Published December 30, 2021 | Version v1
Journal article Open

Diminished Libido, Its Manifestations and Definitions of Hypoactive Sexual Desire Disorder

Creators

  • 1. Kharkiv Medical Academy of Postgraduate Education, Ukraine

Description

The article deals with clinical manifestations of diminished libido as well as definitions of hypoactive sexual desire disorder (HSDD) in the International Classification of Diseases, 10th Revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth Editions (DSM-4 and DSM-5) (USA). Its corresponding code in ICD-10 is F52.0 (“Lack or loss of sexual desire”), which is common for both men and women. DSM-4 has code 302.71 (“Hypoactive Sexual Desire Disorder”), which is common for persons of both sexes too. The point to note is that the above classification considers the presence of distress or difficulties in interpersonal communication, caused by hyposexuality, as one of indicators for diagnosing this disorder. DSM-5 uses diagnosis “Male Hypoactive Sexual Desire Disorder” (code 302.71), whereas for revealing this disorder in women general diagnosis “Female Sexual Interest/Arousal Disorder” (code 302.72) is used, since in compliance with the opinion, present in the above guide, women are characterized by difficulties in differentiation and a frequent comorbidity of disorders of sexual interest and sexual excitement. Also, attention is called to the fact of substitution of the term “sexual desire” with the term “sexual interest”, thereby giving some psychological tint to the first part of the diagnosis and reducing its biological background. Both DSM-5 codes (for men and for women) also provide for a diagnostic criterion, according to which hypoactive sexual manifestations cause a clinically significant distress.

The author also informs about existence of an autonomous classification of female sexual dysfunctions by two international panels of experts in sexual medicine (Nomenclature Committee of the International Society for the Study of Women’s Sexual Health and the International Consultation in Sexual Medicine), who believe that preservation of the separate diagnosis “Hypoactive sexual desire disorder” for women is reasonable. It is reported that ICD-11 will use diagnosis “Hypoactive sexual desire dysfunction” not only for men, but for women too. The given data demonstrate scientific substantiation for such a decision.

Attention is called to the fact that the above classification has fully absolutized the subjective perception of hyposexuality. For example, it is reported that the proposed diagnostic guide takes aim at the absence of any norms for sexual activity. It is suggested to regard as “satisfactory” the sexual activity, which satisfies the given person. If the individual is satisfied with his/her sexual activity, the possibility of diagnosing his/her sexual dysfunction is excluded at once. Validity of such an approach is discussed. Besides the described hypoactive sexual manifestations, the article also lists the clinical phenomena, which are associated with the above manifestations and accompany them.

Files

Diminished_Libido_Its_Manifestations_and_Definitions_of_Hypoactive_Sexual_Desire_Disorder.pdf

Files (1.3 MB)

