Review guides clinicians on hypoactive sexual desire disorder in women

By Anne Harding

NEW YORK (Reuters Health) - A new report from the International Society for the Study of Women's Sexual Health (ISSWSH) offers an evidence-based review of the pathogenesis, diagnosis and treatment of hypoactive sexual desire disorder (HSDD) in women.

HSDD is the most common female sexual health problem, affecting about 10% of women, according to the report, online December 1 in Mayo Clinic Proceedings.

"The condition has existed for many years and has been the bane of many, many women, and the medical community has been relatively unresponsive to these women," lead author Dr. Irwin Goldstein of Alvarado Hospital in San Diego told Reuters Health by phone. "The traditional recommendations are to go find a new partner, go have a glass of wine, go on vacation."

According to the new review, developed by an ISSWSH expert consensus panel, HSDD involves reduced or absent sexual desire, either spontaneously in sexual thoughts or fantasies or in response to sexual cues and stimulation; inability to maintain desire or interest through sexual activity; and loss of interest in initiating or participating in sex, for at least six months. In order to be defined as HSDD, this lack of interest must be accompanied by significant distress.

Dr. Goldstein and his co-authors note that women with HSDD also frequently have depression and fatigue, and their health care costs are higher. "Misunderstandings about HSDD exist, leaving few clinicians feeling competent to inquire about or treat the condition," they add.

The report suggests that clinicians use the Decreased Sexual Desire Screener, a five-question instrument, to assess patients for HSDD. It's important to address risk factors for the condition before going on to treatment, the authors note, such as medication use, fatigue, or problems with a partner. HSDD can also be situational, occurring during especially stressful times, Dr. Goldstein noted.

Effective treatments consist of psychotherapy, including sex therapy, cognitive behavioral therapy, mindfulness-based treatment and other approaches; hormonal therapies such as estrogen or testosterone; and central nervous system agents.

Bupropion and buspirone may be used off-label, the panel suggests, and the U.S. Food and Drug Administration approved the first-ever drug for treating HSDD, flibanserin (Addyi, Sprout Pharmaceuticals), in 2015.

Dr. Goldstein and his team are now working on a process-of-care algorithm for diagnosing and treating HSDD that they expect to be published in the first quarter of 2017.

Dr. Goldstein and several of his co-authors have served as consultants to or hold stock in Sprout Pharmaceuticals and other companies developing treatments for HSDD.

SOURCE: https://bit.ly/2hyVIOI

Mayo Clin Proc 2016.