Overview
Hypoactive sexual desire disorder (HSDD) is characterized by a deficiency or absence of sexual fantasies and desire for sexual activity causing significant distress or interpersonal difficulty 1. It predominantly affects women but can occur in men and across various life stages 2.Diagnosis
Clinical Assessment: Comprehensive evaluation including medical history, sexual history, and psychosocial factors 12.
Diagnostic Criteria: Meets DSM-5 criteria for HSDD, involving persistent deficiency in sexual desire leading to distress 2.
Laboratory Testing: Not routinely required unless assessing for underlying hormonal imbalances 2.
Differential Diagnosis: Rule out other sexual dysfunctions, psychological conditions, and medical issues affecting sexual function 1.Management
First-Line Treatments:
- Psychological Interventions: Counseling, sex therapy 1.
- Lifestyle Modifications: Addressing relationship dynamics, stress management 1.
Adjunctive Treatments:
- Hormonal Therapy: Testosterone therapy for postmenopausal women with HSDD, typically initiated at low doses and titrated based on response and monitoring 2.
- Pharmacotherapy: Off-label use of testosterone patches (e.g., Intrinsa) in surgically induced menopause with concomitant estrogen therapy 4.Special Populations
Postmenopausal Women: Testosterone therapy supported for HSDD management 24.
Surgical Menopause: Testosterone patches like Intrinsa may be considered if estrogen therapy is ongoing 4.
Comorbidities: Chronic pelvic pain may influence treatment outcomes positively 1. Specific management for comorbidities like DSD and Wiedemann-Steiner Syndrome requires multidisciplinary care focusing on genetic and hormonal aspects 3.Key Recommendations
Evaluate HSDD with a biopsychosocial approach, including comprehensive clinical assessment and ruling out medical causes 12. (Evidence: Moderate)
Consider testosterone therapy for postmenopausal women with HSDD, following appropriate dosing and monitoring guidelines 2. (Evidence: Moderate)
Psychological interventions and lifestyle modifications should be integrated into the treatment plan for HSDD 1. (Evidence: Moderate)
Testosterone therapy should be prescribed cautiously in surgically induced menopause with concomitant estrogen therapy, ensuring adherence to licensed indications 4. (Evidence: Weak)References
1 Luz do Nascimento BH, Figueira JR, Rosa-E-Silva ACJS, Reis RM, Andrade MCR, Brito LGO et al.. Management of hypoactive sexual desire dysfunction at a specialized service in women's sexual health. Journal of sex & marital therapy 2024. link
2 Parish SJ, Simon JA, Davis SR, Giraldi A, Goldstein I, Goldstein SW et al.. International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. The journal of sexual medicine 2021. link
3 Calvel P, Kusz-Zamelczyk K, Makrythanasis P, Janecki D, Borel C, Conne B et al.. A Case of Wiedemann-Steiner Syndrome Associated with a 46,XY Disorder of Sexual Development and Gonadal Dysgenesis. Sexual development : genetics, molecular biology, evolution, endocrinology, embryology, and pathology of sex determination and differentiation 2015. link
4 Osborne V, Hazell L, Layton D, Shakir SA. Drug utilization of Intrinsa (testosterone patch) in England: interim analysis of a prescription-event monitoring study to support risk management. Drug safety 2010. link