Additional details

References

  • Vasil'chenko GS. Polovaya konstituciya. Obshchaya seksopatologiya: Rukovodstvo dlya vrachej. Pod red G. S. Vasil'chenko. Moskow: Medicina; 1977. 216-33 р.
  • Kelly GF. Osnovy sovremennoj seksologii. Per. s angl. Sankt Peterburh: Piter; 2000. 896 р.
  • Kocharyan GS. Giperseksual'nost'. Har'kov: OOO DISA PLYUS; 2020. 263 р.
  • Kocharyan GS. Gomoseksual'nost' i sovremennoe obshchestvo. Har'kov: EDENA; 2008. 240 р.
  • Kocharyan GS. Diagnoz rasstrojstv potencii i nekotorye nyuansy obsledovaniya pacientov s seksual'nymi disfunkciyami (lekciya). Zdorov'e muzhchiny. 2014;3(50):139-44.
  • Kocharyan GS. Orgazm, ego rasstrojstva i ih preodolenie. Har'kov: DISA PLYUS; 2018. 395 р.
  • Krishtal' VV, Grigoryan SR. Seksologiya. Moskow: PER SE; 2002. 879 р.
  • Mezhdunarodnaya klassifikaciya boleznej (10-j peresmotr). Klassifikaciya psihicheskih i povedencheskih rasstrojstv. Klinicheskie opisaniya i ukazaniya po diagnostike. Sankt Peterburh: ADIS; 1994. 304 р.
  • Svyadoshch AM. Zhenskaya seksopatologiya. Izdanie pyatoe, pererab. i dopol. Kishinev: SHtiinca; 1991. 184 р.
  • Arnow BA, Millheiser L, Garrett A, Lake PM, Glover GH, Hill KR, et al. Women with hypoactive sexual desire disorder compared to normal females: a functional magnetic resonance imaging study. Neurosci. 2009;158(2):484-502. doi: 10.1016/j.neuroscience.2008.09.044.
  • Balon R, Clayton AH. Female sexual interest/arousal disorder: a diagnosis out of thin air. Arch Sex Behav. 2014;43(7):12279. doi: 10.1007/s10508-013-0247-1.
  • Basson R, Segraves RT, editors. Female Hypoactive Sexual Desire Disoders. Handbook of Sexual Dysfunction. Boca Raton: Taylor & Francis Group; 2005. 43-65 р.
  • Berman JR, Berman LA, Toler SM, Gill J, Haughie S. Sildenafil Study Group. Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder: a double-blind, placebo controlled study. J Urol. 2003;170(6 Pt 1):2333-8. doi: 10.1097/01.ju.0000090966.74607.34.
  • Biddle AK, West SL, D'Aloisio AA, Wheeler SB, Borisov NN, Thorp J. Hypoactive sexual desire disorder in postmenopausal women: quality of life and health burden. Value Health. 2009;12(5):763-72. doi: 10.1111/j.1524-4733.2 008.00483.x.
  • Bishop JR, Ellingrod VL, Akroush M, Moline J. The association of serotonin transporter genotypes and selective serotonin reuptake inhibitor (SSRI)-associated sexual side effects: possible relationship to oral contraceptives. Hum Psychopharmacol. 2009;24(3):207-15. doi: 10.1002/hup.1006.
  • Bishop JR, Moline J, Ellingrod VL, Schultz SK, Clayton AH. Serotonin 2A-1438 G/A and G-protein Beta3 subunit C825T polymorphisms in patients with depression and SSRI-associated sexual side-effects. Neuropsychopharmacol. 2006;31(10):2281-8. doi: 10.1038/sj.npp.1301090.
  • Brotto LA. The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Arch Sex Behav. 2010;39(2):221-39. doi: 10.1007/s10508-009-9543-1.
  • Brotto LA, Basson R, Luria M. A mindfulness-based group psycho-educational intervention targeting sexual arousal disorder in women. J Sex Med. 2008;5(7):1646-59. doi: 10.1111/j.1743-6109.2008.00850.x.
  • Brotto LA, Chivers ML, Millman RD, Albert A. Mindfulness-Based Sex Therapy Improves Genital-Subjective Arousal Concordance in Women With Sexual Desire/Arousal Difficulties. Arch Sex Behav. 2016;45(8):1907-21. doi: 10.1007/s10508-015-0689-8.
  • Burri A, Greven C, Leupin M, Spector T, Rahman Q. A multivariate twin study of female sexual dysfunction. J Sex Med. 2012;9(10):2671-81. doi: 10.1111/j.1743-6109.2012.02861.x.
  • Clayton AH, DeRogatis LR, Rosen RC, Pyke R. Intended or unintended consequences? The likely implications of raising the bar for sexual dysfunction diagnosis in the proposed DSM-V revisions: 2. For women with loss of subjective sexual arousal. J Sex Med. 2012;9(8):2040-6. doi: 10.1111/j.1743-6109.2012.02859.x.
  • Dennerstein L, Koochaki P, Barton I, Graziottin A. Hypoactive sexual desire disorder in menopausal women: a survey of Western European women. J Sex Med. 2006;3(2):212-2. doi: 10.1111/j.1743-6109.2006.00215.x.
  • DeRogatis LR, Clayton AH, Rosen RC, Sand M, Pyke RE. Should sexual desire and arousal disorders in women be merged? Arch Sex Behav. 2011;40(2):221-5. doi: 10.1007/s10508-010-9677-1.
  • Derogatis LR, Melisaratos N. The DSFI: a multidimensional measure of sexual functioning. J Sex Marital Ther. 1979;5(3):244-81. doi: 10.1080/00926237908403732.
  • Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. United States: American Psychiatric Association; 2013. 947 p.
  • American Psychiatric Association. Diagnostic Criteria From DSM-IVTM Washington, DC: American Psychiatric Association; 1994. 358 p.
  • Donahey KM, Carroll RA. Gender differences in factors associated with hypoactive sexual desire. J Sex Marital Ther. 1993;19(1):25-40. doi: 10.1080/00926239308404886.
