Hypoactive Sexual Desire Disorder (HSDD) is a deficiency in sexual or erotic thoughts and a reduction in desire for sexual activity. Common treatments for HSDD include testosterone therapy and other medications, as well as sex therapy. Results for treatment may occur within 2-6 months; longer treatment may be necessary if medications are not deemed appropriate.
Men are more likely to report other sexual dysfunctions, such as Erectile Disorder (ED) or Premature Ejaculation (PE), than HSDD. This may be due in part to the common belief that men have consistently high sex drive, making it difficult for men to feel comfortable discussing or admitting to a lack of desire.1
What Is HSDD?
HSDD is defined by a low or nonexistent sexual drive that is causing someone distress. It can be a slow onset later in life or something you’ve dealt with for a long time. It may sometimes be a problem, while other times someone may not feel bothered by it.
Is HSDD More Common in Women?
HSDD, similar to FSAD, is more common among females. While both men and women deal with this, a significantly higher number of females struggle with HSDD. Females are likely to struggle more due to monthly hormonal changes as well as changes in libido throughout their lifespan. Pregnancy can also impact sexual drive in females, and the life experiences of women tend to lead to dealing with HSDD more often.
HSDD vs. Low Sex Drive
HSDD and low sexual drive have some overlapping symptoms, given that low sexual drive is a symptom of HSDD—however, those with only a low sexual drive may not be feeling distressed about it. HSDD, on the other hand, leaves you feeling distressed about the low sexual drive. Reasons for low sexual drive and HSDD may be related to medications, hormonal changes, mental health issues, or physical issues (such as multiple sclerosis, thyroid dysfunction, etc.)
Signs That You Might Have a Sexual Desire Disorder
The one main sign of HSDD is a lack of sexual drive. Changes in sex drive must cause significant distress to the individual in order to be considered a sexual dysfunction.
Potential signs of HSDD include:2
- Experiencing a significant drop in the frequency of sexual thoughts and fantasies
- Initiating sex less often
- Being less receptive to a partner initiating sex
- Being in a sexless relationship
- Masturbating less frequently
Difference of Libido in Partners
Also crucial to take into consideration is that libido discrepancy between partners is common. Despite the cultural assumption that men want sex and women don’t, females often experience a higher desire for sex than their male partners. Sex is an important part of relationships, so this can cause shame and distress for both partners.
Men can feel as if they should have a higher desire for sex because their partner does, even if his level of desire was not problematic prior to the current relationship. Libido discrepancy is not an inherently diagnosable issue and does not necessarily indicate that HSDD is present. Exploration of the sexual dynamic within a couple and in the individual is necessary before determining whether HSDD is an appropriate diagnosis.
Symptoms of HSDD
Symptoms of Hypoactive Sexual Desire Disorder include:2
- Deficient or absent sexual/erotic thoughts or fantasies
- Lack of desire for sexual activity
- Symptoms occurring for a minimum duration of six months
- Symptoms causing significant distress to the individual
- Sexual dysfunction is not explained by substance use, medication, medical conditions, or other mental disorders
- Sexual dysfunction cannot be attributed to severe relationship distress or other significant stressors
Causes & Triggers of HSDD
Sexual desire is complex and not very well understood scientifically. However, many desire issues can be explained by mood disorders, relationship problems or other significant stressors. If these psychological factors are present, they should be addressed. Assessing for physiological issues, such as medication side effects or medical conditions is also important. Hormone fluctuations, particularly low testosterone, have been linked with low desire in men and can be treated.
Physiological factors that can cause low desire include:
- Side effects of medication, including antidepressants such as SSRIs
- Side effects of recreational drug use
- A drop in testosterone levels
- Pain, tension, or significant physiological issues from other medical conditions
Psychological factors that contribute to low desire include:
- Stress
- A history of sexual trauma
- Mood disorders, such as anxiety and depression can impact sex drive
- History of negative sexual experiences
- Sexual shame or cultural messages of sex negativity
- Body image issues
- Relationship longevity
- Relationship conflict
- Lack of communication, affection, or emotional bonding with a partner
HSDD Treatment
There are many behavioral and medication treatments that can help someone dealing with HSDD, and your doctor and a certified sex therapist can help you figure out what treatments are appropriate for you.
