hypoactive sexual desire disorder
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Hypoactive Sexual Desire Disorder. M. Chantel Long, M.D. June 24, 2011. Objectives. Discuss and Define Sexual Dysfunction in Women Review Causes Provide Strategies to Improve Communication with Patients and Treatment. What is HSDD?. - PowerPoint PPT PresentationTRANSCRIPT
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M. Chantel Long, M.D.
June 24, 2011
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Discuss and Define Sexual Dysfunction in Women
Review Causes Provide Strategies to Improve
Communication with Patients and Treatment
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Defined as the persistent or recurrent deficiency or absence of sexual thoughts, fantasies, and/or desire for sexual activity as per the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition.
It is widely agreed that decreased receptivity is another contributing factor and often the key symptom
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It must cause marked personal distress or interpersonal difficulties for the patient to meet the diagnosis
It can not be associated with another psychiatric disorder, drug, medication side effect, or other medical condition as a primary cause
May occur in women of all ages
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Four categories of female sexual disorders
Six Sexual Disorders
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Hypoactive Sexual Desire Disorder
Sexual Aversion Disorder
Sexual Desire
Disorders
Female Sexual Arousal Disorder
Sexual Arousal Disorder
s
Female Orgasmic Disorder
Orgasmic
Disorders
Dyspareunia
Vaginismus
Pain Disorder
s
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Is usually multifactorial (not just medical or hormonal)
Often, women choose to be sexual for reasons other than desire, such as for emotional intimacy or to please their partner.
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Biopsychosocial model differs from the linear models in that it shows there are multiple factors contributing to whether a woman will have a healthy sexual responseBiologicalPyschologicalSocial Interpersonal
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Hormone Levels Ongoing Disease Processes
(Sjogren’s) Medication Side Effects
Tagamet, Wellbutrin, Diuretics, SSRIs, Narcotics, Anticonvulsants, and Antihistamines
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Depression Anxiety Confidence/Self-Esteem Performance Anxiety
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Religion Cultural Factors
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Marriage Counseling Relationship Issues
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More difficult to treat females due to the many factors, i.e. one can’t simply prescribe “a blue pill”
Must consider all the possible factors, including stress and fatigue
Common after having a baby due to hormone changes, breastfeeding, stress, lack of sleep, lack of privacy, and increase time pressures
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National Health and Life Survey43% reported having a sexual problem
22% Low Sexual Desire 14% Arousal Issues 7% Pain Issues
PRESIDE Study43% reported having a sexual problem
12% reported Distress9.5 % Low Sexual Desire5.0% Arousal Issues4.6% Orgasm Issues
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The most prevalent sexual disorder across all ages
It is not a disorder that only occurs in older women
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Prevalence of Sexual Problems Associated With Distress by Age Group
Desire Arousal Orgasm Any
Valid Responses 28,447 28,461 27,854 28,403
With Distress 2,868 1,556 1,315 3,456Age Stratified Prevalence
18-44 Years 8.9% 3.3% 3.5% 10.8%
45-64 Years 12.3% 7.5% 5.7% 14.8%
>65 Years 7.4% 6.0% 5.8% 8.9%
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Those with underlying medical issues (depression, diabetes)
Postpartum (Natural or Surgical) Age > 45
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Menopause – naturally or surgically induced
Hypotestosteronism Associated Disease – Diabetes Mellitus,
Sleep Apnea, DDD, and even Age Depression – whether the cause or the
consequence Substance Abuse Dyspareunia (lubrication, position,
infections)
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Clinician BasedGenderTimeLack of Screening Tool UseLack of TrainingLack of Effective Treatment
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Decreased Sexual Desire Screener
Female Sexual Function Index Brief HSDD Screener
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1. In the past, was your level of sexual desire or interest good and satisfying to you?
2. Has there been a decrease in your level of sexual desire or interest?
3. Are you bothered by your decreased level of sexual desire or interest?
4. Would you like your level of sexual desire or interest to increase?
5. Which of the factors below do you feel may be contributing to your current decrease in sexual desire or interest? (Check all that apply)
a. An operation, depression, injuries, or other medical condition?
b. Medication, drugs, or alcohol that you are currently taking?
c. Pregnancy, recent childbirth, or are you having any menopausal symptoms?
d. Other sexual issues you may be having (pain, decreased arousal or orgasms)?
e. Your partner’s sexual problems?f. Dissatisfaction with your relationship or partner?g. Stress or fatigue?
Y/N Y/N Y/N Y/N
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Antidepressants Hormone Replacement (Estrogen,
Progesterone, Testosterone) Treatment of Ongoing Diseases Counseling
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Permission Limited Information Specific Suggestions (keep the
patient comfortable) Intensive Therapy
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For postmenopausal women, there are many studies showing that testosterone may be effective.
Hypotestosteronism leads to decreased bone density and decreased libido
Some women may try DHEA which is OTC Testosterone has 20 times the androgen
potency of DHEA or DHEA Sulfate. In premenopausal women, most circulating
testosterone results from ovarian production, with the remainder from the adrenal gland.
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In postmenopausal women, ovaries contribute less to circulating levels.
Currently, there are no guidelines for androgen replacement in women, but making the diagnosis of hypoandrogenemia can be important.
Measurement of total testosterone is not useful because of variable levels of binding with serum hormone-binding globulin
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The free testosterone level and serum hormone-binding globulin levels are better indicators.
Excess oral androgen therapy can lead to an increase in LDL and decrease in HDL
Excess androgens cause unwanted facial hair growth, acne, and hair loss and can occur with elevations of testosterone levels to just slightly above normal
Liver damage possible with oral replacement, including cholestatic juandice, but not with transdermal replacement
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Pregnancy Breastfeeding Hyperandrogenic State Presence of androgen-dependent
tumors
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Further study is needed to determine the clinical significance of androgen deficiency in women
Specifically in post-menopausal women, physiologic low-dose androgen replacement therapy may result in improved bone density, enhanced libido, and increased satisfaction with life
Androgen preparations that avoid liver metabolism and produce physiologic serum androgen level will enhance treatment options
Routine screening is not recommended until such preparations are available
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Estratest 0.625/1.25mg or 1.25/2.5mg daily or
cyclically Methyltestosterone
1mg PO daily with blood levels every 1-2 months
Lozenges, patches, cream Pellets last 3-6 months and are injected
(75mg); slow release into the bloodstream Progesterone 4% cream with 1mg
testosterone/ml. Apply one ml to skin (not genitalia) qHS. Disp: 50 grams. Must be refrigerated.
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Once upon a time, a perfect man and a perfect woman met. After a perfect courtship, they had a perfect wedding. One snowy, stormy Christmas Eve, the perfect couple were driving their perfect car along a winding road and noticed someone in distress. On the roadside, there stood Santa Claus with a huge bundle of toys. The perfect couple picked up Santa and began helping him deliver the toys. Unfortunately, the driving conditions worsened and they had a car accident. Only one survived. Who was the survivor?
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