HSDD. Addyi is the first medication on the market to treat HSDD in women.

      In addition, lower levels of estrogen can cause a decrease in blood supply to the vagina. This decreased blood flow can affect vaginal lubrication, causing the vagina to be too dry for comfortable intercourse. If you are not getting relief from lubricants and vaginal moisturizes, you might ask your healthcare provider about low dose vaginal estrogen. This is a form of estrogen therapy that is available by prescription in the form of vaginal creams, a vaginal ring, and a vaginal table

      How can I treat vaginal dryness?
      Vaginal dryness can be treated with water-soluble lubricants such as Astroglide® or K-Y Jelly®. Do not use non-water soluble lubricants such as Vaseline® because they can weaken latex (the material used to make condoms, which should continue to be used to avoid pregnancy until your healthcare provider verifies you are not producing eggs and to prevent contracting STIs).

      Vaginal moisturizers are another option for treating vaginal dryness. Vaginal moisturizers are applied regularly, not just before sex, and get absorbed into the skin. They can last for up to three to four days before needing to be re-applied.
      In cases where lubricants and vaginal moisturizers are not helpful, low dose vaginal estrogen is another option. This is a form of estrogen therapy that is available by prescription in the form of vaginal creams, a vaginal ring, and a vaginal tablet. This type of therapy restores the health of and sexual functioning of vaginal tissue.

      Can I get help?
      Although sexual problems can be difficult to discuss, talk to your healthcare provider; there are options to consider, such as hormone replacement therapy, topical moisturizers or creams, potential new drugs coming on the market, or counseling. Your provider may refer you and your partner to a health professional who specializes in sexual dysfunction. Sexual concerns may have a mental health component, and so the therapist may advise sexual counseling on an individual basis, with your partner or in a support group. This type of counseling can be very successful, even when it is done on a short-term basis.
      Do I still have to worry about STIs?
      Absolutely! Just as you must use protection if you do not want to become pregnant, you must also take measures to protect yourself against sexually transmitted infections (STIs). It’s important to remember that your risk of contracting STIs is a possibility at any point in your life during which you are sexually active, and this risk does not go down with age.
      How can I protect myself against STIs?
      Here are some basic steps that you can take to help protect yourself from STIs:

      • Use a latex condom consistently and correctly every time you have sex. (If you use a lubricant when using condoms, make sure it is water-based (not oil-based, like Vaseline®.)
      • Make sure to wash sex toys before sharing with a partner, or use a condom and switch condoms before sharing.
      • Limit your number of sexual partners. The more partners you have, the more likely you are to get an STD/STI.
      • Practice mutual monogamy. This means having sex with only one person who only has sex with you.
      • Choose your sex partners with care. Make sure both of you have been tested for STDs/STIs (before having sex).
      • Don’t abuse alcohol or drugs before you have sex. You may be less likely to practice safe sex if you are drunk or high.
      • Learn about STDs/STIs. The more you know about STDs/STIs, the better you can protect yourself.
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