Sex Therapy
Once physiological factors such as hormone levels and medical conditions have been assessed by a doctor, psychological issues are best addressed with an AASECT (American Association of Sexuality Educators, Counselors and Therapists) certified sex therapist (CST). Sex therapists are licensed mental health professionals, such as marriage and family therapists (LMFTs) or licensed professional counselors (LPCs), with additional training in the field of sex therapy.
Common therapeutic approaches in sex therapy for treating low sexual desire include:
- Psycho-education about factors which lead to decreased desire/arousal
- Prioritizing time for sex/intimacy in a couple (or masturbation for an individual)
- Shift in the context for when/how sexual activity occurs
- Increasing agency/control in the sexual experience for low-arousal partner
- Conflict resolution and communication strategies for couples
- Reduction in goal oriented/orgasm focused sexual activities
- Increase in sensation/pleasure focused sensual activities
- Sensation-focused exercises to cultivate awareness and improve communication for couples
- Mindfulness exercises to increase somatic awareness for individuals
Sex therapy can be sought as an individual who is experiencing sexual symptoms or as a couple impacted by lower desire in a male partner. A sex therapist will take a detailed sexual and psychosocial history to assess for psychological factors contributing to reduced sexual arousal. The therapist will explore the onset and context of the symptoms being experienced, especially any changes in the situations or cues that have stimulated desire/arousal in the past. Co-occurring psychological conditions, such as mood disorders, will also be assessed and treated.
Medical Treatments
Common medical approaches for treating low sexual desire in men include:
- Testosterone Therapy: This could be a shot, patch, or topical gel. These may be prescribed for Erectile Disorder (ED) and/or Hypoactive Sexual Desire Disorder (HSDD) if a patient has abnormally low testosterone levels.
- Buproprion (Wellbutrin): Buproprion is an antidepressant that can be prescribed as a substitute for or supplement to other antidepressants (SSRIs) believed to cause a decrease in sexual desire. This is most likely to be prescribed by a psychiatrist, psychiatric RN, or general practitioner.
- Other Medication: Oral medication for erectile dysfunction, such as sildenafil (Viagra) or tadalafil (Cialis), may be appropriate for low desire issues in concurrence with erectile dysfunction. Vyleesi is an FDA-approved injection medication for women with HSDD. These treatments be prescribed by a general practitioner, endocrinologist, or urologist.
How to Get Help for Hypoactive Sexual Desire Disorder
Discussing symptoms with your primary care provider is an important first step to ruling out any underlying medical issues. If warranted, your doctor will order any necessary tests or refer you to a hormone specialist, endocrinologist, urologist, psychiatrist or other appropriate physician. Hormone imbalances, mood disorders, and side effects of medication are common reasons for experiencing a drop in desire.
Seeking further treatment with a qualified mental health professional will also be essential for most situations involving a significant drop in desire that has lasted for six months or more. Even if the initial cause of sexual dysfunction was due to a medical issue that has been resolved, it is common to experience a psychological impact on sexual thoughts and interactions as a result of the disruption. Avoidance of sex or anxiety about sexual intimacy can occur, whether in the individual with Hypoactive Sexual Desire Disorder, in their partner, or in the relationship dynamic as a whole.
Sex therapy can be sought as an individual or a couple. You can start your search for a sex therapist on an online therapy directory.
Finding the Right Sex Therapist
To ensure that you receive adequate and knowledgeable care, make sure that your mental health practitioner is AASECT certified. “Sex therapist” and “sex therapy” are not protected terms; therefore any mental health provider can call themselves a sex therapist in their marketing. Additionally, most licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.3
How Much Does Sex Therapy Cost?