  • Galyer KT, Conaglen HM, Hare A, Conaglen JV. The effect of gynecological surgery on sexual desire. J Sex Marital Ther. 1999;25(2):81-8. doi: 10.1080/00926239908403981.
  • Garde K, Lunde I. Female sexual behaviour. A study in a random sample of 40-year-old women. Maturitas. 1980;2(3):225-40. doi: 10.1016/0378-5122(80)90007-9.
  • Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A, Parish SJ, 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(1):114-28. doi: 10.1016/j.mayocp.2016.09.018.
  • Hill CA, Preston LK. Individual differences in the experience of sexual motivation: theory and measurement of dispositional sexual motives. J Sex Res. 1996;33(1):27-45. doi: 10.1080/00224499609551812.
  • Kingsberg SA. Attitudinal survey of women living with low sexual desire. J Womens Health (Larchmt). 2014;23(10):817-23. doi: 10.1089/jwh.2014.4743.
  • Kinsey AC, Pomeroy VB, Martin CE. Sexual Behavior in the Human Male. Philadelphia: W. B. Saunders Company; 1948. 804 p.
  • Klusmann D. Sexual motivation and the duration of partnership. Arch Sex Behav. 2002;31(3):275-87. https://doi.org/10.1023/a:1015205020769.
  • Laumann E0, Gagnon JH, Michael RT, Michaels S. The social organization of sexuality. Chicago: University of Chicago Press; 1994.
  • Leiblum SR, Rosen RC, editors. Introduction: Changing Perspectives on Sexual Desire. Sexual Desire Disorders. New York; London: The Guilford Press; 1988, 1-17.
  • Leiblum SR, editor. Chapter 1. Introduction and Overview. Clinical Perspectives on and Treatment for Sexual Desire Disorders. Treating Sexual Desire Disorders. A Clinical Casebook. New York; London; The Guilford Press; 2010. 1-22.
  • Lunde I, Larson GK, Fog E, Garde K. Sexual desire, orgasm, and sexual fantasies: a study of 625 Danish women born in 1910, 1936 and 1958. J Sex Educ-Ther. 1991;17(2):111-15. doi:10.1080/01614576.1991.11074012.
  • Maserejian NN, Shifren J, Parish SJ, Segraves RT, Huang L, Rosen RC. Sexual arousal and lubrication problems in women with clinically diagnosed hypoactive sexual desire disorder: preliminary findings from the hypoactive sexual desire disorder registry for women. J Sex Marital Ther. 2012;38(1):41-62. doi: 10.1080/0092 623X.2011.569642.
  • Maurice WL. Male Hypoactive Sexual Desire Disorder. Handbook of Sexual Dysfunction. Boca Raton: Taylor & Francis Group; 2005. 67-109.
  • McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, et al. Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135-43. doi: 10.1016/j.jsxm.2015.12.019.
  • Parish SJ, Goldstein AT, Goldstein SW, Goldstein I, Pfaus J, Clayton AH, et al. Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions-Part II. J Sex Med. 2016;13(12):1888-906. doi: 10.1016/j.jsx m.2016.09.020.
  • Parish SJ, Hahn SR. Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment. Sex Med Rev. 2016;4(2):103-20. doi: 10.1016/j.sxmr.2015.11.009.
  • Pyke RE, Clayton AH. Psychological Treatment Trials for Hypoactive Sexual Desire Disorder: A Sexual Medicine Critique and Perspective. J Sex Med. 2015;12(12):2451-8. doi: 10.1111/jsm.13056.
  • Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, et al. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry. 2016;15(3):20-21. doi: 10.1002/wps.20354.
  • Regan PC, Berscheid E. Beliefs about the state, goals, and objects of sexual desire. J Sex Marital Ther. 1996;22(2):110-20. doi: 10.1080/00926239608404915.
  • Sarin S, Amsel RM, Binik YM. Disentangling desire and arousal: a classificatory conundrum. Arch Sex Behav. 2013;42(6):1079-100. doi: 10.1007/s10508-013-0100-6.
  • Schreiner-Engel P, Schiavi RC. Lifetime psychopathology in individuals with low sexual desire. J Nerv Ment Dis. 1986;174(11):646-51. doi: 10.1097/00005053-198611000-00002.
  • World Health Organization. World Health Organization's ICD-11: Compulsive Sexual Behavior Disorder [Internet]. Geneva: WHO; 2019. Available from: https://www.yourbrainonporn.com/miscellaneous-resources/world-healthorganizations-icd-11-compulsive-sexualbehavior-disorder/.
  • Sungur MZ, Gündüz A. A comparison of DSM-IV-TR and DSM-5 definitions for sexual dysfunctions: critiques and challenges. J Sex Med. 2014;11(2):364-73. doi: 10.1111/jsm.12379.
  • World Health Organization. The World Health Organization (WHO) has announced the official publication of a new version of the International Classification of Diseases (ICD-11) which includes a new chapter on Conditions Related to Sexual Health, bringing together conditions that were previously categorized in other ways and mostly under mental disorders [Internet]. Geneva: WHO; 2018. Available from: https://www.isswsh.org/images/Draft_ICD-11_Statement_7-26-18_with_Simon_Edits.pdf.
  • Weijmar Schultz WC, Van De Wiel HB, Hahn DE, Bouma J. Psychosexual functioning after treatment for gynecological cancer: an integrative model, review of determinant factors and clinical guidelines. Int J Gynecol Cancer. 1992;2(6):281-90. doi: 10.1046/j.1525-1438.1992.02060281.x.