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Decreased Sexual Desire Screener. Figure adapted with permission of the copyright holder, Boehringer Ingelheim International
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Introduction:
Hypoactive sexual desire disorder (HSDD) often has a negative impact on the health and quality of life of women; however, many women do not mention-let alone discuss-this issue with their physicians. Providers of gynecologic services have the opportunity to address this subject with their patients.
Aim:
To review the diagnosis and...
Context in source publication
Context 1
... for HSDD can be accomplished in a time-efficient manner during an office visit. A few brief questions could determine whether further evaluation is warranted. For example, are you sexually active? If not, why not? What sexual concerns do you have? How do you feel about your level of sexual desire, arousal, or orgasm? To facilitate these discussions, ensure a safe, non-judgmental environment for the patient. 29 This could include educating and training staff to be comfortable with sexual topics, offering patient-friendly materials in the waiting and ex- amination rooms, and including questions about sexual topics on intake forms. To assist in the diagnosis of acquired, generalized HSDD, the Decreased Sexual Desire Screener is a 5-item vali- dated questionnaire designed for clinical practice (Figure 2) 30 and is available online. 31 Although screening for HSDD is easily performed as part of an office visit, follow-up might be necessary to address sexual concerns and to provide office-based counseling or medication management. 29 ...
Citations
... Sexual therapy and education presently form the basis of treatment for HSDD, with limited pharmacologic therapeutic options available (34). Flibanserin is a 5-HT 1A agonist/5-HT 2A antagonist that is licensed by the FDA for the treatment of premenopausal women with HSDD. ...
BACKGROUND. Hypoactive sexual desire disorder (HSDD) is characterized by a persistent deficiency of sexual fantasies and desire for sexual activity, causing marked distress and interpersonal difficulty. It is the most prevalent female sexual health problem globally, affecting approximately 10% of women, but has limited treatment options. Melanocortin 4 receptor (MC4R) agonists have emerged as a promising therapy for women with HSDD, through unknown mechanisms. Studying the pathways involved is crucial for our understanding of normal and abnormal sexual behavior.
METHODS. Using psychometric, functional neuroimaging, and hormonal analyses, we conducted a randomized, double-blinded, placebo-controlled, crossover clinical study to assess the effects of MC4R agonism compared with placebo on sexual brain processing in 31 premenopausal heterosexual women with HSDD.
RESULTS. MC4R agonism significantly increased sexual desire for up to 24 hours after administration compared with placebo. During functional neuroimaging, MC4R agonism enhanced cerebellar and supplementary motor area activity and deactivated the secondary somatosensory cortex, specifically in response to visual erotic stimuli, compared with placebo. In addition, MC4R agonism enhanced functional connectivity between the amygdala and the insula during visual erotic stimuli compared with placebo.
CONCLUSION. These data suggest that MC4R agonism enhanced sexual brain processing by reducing self-consciousness, increasing sexual imagery, and sensitizing women with HSDD to erotic stimuli. These findings provide mechanistic insight into the action of MC4R agonism in sexual behavior and are relevant to the ongoing development of HSDD therapies and MC4R agonist development more widely.
TRIAL REGISTRATION. ClinicalTrials.gov NCT04179734.
FUNDING. This is an investigator-sponsored study funded by AMAG Pharmaceuticals Inc., the Medical Research Council (MRC) (MR/T006242/1), and the National Institute for Health Research (NIHR) (CS-2018-18-ST2-002 and RP-2014-05-001).
... Hypoactive Sexual Desire Disorder (HSDD) is one of the most frequent sexual dysfunctions. Its prevalence is estimated to be between 8% and 19% among women, [1][2][3][4] thus representing an important problem in clinical practice [5,6] and negatively impacting the Quality of life (QoL). [7][8][9] Therapeutic alternatives to deal with the problem are still controversial. ...
... The difficulty in objectively evaluating treatment outcomes, the discomfort of patients and health professionals in addressing the issue, insufficient time during a medical consultation to discuss sexuality issues, and the lack of skilled care services make HSDD a challenge in clinical practice. 5,6,10,11 The DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) placed sexual desire disorders with arousal dysfunctions under the name of Female Sexual Interest/Arousal Disorder (FSIAD). 12 There are sparse data in the literature about the prevalence of FSIAD and the variables which interfere with this disorder, 11 limiting its clinical applicability.WHO's (World Health Organization) ICD (International Classification of Diseases) 11 [13] defines HSDD as a reduction in or absence of desire (spontaneous or in response to erotic stimulation) or an inability lasting several months associated with personal distress to maintain desire or interest after the onset of sexual activity, 6,14 negatively impacting the woman or her partner's quality of life. ...
