Hypoactive Sexual Desire Disorder

Hypoactive Sexual Desire Disorder called also Female sexual arousal disorder is a disorder defined by a persistent inability to attain or maintain arousal until of a sexual activity. This diagnosis can also refer to inadequate lubrification normally present at arousal and sexual activity. There are other conditions sexual dysfunctions such as Anorgasmia (absence of Orgasm) and Hypoactive sexual desire disorder (absence sexual fantasies / absence of desire for sexual activity) which need to not be confused with.   In recent years, it becomes more common to use testosterone to treat female dysfunction.

Psychological factors and physical factors have been investigated in these disorders with windows on adolescence and childhood experiences. The impact of individual factors such as stress, fatigue, Health and gender identity or dysfunctional sexual beliefs have shown to affect sexual desire.  Over exposure to pornography lead to poor image, self-consciousness and lower esteem resulting in an inability to attain sexual pleasure. Sexual dysfunction can also occur secondary to major psychiatric disorders, including depression. Finally. factors exploring interpersonal factors in sexual dysfunction especially in relation to orgasm can play a role.

The quality of a relationship of sexual partners distressed or sexually dysfunctional, was approached based on attitudes or events resulting in satisfied relationships. The social context with the cultural backgrounds was also taken in consideration.

The Ovarian hormones influence female sexual desire but is conditioned by Pregnancy. Physical factors have been more than 70% of the time responsible of sexual dysfunction leading to neurological or circulatory components. In men these factors were extensively studied in premature or retarded ejaculation as well as erectile dysfunction. In women, the physiological factors in female sexual function is not so clear.  More recent studies may prove an impairment in female with Diabetes Mellitus. Indeed, Kenneth Maravilla, Professor of Radiology and Neurological Surgery and Director of MRI Laboratory at the University of Washington in Seattle has reported less brain activation in a small pilot group of diabetic women with increase in activation in the “Amygdala” and the temporal lobes while women with no sexual difficulties have demonstrated deactivation. This may suggest an area of Inhibition where a lack of selective serotonin reuptake inhibitors can cause sexual dysfunction in the women like it is seen with women taking selective serotonin reuptake inhibitors (SSRI’s).

Kaplan suggested that sexual dysfunction be based on interpersonal, intrapsychic and behavioral components. Guilt and Anxiety as well as performance anxiety and failure to communicate were found partly responsible.

The American Psychiatric Association Diagnostic criteria in 1994 were based on:

1- Persistent or Recurrent inability to attain or maintain an adequate lubrication/swelling response of sexual excitement until completion of sexual activities

2-The sexual dysfunction is not accounted by another axis of sexual dysfunction.

3- The dysfunction causes marked distress and interpersonal difficulty

There are limitations and variations in the definitions. How long it takes to have a lubrification- swelling response or how long it takes to become aroused? Responses will differ from one woman to another especially whenever they will report the evidences differently. They may be aroused occasionally by different partners and not by their spouse by example. How Long the disorder has existed? Finally, a combination of psychological factors. 


There is only one treatment approved by the FDA for this condition with the use of Flibanserin medication. Unfortunately, there are often no correlation between women subjective and physiological arousal. One problem with the current definition is that subjective arousal is not included. There is often no correlation between women’s subjective and physiological feelings. Another criticism for female sexual arousal disorder is that we may not be always sure that we are dealing with an actual disorder, or an invention of the pharmaceutical companies to promote billion-dollar companies. This does not include women who have experienced a loss of libido following hysterectomy.

Sexual arousal disorder is rarely a solitary disease in which vaginal lubrification/swelling is being judged to allow sexual encounters to have sex. We hope that we have demonstrated enough light on such complex problems. I would suggest more reading as well on this topic.



1-  Noble Pedro J, Pinto, Gouveia, Jose (2006)

“Dysfunctional sexual beliefs as vulnerability factors for sexual dysfunction”, Journal of Sex Research 43, (1) 68-75

2- Senna, Sandhu

“One in three women watch porn at least once a week, survey finds”. The Independent

Retrieved 2015-12-21.

3- McCabe, Martha P, (29 May 2006) “Female Sexual Arousal Disorder and Female Orgasmic Disorder” American Medical Network

4-Mullard, Asher (1 October 2015) “FDA approves female sexual dysfunction drug”. Nature Reviews Drug Discovery 14. 669

5-Cohen, Paul G (1999) “Sexual dysfunction in the United States” JAMA 282 (13) 1229

6-Graham, Cynthia A (2009). The DSM Diagnostic Criteria for Female Arousal Disorder”. Archives of sexual Behavior. 39 (2). 240-55.

7-Female Sexual Dysfunction: A feminist View. (2007-4-26) Archived Our Bodies Ourselves. Mental and behavior disorders ( F00-F99 and 290-319)


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