Hypoactive Sexual Desire Disorder in Women (HSDD)

Content written by Irwin Goldstein MD


The most prevalent sexual health problem in women is hypoactive sexual desire disorder (HSDD), defined as persistent or recurrent deficiency or absence of sexual fantasies/thoughts and/or desire for or receptivity to sexual activity, which causes marked distress or interpersonal difficulty. HSDD may be classified as primary or lifelong if the problem has always existed, or secondary or acquired if she previously had sexual desire but no longer has interest.


Primary and acquired forms of HSDD may be the result of both psychologic and biologic factors. For example, primary HSDD may be the consequence of sexual trauma such as incest, sexual abuse, or rape at a very young age. Primary HSDD may result from a repressive family attitude concerning sex that is sometimes enhanced by rigid religious training. Primary HSDD may be an outcome of dyspareunia when initial attempts at sexual intercourse resulted in pain.

Acquired HSDD may occur as a consequence of a drug side effect. The use of selective serotonin reuptake inhibitors (SSRI) and certain antihypertensive medications are common agents that may induce a state of HSDD. Acquired HSDD may be situational, related to the relationship with the sexual partner, especially if there are relationship problems or conflicts, concerns for safety or boredom or an excessively demanding partner with unrealistically high libido. Acquired HSDD may exist related to the sexual function of the partner, especially if the partner has premature ejaculation or erectile dysfunction. Acquired HSDD may exist as a result of a changing hormonal state, such as menopause, post-operative bilateral oophorectomy, or with the use of oral contraceptive pills. Acquired HSDD may result if the woman herself has sexual dysfunction as a result of severe pain or dyspareunia.

The lack of sexual desire may exist in a spectrum. In some, lack of thoughts and fantasies may be expressed as repulsion where sexual thoughts are considered sickening, or disgusting. In some extreme cases, HSDD may induce a phobia or panic response. HSDD may be seen in both women and men.


Screening questions can help identify women who have HSDD. Questions include: 1) Are you feeling sexual interest or desire? 2) Are you receptive to your partner’s desire and 3) Are you losing your interest in sex once activity begins. Answers to three additional questions range from no difficulty at all, slight difficulty, moderate difficulty, a great deal of difficulty, to a very great deal of difficulty. An additional question asks: 4) To what extent are you concerned or worried about any of the above difficulties? The answer to this question ranges from not concerned, slightly concerned, moderately concerned, a great deal of concern to a very great deal of concern. The last question asks if would you like to speak with your doctor about any difficulty or concern.