Background
Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD.
Objective
To evaluate the effects of group CBT on women with HSDD.
Method
Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. Main Outcome Measures: demographics, education, sexual history, FSQQ and its domains for sexual function assessment.
Results
Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001).
Conclusion
Group CBT was shown to be an effective tool for treating HSDD.
... Not surprisingly, several ED subgroups also showed modest differences on both masturbation frequency and pornography use: men with both ED and DE used pornography more frequently, most likely an attempt enhance their sexual/physical arousal to overcome barriers to erection and ejaculation [50,65]. In addition, men with low sexual interest were less likely to masturbate and use pornography, not surprising given that lower levels of sexual activity would be expected from men with low sexual interest [66,67]. Nevertheless, although ED subgroups showed varying patterns of pornography use and masturbation frequency, when analyzed within the larger follow-up multivariate regression analyses, these subgroup differences were not relevant to predicting general ED status or ED severity. ...
... Masturbation frequency, pornography use, and erectile functioning In follow-up regression analyses, we not only distinguished between non-ED men and ED men with and without sexual comorbidities, but also tested for associations within a sample of men aged 30 or younger. In these analyses, the strongest predictors of erectile functioning included ones that have long been known to affect erectile response: age, having a medical issue likely affecting sexual response, and diminished interest in sex [60,[66][67][68]. Low relationship satisfaction and having anxiety/ depression were also associated with poorer erectile functioning [69][70][71][72][73][74][75][76]. ...
Both masturbation frequency and pornography use during masturbation have been hypothesized to interfere with sexual response during partnered sex as well as overall relationship satisfaction. However, results from prior studies have been inconsistent and frequently based on case studies, clinical reports, and simple binary analyses. The current study investigated the relationships among masturbation frequency, pornography use, and erectile functioning and dysfunction in 3586 men (mean age = 40.8 yrs, SE = 0.22) within a multivariate context that assessed sexual dysfunctions using standardized instruments and that included other covariates known to affect erectile functioning. Results indicated that frequency of pornography use was unrelated to either erectile functioning or erectile dysfunction (ED) severity in samples that included ED men with and without various sexual comorbidities or in a subset of men 30 years or younger (p = 0.28–0.79). Masturbation frequency was also only weakly and inconsistently related to erectile functioning or ED severity in the multivariate analyses (p = 0.11–0.39). In contrast, variables long known to affect erectile response emerged as the most consistent and salient predictors of erectile functioning and/or ED severity, including age (p < 0.001), having anxiety/depression (p < 0.001 except for a subset of men ≤ 30 years), having a chronic medical condition known to affect erectile functioning (p < 0.001 except for a subset of men ≤ 30 years), low sexual interest (p < 0.001), and low relationship satisfaction (p ≤ 0.04). Regarding sexual and relationship satisfaction, poorer erectile functioning (p < 0.001), lower sexual interest (p < 0.001), anxiety/depression (p < 0.001), and higher frequency of masturbation (p < 0.001) were associated with lower sexual and lower overall relationship satisfaction. In contrast, frequency of pornography use did not predict either sexual or relationship satisfaction (p ≥ 0.748). Findings of this study reiterate the relevance of long-known risk factors for understanding diminished erectile functioning while concomitantly indicating that masturbation frequency and pornography use show weak or no association with erectile functioning, ED severity, and relationship satisfaction. At the same time, although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor for diminished sexual performance during partnered sex and/or relationship satisfaction in subsets of particularly vulnerable men (e.g., younger, less experienced).
... The questionnaire-based assessment findings suggestive of MHSDD are further examined/assessed with detailed sexual history and comorbidities such as diabetes and hypothyroidism. The assessment is extended with psychological examination for depression, anxiety, relationship issues, etc. Hormonal assay for testosterone, prolactin, and gonadotropin hormones and investigation for co-morbid conditions like diabetes and hypothyroidism are included in the assessment of MHSDD (Clayton, 2018). ...