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy fees. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180 and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
Behavioral Changes for HSDD
A major component of HSDD is the distress a person experiences from a loss in libido or a consistently low sex drive.2 Part of living with HSDD may be accepting the phase of life that one is in, including a natural drop in desire that comes with aging or the evolution of a relationship. If you (or your partner) believes that having an increase in sexual interactions is vital to your happiness, or to the health of your relationship, there are adjustments you can make to your sexual dynamic that are likely to increase satisfaction.
Initiate Before You Feel Aroused
Being willing to initiate sexual play, whether partnered or solo, before physiological arousal occurs can make a significant impact on the frequency of opportunities for sexual pleasure.
Change Your Mindset Around Sex
Assumptions that erections are the only indicator for attraction or arousal in a man can be counterproductive to positive sexual engagement. If a man has typically had erections in the past without much thought or effort, he may be disinclined to engage sexually when an erection is not already present. If sexual thoughts do not occur as frequently and physiological arousal is not as strong as it used to be, men may stop engaging in sexual touch altogether. A shift in the mindset around what sex is and how it progresses is necessary to find renewed satisfaction.
Engage in Sensual Touch
Many men experience “spontaneous desire” or arousal without much cueing or context. However, some men have more “responsive desire” or develop more responsive desire over the course of a lifetime.5 Engaging in sensual touch without erection, which may include more non-genital touch, can help to cultivate subjective arousal. Utilizing stimulation of erotic toys, such as vibrators or c-rings, can help the body to respond sexually. Cues such as erotic literature or pornography can mentally stimulate and focus a mind that is stressed out or distracted away from sex.
Don’t Put Pressure on Yourself to Perform
Letting go of the goal of erection and orgasm can reduce performance anxiety around sex and expand the sexual repertoire to include pleasurable touch and connection that may not involve climax. Creating time for sensual touch, either solo or with a partner, while removing any pressure to “perform,” can allow sexual play to become enjoyable again. Being patient in cultivating subjective arousal is crucial for reducing anxiety and increasing pleasure. Sexuality can be renewed by evolving into a new paradigm of how sexuality is experienced, rather than trying to “get back” to a way of having sex that no longer feels optimal or achievable.
Hypoactive Sexual Desire Disorder vs. Other Sexual Disorders
HSDD is one of many sexual disorders that may appear alongside or separate from other sexual issues. It is important to note the differences in symptoms in order to seek out appropriate treatment.6
HSDD vs. Male Hypoactive Sexual Desire Disorder (MHSDD)
In 2013 with the release of the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Hypoactive Sexual Desire Disorder was changed to Male Hypoactive Sexual Desire Disorder and differentiated from Female Sexual Interest/Arousal Disorder (FSIAD). Because of significant and crucial differences in how desire tends to manifest between men and women, those disorders were separated and redefined.
HSDD vs. Erectile Disorder (ED)
Hypoactive Sexual Desire Disorder is characterized by a lack of interest in sex and a lack of sexual thoughts and fantasies lasting for a period of six months or more. Erectile Disorder is characterized by a recurrent inability over a period of six months or more to achieve or maintain an adequate erection during partnered sexual activities. HSDD and ED may be co-occurring disorders. ED symptoms may trigger HSDD symptoms; the experience of consistently losing erections can cause a loss of interest in sexual activity.
HSDD vs. Premature Ejaculation (PE)
Hypoactive Sexual Desire Disorder is characterized by a lack of interest in sex and a lack of sexual thoughts and fantasies lasting for a period of six months or more. Premature ejaculation is characterized by a man’s recurrent inability over a period of six months or more to feel in control of his orgasms, with climaxes occurring within one minute of penetration during intercourse. HSDD and PE may be co-occurring disorders. Anxiety over PE symptoms may trigger HSDD symptoms.
HSDD vs. Delayed Ejaculation (DE)
Hypoactive Sexual Desire Disorder is characterized by a lack of interest in sex and a lack of sexual thoughts and fantasies lasting for a period of six months or more. Delayed ejaculation is characterized by a man’s recurrent inability over a period of six months or more to ejaculate during partnered sexual intercourse. HSDD and DE may be co-occurring disorders. Frustration with an inability to orgasm during partnered sex may result in a loss of interest in sexual activity.