Sexuality and sexual dysfunction have been described in various world literature since ancient times. With time advances, science and socio-cultural changes have evolved our understanding of sexuality and sexual disorders. Male sexual dysfunction is more commonly reported than female sexual dysfunction because of shyness, socio-cultural practices, and various associated stigma with sexual disorders. Male sexual disorders are a group of heterogeneous disorders involving multiple systems. Male sexual disorders have psychogenic as well as biogenic in origin. Commonly reported male sexual disorders are erectile dysfunctions, premature ejaculations, Dhat syndrome, and delayed ejaculations. The review focuses on highlighting the burden of illness and enhancing the understanding and approach to male sexual disorders. The review also highlights the available treatment options and appropriate referral services to address the problems adequately.
... These results were very close to those found in a recent Tunisian study among a sample of married female resident medical doctors (respective scores = 3.6; 4.5 and 4.48) [4]. In agreement with the data in the literature [4,10,11], sexual desire problem are widespread, especially among the female population [12]. According to Ferguson, et al. [9], they would lead inevitably to other sexual problems. ...
... Although distressing low sexual desire can be attributed to several biological, psychological, social, and contextual components, it is important to understand the complexity of the female sexual response and how other factors can contribute to hypoactive sexual desire disorder. In this context, the authors hypothesized that environment and lifestyle may play an important role [12]. Among medical residents, work stress and burnout could affect negatively sexual desire [6]. ...
Introduction: Studies have shown a high prevalence of sexual dysfunction in Medical residents. Psychological, interpersonal, and sociocultural factors play an important role in sexual vulnerability. In addition, distraction or interference in the cognitive process of the erotic stimulus plays an important role in the development of sexual dysfunction. The aim of our study was to determine the prevalence of sexual dysfunctions among a sample of married female medical resident doctors and to explore its relation with cognitive distraction during sex. Subjects and methods: This was a cross-sectional study, which was carried out in October 2017 with 70 married female medical resident doctors. We used the Female Sexual Function Index (FSFI) for sexual functioning assessment and the cognitive distraction during sex scale. Results: The mean age of women was 30.52 years. They had been married for 6.04 years on the mean. The majority (74%) had children. According to the FSFI, 40% of resident doctors had sexual dysfunction. The mean cognitive distraction during sex score was 4.37. In our study, women with female sexual dysfunction reported significantly lower sexual desire score = 3.2 vs. 4.1 and p = 0.03) and arousal (score = 3.è vs. 4.7 and p = 10-3), decreased lubrication (score = 3.8 vs. 5.1; p = 10-3), less sexual satisfaction (score = 3.9 vs. 5.8; p = 10-3) and higher orgasm difficulties (score = 3.4 vs. 5.1; p = 10-3). Yet, our results highlighted that women with female sexual dysfunction presented significantly more cognitive distraction during sex (score = 3.9 vs. 4.6; p = 0.03). Conclusion: According to our study, it appears that the prevalence of FSD in medical resident doctors is considerable. Besides, intrusive thoughts and cognitive distraction during sexual intercourse are importantly associated with sexual functioning. Therefore, several measures should be implemented in this population to prevent or act on these factors.
... Following this perspective, and based on evidence of some researches [17], it is possible to consider hypersexuality following a dimensional and biopsychosocial perspective, where the concept of "quantity of the sexual behaviour", in interaction with several biological, psychological and socio-cultural variables, becomes the index of severity of hypersexual behavior. So, we can hypothesize a continuum, where on the one extreme we find the Sexual Aversion [18], a diagnosis based on the criteria inserted in precedent versions of the Diagnostic and Statistical Manual of Mental Diseases (DSM), and the hypoactive sexual desire disorder (HSDD) [19], and on the other one the hypersexual disorder (HD). All the central points during the continuum may be considered softened features of a more or less "normotypical sexual behavior" (Fig. 1). ...
In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.
... 19 Treatment for HSDD often starts with programs geared to biopsychosocial elements unique to a patient's medical history and current symptoms. 20 Cognitive behavioral therapy, mindfulness meditation training, and couples therapies have been suggested to be effective, although randomized controlled trials in women with HSDD should be performed. [21][22][23][24][25] Pharmacotherapies that have been tried or utilized for HSDD include off-label bupropion and buspirone, although sufficient data are lacking for their efficacy in patients with HSDD. ...
Background: Hypoactive sexual desire disorder (HSDD), which affects ∼10% of women in the United States, is defined as the persistent or recurrent deficiency/absence of sexual desire accompanied by personal distress. Although HSDD impacts patient quality of life and interpersonal relationships, the disorder often goes unaddressed or untreated. Recent studies of the burden of illness in women with HSDD, especially premenopausal women, are limited. Materials and Methods: A 45-minute web-based survey was designed to investigate the experience of women seeking treatment for HSDD and the impact of this disorder on several psychosocial aspects of women's lives. Women were recruited from an online panel of patients who participated in research studies for compensation. Validated questionnaires assessed sexual function (Female Sexual Function Index) and health-related quality of life (12-Item Short Form Survey [SF-12]), including mental and physical component scores. Results: A total of 530 women, aged ≥18 years, diagnosed with acquired generalized HSDD were included in the study. Premenopausal women indicated greater overall HSDD symptom burden compared with postmenopausal women. Patients with HSDD reported lower SF-12 scores compared with the general population. A multivariable regression analysis demonstrated that psychosocial factors influencing the burden of HSDD, including interference with their relationship with their partner (β = -0.18; p < 0.005), mental and emotional well-being (β = -0.23; p < 0.005), and household and personal activities (β = -0.23; p = 0.02), negatively affected SF-12 mental component scores. Conclusions: HSDD symptom burden was found to be negatively and statistically significantly associated with patients' mental health; the impact was greater among premenopausal women compared with postmenopausal women.
... Female sexual dysfunction (FSD) is a prevalent medical problem worldwide [1]. The bio-psycho-social focus of interventions has been viewed as the best approach to this pivotal clinical entity [2,3]. Managing women with the problem related to sexual desire, sometimes referred to as hypoactive sexual desire disorder (HSDD) as part of the FSD, is a great challenge for many clinicians [2,3]. ...
... The bio-psycho-social focus of interventions has been viewed as the best approach to this pivotal clinical entity [2,3]. Managing women with the problem related to sexual desire, sometimes referred to as hypoactive sexual desire disorder (HSDD) as part of the FSD, is a great challenge for many clinicians [2,3]. HSDD has been reported with rates of <10-30% [4]. ...
... Extensive population-based studies reported 36% to 39% of women with low sexual desire problems. From this proportion, 8% to 10% met the primary diagnostic criteria for HSDD [3]. In women, low sexual desire commonly increases with age, whereas related distress decreases, resulting in a reasonably steady prevalence of HSDD across the adult lifespan [3]. ...
Although few clinical trials examined the efficacy of bupropion to treat sexual dysfunction among female patients, a comprehensive and objective synthesis of the best available evidence is still lacking. To date, to the best of our knowledge, there are no published systematic reviews or meta-analyses specifically focusing on the role of bupropion in the treatment of female sexual dysfunction. The main objective of the present study was to evaluate the efficacy of bupropion in the treatment of female sexual dysfunction, and we hypothesized that bupropion is efficient in treating female patients with sexual dysfunction. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search for published literature was performed using. Ovid, Medline, Scopus, Cochrane Library, Science Direct, and PubMed databases. In our study, we found bupropion was almost three-fold more favorable in improving problems with sexual desire (pool estimate 2.845, 95% CI: 0.215 to 5.475, I2= 95.6%, p=0.034). Because of high heterogeneity, we performed a meta-regression and found that only the dosage of bupropion was statistically significant in explaining the variance, i.e., the higher the dosage (300 mg vs. 150 mg), the better the sexual desire the women with hypoactive sexual desire disorder (HSDD) can improve. Based on the results of this systematic review and meta-analysis, there is a potential role for bupropion as an effective treatment for women with HSDD.
... Female hypoactive sexual desire disorder (HSDD) affects up to 30% of women in the USA (Clayton et al., 2018). It is described as persistent pre-menopausal reduced sexual desire that causes emotional distress and relationship difficulties and is not related to another mental condition or medication (American Psychiatric Association, 2013). ...
Flibanserin (FLB) was approved by FDA for the treatment of pre-menopausal female hypoactive sexual desire disorder (HSDD). FLB suffers from low oral bioavailability (33%) which might be due to hepatic first-pass metabolism in addition to its poor aqueous solubility. The sublingual route could be a promising alternative for FLB due to the avoidance of enterohepatic circulation. However, the drug needs to dissolve in the small volume of saliva in order to be absorbed through the sublingual mucosa. Therefore, FLB nanocrystals were prepared by sono-precipitation technique according to 2³ full factorial design. FLB-nanocrystals were formulated using two surfactants (PVP K30 and PL F127) in two different amounts (200 and 400 mg) and the volume of ethanol was either 3 or 5 mL. Nanocrystal formulation was optimized according to the desirability function to have a minimum particle size, zeta potential, polydispersity index, and maximum saturated solubility. The optimized formula had a particle size of 443.12 ± 14.91 nm and a saturated solubility of 23.27 ± 4.62 mg/L which is five times the saturated solubility of FLB. Nanocrystal dispersion of the optimized formula was solidified by freeze-drying and used to prepare rapidly disintegrating sublingual tablets containing Pharmaburst® as superdisintegrant. Sublingual tablet formulation with the shortest disintegration time (36 s) was selected for the in vivo study. FLB nanocrystal-based sublingual tablets exhibited a two-fold increase in bioavailability with a faster onset of action compared to the commercially available oral formulation. These findings prove the potential application of FLB nanocrystal-based sublingual tablets in the treatment of HSDD.
... Then we used the Female Sexual Function Index (FSFI) Scoring 1 and Decreased Sexual Desire Screener (DSDS). 7 FSFI has 19 multiple-choice questions, and is a standard tool for assessing the main dimensions of female sexual function over the past four weeks. These dimensions include sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. ...
... and scores less than or equal to these values indicated sexual problems in that domain. 1 The DSDS is an applicable user-friendly brief five-item validated questionnaire designed for clinical practice, relies on (yes-or-no) answers, with no population-specific cut-off scores. It is an easy-to-use, brief assessment instrument used to diagnose HSDD in women presenting with complaints of decreased sexual desire regardless the age.The DSDS is intended for use by practicing clinicians with little or no experience in diagnosing HSDD, and requires no special training to administer/interpret. 7,8 The diagnosis of HSDD requires low sexual desire which was preceded by normal sexual desire. 9 If the woman answers "Yes" to all (1 through 4) questions, and "No" to all question 5 items, the GA-HSDD diagnosis will be set. ...
... Different co-morbid conditions like arousal or orgasmic disorders may co-exist with HSDD. 3,7 These two scoring systems were used to ask the couples verbally in a common Arabic language after full description for each item. The answer responses of the couples were recorded by the interviewing endocrinologist and marked the answer on the printed questionnaires directly. ...
Background: Help-seeking behavior for female sexual dysfunction (FSD) in conservative communities is affected by cultural and religious factors. Our objective was to evaluate psychosexual, social, physical, and biochemical factors which impact FSD in premenopausal women from Basrah. Methods: From (Sep 2018-Jan 2021), we conducted a cross-sectional study in a tertiary endocrine center on 673 married premenopausal women with sexually-related complaints for >6 months. Initial visit involvedrelevant history and examination using non-judgmental patient-centered integrative approaches. FSD diagnosis was fulfilled in 219 women, for whom a couple-interview session was scheduled, involved intimacy assessment, use of Female Sexual Function Index (FSFI) Scoring and Decreased Sexual Desire Screener (DSDS) for hypoactive sexual desire disorder (HSDD) diagnosis. Relevant hormonal and biochemical tests were tested. The ultimately enrolledwomen were 166 women. We used Pearson's correlational analysis to confirm significant correlations between FSD and different parameters. We used Mann-Whitney U test in a subgroup analysis of HSDD subtypes. Results: FSD prevalence was 24.67% with a mean duration (8±2 months). Intercourse frequency prior to complaint onset (3±1 times weekly), compared to (2±1 times monthly) in the latest month before presentation. All FSFI domains scores were reduced. DSDS diagnosed generalized and secondary acquired-HSDD in 31 and 57 women, respectively. The hormonal investigation did not aid FSD diagnosis. Pearson's correlational analysis showed no significant correlation between the test variables and FSD. Conclusion: No significant correlation between FSD and any psychosexual, physical, and biochemical parameters could be seen. Longitudinal multicenter larger-scale studies are needed.
